MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH

2547. This much-dreaded disease, which forms the next subject in our series of infantine diseases, and which entails more evils on the health of childhood than any other description of physical suffering to which that age of life is subject, may be considered more an affection of the venous circulation, tending to general and local congestion, attended with a diseased condition of the blood, than either as a fever or an inflammation; and though generally classed before or after scarlet fever, is, in its pathology and treatment, irrespective of its after-consequences, as distinct and opposite as one disease can well be from another.

4548. As we have already observed, measles are always characterized by the running at the nose and eyes, and great oppression of breathing; so, in the mode of treatment, two objects are to be held especially in view; first, to unload the congested state of the lungs,--the cause of the oppressed breathing; and, secondly, to act vigorously, both during the disease and afterwards, on the bowels. At the same time it cannot be too strongly borne in mind, that though the patient in measles should on no account be kept unduly hot, more care than in most infantine complaints should be taken to guard the body from _cold_, or any abrupt changes of temperature. With these special observations, we shall proceed to give a description of the disease, as recognized by its usual--

2549. _Symptoms_, which commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, deduction or running at the eyes and nose, nausea, sometimes vomiting, thirst, a furred tongue; the pulse throughout is quick, and sometimes full and soft, at others hard and small, with other indications of an inflammatory nature.

2550. On the third day, small red points make their appearance, first on the face and neck, gradually extending over the upper and lower part of the body. On the fifth day, the vivid red of the eruption changes into a brownish hue; and, in two or three days more, the rash entirely disappears, leaving a loose powdery desquamation on the skin, which rubs off like dandriff. At this stage of the disease a diarrhoea frequently comes on, which, being what is called "critical," should never be checked, unless seriously severe. Measles sometimes assume a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes both doubtful and dangerous. In this condition the eruption comes out sooner, and only in patches; and often, after showing for a few hours, suddenly recedes, presenting, instead of the usual florid red, a dark purple or blackish hue; a dark brown fur forms on the gums and mouth, the breathing becomes laborious, delirium supervenes, and, if unrelieved, is followed by coma; a fetid diarrhoea takes place, and the patient sinks under the congested state of the lungs and the oppressed functions of the brain.

2551. The unfavourable symptoms in measles are a high degree of fever, the excessive heat and dryness of the skin, hurried and short breathing, and a particularly hard pulse. The sequels, or after-consequences, of measles are, croup, bronchitis, mesenteric disease, abscesses behind the ear, ophthalmia, and glandular swellings in other parts of the body.

2552. _Treatment_.--In the first place, the patient should be kept in a cool room, the temperature of which must be regulated to suit the child's feelings of comfort, and the diet adapted to the strictest principles of abstinence. When the inflammatory symptoms are severe, bleeding, in some form, is often necessary, though, when adopted, it must be in the _first stage_ of the disease; and, if the lungs are the apprehended seat of the inflammation, two or more leeches, according to the age and strength of the patient, must be applied to the upper part of the chest, followed by a small blister; or the blister may be substituted for the leeches, the attendant bearing in mind, that the benefit effected by the blister can always be considerably augmented by plunging the feet into very hot water about a couple of hours after applying the blister, and kept in the water for about two minutes. And let it further be remembered, that this immersion of the feet in hot water may be adopted at any time or stage of the disease; and that, whenever the _head_ or _lungs_ are oppressed, relief will _always_ accrue from its sudden and brief employment. When the symptoms commence with much shivering, and the skin early assumes a hot, dry character, the appearance of the rash will be facilitated, and all the other symptoms rendered milder, if the patient is put into a warm bath, and kept in the water for about three minutes. Or, where that is not convenient, the following process, which will answer quite as well, can be substituted:--Stand the child, naked, in a tub, and, having first prepared several jugs of sufficiently warm water, empty them, in quick succession, over the patient's shoulders and body; immediately wrap in a hot blanket, and put the child to bed till it rouses from the sleep that always follows the effusion or bath. This agent, by lowering the temperature of the skin, and opening the pores, producing a natural perspiration, and unloading the congested state of the lungs

2553. _Aperient Powders_.--Take of scammony and jalap, each 24 grains; grey powder and powdered antimony, each 18 grains. Mix and divide into 12 powders, if for a child between two and four years of age; into 8 powders, if for a child between four and eight years of ago; and into 6 powders for between eight and twelve years. One powder to be given, in a little jelly or sugar-and-water, every three or four hours, according to the severity of the symptoms.

2554. _Saline Mixture_.--Take of mint-water, 6 ounces; powdered nitre, 20 grains; antimonial wine, 3 drachms; spirits of nitre, 2 drachms; syrup of saffron, 2 drachms. Mix. To children under three years, give a teaspoonful every two hours; from that age to six, a dessertspoonful at the same times; and a tablespoonful every three or four hours to children between six and twelve.

2555. The object of these aperient powders is to keep up a steady but gentle action on the bowels; but, whenever it seems necessary to administer a stronger dose, and effect a brisk action on the digestive organs,--a course particularly imperative towards the close of the disease,--two of these powders given at once, according to the age, will be found to produce that effect; that is, two of the twelve for a child under four years, and two of the eight, and two of the six, according to the age of the patient.

2556. When the difficulty of breathing becomes oppressive, as it generally does towards night, a hot bran poultice, laid on the chest, will be always found highly beneficial. The diet throughout must be light, and consist of farinaceous food, such as rice and sago puddings, beef-tea and toast; and not till convalescence sets in should hard or animal food be given.

2557. When measles assume the malignant form, the advice just given must be broken through; food of a nutritious and stimulating character should be at once substituted, and administered in conjunction with wine, and even spirits, and the disease regarded and treated as a case of typhus. But, as this form of measles is not frequent, and, if occurring, hardly likely to be treated without assistance, it is unnecessary to enter on the minutiae of its practice here. What we have prescribed, in almost all cases, will be found sufficient to meet every emergency, without resorting to a multiplicity of agents.

2558. The great point to remember in measles is, not to give up the treatment with the apparent subsidence of the disease, as the _after-consequences_ of measles are too often more serious, and to be more dreaded, than the measles themselves. To guard against this danger, and thoroughly purify the system, after the subsidence of all the symptoms of the disease, a corrective course of medicine, and a regimen of exercise, should be adopted for some weeks after the cure of the disease. To effect this, an active aperient powder should be given every three or four clays, with a daily dose of the subjoined tonic mixture, with as much exercise, by walking, running after a hoop, or other bodily exertion, as the strength of the child and the state of the atmosphere will admit, the patient being, wherever possible, removed to a purer air as soon as convalescence warrants the change.

2559. _Tonic Mixture_.--Take of infusion of rose-leaves, 6 ounces; quinine, 8 grains; diluted sulphuric acid, 15 drops. Mix. Dose, from half a teaspoonful up to a dessertspoonful, once a day, according to the ago of the patient.

Scarlatina, or Scarlet Fever.

2560. Though professional accuracy has divided this disease into several forms, we shall keep to the one disease most generally mot with, the common or simple scarlet fever, which, in all cases, is characterized by an excessive heat on the skin, sore throat, and a peculiar speckled appearance of the tongue.

2561. _Symptoms_.--Cold chills, shivering, nausea, thirst, hot skin, quick pulse, with difficulty of swallowing; the tongue is coated, presenting through its fur innumerable specks, the elevated papillae of the tongue, which gives it the speckled character, that, if not the invariable sign of scarlet fever, is only met with in cases closely analogous to that disease. Between the _second_ and __third_ day, but most frequently on the _third_, a bright red efflorescence breaks out in patches on the face, neck, and back, from which it extends over the trunk and extremities, always showing thicker and deeper in colour wherever there is any pressure, such as the elbows, back, and hips; when the eruption is well out, the skin presents the appearance of a boiled lobster-shell. At first, the skin is smooth, but, as the disease advances, perceptible roughness is apparent, from the elevation of the rash, or, more properly, the pores of the skin. On the _fifth_ and _sixth_ days the eruption begins to decline, and by the _eighth_ has generally entirely disappeared. During the whole of this period, there is, more or less, constant sore throat.

2562. The _Treatment_ of scarlet fever is, in general, very simple. Where the heat is great, and the eruption comes out with difficulty, or recedes as soon as it appears, the body should be sponged with cold vinegar-and-water, or tepid water, as in measles, poured over the chest and body, the patient being, as in that disease, wrapped in a blanket and put to bed, and the same powders and mixture ordered in measles administered, with the addition of a constant hot bran poultice round the throat, which should be continued from the first symptom till a day or two after the declension of the rash. The same low diet and cooling drink, with the same general instructions, are to be obeyed in this as in the former disease.

2563. When the fever runs high in the first stage, and there is much nausea, before employing the effusions of water, give the patient an emetic, of equal, parts of ipecacuanha and antimonial wine, in doses of from a teaspoonful to a tablespoonful, according to age. By these means, nine out of every ten cases of scarlatina may be safely and expeditiously cured, especially if the temperature of the patient's room is kept at an even standard of about sixty degrees.

HOOPING-COUGH, CROUP, AND DIARRHOEA, WITH THEIR MODE OF TREATMENT.

Hooping-Cough.

2564. THIS is purely a spasmodic disease, and is only infectious through the faculty of imitation, a habit that all children are remarkably apt to fall into; and even where adults have contracted hooping-cough, it has been from the same cause, and is as readily accounted for, on the principle of imitation, as that the gaping of one person will excite or predispose a whole party to follow the same spasmodic example. If any one associates for a few days with a person who stammers badly, he will find, when released from his company, that the sequence of his articulation and the fluency of his speech are, for a time, gone; and it will be a matter of constant vigilance, and some difficulty, to overcome the evil of so short an association. The manner in which a number of school-girls will, one after another, fall into a fit on beholding one of their number attacked with epilepsy, must be familiar to many. These several facts lead us to a juster notion of how to treat this spasmodic disease. Every effort should, therefore, be directed, mentally and physically, to break the chain of nervous action, on which the continuance of the cough depends.

2565. _Symptoms._--Hooping-cough comes on with a slight oppression of breathing, thirst, quick pulse, hoarseness, and a hard, dry cough. This state may exist without any change from one to two or three weeks before the peculiar feature of the disease-the _hoop_-sets in. As the characteristics of this cough are known to all, it is unnecessary to enter here, physiologically, on the subject. We shall, therefore, merely remark that the frequent vomiting and bleeding at the mouth or nose are favourable signs, and proceed to the

2566. _Treatment_, which should consist in keeping up a state of nausea and vomiting. For this purpose, give the child doses of ipecacuanha and antimonial wines, in equal parts, and quantities varying from half to one and a half teaspoonful once a day, or, when the expectoration is hard and difficult of expulsion, giving the following cough mixture every four hours. Take of

Syrup of squills 1/2 ounce. Antimonial wine 1 ounce. Laudanum 15 drops. Syrup of Toulou 2 drachms. Water 1-1/2 ounce.

Mix. The dose is from half a spoonful to a dessertspoonful. When the cough is urgent, the warm bath is to be used, and either one or two leeches applied over the breastbone, or else a small blister laid on the lower part of the throat.

2567. Such is the medical treatment of hooping-cough; but there is a moral regimen, based on the nature of the disease, which should never be omitted. And, on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping, so the like means should be adopted with the hooping-cough patient; and, in the first stage, before the _hooping_ has been added, the parent should endeavour to break the paroxysm of the cough by abruptly attracting the patient's attention, and thus, if possible, preventing the cough from reaching that height when the ingulp of air gives the hoop or crow that marks the disease; but when once that symptom has set in, it becomes still more necessary to endeavour, by even measures of intimidation, to break the spasmodic chain of the cough. Exercise in the open air, when dry, is also requisite, and charge of scene and air in all cases is of absolute necessity, and may be adopted at any stage of the disease.

2568. This is by far the most formidable and fatal of all the diseases to which infancy and childhood are liable, and is purely an inflammatory affection, attacking that portion of the mucous membrane lining the windpipe and bronchial tubes, and from the effect of which a false or loose membrane is formed along the windpipe, resembling in appearance the finger of a glove suspended in the passage, and, consequently, terminating the life of the patient by suffocation; for, as the lower end grows together and becomes closed, no air can enter the lungs, and the child dies choked. All dull, fat, and heavy children are peculiarly predisposed to this disease, and those with short necks and who make a wheezing noise in their natural breathing. Croup is always sudden in its attack, and rapid in its career, usually proving fatal within three days; most frequently commences in the night, and generally attacking children between the ages of three and ten years. Mothers should, therefore, be on their guard who have children predisposed to this disease, and immediately resort to the means hereafter advised.

2569. _Symptoms_.--Languor and restlessness, hoarseness, wheezing, and short, dry cough, with occasional rattling in the throat during sleep, the child often plucking at its throat with its fingers; difficulty of breathing, which quickly becomes hard and laboured, causing great anxiety of the countenance, and the veins of the neck to swell and become knotted; the voice in speaking acquires a sharp, crowing, or croupy sound, while the inspirations have a harsh, metallic intonation. After a few hours, a quantity of thick, ropy mucus is thrown out, hanging about the mouth, and causing suffocating fits of coughing to expel.

2570. Treatment.--Place the child immediately in a hot bath up to the throat; and, on removal from the water, give an emetic of the antimonial or ipecacuanha wine, and, when the vomiting has subsided, lay a long blister down the front of the throat, and administer one of the following powders every twenty minutes to a child from three to six years of age.

2571. Take of calomel, 12 grains; tartar emetic, 2 grains; lump sugar, 30 grains. Mix accurately, and divide into 12 powders. For a child from six to twelve years, divide into 6 powders, and give one every half-hour.

2572. Should the symptoms remain unabated after a few hours, apply one or two leeches to the throat, and put mustard poultices to the foot and thighs, retaining them about eight minutes; and, in extreme cases, a mustard poultice to the spine between the shoulders, and at the same time rub mercurial ointment into the armpits and the angles of the jaws.

2573. Such is a vigorous and reliable system of treatment in severe cases of croup; but, in the milder and more general form, the following abridgment will, in all probability, be all that will be required:--First, the hot bath; second, the emetic; third, a mustard plaster round the throat for five minutes; fourth, the powders; fifth, another emetic in six hours, if needed, and the powders continued without intermission while the urgency of the symptoms continues. When relief has been obtained, these are to be discontinued, and a dose of senna tea given to act on the bowels.

Diarrhoea.

2574. The diarrhoea with which children are so frequently affected, especially in infancy, should demand the nurse's immediate attention, and when the secretion, from its clayey colour, indicates an absence of bile, a powder composed of 3 grains of grey powder and 1 grain of rhubarb, should be given twice, with an interval of four hours between each dose, to a child from one to two years, and, a day or two afterwards, an aperient powder containing the same ingredients and quantities, with the addition of 2 or 3 grains of scammony. For the relaxation consequent on an overloaded stomach, or acidity in the bowels, a little magnesia dissolved in milk should be employed two or three times a day.

2575. When much griping and pain attend the diarrhoea, half a teaspoonful of Dalby's Carminative (the best of all patent medicines) should be given, either with or without a small quantity of castor oil to carry off the exciting cause.

2576. For any form of diarrhoea that, by excessive action, demands a speedy correction, the most efficacious remedy that can be employed in all ages and conditions of childhood is the tincture of Kino, of which from 10 to 30 drops, mixed with a little sugar and water in a spoon, are to be given every two or three hours till the undue action has been checked. Often the change of diet to rice, milk, eggs, or the substitution of animal for vegetable food, or _vice versa_, will correct an unpleasant and almost chronic state of diarrhoea.

2577. A very excellent carminative powder for flatulent infants may be kept in the house, and employed with advantage, whenever the child is in pain or griped, by dropping 5 grains of oil of aniseed and 2 of peppermint on half an ounce of lump sugar, and rubbing it in a mortar, with a drachm of magnesia, into a fine powder. A small quantity of this may be given in a little water at any time, and always with benefit.