The Book of Household Management

by Mrs. Beeton

MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH.

Measles.

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, in most cases does away entirely with the necessity both for leeches and a blister. Whether any of these external means have been employed or not, 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 partially 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.

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.