The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not
very easy to explain; at the same time it is very certain that some
known circumstances favour their production.
If the general health of a child be enfeebled, particularly if the
child be strumous, such a condition will favour the generation of these
animals. The protracted use of unwholesome and innutritious articles of
food, or a deficient supply of salt (the most necessary stimulant to
the digestive organs), or other condiments, predisposes to worms. This
observation is strikingly illustrated by an occurrence which formerly
took place in Holland, where an ancient law existed forbidding salt in
the bread of certain criminals; they were in consequence horribly
infested with worms, and quickly died. Sugar, too, whilst a necessary
condiment for the food of children, if given in the form of sweetmeats,
and their indulgence, long persisted in, may so enfeeble the organs of
digestion as to cause worms. And, lastly, (though many other causes
might be referred to) the injudicious means occasionally employed to
effect the removal of these animals, by the debility produced in the
intestinal canal, favours not only their re-appearance but their
increase.
These, then, are so many causes which may occasion worms in the child,
and of course the best and most effectual method to prevent their
production is their avoidance. A mother, therefore, should at all times
be careful in the regulation of the diet and general management of her
child's habits and health, even if no stronger obligations existed than
the dread of this disorder; and she must be more than ordinarily
vigilant on this head, when the slightest disposition to such disorder
is manifested. Again; she must not forget that the symptoms so commonly
ascribed as characteristic of worms are much more frequently caused by
other diseases; that at no time, therefore, is she justified in giving
worm powders, or strong doses of medicine for such symptoms; for if
they do exist, their use is always attended with risk, and if they do
not, the debility which they occasion in the stomach and bowels may
itself become the source of their production.
Sect. V. SCARLET FEVER.
There are several varieties of this disease; it will be more
perspicuous, however, for our purpose to speak of it under the two
following forms:--
Mild scarlet fever;
Scarlet fever, with sore throat.
MILD SCARLET FEVER.--In this form of the disease there is only the rash
with fever.
SYMPTOMS.--The anticipating symptoms are those of fever: they precede
the eruption. The degree of fever, however, is variable; for the
symptoms are sometimes so moderate as scarcely to attract attention,
slight and irregular shivering, nausea, perhaps vomiting, thirst, and
heat of skin; whilst, at others, there is considerable constitutional
disturbance, indicated by pungent heat of skin, flushing of the face,
suffusion of the eyes, pain in the head, great anxiety and
restlessness, and occasionally slight delirium.
These symptoms are followed on the second day (in the majority of
instances) by the rash. This first appears in numerous specks or minute
patches of a vivid red colour on the face, neck, and chest. In about
four-and-twenty hours it becomes gradually diffused over the whole
trunk. On the following day (the third) it extends to the upper and
lower extremities, so that at this period the whole surface of the body
is of a bright red colour, hot and dry. The efflorescence, too, is not
always confined to the skin, but occasionally tinges the inside of the
lips, cheeks, palate, throat, nostrils, and even the internal surface
of the eyelids. Sometimes the efflorescence is continuous and
universal; but more generally on the trunk of the body there are
intervals of a natural hue between the patches, with papulous dots
scattered over them, the colour being most deep on the loins and
neighbouring parts, at the flexure of the joints, and upon those parts
of the body which are subjected to pressure. It is also generally most
vivid in the evening, gradually becoming paler towards morning.
The eruption is at its height on the fourth day;--it begins to decline
on the fifth, when the interstices widen, and the florid hue fades;--on
the sixth, the rash is very indistinct; and on the eighth day it is
wholly gone.
The various symptoms with which the eruption is accompanied, gradually
disappear with the efflorescence; but the tongue still remains morbidly
red and clean. The peeling off of the cuticle (the outer layer of the
skin), which begins about the end of the fifth day on the parts on
which the eruption first appeared, proceeds; so that about the eighth
or ninth, portions of the cuticle are thrown off, the thickest and
largest being those detached from the skin of the hands and feet.
SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the
fever and rash are accompanied with inflammation of the throat.
SYMPTOMS.--The symptoms are more severe than in the mild form of this
disease, and, in the majority of instances, the inflammation of the
throat appears with the eruption, and goes through its progress of
increase and decline with the cutaneous eruption. Sometimes, however,
it precedes the fever; whilst at others it does not appear until the
rash is at its height.
It is generally in the course of the second day that the child
complains of considerable stiffness in the muscles of the neck,
extending to the lower jaw, and under the ears;--of a roughness of the
throat, and difficulty in swallowing;--and some degree of hoarseness
will be noticed: all so many indications that the throat is affected.
Very shortly, an increased secretion of the mucus of these parts
occurs, and, collecting about the tonsils, aggravates the child's
sufferings, from the frequent and ineffectual efforts made to expel it.
If the inflammatory action be more severe, exudations of lymph will
also be poured out, and intermingling with the mucus, greatly augment
the difficulty of swallowing. At this time the lining membrane of the
mouth, as also the tongue, assume a florid red colour; the red points
of the latter becoming much elongated.
The febrile symptoms are severe from the first; amongst others, there
will be headach, sometimes accompanied by slight delirium, nausea,
intense heat of skin, languor, and considerable inquietude and anxiety:
and as the inflammation approaches its height, the fever increases, the
pulse rises, the breathing becomes oppressed, the skin becomes more
pungently hot and dry, and the thirst urgent. All these symptoms being
increased towards evening, when the febrile restlessness is often
succeeded by delirium.
The rash is seldom perceptible before the third day, and then comes
out in irregular patches on various parts of the body, particularly
about the elbows and wrists; thus differing as to the time and mode of
its appearance, from the mild form of the disease. It frequently
recedes, or entirely vanishes, the day after it first comes out, and
then reappears partially, and at uncertain times. This generally
protracts the duration of the disorder, without, however, producing any
perceptible change in the other symptoms. On the fifth or sixth day of
the disease, the fever and inflammation of the throat begin to abate;
at the same time the rash declines, and the peeling off of the cuticle
soon follows.
This is the ordinary course of scarlet fever with sore throat; but in
many cases the symptoms run still higher, and the disease is alarmingly
dangerous from its commencement. In some instances, there is an acrid
discharge from the nostrils or ears, often accompanied with deafness;
as also enlargements of the glands in the neck, followed by the
formation of abscesses in their immediate neighbourhood. It is
unnecessary, however, to follow out the symptoms of scarlet fever more
fully; as all that has been attempted here, has been so to sketch out
the more prominent symptoms of this disease, that the directions upon
the parental management may be readily comprehended: they will be very
brief, but a strict attention thereto will be found all-important to
the well-doing and comfort of the child.
CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be
seldom difficult to distinguish this disease from other acute eruptive
disorders. The one to which it bears the greatest resemblance is the
measles; but from this it is readily distinguished by the absence of
the cough, the inflamed and watery eye, running at the nose and
sneezing, which are the predominant symptoms in the early stage of the
measles; but which do not usually attend on scarlet fever--at least, in
any high degree. In measles, also, there is an absence of that
restlessness, anxiety, and depression of spirits, by which scarlet
fever is peculiarly distinguished.--The rash, too, in measles, does not
appear till two or three days later than that of scarlet fever. It also
differs in its characters. In scarlet fever, the eruption consists of
innumerable minute dots or points, diffused in patches with uneven
edges of various sizes and forms; and gives to those portions of the
skin on which it appears, a diffused bright red colour. In measles, the
rash comes out in irregular semi-lunar or crescentic shaped patches,
distinctly elevated; the spots being of a deeper red in the centre
than in the circumference, and leaving intervening spaces in which the
skin retains its natural pale colour.
MATERNAL MANAGEMENT.--The chief points to which the parent's attention
must be directed, irrespective of a strict attention to the more
immediate medical treatment directed by the physician, are the
following:--
VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must
be kept in bed from the first accession of the fever. He must not be
loaded, however, as was formerly the practice, with a quantity of
bed-clothes, in order to encourage the fever and increase the quantity
of eruption. A moderate quantity of clothing is all that is required,
adapted to the heat of skin and feelings of the patient.
The bed-room must be kept cool and well ventilated. This is of
importance in the mildest cases; but in the more severe forms of this
disease, in which the throat is much affected, the constant and free
admission of pure air will have a most decided and marked good effect
upon the symptoms. The air should be renewed, therefore, from time to
time. The linen, both of the bed and the patient, should also be
frequently changed daily,--if practicable.
However mild the symptoms of this disease may be at the commencement,
the child must always be carefully and vigilantly watched by the
parent, as inflammation of some internal organ may suddenly arise
(which is generally indicated by symptoms sufficiently obvious), and
thus change an apparently mild form of this disease into one of an
alarming character.
COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole
surface of the body should be sponged with cold water, or with vinegar
and water. The heat is by this means rapidly abstracted, and the child
refreshed; and this may again and again be resorted to, as the heat
again returns. By this application alone, "the pulse has been
diminished in frequency, the thirst has abated, the tongue has become
moist, a general free per spiration has broken forth, the skin has
become soft and cool, and the eyes have brightened; and these
indications of relief have been speedily followed by a calm and
refreshing sleep. In all these respects, the condition of the patient
presented a complete contrast to that which preceded the cold washing;
and his languor was exchanged for a considerable share of vigour. The
morbid heat, it is true, when thus removed, is liable to return, and
with it the distressing symptoms; but a repetition of the remedy is
followed by the same beneficial effects as at first."[FN#40]
[FN#40] Bateman's Practical Synopsis of Cutaneous Diseases.
GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected,
gargles are sometimes ordered; but the pain and inconvenience which
their employment gives rise to, frequently precludes their use: and
children seldom understand how to employ them, even if the state of the
throat permitted it. Under these circumstances, the inhalation of the
steam of hot water, or hot vinegar and water, may be substituted, and
with decided benefit. Mudge's inhaler is a good contrivance to effect
this.
When the throat is found by the mother to be early affected, an
immediate application to the medical adviser is especially important.
For, if he be called upon to treat this form of scarlet fever at its
very commencement, by judicious treatment, the duration and violence of
the disease may be both shortened and greatly mitigated.
REGIMEN.--Cooling drinks, as plain water, toast and water, barley water
flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may
all be resorted to in their turn. The child may also be allowed
oranges, grapes, or lemons sweetened with sugar, particularly when the
mouth is foul and dry; but care must be taken that neither the pulp nor
the stones are swallowed. These will both refresh and feed the patient
as much as is necessary until the decline of the disease. The parent
must strictly forbid the attendants in the sick chamber giving, at this
period, any heating or stimulating fluid, as also animal food; and this
injunction must be strictly regarded, even in the mildest form of the
disease.
When the child is convalescent, mild nourishment will be required,
such as arrow-root, tapioca, chicken or mutton broth, beef tea,
jellies, and roasted apples; and by and by a mutton chop. Wine is
seldom necessary, except under circumstances of unusual debility after
a protracted illness, when its moderate use tends much to assist the
convalescence; but, if given unadvisedly, there will be great hazard of
exciting internal inflammatory disease.
Relapses are sometimes caused by the child getting about too soon, and
by indulgence of the appetite, particularly for food: a proper degree
of restraint, therefore, must be placed upon the child by the parent,
who cannot too strictly carry out the directions of the medical
attendant upon the diet and regimen during this period.
Great attention must still be paid to the state of the bowels, and,
indeed, to all the secretions and excretions.
PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote
the more easy separation of the cuticle from the surface of the body, a
warm or tepid bath may be usefully employed at the close of the
disease. It will, moreover, greatly contribute to the comfort of the
child, and induce a more healthy condition of the skin. Occasionally
the cuticle of the whole hand and fingers will peel off unbroken, when
it will resemble precisely a glove in shape.
As is the case in all fevers, more or less, so particularly after
scarlet fever, there is a great tendency to the falling off of the
hair. It will be always well, therefore, to shave the head at this
time, and exhibit daily a tepid shower bath, as early as the strength
of the child will permit.
CAUTIONS, ETC.--The contagious character of this disease requires the
separation of the invalid from the rest of the family; and, when it is
practicable, the children should be removed to a distance. This measure
is imperatively called for, when the form of the disease is very severe
in its character.
Great caution must also be exercised, after the convalescence of the
patient, that the other children are not brought into too early contact
with him: for infection may be thus produced, though several weeks may
have elapsed from the period of the peeling off of the skin.
The period at which the disease shows itself after the exposure of an
individual to sources of contagion, is exceedingly various. One child
will be seized within a few hours; another, not for some days; and now
and then (though rarely), five or six weeks have intervened between the
period of exposure and the manifestation of the disease.
When this disease is rife in a family, it will frequently affect the
individuals composing it very differently. Some escape altogether;--
others have the mild form of the complaint;--others the severe;--and,
again, the attendant in the sick room may be attacked with the sore
throat and fever only, both of which may subside without any appearance
of a rash.
In conclusion, this disease is a complaint of infancy and childhood,
rather than of adult age; generally affects the same individual but
once during his life; and, though examples of a second attack have
occurred, such a circumstance is extremely rare.
Sect. VI.--MEASLES.
Measles consists of a fever, in which the mucous lining of the air-
passages is principally affected, and which, after about three days'
duration, results in an eruption of a red rash over the surface.
It depends upon a specific contagion;--occurs most frequently during
childhood and adolescence, though no age is exempt from it;--and affects
the system but once; a peculiarity to which an exception is very rare,
proved by the few instances of the kind which have been recorded.
The period at which the disease manifests itself after infection is
various,--generally about the ninth day; it has, however, been delayed
until the sixteenth.
DESCRIPTION OF THE DISEASE.--The child infected will be observed not to
be as well as usual, less active, and out of spirits; his appetite
will fail, and his sleep be restless and disturbed. It will soon be
evident that he has apparently taken a cold in his head, and that this
is accompanied by fever. His voice will be hoarse; there will be
frequent cough, headach, sneezing, running from the nose and eyes,--the
eyelids being somewhat swollen, and the eyes inflamed;--the skin will be
hot and dry, and he will complain of occasional chilliness. In the
course of the next two or three days, these symptoms will increase in
severity, and perhaps be accompanied by oppression at the chest and
hurried breathing, and towards evening by slight delirium.
On the fourth day, the rash will appear, but the symptoms will be
little, if at all, mitigated; indeed, they will sometimes increase in
severity. The eruption will first be perceived about the head and face,
in the form of small red spots, at first distinct from each other, but
soon coalescing, and forming patches of an irregular crescent-like or
semilunar figure, of a dull red colour, and slightly elevated (giving a
sensation of hardness to the finger), while portions of the skin
intervening between them will retain their natural appearance. At this
time the eruption will also be found on the inside of the mouth and
throat, and the hoarseness will consequently increase.
On the fifth day, the rash usually covers the whole surface of the
body, with the exception of the legs and feet; and is now very vivid on
the face, which is not unfrequently so much swelled, especially the
eyelids, that the eyes are quite closed up, as in small-pox. On the
sixth day, it is fully out on the extremities, and is beginning to fade
on the face. On the eighth, it is fading from all parts; on the ninth,
it is hardly perceptible; and has entirely disappeared on the tenth day
from the commencement of the fever, or the sixth from its own first
appearance. As the fading proceeds, the spots drop off in the form of
little branny scales, which are sometimes, from their minuteness,
scarcely perceptible. They leave a slight discolouration on the skin,
with considerable itching.
Such is the ordinary course of this disease; occasionally, however,
deviations are met with.
CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under
the description given of Scarlet Fever, are noticed several signs by
which that disease may be distinguished from measles: to these may be
added the absence of cough, of water flowing from the eyes, and of
redness and swelling of the eyelids as in measles. Again, in measles,
the eruption is more pointed, of a crimson instead of a scarlet hue,
and does not appear until two days later than in scarlet fever.
In small-pox, the fever abates as soon as the eruption makes its
appearance. In scarlet fever, this is by no means the case; and as
little so in measles: the vomiting, indeed, subsides; but the cough,
fever, and headach grow more violent; and the difficulty of breathing,
weakness of the eyes, and, indeed, all the catarrhal symptoms, remain
without any abatement till the eruption has all but completed its
course.
MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a
mild, and by no means dangerous, disease: it is sometimes, however,
accompanied or immediately followed by symptoms of a very serious
character, and which, it is to be feared, in many instances, owe their
origin to the carelessness of the attendants in the sick chamber. A
mother's superintendence, therefore, is much required at this time to
insure a careful attention to the medical directions, as also to those
general points of management upon which the well-doing of her child
much depend, of which the following are the most important:--
VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from
the onset of the attack. He must have so much clothing only as will
secure his comfort, avoiding equally too much heat or exposure to cold.
To these points the parent's attention must be particularly directed.
It is the practice with some nurses, in the belief that a breath of
cool air is most pernicious, to keep the child constantly enveloped in
a smothering heap of bed-clothes, with curtains closely drawn, and the
room well heated by fire, by which means the fever and all its
concomitant dangers are greatly augmented. It is equally a popular
error (and yet by many it is still held and acted upon) to suppose that
because in small-pox exposure to cold is useful, that therefore it
must be of equal advantage in measles. It cannot be too generally known
that the nature of the fevers accompanying the two diseases are widely
different, and that the adoption of this error is productive of the
most serious consequences; for it would most likely produce in measles
inflammation of the lungs, which, in truth, is commonly the result of
carelessness upon this point.
The bed-room should be large and airy; free from currents of cold, but
well ventilated, and not hot. The room, also, must be darkened, on
account of the tenderness of the eyes; all noise excluded, and mental
excitement or irritation carefully avoided.
REGIMEN.--Little or no food must be allowed, and whatever is taken must
be of the simplest kind, and in a liquid form. Mild mucilaginous
drinks, and warm, may be given liberally; as barley-water, or thin
gruel, etc.
SPONGING, ETC.--The face, chest, arms, and hands should be sponged
occasionally with vinegar and warm water (one fourth and three
fourths). This will be productive of great comfort to the little
patient; it removes the heat, dryness, and itching of the skin, which
are often very distressing; and is especially useful at night in
relieving wakefulness. If the cough be troublesome, it will be useful
for the child to breathe the steam of warm water; not through an
inhaler, but over a large basin, with the head covered with flannel
large enough to hang over its edges. By this means the tender and
inflamed eyes will at the same time derive advantage from the soothing
effect of the vapour.
CAUTIONS.--Whenever the measles is known to be prevalent in a
neighbourhood, and a child manifests symptoms of cold in the head and
fever, it should at once be a reason for carefulness on the part of the
parent. The diet should be light, cooling, and scanty; and the child
should be carefully kept in doors.
It has been before remarked, that in its ordinary course measles is a
disease unaccompanied with danger, but that the mildest form may be
speedily converted into the most dangerous. That is to say, a sudden
change may lake place in the symptoms, arising out of circumstances
which could not have been foreseen, and therefore unavoidable; or may
be produced by improper management on the part of the nurse, such as
the giving of stimulants, by too much heat, or by exposure to cold. Now
it is for the parent early to notice any change which may occur from
the first source, and by her watchfulness to guard against the
possibility of its arising from either of the second.
In reference to the first, if the child should complain at any period
of the disease of severe headach, with piercing pain through the
temples, and if this is accompanied by wandering of mind, great
increase of suffusion of the eyes, as also intolerance of light, the
immediate attention of the medical man is demanded. So, if towards the
dose of the eruption, that is, from the seventh to the ninth day, the
breathing should again become hurried (this symptom is very generally
present during the height of the eruption, and is not necessarily
connected with disease of the lungs), with pain and oppression felt at
the chest, the cough becoming hacking and incessant, etc. (all symptoms
cognizable by the mother, and indicative of inflammation of the
lungs), no time must be lost in seeking medical aid.