Chapter XX: Part II: Childhood (3)

183. _Do you approve of a child sleeping on a_ FEATHER _bed_?

A _feather_ bed enervates his body, and, if he be so predisposed, causes rickets, and makes him crooked. A horse-hair mattress is the best for a child to lie on. The pillow, too, should be made of horse-hair. A _feather_ pillow often causes the head to be bathed in perspiration, thus enervating the child and making him liable to catch cold. If he be at all rickety, if he be weak in the neck, if he be inclined to stoop, or if he be at all crooked, let him, by all means, lie without a pillow.

184. _Do you recommend a child, in the middle of the day, to be put to sleep?_

Let him be put on his mattress _awake_ at twelve o’clock, that he may sleep for an hour or two before dinner, then he will rise both refreshed and strengthened for the remainder of the day. I said, let him be put down _awake_. He might, for the first few times, cry; but, by perseverance, he will without any difficulty fall to sleep. The practice of sleeping before dinner ought to be continued until he be two years old, and if he can be prevailed upon, even longer. For if he do not have sleep in the middle of the day, he will all the afternoon and the evening be cross; and when he does go to bed, he will probably be too tired to sleep, or his nerves, having been exhausted by the long wakefulness, he will fall into a troubled, broken slumber, and not into that sweet, soft, gentle repose, so characteristic of healthy, happy childhood!

185. _At what hour ought a child to be put to bed in the evening?_

At six in the winter, and at seven o’clock in the summer. _Regularity_ ought to be observed, as _regularity is very conducive to health_. It is a reprehensible practice to keep a child up until nine or ten o’clock at night. If this be done, he will, before his time, become old, and the seeds of disease will be sown.

As soon as he can run, let him be encouraged, for half an hour before he goes to bed, to race either about the hall, or the landing, or a large room, which will be the best means of warming his feet, of preventing chilblains, and of making him sleep soundly.

186. _Have you any directions to give me as to the placing of my child in his bed?_

If a child lie alone, place him fairly on his side in the middle of the bed; if it be winter time, see that his arms and hands be covered with the bedclothes; if it be summer, his hands might be allowed to be outside the clothes.

In putting him down to sleep, you should ascertain that his face be not covered with the bedclothes; if it be, he will be poisoned with his own breath—the breath constantly giving off carbonic acid gas; which gas must, if his face be smothered in the clothes, be breathed—carbonic acid gas being highly poisonous.

You can readily prove the existence of carbonic acid gas in the breathing, by simply breathing into a little lime-water; after breathing for a few seconds into it, a white film will form on the top; the carbonic acid gas from the breath unites with the lime of the lime-water, and the product of the white film is carbonate of lime.

187. _Do you advise a bedroom to be darkened at night?_

Certainly. A child sleeps sounder and sweeter in a dark than in a light room. There is nothing better, for the purpose of darkening a bed room, than Venetian blinds.

Remember, then, a well-ventilated, but a darkened chamber at night. The cot or the crib ought _not_ to face the window, “as the light is best behind.”[217]

188. _Which is the best position for a child when sleeping—on his back, or on his side?_

His side. He ought to be accustomed to change about—on the right side one night, on the left another; and occasionally, for a change, he should lie on his back. By adopting this plan you will not only improve his figure, but likewise his health. Lying, night after night, in one position, would be likely to make him crooked.

189. _Do you advise, in the winter time, that there should be a fire in the night nursery?_

Certainly not, unless the weather be intensely cold. I dislike fires in bedrooms, especially for children; they are very enervating, and make a child liable to catch cold. Cold weather is very bracing, particularly at night. “Generally speaking,” says the _Siècle_, “during winter, apartments are too much heated. The temperature in them ought not to exceed 16° Centigrade (59° Fahrenheit); and even in periods of great cold, scientific men declare that 12° or 14° had better not be exceeded. In the wards of hospitals, and in the chambers of the sick, care is taken not to have greater heat than 15°. Clerks in offices, and other persons of sedentary occupations, when the rooms in which they sit are too much heated, are liable to cerebral [brain] congestion and to pulmonary [lung] complaints. In bedrooms, and particularly those of children, the temperature ought to be maintained rather low; it is even prudent only rarely to make fires in them, especially during the night.”

“If a cold stable make a healthy horse,” I am quite sure that a moderately cold and well-ventilated bedroom helps to make a healthy child. But still, in the winter time, if the weather be biting cold, a _little_ fire in the bedroom grate is desirable. In bringing up children, we must never run into extremes—the coddling system and the hardening system are both to be deprecated; the coddling system will make a strong child weakly, while the hardening system will probably kill a delicate one.

A child’s bed ought, of course, to be comfortably clothed with blankets—I say blankets, as they are much superior to coverlids; the perspiration will more readily pass through a blanket than a coverlid. A _thick_ coverlid ought never to be used; there is nothing better for a child’s bed than the old-fashioned patchwork coverlid, as the perspiration will easily escape through it.

190. _Should a child be washed and dressed_ AS SOON AS HE AWAKES _in the morning_?

He ought, if he awakes in anything like reasonable time; for if he doze after he be once awake, such slumber does him more harm than good. He should be up every morning as soon as it is light. If, as a child, he be taught to rise early, it will make him an early riser for life, and will tend greatly to prolong both his existence and his happiness.

_Never awake a child from his sleep_ to dress him, to give him medicine, or for any other purpose; _let him always sleep as long as he can_; but the moment he awakes let him be held out, and then let him be washed and dressed, and do not wait, as many a silly nurse does, until he has wet his bed, until his blood be chilled, and until he be cross, miserable, and uncomfortable! How many babies are made ill by such foolish practices!

The moment he leaves his bed, turn back to the fullest extent the clothes, in order that they may be thoroughly ventilated and sweetened. They ought to be exposed to the air for at least an hour before the bed be made. As soon as he leaves his room, be it winter or summer, throw open the windows.

191. _Ought a child to lie alone?_

He should after he is weaned. He will rest more comfortably, and his sleep will be more refreshing.

192. _Supposing a child should not sleep well, what ought to be done? Would you give him a dose of composing medicine?_

Certainly not. Try the effects of exercise. Exercise in the open air is the best composing medicine in the world. Let the little fellow be well tired out, and there will be little fear of his not sleeping.

193. _Have you any further observations to make on the subject of sleep?_

Send a child joyful to bed. Do not, if you can possibly help it, let him go to bed crying. Let the last impressions he has at night be of his happy home, and of his loving father and mother, and let his last thoughts be those of joy and gladness. He will sleep all the sounder if he be sent to bed in such a frame of mind, and he will be more refreshed and nourished in the morning by his sleep.

194. _What is the usual cause of a child walking in his sleep, and what measures, during such times, ought to be adopted to prevent his injuring himself?_

A disordered stomach in a child of nervous temperament is usually the cause. The means to be adopted to prevent his throwing himself out of the window are to have bars to his chamber casement, and if that be not practicable, to have either nails or screws driven into the window-sash to allow the window to open only for a sufficient space for ventilation, and to have a screw window-fastening, in order that he cannot, without difficulty, open the window; to have a trusty person to sleep in his room, who should have directions given not to rouse him from his sleep, but to gently lead him back to his bed, which may frequently be done without awaking him; and to consult a medical man, who will adopt means to put his stomach into order, to brace his nerves, and to strengthen his general system. A trip to the coast and sea bathing, in such a case, is often of great service.

SECOND DENTITION.

195. _When does a child begin to cut his_ SECOND _set of teeth_?

Generally at seven years old. He _begins_ to _cut_ them at about that time; but it should be borne in mind (so wonderful are the works of God) that the _second_ crop of teeth _in embryo_ is actually bred and formed from the very commencement of his life, _under_ the first tier of teeth, but which remain in abeyance for years, and do not come into play until the _first_ teeth, having done their duty, loosen and fall out, and thus make room for _the_ more numerous, larger, stronger, and more permanent teeth, which latter have to last for the remainder of his existence. The _first_ set is sometimes cut with a great deal of difficulty, and produces various disease; the _second_, or permanent teeth, come easily, and are unaccompanied with any disorder. The following is the process: one after another of the _first_ set gradually loosen, and either drop out, or with little pain are readily pulled out; under these, the _second_—the permanent teeth—make their appearance, and fill up the vacant spaces. The fang of the tooth that has dropped out is nearly all absorbed or eaten away, leaving little more than the crown. The _first_ set consists of twenty; the _second_ (including the wise teeth, which are not generally cut until after the age of twenty-seven) consists of thirty-two.

I would recommend you to pay particular attention to the teeth of your children; for, besides their being ornamental, their regularity and soundness are of great importance to the present as well as to the future health of your offspring. If there be any irregularity in the appearance of the _second_ set, lose no time in consulting an experienced and respectable dentist.

DISEASE, ETC.

196. _Do you think it important that I should be made acquainted with the symptoms of the_ SERIOUS _diseases of children_?

Certainly. I am not advocating the doctrine of a mother _treating serious_ diseases; far from it; it is not her province, except in certain cases of extreme urgency where a medical man cannot be procured, and where delay might be death; but I do insist upon the necessity of her knowing the _symptoms_ of disease. My belief is, that if parents were better informed on such subjects, many children’s lives might be saved, much suffering might be averted, and much sorrow might be spared. The fact is, the knowledge of the symptoms of disease is, to a mother, almost a sealed book. If she were better acquainted with these matters, how much more useful would she be in a sick-room, and how much more readily would she enter into the plans and views of the medical man! By her knowledge of the symptoms, and by having his advice in time, she would nip disease in the bud, and the fight might end in favor of life, for “sickness is just a fight between life and death.”[218]

It is really lamentable to contemplate the amount of ignorance that still exists among mothers in all that appertains to the diseases of children; although, fortunately, they are beginning to see and to feel the importance of gaining instruction on such subjects; but the light is only dawning. A writer of the present day makes the following remarks, which somewhat bear on the subject in question. He observes: “In spite of the knowledge and clear views possessed by the profession on all that concerns the management of children, no fact is more palpable than that the most grievous ignorance and incompetency prevail respecting it among the public. We want some means of making popular the knowledge which is now almost restricted to medical men, or at most, to the well-educated classes.”[219]

In the earlier editions of this work, I did not give the _treatment_ of any serious diseases, however urgent. In the three last editions I have been induced, for reasons I will presently state, to give the _treatment_ of some of the more urgent _serious_ diseases, when a medical man cannot instantly be procured, and where delay might be death.

Sir Charles Locock, who has taken a kind interest in this little work, has given me valid reasons why a mother should be so enlightened. The following extracts are from a letter which I received from Sir Charles on the subject, and which he has courteously allowed me to publish. He says: “As an old physician of some experience in complaints of infants and children, I may perhaps be allowed to suggest that in a future edition you should add a few words on the actual treatment of some of the more urgent infantile diseases. It is very right to caution parents against superseding the doctor, and attempting to manage serious illness themselves; but your advice, with very small exceptions, always being ‘to lose no time in sending for a medical man,’ much valuable and often irremediable time may be lost _when a medical man is not to be had_. Take, for instance, a case of croup: there are no directions given at all, except to send for a medical man, and always to keep medicines in the house which he may have directed. But how can this apply to a first attack? You state that a first attack is generally the worst. But why is it so? Simply because it often occurs when the parents do not recognize it, and it is allowed to get to a worse point than in subsequent attacks, when they are thoroughly alive to it. As the very best remedy, and often the only essential one, if given early, is a full emetic, surely it is better that you should give some directions as to this in a future edition, and I can speak from my own experience when I say that an emetic, _given in time_, and repeated to free vomiting, will cut short _any_ case of croup. In nine cases out of ten the attack takes place in the evening or early night, and when vomiting is effected the dinner of that day is brought up nearly undigested, and the severity of the symptoms at once cut short. Whenever any remedy is valuable, the more by its being administered _in time_, it is surely wiser to give directions as to its use, although, as a general rule, it is much better to advise the sending for medical advice.”

The above reasons, coming from such a learned and experienced physician as Sir Charles Locock, are conclusive, and have decided me to comply with his advice, to enlighten a mother on the _treatment_ of some of the more urgent diseases of infants and of children.

In a subsequent letter addressed to myself, Sir Charles has given me the names of those _urgent_ diseases which he considers may be treated by a mother, “where a medical man cannot be procured quickly, or not at all;” they are—Croup; Inflammation of the Lungs; Diphtheria; Dysentery; Diarrhœa; Hooping-cough, in its various stages; and Shivering Fit. Sir Charles sums up his letter to me by saying: “Such a book ought to be made as complete as possible, and the objections to medical treatment being so explained as to induce mothers to try to avoid medical men is not so serious as that of leaving them without any guide in those instances where every delay is dangerous, and yet where medical assistance is not to be obtained or not to be had quickly.”

In addition to the above, I shall give you the _treatment_ of Bronchitis, Measles, and Scarlet Fever. Bronchitis is one of the most common diseases incidental to childhood, and, with judicious treatment, is, in the absence of the medical man, readily managed by a sensible mother. Measles is very submissive to treatment. Scarlet Fever, _if it be not malignant_, and if certain rules be strictly followed, is also equally amenable to treatment.

I have been fortunate in treating Scarlet Fever, and therefore think it desirable to enter fully into the _treatment_ of a disease, which is looked upon by many parents, and according to the usual mode of treatment, with just cause, with great consternation and dread. By giving my plan of treatment fully and simply, and without the slightest reservation, I am fully persuaded, through God’s blessing, that I may be the humble means of saving the lives of numbers of children.

The diseases that might be treated by a mother, in the absence of a medical, man, will form the subject of future Conversations.

197. _At what age does Water on the Brain usually occur, and how is a mother to know that her child is about to labor under that disease?_

Water on the brain is, as a rule, a disease of childhood; after a child is seven years old it is comparatively rare. It more frequently attacks delicate children—children who have been dry-nursed (especially if they have been improperly fed), or who have been suckled too long, or who have had consumptive mothers, or who have suffered severely from teething, or who are naturally of a feeble constitution. Water on the brain sometimes follows an attack of inflammation of the lungs, more especially if depressing measures (such as excessive leeching and the administration of emetic tartar) have been adopted. It occasionally follows in the train of contagious eruptive diseases, such as either small-pox or scarlatina. We may divide the symptoms of water on the brain into two stages. The first—the premonitory stage—which lasts four or five days, in which medical aid might be of great avail; the second—the stage of drowsiness and of coma—which usually ends in death.

I shall dwell on the first—the premonitory stage—in order that a mother may see the importance without loss of time of calling in a medical man:

If her child be feverish and irritable, if his stomach be disordered, if he have urgent vomitings, if he have a foul breath, if his appetite be capricious and bad, if his nights be disturbed (screaming out in his sleep), if his bowels be disordered, more especially if they be constipated, if he be more than usually excited, if his eye gleam with unusual brilliancy, if his tongue ran faster than it is wont, if his cheek be flushed and his head be hot, and if he be constantly putting his hand to his head, there is cause for suspicion. If to these symptoms be added, a more than usual carelessness in tumbling about, in hitching his foot in the carpet, or in dragging one foot after the other; if, too, he has complained of darting, shooting, lancinating pains in his head, it may then be known that the _first_ stage of inflammation (the forerunner of water on the brain) either has taken or is about taking place. Remember, no time ought to be lost in obtaining medical aid; for the _commencement_ of the disease is the golden opportunity, when life might probably be saved.

198. _At what age, and in what neighborhood, is a child most liable to Croup, and when is a mother to know that it is about to take place?_

It is unusual for a child until he be twelve months old to have croup; but, from that time until the age of two years, he is more liable to it than at any other period. The liability after two years gradually, until he be ten years old, lessens, after which time it is rare.

A child is more liable to croup in a low and damp, than in a high and dry neighborhood; indeed, in some situations, croup is almost an unknown disease; while in others it is only too well understood. Croup is more likely to prevail when the wind is either easterly or northeasterly.

There is no disease that requires more prompt treatment than croup, and none that creeps on more insidiously. The child at first seems to be laboring under a slight cold, and is troubled with a little _dry_ cough; he is hot and fretful, and _hoarse_ when he cries. Hoarseness is one of the earliest symptoms of croup; and it should be borne in mind that a young child, unless he be going to have croup, is seldom hoarse; if, therefore, your child be hoarse, he should be carefully watched, in order that, as soon as croup be detected, not a moment be lost in applying the proper remedies.

His voice at length becomes gruff, he breathes as though it were through muslin, and the cough becomes crowing. These three symptoms prove that the disease is now fully formed. These latter symptoms sometimes come on without any previous warning, the little fellow going to bed apparently quite well, until the mother is awakened, perplexed, and frightened, in the middle of the night, by finding him laboring under the characteristic cough and the other symptoms of croup. If she delay either to send for assistance, _or if proper medicines be not instantly given_, in a few hours it will probably be of no avail, and in a day or two the little sufferer will be a corpse!

When once a child has had croup the after-attacks are generally milder. If he has once had an attack of croup, I should advise you always to have in the house medicine—a 4 oz. bottle of ipecacuanha wine, to fly to at a moment’s notice;[220] but never omit, where practicable, in a case of croup, whether the attack be severe or mild, to send _immediately_ for medical aid. There is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death.

199. _But suppose a medical man is not_ IMMEDIATELY _to be procured, what then am I to do? more especially, as you say, that delay might be death._

_What to do._—I never in my life lost a child with croup where I was called in at the _commencement_ of the disease, and where my plans were carried out to the very letter. Let me begin by saying, Look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. What medicine? _Ipecacuanha wine!_ At the earliest dawn of the disease give a teaspoonful of ipecacuanha wine every five minutes, until free vomiting be excited. In croup, before he is safe, free vomiting _must_ be established, and that without loss of time. If, after the expiration of an hour, the ipecacuanha wine (having given during that hour a teaspoonful of it every five minutes) is not sufficiently powerful for the purpose—although it generally is so (if the ipecacuanha wine be good)—then let the following mixture be substituted:

Take of—Powdered Ipecacuanha, one scruple;
Wine of Ipecacuanha, one ounce and a half:

Make a Mixture. A teaspoonful to be given every five minutes, until
free vomiting be excited, first _well_ shaking the bottle.

After the vomiting, place the child for a quarter of an hour in a warm bath.[221] When out of the bath give him small doses of ipecacuanha wine every two or three hours. The following is a palatable form for the mixture:

Take of—Wine of Ipecacuanha, three drachms;
Simple Syrup, three drachms;
Water, six drachms:

Make a Mixture. A teaspoonful to be taken every two or three hours.

But remember, the emetic which is given at _first_ is _pure ipecacuanha wine, without a drop of either water or of syrup_.

A large sponge dipped out of very hot water, and applied to the throat, and frequently renewed, oftentimes affords great relief in croup, and ought during the time the emetic is being administered in all cases to be adopted.

If it be a _severe_ case of croup, and does not in the course of two hours yield to the free exhibition of the ipecacuanha emetic, apply a narrow strip of _Smith’s tela vesicatoria_ to the throat, prepared in the same way as for a case of inflammation of the lungs (see the Conversation on the _treatment_ of inflammation of the lungs). With this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. If a child has a very short, fat neck, there may not be room for the _tela_, then you ought to apply it to the _upper_ part of the chest—just under the collar bones.

Let it be understood that the _tela vesicatoria_ is not a severe remedy, that the _tela_ produces very little pain—not nearly so much as the application of leeches; although, in its action, it is much more beneficial, and is not nearly so weakening to the system.

Keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrow-root, etc.; and let the room be, if practicable, at a temperate heat—60° Fahrenheit, and be well ventilated.

So you see that the _treatment_ of croup is very simple, and that the plan might be carried out by an intelligent mother. Notwithstanding which, it is your duty, where practicable, to send at the very _onset_ of the disease for a medical man.

Let me again reiterate that if your child is to be saved the _ipecacuanha wine must be genuine and good_. This can only be effected by having the medicine from a highly respectable chemist. Again, if ever your child has had croup, let me again urge you _always_ to have in the house a 4 oz. bottle of ipecacuanha wine, that you may resort to at a moment’s notice in case there be the slightest return of the disease.

Ipecacuanha wine, unfortunately, is not a medicine that keeps well; therefore, every three or four months a fresh bottle ought to be procured either from a medical man or from a chemist. As long as the ipecacuanha wine remains _clear_, it is good; but as soon as it becomes _turbid_ it is bad, and ought to be replaced by a fresh supply.

An intelligent correspondent of mine makes the following valuable remarks on the preservation of ipecacuanha wine: “Now, I know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a _perfectly full_ bottle. If so, would it not be a valuable suggestion if the Apothecaries’ Hall, or some other London firm of _undoubted_ reliability, would put up 1 oz. phials of ipecacuanha wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. By keeping a few such ounce bottles in an unopened state in one’s house, one might rely on being ready for any emergency. If you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, I think, be adding another most valuable item to an already invaluable book.”

The above suggestion of preserving ipecacuanha wine in ounce bottles, quite full, and hermetically sealed, is a very good one. The best way of hermetically sealing the bottle would be to cut the cork level with the lip of the bottle, and to cover the cork with sealing-wax, in the same manner wine merchants serve some kinds of their wines, and then to lay the bottles on their sides in sawdust in the cellar. I have no doubt, if such a plan were adopted, the ipecacuanha wine would for a length of time keep good. Of course, if the wine of ipecacuanha be procured from the Apothecaries’ Hall Company, London (as suggested by my correspondent), there can be no question as to the genuineness of the article.

_What_ NOT _to do._—Do not give emetic tartar; do not apply leeches; do not keep the room very warm; do not give stimulants; do not omit to have always in the house either a 4 oz. bottle, or three or four 1 oz. bottles of ipecacuanha wine.

200. _I have heard Child-crowing mentioned as a formidable disease; would you describe the symptoms?_

Child-crowing, or _spurious croup_, as it is sometimes called, is occasionally mistaken for _genuine croup_. It is a more frequent disorder than the latter, and requires a different plan of treatment. Child-crowing is a disease that almost invariably occurs only during dentition, and is _most perilous_. But if a child laboring under it can fortunately escape suffocation until he has cut the whole of his first set of teeth—twenty—he is then, as a rule, safe.

Child-crowing comes on in paroxysms. The breathing during the intervals is quite natural—indeed, the child appears perfectly well; hence the dangerous nature of the disease is either overlooked, or is lightly thought of, until perhaps a paroxysm worse than common takes place, and the little patient dies of suffocation, overwhelming the mother with terror, with confusion, and dismay.

The _symptoms_ in a paroxysm of child-crowing are as follows: The child suddenly loses and fights for his breath, and in doing so makes a noise very much like that of crowing; hence the name child-crowing. The face during the paroxysm becomes bluish or livid. In a favorable case, after either a few seconds, or even, in some instances, a minute, and a frightful struggle to breathe, he regains his breath, and is, until another paroxysm occurs, perfectly well. In an unfavorable case, the upper part (chink) of the windpipe remains for a minute or two closed, and the child, not being able to breathe, drops a corpse in his nurse’s arms. Many children, who are said to have died of fits, have really died of child-crowing.

I have entered thus rather fully into the subject, as many lives might be saved if a mother knew the nature of the complaint, and the _great necessity, during the paroxysms, of prompt and proper measures_. For, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent herself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting information, in a _popular_ style, in a work of this kind.

201. _What treatment, then, during a paroxysm of Child-crowing should you advise?_

The first thing, of course, to be done is to send _immediately_ for a medical man. Have a plentiful supply of cold and of hot water always at hand, ready at a moment’s notice for use. The instant the paroxysm is upon the child, plentifully and perseveringly dash _cold_ water upon his head and face. Put his feet and legs in _hot_ salt, mustard, and water; and, if necessary, place him up to his neck in a hot bath, still dashing water upon his face and head. If he does not quickly come round, sharply smack his back and buttocks.

As soon as a medical man arrives, he will lose no time in thoroughly lancing the gums and in applying other appropriate remedies.

Great care and attention ought, during the intervals, to be paid to the diet. If the child is breathing a smoky, close atmosphere, he should be immediately removed to a pure one. In this disease, indeed, there is no remedy equal to a change of air—to a dry, bracing neighborhood. Change of air, even if it be winter, is the best remedy, either to the coast or to a healthy farm-house. I am indebted to Mr. Roberton, of Manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject[222]), for the knowledge of this fact. Where, in a case of this kind, it is not practicable to send a child _from_ home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. I am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and principal remedy.

202. _When is a mother to know that a cough is not a “tooth-cough,” but one of the symptoms of Inflammation of the Lungs?_

If the child has had a shivering fit; if his skin be very hot and very dry; if his lips be parched; if there be great thirst; if his cheeks be flushed; if he be dull and heavy, wishing to be quiet in his cot or crib; if his appetite be diminished; if his tongue be furred; if his mouth be _burning_ hot and dry;[223] if his urine be scanty and high-colored, staining the napkin or the linen; _if his breathing be short, panting, hurried, and oppressed; if there be a hard, dry cough; and if his skin be burning hot_; then there is no doubt that inflammation of the lungs has taken place.

No time should be lost in sending for medical aid; indeed, the _hot, dry mouth and skin, and short hurried breathing_ would be sufficient cause for your procuring _immediate_ assistance. If inflammation of the lungs were properly treated at the _onset_, a child would scarcely ever be lost by that disease. I say this advisedly, for in my own practice, _provided I am called in early, and if my plans are strictly carried out_, I scarcely ever lose a child from inflammation of the lungs.

You may ask—What are your plans? I will tell you, in case _you cannot promptly obtain medical advice_, as delay might be death.

_The treatment of Inflammation of the Lungs, what to do._—Keep the child to one room, to his bedroom, and to his bed. Let the chamber be properly ventilated. If the weather be cool, let a small fire be in the grate; otherwise, he is better without a fire. Let him live on low diet, such as weak black tea, milk and water, and toast and water, thin oatmeal gruel, arrow-root, and such like simple beverages, and give him the following mixture:

Take of—Wine of Ipecacuanha, three drachms;
Simple Syrup, three drachms;
Water, six drachms:

Make a Mixture. A teaspoonful of the mixture to be taken every four
hours.

Be careful that you go to a respectable chemist, in order _that the quality of the ipecacuanha wine may be good, as the child’s life may depend upon it_.

If the medicine produces sickness, so much the better; continue it regularly until the short, oppressed, and hurried breathing has subsided, and has become natural.

If the attack be very severe, in addition to the above medicine, at once apply a blister, not the common blister, but _Smith’s tela vesicatoria_—a quarter of a sheet, which ought to be fastened on to a piece of sticking-plaster, taking care to apply the tela vesicatoria (which is on paper) to the warmed plaster, so as to securely fasten the tela vesicatoria on the sticking-plaster. The plaster should be rather larger than the blister, so as to leave a margin. Any respectable chemist will understand the above directions, and will prepare the tela ready for use. If the child be a year old, the blister ought to be kept on for three hours, and then a piece of dry, soft linen rag should be applied for another three hours. At the end of which time—six hours—there will be a beautiful blister, which must then, with a pair of scissors, be cut, to let out the water; and then let the blister be dressed, night and morning, with simple cerate spread on lint.

If the little patient be more than one year, say two years old, let the tela remain on for five hours, and the dry linen rag for five hours more, before the blister, as above recommended, be cut and dressed.

If in a day or two the inflammation still continue violent, let another tela vesicatoria be applied, not over the old blister, but let a narrow slip of it, on sticking-plaster, be applied on each side of the old blister, and managed in the same manner as before directed.

_I cannot speak too highly of Smith’s tela vesicatoria._ It has, in my hands, through God’s blessing, saved the lives of scores of children. It is far, very far superior to the old-fashioned blistering plaster. It seldom, if the above rules be strictly observed, fails to rise; it gives much less pain than the common blister; when it has had the desired effect, it readily heals, which cannot always be said of the common fly-blister, more especially with children.

My sheet-anchors, then, in the inflammation of the lungs of children, are, ipecacuanha wine and Smith’s _tela vesicatoria_. Let the greatest care, as I before advised, be observed in obtaining the ipecacuanha wine genuine and good. This can only be depended upon by having the medicine from a highly respectable chemist. Ipecacuanha wine, when genuine and good, is, in many children’s diseases, one of the most valuable of medicines.

_What, in a case of Inflammation of the Lungs_, NOT _to do_.—Do not, on any account, apply leeches. They draw out the life of the child, but not his disease. Avoid—_emphatically let me say so_—giving emetic tartar. It is one of the most lowering and death-dealing medicines that can be administered either to an infant or to a child! If you wish to try the effect of it, take a dose yourself, and I am quite sure that you will then never be inclined to poison a baby with such an abominable preparation! In olden times—many, many years ago—I myself gave it in inflammation of the lungs, and lost many children! Since leaving it off, the recoveries of patients by the ipecacuanha treatment, combined with the external application of Smith’s _tela vesicatoria_, have been in many cases marvelous. Avoid broths and wine, and all stimulants. Do _not_ put the child into a warm bath, it only oppresses the already oppressed breathing. Moreover, after he is out of the bath, it causes a larger quantity of blood to rush back to the lungs and to the bronchial tubes, and thus feeds the inflammation. Do not, by a large fire, keep the temperature of the room high. A small fire, in the winter time, encourages ventilation, and in such a case does good. When the little patient is on the mother’s or on the nurse’s lap, do not burden him either with a _heavy_ blanket or with a _thick_ shawl. Either a child’s _thin_ blanket, or a thin _woolen_ shawl, in addition to his usual night-gown, is all the clothing necessary.

203. _Is Bronchitis a more frequent disease than Inflammation of the Lungs? Which is the most dangerous? What are the symptoms of Bronchitis?_

Bronchitis is a much more frequent disease than inflammation of the lungs; indeed, it is one of the most common complaints both of infants and of children, while inflammation of the lungs is comparatively a rare disease. Bronchitis is not nearly such a dangerous disease as inflammation of the lungs.

_The symptoms._—The child for the first few days labors under symptoms of a heavy cold; he has not his usual spirits. In two or three days, instead of the cold leaving him, it becomes more confirmed; he is now really poorly, fretful, and feverish; his breathing becomes rather hurried and oppressed; his cough is hard and dry and loud; he wheezes, and if you put your ear to his naked back, between his shoulder-blades, you will hear the wheezing more distinctly. If at the breast, he does not suck with his usual avidity; the cough, notwithstanding the breast is a great comfort to him, compels him frequently to loose the nipple; his urine is scanty, and rather high-colored, staining the napkin, and smelling strongly. He is generally worse at night.

Well, then, remember if the child be feverish, if he have symptoms of a heavy cold, if he have an oppression of breathing, if he wheeze, and if he have a tight, dry, noisy cough, you may be satisfied that he has an attack of bronchitis.

204. _How can I distinguish between Bronchitis and Inflammation of the Lungs?_

In bronchitis the skin is warm but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful; in inflammation of the lungs he is dull and heavy, and his countenance denotes distress.

We have sometimes a combination of bronchitis and of inflammation of the lungs, an attack of the latter following the former. Then the symptoms will be modified, and will partake of the character of the two diseases.

205. _How would you treat a case of Bronchitis?_

If a medical man cannot be procured, I will tell you _what to do_: Confine the child to his bedroom, and if very ill, to his bed. If it be winter time, have a little fire in the grate, but be sure that the temperature of the chamber is not above 60° Fahrenheit, and let the room be properly ventilated, which may be effected by occasionally leaving the door a little ajar.

Let him lie either _outside_ the bed or on a sofa; if he be very ill, _inside_ the bed, with a sheet and a blanket only to cover him, but no thick coverlid. If he be allowed to lie on the lap, it only heats him and makes him restless. If he will not lie on the bed, let him rest on a pillow placed on the lap; the pillow will cause him to lie cooler, and will more comfortably rest his wearied body. If he be at the breast, keep him to it; let him have no artificial food, unless, if he be thirsty, a little toast and water. If he be weaned, let him have either milk and water, arrow-root made with equal parts of milk and water, toast and water, barley-water, or weak black, tea, with plenty of new milk in it, etc.; but, until the inflammation has subsided, neither broth nor beef-tea.

Now, with regard to medicine, the best medicine is ipecacuanha wine, given in large doses, so as to produce constant nausea. The ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases will rapidly effect a cure. I have in a preceding Conversation[224] given you a prescription for the ipecacuanha wine mixture. Let a teaspoonful of the mixture be taken every four hours.

If in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise; and put on the chest a _tela vesicatoria_, prepared and applied as I recommended when treating of inflammation of the lungs.[224]

The ipecacuanha wine and the tela vesicatoria are my sheet-anchors in the bronchitis, both of infants and of children. They rarely, even in very severe cases, fail to effect a cure, provided the tela vesicatoria be properly applied, and the ipecacuanha wine be genuine and of good quality.

If there be any difficulty in procuring _good_ ipecacuanha wine, the ipecacuanha may be given in powder instead of the wine. The following is a pleasant form:

Take of—Powder of Ipecacuanha, twelve grains;
White Sugar, thirty-six grains:

Mix well together, and divide into twelve powders. One of the powders
to be put dry on the tongue every four hours.

The ipecacuanha powder will keep better than the wine, an important consideration to those living in country places; nevertheless, if the wine can be procured fresh and good, I far prefer the wine to the powder.

When the bronchitis has disappeared, the diet ought gradually to be improved—rice, sago, tapioca, and light batter pudding, etc.; and in a few days, either a little chicken or a mutton-chop, mixed with a well-mashed potato and crumb of bread, should be given. But let the improvement in his diet be gradual, or the inflammation might return.

_What_ NOT _to do_.—Do not apply leeches. Do not give either emetic tartar, or antimonial wine, which is emetic tartar dissolved in wine. Do not administer either paregoric or syrup of poppies, either of which would stop the cough, and would thus prevent the expulsion of the phlegm. Any fool can stop a cough, but it requires a wise man to rectify the mischief. A cough is an effort of nature to bring up the phlegm, which would otherwise accumulate, and in the end cause death. Again, therefore, let me urge upon you the immense importance of _not_ stopping the cough of a child. The ipecacuanha wine will, by loosening the phlegm, loosen the cough, which is the only right way to get rid of a cough. Let what I have now said be impressed deeply upon your memory, as thousands of children in England are annually destroyed by having their coughs stopped. Avoid, until the bronchitis be relieved, giving him broths, and meat, and stimulants of all kinds. For further observations on _what_ NOT _to do_ in bronchitis, I beg to refer you to a previous Conversation we had on _what_ NOT _to do_ in inflammation of the lungs. That which is injurious in the one case is equally so in the other.

206. _What are the symptoms of Diphtheria, or, as it is sometimes called, Boulogne sore-throat?_

This terrible disease, although by many considered to be a new complaint, is, in point of fact, of very ancient origin. Homer, and Hippocrates, the father of physic, have both described it. Diphtheria first appeared in England in the beginning of the year 1857, since which time it has never totally left our shores.

_The symptoms._—The little patient, before the disease really shows itself, feels poorly, and is “out of sorts.” A shivering fit, though not severe, may generally be noticed. There is heaviness, and slight headache, principally over the eyes. Sometimes, but not always, there is a mild attack of delirium at night. The next day he complains of slight difficulty of swallowing. If old enough, he will complain of constriction about the swallow. On examining the throat the tonsils will be found to be swollen and redder—more darkly red than usual. Slight specks will be noticed on the tonsils. In a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and the nostrils. This exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather; hence its name diphtheria. This membrane peels off in pieces; and if the child be old and strong enough he will sometimes spit it up in quantities, the membrane again and again rapidly forming as before. The discharges from the throat are occasionally, but not always offensive. There is danger of croup from the extension of the membrane into the windpipe. The glands about the neck and under the jaw are generally much swollen; the skin is rather cold and clammy; the urine is scanty and usually pale; the bowels at first are frequently relaxed. This diarrhœa may or may not cease as the disease advances.

The child is now in a perilous condition, and it becomes a battle between his constitution and the disease. If, unfortunately, as is too often the case—diphtheria being more likely to attack the weakly—the child be very delicate, there is but slight hope of recovery. The danger of the disease is not always to be measured by the state of the throat. Sometimes, when the patient appears to be getting well, a sudden change for the worse rapidly carries him off. Hence the importance of great caution, in such cases, in giving an opinion as to ultimate recovery. I have said enough to prove the terrible nature of the disease, and to show the necessity of calling in, at the earliest period of the symptoms, an experienced and skillful medical man.

207. _Is Diphtheria contagious?_

_Decidedly._ Therefore, when practicable, the rest of the children ought instantly to be removed to a distance. I say _children_, for it is emphatically a disease of childhood. When adults have it, it is the exception, and not the rule. “Thus it will be seen, in the account given of the Boulogne epidemic, that of 366 deaths from this cause, 341 occurred among children under ten years of age. In the Lincolnshire epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred among children under twelve years of age.”[225]

208. _What are the causes of Diphtheria?_

Bad and imperfect drainage;[226] want of ventilation; overflowing privies; low neighborhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air and thus depresses the system, more especially if the weather be close and muggy; poor and improper food; and last, though not least, contagion. Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.

209. _What is the treatment of Diphtheria?_

_What to do._—Examine well into the ventilation, for as diphtheria is frequently caused by deficient ventilation, the best remedy is thorough ventilation. Look well both to the drains and to the privies, and see that the drains from the water-closets and from the privies do not in any way contaminate the pump-water. If the drains be defective or the privies be full, the disease in your child will be generated, fed, and fostered. Not only so, but the disease will spread in your family and all around you.

Keep the child to his bedroom and to his bed. For the first two or three days, while the fever runs high, put him on a low diet, such as milk, tea, arrow-root, etc.

Apply to his throat every four hours a warm barm and oatmeal poultice. If he be old enough to have the knowledge to use a gargle, the following will be found serviceable:

Take of—Powdered Alum, one drachm;
Simple Syrup, one ounce;
Water, seven ounces:

To make a Gargle.

The best medicine for the first few days of the attack, is one of the following mixtures:

Take of—Chlorate of Potash, two drachms;
Boiling Water, seven ounces and a half;
Syrup of Red Poppy, half an ounce:

To make a Mixture. A tablespoonful to be taken every four hours.

Or,

Take of—Diluted Sulphuric Acid, one drachm;
Simple Syrup, one ounce and a half;
Infusion of Roses,[227] four ounces and a half;

To make a Mixture. A tablespoonful to be given every four hours.

As soon as the skin has lost its preternatural heat, beef-tea and chicken broth ought to be given. Or if great prostration should supervene, in addition to the beef-tea, port wine, a tablespoonful every four hours, should be administered. If the child be cold, and there be great sinking of the vital powers, brandy and water should be substituted for the port wine. Remember, in ordinary cases, port wine and brandy are not necessary, _but in cases of extreme exhaustion_ they are most valuable.

As soon as the great heat of the skin has abated and the debility has set in, one of the following mixtures will be found useful:

Take of—Wine of Iron, one ounce and a half;
Simple Syrup, one ounce;
Water, three ounces and a half:

To make a Mixture. A tablespoonful to be taken every four hours.

Or,