Chapter VII (1)

Care of the Sick—Management of the Sick-Room—Food of
Invalids—Adaptation of Management to Particular Cases—Nurses,
and Things essential to Nursing—Importance of Calmness and
Patience.

Another duty of great importance devolves on woman, namely, the care of the sick. From the highest to the lowest none are, properly speaking, exempt from this charge. It is true that those who are rich can hire experienced nurses; but still the responsibility, the anxiety, rests with the mistress, for she cannot hire affection, thoughtful care, and all those little attentions which make the sole comfort of an invalid; she can merely secure a species of human machine which mechanically performs its duties, and between whiles eats, drinks, sleeps, and comforts itself. There are many excellent and kind-hearted professional nurses; but there are also more who become, as it were, petrified by the habitual contemplation of suffering, and who merely regard the patient with a business-like eye.

In a sick-room, the kindness and attention of the nurse often work far greater marvels than the skill of the doctor, for she is there every hour, she sees every change, and can minister to so many little wants; those trifles which make up the events of an invalid, those minor details so unimportant to a person in health, those whims and desires, and nervous susceptibilities which appear almost childish to lookers-on, will be studied by a good, conscientious nurse, and overlooked or disregarded by one who either does not feel interested in the patient, or has not sufficient sympathy to induce her to study these matters. In the former case, the invalid will be soothed and cheered; in the latter, irritated and depressed. Surely, it is not difficult to conceive which influence must act most beneficially upon the system.

Gentleness, watchfulness, firmness, judgment, some delicacy of feeling and _savoir faire_, and a truly Christian spirit, are the distinguishing characteristics which will best adapt a woman for fulfilling this phase of her duties. There are many who, from intense solicitude and sense of duty, will give way to those impulses of feeling which lead them to devote themselves so entirely to the nursing of some beloved relative, that all other duties, and even self, are wholly forgotten. What is the consequence of this error of judgment? Their own health succumbs, and they become not only useless, but render themselves sources of trouble and anxiety. How much better to have husbanded their strength, so as to be able to remain useful! That despised article, common sense, would teach us all so much if we would but stop to listen, if we would not mount, each one, our own peculiar hobby, and gallop off at a tremendous rate, heedless of all sign-posts, and often regardless of even hedges and ditches. Affection! feeling! sentiment! nerves! how much has been done and left undone in these names, especially as regards the subject we are now treating of, while poor dear common sense has been decried as a most unfeeling person, and rudely ejected when she strove to make herself heard!

Yet in few places is common sense a more valuable assistant than in the sick-room; aided by self-command and good feeling, she will transform the most uninitiated person into an excellent and efficient nurse. Let us hear a few of her fundamental principles.

Speak in a low but perfectly distinct voice, both to the invalid and to any one who enters the room, in order that, although no unnecessary sound may be heard, the patient’s ear may not be fatigued by striving to catch the words, or excited by mutterings or whispers addressed to some one else.

Let your countenance be calm and cheerful, your manner soothing and hopeful, and your words such as may cheer or comfort the mind. Avoid all fuss, all hasty movements, all noises that may startle or disturb; let even your dress and shoes be chosen with reference to quiet.

Keep everything in its place, so that in an instant you can put your hand on it when required; have hot water, clean cups, spoons, and glasses, and well-aired body and bed linen always handy; let the air of the room be changed frequently; avoid all bad smells, or remove them as soon as possible; pay strict attention to the temperature of the chamber, and keep it as even as may be; and regulate the light with equal care.

All food offered to invalids should be daintily prepared, and presented in the most careful manner. How often, when we have been longing for food, have we turned from it with disgust, because we had seen the nurse cool it with her breath, or taste it, and then drop the spoon back into it, and present it to us! Nor is it well to inquire of invalids what shall be got for them. If they express a wish for some particular thing, well and good, let it be got for them, if reasonable; but a trifling delicacy unexpectedly brought, will often tempt the appetite; besides, a sick person, or even a convalescent, is often too languid to be at the trouble of thinking about eating, and would sooner go without; or, if he or she chooses something, it may be the very thing which would be improper or prejudicial, and then comes disappointment, and a species of disgust of all else, for in illness the appetite is ever capricious.

Nowhere is cleanliness of such paramount importance as in the sick-room. Do not let us be misunderstood here. We do not mean that an immensity of sweeping, scouring, and dusting is to be done, but simply that the chamber must be kept clean and ventilated, that the bed and body linen must be changed often enough to refresh without fatiguing the patient, and that the air must be purified by means of vinegar, or other disinfectants.

As there are so many kinds of illness, no general rules can be laid down, and our friend, common sense, must be allowed to be the special adviser. In one case body and mind may be paralysed by weakness or languor; in another the body may be agonised, and yet the mind clear and active; while in a third the body may be sane, the mind insane. Hence no one who is a mere machine, guided by certain rules, can be a good and efficient nurse; no one who does not study how to minister to the mind as well as the body, who will not endeavour, to a certain extent, to identify herself with the tastes, feelings, and even prejudices of the patient, can be really useful.

What we have hitherto said applies chiefly to adult patients; to nurse a sick child may seem a far easier task, but is not so. What gentleness, firmness, playfulness, and, above all, what patience is needed in the sick chamber of a child!—for in time of illness, a child is doubly a child, almost a baby again.

The nurse should be constantly watchful over the little sufferer, and mark attentively those positions, and the particular treatment, which most effectually alleviate its sufferings, so that the latter may be repeated under a recurrence of similar circumstances. One great principle in child-nursing is to avoid over-feeding and over-dosing.

Every housekeeper should have a store of old linen, cambric, and calico rags, and old pieces of flannel; these are easily obtained by saving worn-out linen, flannel, and other garments, or at least the useful portions of them, and treasuring old silk and cambric handkerchiefs. Such things are invaluable in time of sickness for poultices, fomentations, leeches, &c. Those who have them not will do well to visit a pawnshop, or the emporium of a purchaser of wardrobes; and having there found one or two articles of no value but to be torn up, to buy these, bring them home, have them thoroughly washed, and then put them away for use.

It is good for us at times to be serious, to turn from the contemplation of life’s pleasures and enjoyments, and look upon its darker pages; for it has been beautifully said by an eminent writer, that “Suffering is not a slender dark thread, winding every now and then through a warp of dazzling brightness, but it is interwoven with the whole texture. It is not incidental, but designed for us; it enters into God’s purposes; it has a great work to do, and we know nothing of life until we comprehend its purposes.” Again: “Suffering nourishes the tenderest sympathies of our nature; it rouses us to energy and a consciousness of our own powers, and at the same time infuses the meekest dependence on God; it stimulates us to cherish and to prize the blessings of this world, and at the same time weans us from and lifts us above mere earthly things.”

There is no home into which sickness may not come at any hour; and as it is to woman that the office of nurse is invariably delegated, surely every woman ought to learn betimes all that will best qualify her to become the ministering angel, whose presence shall bless the long hours of pain and confinement. False delicacy, foolish weakness, and all that can detract from usefulness, should be early overcome. We have seen a daughter scream, and weep, and wring her hands, while her mother lay fainting before her; we have seen a mother shriek and fall on her knees and utter words of agony, when some accident happened to her child. But what did all this unavailing grief benefit the sufferers? How much better she who, controlling her feelings, thinks calmly how she can administer relief, and performs her duties in an intelligent and patient manner.

THE FAMILY MEDICAL GUIDE.

Under this head directions will be given for the domestic management of some of the more frequent ailments to which families are subject. Book-doctoring is a very doubtful economy, except where it is made the means of enabling the nurse or the mother to co-operate intelligently with the medical adviser. But there are cases, as among emigrants, or persons residing in remote places in the country, in which medical aid cannot readily be obtained. In such cases, the following papers will be found of great value. A number of specific remedies for various minor ailments will be found appended to the Medical Articles.

HOOPING-COUGH.

Hooping-cough is thought to have been introduced into Europe from Africa, and, like most other complaints, varies much in intensity. It is a highly infectious disease, and grown persons are liable to its influence; but it commonly takes place between the ages of four months and twelve years. It usually begins as a common cough, and is attended with the general symptoms of having taken cold; but in its progress, soon becomes more severe; though, the longer it is discoverable by the hoop, the more favourable it is likely to be. A frequent discharge from the mouth, nose, and eyes, food often rejected, together with large quantities of phlegm, after which the child generally appears pretty well, and eats his food heartily—these are the most common symptoms. When the disease is violent, they become greatly aggravated, especially during the night, and the child will appear almost strangled, becoming livid, and blood often starting from the nose and eyes.

The following is a favourite prescription of the late Mr. Tuckwell, of Oxford, who, for skill in his profession, courtesy of manners, and kindness of heart, has had few equals, and who has left in that University an almost imperishable memory:—

Dissolve one scruple of salt of tartar, in a quarter of a pint of soft water: add to it ten grains of cochineal finely powdered, and sweeten it with lump sugar.

This medicine is also highly recommended in the _Lancet_. The dose for an infant is a tea-spoonful four times a day; from five years old upwards, a table-spoonful may be taken: but as the paroxysms of this complaint are much aggravated by the resistance of the child to swallow medicine, it is very desirable to abstain, if possible, from giving any internal remedy.

The following embrocation was prescribed by a gentleman, one of the leading practitioners in Oxford; and for spasmodic coughs of all kinds, as well as for inflammatory croup, it is invaluable:—

Two drachms of Tincture of Opium.
Two ounces of Camphor Liniment.

A tea-spoonful to be rubbed in over the throat and chest every night and morning, and cover the parts immediately with flannel. If the chest is loaded with phlegm, an emetic must be given once, twice, or three times a week, as required. Ipecacuanha wine is most suitable, and the dose for a child of four or five years is 2½ or 3 drachms.

During the first stages of this disorder, the patient should breathe an equal temperature, as nearly as it can be managed, not too warm and close, but equal; and when the virulence of the disorder _has passed away_, the open air (if the weather be mild) may be frequently resorted to; and a change of air, where it is practicable, will often remove at once all remains of the complaint.

The only thing that remains to be mentioned, is the proper diet, which is, indeed, of paramount importance; and for children of even six and seven years of age, ought to be little more than milk and broths. These are nourishing, and more readily digested than meats or puddings. One prevalent error is, that milk engenders phlegm; but this is a mistake. Should the milk be found to curdle on the stomach, a little common salt must be added; or, better still, use asses’ milk, if it is attainable. These light nutriments quickly pass out of the stomach, or if brought out by coughing twenty times during the day (which is sometimes the case), the child will immediately take more with avidity.

If thirst prevails, a little toast-and-water may be given. When taken in time, and treated properly, hooping-cough is scarcely ever fatal, indeed never, as long as the patient is free from fever, or other disease. If the attack, from its length and severity, should cause a loss of strength, health will soon be recruited by a cold infusion of bark, gentle exercise, and pure uninfected air, and dieted with a nourishing broth, made as follows:—

Take three-quarters of a pound of veal, the same quantity of beef, chopped very fine, and simmered for three hours in about two quarts of water. Strain it, and let the invalid drink the clear liquid, hot or cold, as may be most agreeable.

_Mixture for Hooping-Cough._

Ipecacuanha Wine 2 drachms.
Carbonate of Soda ½ drachm.
Paregoric Elixir 2 drachms.
Water 1 ounce.

A tea-spoonful or two (according to the age of the patient) may
be given three times a day.

TEETHING.

This natural process in a child’s development, usually commences about the third month, though it is seldom till the fifth or sixth that the teeth make their appearance through the gums. The period when the teeth may be expected is indicated by an increased irritability of the infant, the gums become tense, shiny, and swollen; while the excited glands in the neighbourhood pour out so large a quantity of saliva, that it overflows the mouth, causing the infant to _drivel_, as the nurses call this natural salivation. At the same time the child, as if to relieve the heat and irritation it feels, thrusts its hands into its mouth in the attempt to do what the watchful mother will do for it—_scratch_ the top of the gum with her nail, or, making a rasp of a rough crust, or a proper _gum-ring_, rub it freely along the top ridge, that, by abrading it of the binding cuticle, the imprisoned gum may have the power to expand. As the only benefit that can accrue from rubbing the child’s gum is the tearing or relaxing this fine but tenacious cuticle, all smooth surfaces, such as coral or ivory rings, are perfectly useless; such instruments to be of any service, should be cut into small diamonds like a fine file, and used frequently by the parent, exactly in that manner. The crust, though serviceable from its roughness, is dangerous from the chance of crumbs breaking off and getting into the infant’s throat. After the irritation and drivelling have continued for some weeks, a white line or a round spot appears on the top of the gum of the lower jaw, and ultimately of the upper; through these white spots the teeth finally burst their way in the following order: the two incisors of the lower jaw are the first to make their appearance, though frequently several weeks elapse between the advent of the first and second; the next cut are the four incisors of the upper, then the remaining two incisors of the lower jaw, one on each side, but not joining. There is now a pause for a short time in the process. The next in succession are the four eye teeth in either jaw, thus completing the infantine set of sixteen teeth. Another pause, usually of some months, succeeds before nature resumes her active operations; when she does, it is to place one double tooth on each side of both jaws, thus perfecting the child’s complement of twenty teeth. When these are shed, and nature completes her office, instead of the first ten she places sixteen teeth in each jaw, thus doubling her first complement, and making the adult set thirty-two. Each tooth as it is formed makes half a circle on its axis, and rising sideways, pierces the gum with the extreme point of its edge, revolving as it rises to the perpendicular.

The _diseases_ that teething gives rise to in infants are very numerous, and the consequences of so natural a process are some of the most remarkable facts connected with the development of the human economy. The disorders excited by difficult dentition are, diarrhœa, convulsions, mesenteric disease, water on the brain, rickets, and remittent fever—all of them to the infant fearfully mortal diseases. Each of these affections, though so different in its locality, and so opposite in its symptoms, is induced by the same cause—long-continued irritation in the gums reacting on the delicate organization of the brain and nervous system. And, as this irritation is caused by the difficulty the imprisoned tooth finds in escaping from the fibrous membrane in which it is enveloped, and making its way through the tightly bound gum, it becomes the duty of the medical man or parent, as soon as the first constitutional disturbance manifests itself, to assist the efforts of nature to effect the escape of the tooth, by dividing the gum and leaving an aperture through which the new-formed tooth may reach its destination. But, as _lancing_ the gums, as the process is called, will be worse than useless unless _effectually done_, the gums should never be cut unless the tooth can be plainly felt below, and, to be of service, the incision must be carried down to the tooth, or else the unyielding membrane in which it is encased will be undivided, and the child put to the inconvenience of lancing without effecting the slightest benefit. As, however, the irritation commences from the first entrance of the tooth into the gum on emerging from its bony socket, and long before the actual pressure of the tooth can cause the graver mischief, or simply from the increased amount of blood circulating in the parts, it is evident that lancing the gums in so early a stage of formation is not only impolitic, but hurtful.

Another mode of relief, both for the diarrhœa and convulsions that so frequently occur in weakly infants at this period, must be looked for; and that means, in all stages of dentition, from the first to the last, will be found either a source of instant relief or of certain recovery; that remedy is the _hot bath_, which, in all cases of infantine suffering, is the mother’s best hope, and should be her unshaken reliance. The time a child should be kept in a hot bath should seldom exceed _two minutes_; and, as the object is to unload some congested organ, or to relieve certain parts of their excess of blood by causing a rapid determination to the skin, the water should be hot enough to produce this effect as instantaneously as possible. When diarrhœa continues in despite of the hot bath, a little magnesia or a few grains of prepared chalk may be given two or three times a day until the excessive action is checked; or if unabated by these means, a few drops of tincture of kino is to be administered, as prescribed for diarrhœa.

SCARLET FEVER, OR SCARLATINA.

When scarlet fever becomes epidemic among adults, children rarely fail of being attacked by it in great numbers, and very frequently sink under it. It is, indeed, rather a child’s disease, and is very contagious amongst children; but is not often communicated from them to adults. This disease begins with the common symptoms of fever, often with languor and disposition to fainting, shivering, sickness, a quick pulse, and pain in the head; there is frequently, very early in the disorder, a stiffness in the muscles of the neck, which is soon followed by some difficulty in swallowing. This affection of the neck should be carefully inquired into, especially in young children; the soreness of the throat being sometimes not complained of in the most severe attacks of the disease, until but little hope remains of any mode of treatment being attended with success.

The fever generally increases in the evening, and is often accompanied with delirium; but some remission takes place towards morning, and perspirations come on. There is no complaint in which delirium is of so little consequence as in scarlatina. On the second or third day the efflorescence (or redness) appears on the skin, and generally first on the face, neck, and breast. Up to this period the disorder is sometimes supposed to be measles, as many of the premonitory symptoms are similar; but scarlatina is readily distinguished by the absence of that hoarse cough, frequent sneezing, and watery discharge from the nose and eyes, which are the constant attendants on the early stages of measles: in this latter complaint also, the skin is covered with a _distinct_ eruption, raised above the skin, leaving it clear and well-defined between the marks,—while in scarlatina, the redness is _on_ the skin, and its appearance seldom produces any remission of fever.

When the complaint is to terminate in health, the fiery redness abates gradually, and is succeeded by a brown colour, when the skin, becoming rough, peels off in small scales, and health is generally restored.

On the contrary, when it is to terminate fatally, the febrile symptoms run very high from the first attack, the skin is intensely hot and dry, the pulse is very frequent but small, great thirst prevails, the redness appears on the second day or earlier, and about the third or fourth is often interspersed with large livid spots, and the patient is cut off about the sixth or eighth day. Sometimes a severe purging comes on, which never fails to prove fatal. No complaint is more arbitrary in its attacks, and none on which, humanly speaking, you can reckon with so little certainty.

To determine to the surface of the body, it will be right to give the simple saline, made as follows:—

Take of

Citric Acid 1½ drachm.
Bi-carbonate of Potash 2 drachms.
Water 7½ ounces.
Simple Syrup ½ ounce.
Spirits of Nitre 2 drachms.

Mix, and take a sixth part every four hours. If the child is
very young, give half the dose.

On the first appearance of this disorder, it will be proper to administer an emetic of ipecacuanha powder; and for children of four years of age, seven grains will be a sufficient quantity, and even a repetition of it may be the means of preventing any disposition to diarrhœa (purging). Throughout the whole of this disease it will be advisable to make frequent use of some detergent (cleansing) gargle, which in young children must be thrown into the throat with a syringe.

_Detergent Gargle._

Take of

Purified Alum 1 drachm.
Barley Water 8 ounces (half a pint).
Honey of Roses 1 ounce.

Mix, and gargle the throat frequently.

Camphor is a medicine much employed in scarlatina, and with good effect; but more particularly where the pulse is very low, and the redness disappears suddenly from off the skin. In these cases volatiles, the aromatic confection, and wine will be proper remedies—this latter to be given in moderate quantity, according to the age and other circumstances of the patient, and it should be given in the food, which must consist of thin, nutritious aliments, such as sago, arrow-root, barley water with milk, &c., &c., and _thin_ warm barley water, _without_ milk, should be often drunk, in order to induce moderate perspiration.

In a general way, a cordial plan is required throughout the disease; and where the throat is much affected, either with sloughs (discharges of matter), or total blackness, bark is indispensably necessary, however thick and florid the rash, however hot and dry the skin. Bark, in moderate doses (for children of four years of age, six grains of Peruvian bark may be given four times a day), reduces the fever in the milder species of scarlatina, above every other remedy; and in the more malignant scarlet fever, it supports the system until the regular stages of the fever are accomplished, and a perfect crisis is formed. Should it be disposed to act too freely on the child’s bowels, one drop of opium may be added.

An unpleasant turn in the complaint sometimes takes place in a secondary fever, and is often the consequence of administering bark and wine _too early_, or too liberally, in the _milder_ scarlatina.

As parents and nurses are naturally much alarmed at delirium, it may be well to assure them that there is no disease in which delirium is of so little consequence as in the one before us. In other fevers it seldom comes on until they have arrived at a dangerous height, but it sometimes accompanies scarlatina from the very first day, and many of the patients never fail to be delirious every night, though, excepting this, there exists no other unfavourable symptom from the beginning, and during the illness.

THRUSH, OR APHTHÆ.

This is a disease of the mucous membrane of the mouth, stomach, and bowels; and when severe, may be traced throughout the whole alimentary canal. Though thrush may attack persons at any stage of life, still it is regarded as a disease more peculiarly incident to childhood and infancy; and is generally induced by an abrupt change of diet, or some cause impairing the nutritive quality of the mother’s milk, which produces this eruptive fever in the infant’s digestive organs. The _symptoms_ of thrush are heat, pain, and restlessness, followed by a series of small, raised, white spots, scattered over the mouth, tongue, and lips; sometimes there are but few, at others the whole mouth is studded with them. After a day or two, they enlarge and become distended with a white puriform fluid; the eruption looking like a cross of minute beads: this completes the suppurating or second stage; after which, the vesicles proceed to ulceration, when they burst, discharge their fluid, and degenerate into small flat ulcers, causing throughout, but especially in this the last stage, considerable irritation and pain.

_Treatment._—Having, if possible found the immediate cause of the disease, and if an improper food, removed it, the child must be carefully fed on a diet that in no way can irritate the tender and inflamed lining membrane; and, if necessary, a few spoonfuls of beef tea are to be given occasionally as a gentle stimulant. The medical treatment consists in the exhibition of the subjoined powders and mixture, and the employment, each evening, of the warm bath as a sedative to the restless child.

Take of

Grey Powder 8 grains.
Scammony 6 grains.
Rhubarb 3 grains.

Mix and divide into nine powders for an infant from six to
twelve months, giving one powder twice a day; into six powders
for an infant from one to two years old, one twice a day; and
into four powders for a child of three years, to be given in
the same manner.

Take of

Mucilage ½ ounce.
Castor Oil 2 drachms.
Syrup 2 drachms.

Mix well in a mortar, and add

Dill Water ½ ounce.

Mix, and give a small tea-spoonful twice a day to an infant
from six to twelve months; three times a day to one of from one
to two years; and every six hours to a child of three years
old. Should the thrush have proceeded to ulceration, the mouth
of the infant or child should be washed out by a lotion, made
by dissolving a small quantity of alum or borax in water well
sweetened with honey; and then, by tying a fold of lint to a
piece of stick, and using it as a mop, to cleanse the mouth,
having first well wetted it in the lotion.

ITCH.

This cutaneous disease, the result of dirt and insufficient food, is communicated by the merest contact; and as this is a misfortune that any person may be exposed to, by touching in a cursory manner the person of an affected individual, it is necessary to show the means by which, with a day or two’s seclusion, it may be effectually eradicated. The intolerable itching that so remarkably distinguishes this disease, is the consequence of a very minute microscopic insect which burrows under the scarf skin of the hands and body; and all that is necessary to destroy the life of this insect, and of course cure the disease, is to block up the pores of the skin, by rubbing in some stiff simple ointment upon going to bed; use a hot bath in the morning to cleanse the body of the grease, and repeat the ointment again; and so continue the one at night, and the other in the morning till the cure is effected. For long standing cases sulphur or creosote is necessary, but for trifling cases, spermaceti ointment is quite sufficient, the hands being kept greased and gloved both day and night.

ERYSIPELAS.

This disease is an inflammatory affection principally of the skin, when it makes its appearance externally; it is most frequent in its attacks on women and children, and on those of an irritable habit, rather than of a full robust constitution. Erysipelas will sometimes return periodically, attacking the patient once or twice in the year, or even once in the month; and then, by its repeated attacks, it often gradually exhausts the strength, especially if the sufferer be aged, or of a bad habit of body.

This disease is brought on by all the causes that are apt to excite inflammation, such as injuries of all kinds, the external application of stimulants, exposure to cold, and obstructed perspiration; and it may likewise be occasioned by humours generated within the body, and thrown out on its surface. In slight cases where it attacks the extremities, it makes its appearance with a sensation of heat, accompanied by roughness, pain, and redness of the skin, which becomes pale when the finger is pressed upon it, and again returns to its fiery hue when the pressure is withdrawn. There prevails some fever, and the patient is hot, thirsty, and restless. If the attack is mild, these symptoms will continue only for a few days, the surface of the part affected will become dry and yellow, and the scarf skin (or outer skin) will fall off in scales; but this complaint appears more frequently in the form of small vesicles, or blisters, containing a thin fluid. In some instances the fluid is of a different consistency, and instead of escaping when the blister is broken, it adheres to, and dries upon the skin. In unfavourable cases, these blisters sometimes degenerate into very obstinate ulcers, which now and then become gangrenous. This, however, does not frequently happen, for although it is not uncommon for the surface of the skin and the blistered places to appear livid, or even blackish, yet this usually disappears with the other symptoms of the disorder. No remission of fever takes place on the appearance of the vesicles; and when the complaint is not of a dangerous tendency, the inflammation and fever cease gradually without any evident crisis. During these symptoms (fever and inflammation) it will be proper to administer aperient medicines, and nothing, perhaps, suits the purpose better than the old-fashioned black draught. The external application of Goulard’s Lotion will allay heat and irritation very successfully.

As erysipelatous fevers often terminate when profuse perspiration can be induced, the patient must drink freely of tea, bran tea, or warm barley water: and this is a necessary part of the treatment, which must never be neglected. The vesicles must be kept lightly covered with pure, unadulterated wheat flour; where the inflammatory symptoms run high, the diet must consist of light nourishing food, such as sago, arrow-root, bread pudding, and such like things; but in those cases where symptoms of irritation prevail, a more generous diet, such as animal broths, ought to be allowed.

When the attack is mild, the patient must be kept in the house, but need not be confined to bed. Very earnestly impress on the minds of your patients the baneful effects of opening the little watery blisters. An instance of this kind occurred in the writer’s vicinity, followed by the most lamentable and fatal results. The victim was a married woman, about 33 years of age; the blister appeared on the upper lip, and she, not knowing its nature, punctured it; inflammation, delirium, and death quickly succeeded each other, and baffled the skill of two medical men of long experience.

There is another species of erysipelatous inflammation, which usually attacks the trunk of the body, and is vulgarly known as “Shingles.” It consists of a number of blisters extending round the waist. Little or no danger ever attends this species of erysipelas, but much pain is felt darting through the body; and these pains will continue to annoy the patient at times for some weeks after the eruption has disappeared.

SMALL-POX.

This, the most serious of all eruptive diseases, though having many symptoms in common with other affections of this inflammatory class, has some peculiar to itself, and which, carefully observed, will always accurately define the disease, and point out small-pox from every other analogous affection. These distinctive features are the _greater heat of the skin_, the _nausea_ and _sickness_ that from the first attend it, and the fact that the rash appears on the _fourth_ day of the illness, and not on the third, as in other eruptive diseases. Small-pox usually commences with shivering, pains in the back and head, heat, thirst, nausea, often sickness, a general feeling of languor and debility, quick full pulse, great heat and dryness of the skin, and a white furred tongue. This state continues with the usual febrile symptoms and nightly paroxysms till the fourth day, when a fine papillary rash, like grains of millet seed, breaks out on the face, neck, arms, and breast; in a few hours more extending over the rest of the body. On the fifth day the rash has become more distinct, each papilla has become larger and filled with a transparent fluid, changing its form into that of a vesicle, which, as the disease advances, enlarges with a _flat head_ and _depressed_ centre, the fluid passing from a transparent lymph into a yellowish matter. While this change is taking place, the extremities and the head swell, the head and face often becoming immensely distended, closing the eyes, and giving to the countenance a deformed and unnatural appearance. About the eighth day the maturation of the pustules is completed, and from thence to the eleventh day the declension of the eruption takes place, the pustules burst, the matter is effused, scabs are formed, and the dead cuticle begins, from the twelfth day, to peel off or disquamate, leaving pits in the skin, the consequence of the suppuration having destroyed the fatty matter beneath the cuticle.

As the different stages of the disease are advancing, corresponding changes are taking place in the constitution of the patient; the heat and thirst increase, the pain, restlessness, and anxiety are augmented; the inflammatory and febrile actions keep advancing, rendering the slightest noise intolerable, and causing delirium and a chain of the most dangerous symptoms.

_Treatment._—The inflammatory nature of small-pox renders what is called the cooling mode of treatment, in all its details, a duty of imperative importance. For this purpose, the room in which the patient is placed should during the disease be kept dark and cool, and at least once a day thoroughly ventilated by means of a fire in the grate, for a short time night and morning, but especially at the latter period. The room, also, should be frequently purified by sprinkling the floor with chloride of lime, or by the burning of vinegar on a heated shovel. As the stomach is the first organ sensibly affected, and continues more or less disturbed during the whole disease, the treatment should begin by giving the patient an emetic, composed, if an adult, of twenty grains of ipecacuanha and one grain of tartar emetic; and as soon as that operation has ceased, the following powders and saline purgatives are to be employed, giving the mixture every _two_, and the powders every _four hours_.

Take of

Epsom Salts 1 ounce.
Mint Water 8 ounces.
Antimonial Wine 3 drachms.
Spirits of Nitre 2 drachms.
Syrup of Saffron 2 drachms.

Mix, and give to an adult two table-spoonfuls for a dose, and
to children, according to their age, from a dessert-spoonful
upwards.

Take of

Calomel 3 grains.
Powdered Antimony 2 grains.
Rhubarb 3 grains.
Jalap 10 grains.

Mix, and make a powder. Give _one_ of such a strength, every
_four hours_ to an adult till the bowels are _well_ acted on,
when they are to be discontinued; but the mixture is to be
persisted in, though less frequently, or in half the dose. For
a child from nine to twelve years of age, _half_ of one of the
above powders is to be given every _four hours_, till the same
result is effected; and for younger children, each powder of
the above strength is to be divided into _three parts_, and
administered as the others. For an ordinary drink, in which the
patient should on no account be stinted, lemonade, thin gruel,
or cold tea is to be used; all solid food or nutritious aliment
must be withheld, the patient kept low, his head cool, and the
feet hot.

When the fever runs high, and the head symptoms are severe, it may be necessary to bleed, but if not, a blister is to be laid on the nape of the neck, and perhaps two small ones behind the ears, to relieve the tumefaction of the eyes, and where the want of sleep demands it, a draught at bed-time, composed of fifteen grains of nitre dissolved in two ounces of water, with twenty-five drops of laudanum; or to children, from three to ten drops in a little gruel, according to their ages. Such, in mild or _distinct_ small-pox, is generally all the treatment needed; and even in the aggravated _confluent_, till the time of disquamation often no other means are necessary.

In cases, however, where the rash, after showing favourably, suddenly recedes from the skin, or only partly comes out, the patient must be put into a warm, or rather hot bath for three or four minutes; and when the pulse falls, and becomes small and feeble, as it becomes absolutely necessary to bring back the rash to the skin, hot wine and water must be given, together with soups, tonics, and stimulants, till the invigorated constitution has power to re-act. Should this not have been called for, a system of careful feeding, aided with wine and bark, must be commenced at the period when nature begins to throw off the dead eruption.

The great object to be observed in the treatment of small-pox, is to keep the patient cool, and on the lowest regimen, till the disquamation begins to act freely on the bowels, and to allay fever by cooling drinks. As soon as the patient is convalescent, the diet should be light, and composed chiefly of farinaceous foods, puddings, custards, &c. The body should be bathed once a week, and the cuticle excited by dry rubbing with a towel, and especial care taken for some weeks to keep children from the contact of the patient, who should for that time take an aperient every three days.

To prevent the face and neck from being pitted, each pock in that neighbourhood should be lightly wetted with a weak solution of lunar caustic, at the period when the pustules are filled with a transparent fluid, while they are yet round, and before suppuration has set in or the tops of the vesicles grown flat—or in other words, at the end of the second stage.

MEASLES.

This is a disease characterized by a species of inflammatory fever, attended with all the symptoms of a severe cold, running at the nose and eyes, sneezing, cough, cold chills, tightness at the chest, languor, lassitude, pain in the back and head, and, in fact, by all the indications of constitutional disturbance and fever; though the sign by which it may be most readily known and determined, is the running of humour from the eyes, and constriction of the chest, with a short dry cough. The great secret in the treatment of measles to be borne in mind, is not to discontinue the treatment with the subsidence of the symptoms, for no disease leaves behind it so many and hurtful consequences; therefore, to purify the system, and save the body of the child from mumps, dropsy, tumours, bad eyes, and many other distressing affections, it is necessary to keep up for some weeks, after the disease is cured, a mild but steady action on the body; give the child change of air, plenty of exercise, and a nutritive but light and stimulating diet.

The _symptoms_ of measles commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, defluction 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. On the _third_ day, small red spots 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 disquamation on the skin, which rubs off like dandriff. At this stage of the disease, a diarrhœa frequently comes on, and being what is called “_critical_” should never be checked unless seriously severe. Measles sometimes assumes a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes 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 fœtid diarrhœa takes place, and the patient sinks under the congested state of the lungs and the opposed functions of the brain. The unfavourable symptoms in measles are a high state of fever, excessive heat and dryness of the skin, hurried and short breathing, and a particularly hard pulse. The ordinary after-consequences of measles are, croup, bronchitis, mesenteric disease, abscesses behind the ear, ophthalmia, and glandular swellings in other parts of the body.

_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 keeping them in the water for about two minutes. The first internal remedies should commence with a series of aperient powders, and a saline mixture, as prescribed in the following formularies; at the same time as a beverage to quench the thirst, let a quantity of barley water be made, slightly acidulated by the juice of an orange, and partly sweetened by some sugar-candy, and of which, when properly made and cold, let the patient drink as often as thirst or the dryness of the mouth renders necessary.

_Aperient Powders._—Take of scammony and jalap, each twenty-four grains; gray powder and antimonial powder, of each eighteen grains. Mix and divide into twelve powders, if for a child between two and four years of age; into eight powders, if for a child between four and eight years; and into six powders for between eight and twelve years of age. 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.

_Saline Mixture._—Take of mint water, six ounces; powdered nitre, twenty grains; antimonial wine, three drachms; spirits of nitre, two drachms; syrup of saffron, two drachms. Mix. To children under three years, give a tea-spoonful every two hours; from that age to six a dessert-spoonful at the same intervals; and to children between six and twelve, a table-spoonful every three or four hours. 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. Thus, 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. 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 beneficial. The diet throughout must be light, and consist of farinaceous food, such as rice and sago puddings, with beef tea and toast; and not till convalescence sets in, should hard or animal food be given. When measles assumes 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 minutiæ 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. 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 more to be 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, according to the cure of the disease.

CHICKEN-POX.

This disease, like the Small-Pox, seems to depend on specific contagion, and seldom affects a person but once in his life. The eruption is often succeeded by chilliness, succeeded by flushings, pains in the head and back, thirst, restlessness, and a quick pulse; but at other times, none of these premonitory symptoms are observable. Pustules soon appear, and about the second or third day are filled with a watery fluid, which is never converted into yellow matter, as in the small-pox (to which it bears great affinity); and about the fifth day they usually dry away, and are formed into hard crusts or scabs. No danger attends chicken-pox, but often a good deal of suffering. The small-pox and chicken-pox differ: the eruption of the former is preceded by a fever of a certain duration, while that of the latter is either preceded by none, or by one of uncertain duration; also in the pustules and succeeding scabs appearing much earlier in the chicken-pox than in the small-pox; and in the fluid of the pustules never acquiring the thick purulent appearance, which it always does in distinct small-pox.

Let the patient partake freely of water or cooling drinks, as thirst is always an attendant on the disease, and gentle laxatives should be occasionally given—a tea-spoonful of lenitive electuary, with a little milk of sulphur in it, is all that is generally required; but should febrile symptoms run high, it may be advisable to take two or three saline draughts during the day. The following is a recipe for an excellent saline, to be drunk while effervescing:—Twenty grains of carbonate of soda dissolved in a tumbler containing two table-spoonfuls of water; add two tea-spoonfuls of lump sugar rolled; then put a dessert-spoonful of lemon into a wine-glass (or fifteen grains of citric acid dissolved in one table-spoonful of water). Pour it into the tumbler, and drink it while the effervescence is taking place.

The benefit of this draught cannot be too highly estimated where the stomach is deranged, and there is nausea and faintness, or in cases of fever and thirst.

CROUP.

The Croup is a complaint somewhat similar to the hooping-cough, and to which children _only_ are subject. There are two species of it, the one acute, the other chronic: neither of them often attack children so late as ten or twelve years of age; while they may seize infants newly weaned, and are then the most severe. The cause of this disease is a morbid secretion of thick mucus in the trachea (windpipe), adhering so firmly to its sides as to impede respiration. The quantity and thickness of mucus increasing, gradually lessens the diameter of the part, and if it effects this to a considerable degree, the disease must of necessity prove fatal. The symptoms by which croup is manifested, even to the most uninitiated in the duties of the sick-room, is the peculiar croaking noise made in respiration (from whence it takes its name); and when the disorder is light, there is but little apparent indisposition between the paroxysms, save a certain dulness, and a sense of fear in children of an age to express it.

The fits frequently terminate by sneezing, coughing, or vomiting, and return without any regularity. It is attended with a sharp and shrill voice, and a flushed countenance, which grows livid during the paroxysms. A warm bath should immediately be administered, and an emetic given as soon as possible; say, ten drops of antimonial wine for a child three years of age, and repeated every quarter of an hour until effectual, and according to the age and strength of the patient; a blister should be applied across the throat, the sufferer being made to inhale the vapour of warm water with vinegar in it, and kept nearly upright in bed. A doctor should be procured as soon as possible; and, until his arrival, the foregoing directions may, in most cases, materially influence the physician’s proceedings, and often save life.

Children liable to this disease should be warmly clad, wearing flannel next the skin, and an emetic given upon the earliest appearance of the attack; for remember, this disease requires prompt attention to save life. With care, children usually grow out of it; that is, the constitution will repel the attacks after the tenth or twelfth year.

NETTLE RASH.

This disease takes its name from its being attended by an eruption similar to what is produced by the stinging of nettles. The causes of this complaint are by no means obvious; but it seems to proceed either from the perspiration being checked, or from some irritating matter in the stomach. In all cases, there prevails considerable itching and some heat in the parts affected; and, in some constitutions, a slight degree of fever either precedes or attends the eruption. Its duration seldom exceeds three or four days.

In some cases, Nettle Rash is accompanied with large wheals or bumps, which appear of a solid nature, without any cavity or head, containing either water or other fluid.