Advice to a Mother on the Management of Her Children

by Pye Henry Chavasse

ON DISEASE, ETC.

198. Do you think it important that I should be made acquainted with the symptoms of the SERIOUS diseases of children?

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

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

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

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

The above reasons, coming from such a learned and experienced physician as Sir Charles Locock, are conclusive, and have decided me to comply with his advice, to enlighten a mother on the treatment of some of the more urgent diseases of infants and of children. In a subsequent letter addressed to myself, Sir Charles has given me the names of those urgent diseases, which he considers may be treated by a mother "where a medical man cannot be procured quickly, or not at all." They are Croup: Inflammation of the Lungs; Diptheria; Dysentry; Diarrhoea; Hooping Cough, in its various stages; and Shivering Fit. Sir Charles sums up his letter to me by saying, "Such a book ought to be made as complete as possible, and the objections to medical treatment being so explained as to induce mothers to try to avoid medical men is not so serious as that of leaving them without any guide in those instances where every delay is dangerous, and yet where medical assistance is not to be obtained or not to be had quickly."

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

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

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

I think it right to promise that in all the prescriptions for a child I have for the use of a mother given, I have endeavoured to make them as simple as possible, and have, whenever practicable, avoided to recommend powerful drugs. Complicated prescriptions and powerful medicines might, as a rule, to be seldom given; and when they are, should only be administered by a judicious medical man: a child requiring much more care and gentleness in his treatment than an adult: indeed, I often think it would be better to leave a child to nature rather than to give him powerful and large doses of medicines. A remedy—calomel, for instance—has frequently done more mischief than the disease itself; and the misfortune of it is, the mischief from that drug has oftentimes been permanent, while the complaint might, if left alone, have only been temporary.

199. At what age does Water in the Brain usually occur, and how is a mother to know that her child is about to labour under that disease?

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

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

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

200. At what age, and in what neighbourhood, is a child most liable to croup, and when is a mother to know that it is about to take place?

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

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

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

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

When once a child has had croup the after attacks are generally milder. If he has once had an attack of croup, I should advise you always to have in the house medicine—a 4 oz. bottle of Ipecacuanha Wine, to fly to at a moments notice, [Footnote: In case of a sudden attack of croup, instantly give a teaspoonful of Ipecacuanha Wine, and repeat it every fire minutes natal free vomiting be excited.] but never omit, where practicable, in a case of croup, whether the case be severe or mild to send immediately for medical aid. There is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death.

201. But suppose a medical man is not IMMEDIATELY to be procured, what then am I to do? more especially, as you say, that delay might be death?

What to do.—I never, in my life, lost a child with croup with catarrhal croup where I was called in at the commencement of the disease, and where my plans were carried out to the very letter. Let me begin by saying, look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. What medicine! Ipecacuanha Wine! At the earliest dawn of the disease give a few spoonful of Ipecacuanha Wine every five minutes, until free vomiting be exerted. In croup, then, before he be safe, free vomiting must be established, and that without loss of time. If, after the expiration of an hour, the Ipecacuanha Wine (having given during that hour one or two tea-spoonfuls of it every five minutes) be not sufficiently powerful for the purpose—although it generally is so—(if the Ipecacuanha Wine be good)—then let the following mixture be substituted—

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

Make a mixture. One or two tea spoonfuls to be given every five minutes, until free vomiting be excited, first well shaking the bottle.

After the vomiting, place the child for a quarter of an hour in a warm bath. [Footnote: See "Warm Baths"—directions and precautions to be observed.] When out of the bath give him small doses of Ipecacuanha Wine every two or three hours. The following is a palatable form for the mixture—

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

Make a Mixture. A tea-spoonful to be taken every two or three hours.

But remember the emetic which is given at first is pure Ipecacuanha
Wine, without a drop of either water or of syrup.

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

If it be a severe case of croup, and does not in the course of two hours yield to the free exhibition of the Ipecacuanha Emetic, apply a narrow strip of Smith's Tela Vesicularia to the throat, prepared in the same way as for a case of inflammation of the lungs (see the Conversation on the treatment of inflammation of the lungs). With this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. If a child has a very short, fat neck, there may not be room for the Tela, then you ought to apply it to the upper part of the chest—just under the collar-bones.

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

Keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrowroot, &c.; and let the room be, if practicable, at a temperate heat—60 deg. Fahrenheit, and be well ventilated.

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

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

Ipecacuanha Wine, unfortunately, is not a medicine that keeps well, therefore, every three or four months a fresh bottle ought to be procured, either from a medical man or from a chemist. As long as the Ipecacuanha Wine remains clear, it is good; but as soon as it becomes turbid, it is bad, and ought to be replaced by a fresh supply. An intelligent correspondent of mine makes the following valuable remarks on the preservation of Ipecacuanha Wine:—"Now, I know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a perfectly full bottle. If so, would it not be a valuable suggestion if the Apothecaries' Hall, or some other London firm of undoubted reliability, would put up 1 oz. phials of Ipecacuanha Wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. By their keeping a few such ounce bottles in an unopened state in one's house, one might rely in being ready for any emergency. If you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, I think, be adding another most valuable item to an already invaluable book."

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

What NOT to do—Do not give emetic tartar, do not apply leeches, do not keep the room very warm, do not give stimulants, do not omit to have always in the house either a 4 oz. bottle, or three or four 1 oz. bottles, of Ipecacuanha Wine.

202. I have heard Child crowing mentioned as a formidable disease, would you describe the symptoms?

Child-crowing, or spasm of the glottis, or spurious croup, as it is sometimes called, is occasionally mistaken for genuine croup. It is a more frequent disorder than the latter, and requires a different plan of treatment Child crowing is a disease that invariably occurs only during dentition, and is most perilous, indeed, painful dentition is the cause—the only cause—of child crowing. But, if a child labouring under it can fortunately escape suffocation until he have cut the whole of his first set of teeth—twenty—he is then safe.

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

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

Child-crowing is very apt to cause convulsions, which complication, of course, adds very much to the danger. Such a complication requires the constant supervision of an experienced and skilful medical man.

I have entered thus rather fully into the subject, as nearly every life might be saved, if a mother knew the nature and the treatment of the complaint, and of the great necessity during the paroxysm of prompt and proper measures. For, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent himself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting such information, in a popular style, in conversations of this kind.

203. What treatment, then, during a paroxysm of Child-crowing should you advise?

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

In every severe paroxysm of child-crowing, put your fore-finger down the throat of the child, and pull his tongue forward. This plan of pulling the tongue forward opens the epiglottis (the lid of the glottis), and thus admits air (which is so sorely needed) into the glottis and into the lungs, and thus staves off impending suffocation. If this plan were generally known and adopted, many precious lives might be saved. [Footnote: An intelligent correspondent first drew my attention to the efficacy of pulling forward the tongue in every severe paroxysm of child-crowing.]

There is nothing more frightfully agonising to a mother's feelings than to see her child strangled,—as it were,—before her eyes, by a paroxysm of child crowing.

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

Great care and attention ought, during the intervals, to be paid to his diet. If the child be breathing a smoky, close atmosphere, he should be immediately removed to a pure one. In this disease, indeed, there is no remedy equal to a change of air—to a dry, bracing neighbourhood. Change of air, even if it be winter, is the best remedy, either to the coast or to a healthy mountainous district. I am indebted to Mr Roberton of Manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject [Footnote: See the end of the volume of "Physiology and Diseases of Women," &c. Churchill, 1851.]) for the knowledge of this fact. Where, in a case of this kind, it is not practicable to send a child from home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. I am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and principal remedy. Cold sponging of the body too is useful.

Mr Roberton, who, at my request, has kindly given me the benefit of his extensive experience in child-crowing, considers that there is no remedy, in this complaint, equal to fresh air—to dry cold winds—that the little patient ought, in fact, nearly to live, during the day, out of doors, whether the wind be in the east or in the north-east, whether it be biting cold or otherwise, provided it be dry and bracing, for "if the air be dry, the colder the better,"—taking care, of course, that he be well wrapped up. Mr Roberton, moreover, advises that the child should be sent away at once from home, either to a bracing sea-side place, such as Blackpool or Fleetwood; or to a mountainous district, such as Buxton.

As the subject is so important, let me recapitulate: the gums ought, from time to time, to be well lanced, in order to remove the irritation of painful dentition—painful dentition being the real cause of the disease. Cold sponging should be used twice or thrice daily. The diet should be carefully attended to (see Dietary of Child); and everything conducive to health should (as recommended in these Conversations) be observed. But, remember, after all that can be said about the treatment, there is nothing like change of air, of fresh air, of cold, dry pure air, and of plenty of it—the more the little fellow can inhale, during the day, the better it will be for him, it will be far better than any drug contained in the pharmacopoeia.

I have dwelt on this subject at some length—it being a most important one—as, if the above advice were more generally known and followed, nearly every child, labouring under this complaint, would be saved; while now, as coroners' inquests abundantly testify, the disease carries off yearly an immense number of victims.

204. When is a mother to know that a cough is not a "tooth cough" but one of the symptoms of Inflammation of the lungs?

If the child has had a shivering fit; if his skin be very hot and very dry; if his lips be parched; if there be great thirst; if his cheeks be flushed; if he be dull and heavy, wishing to be quiet in his cot or crib; if his appetite be diminished; if his tongue be furred; if his mouth be burning hot and dry; [Footnote: If you put your finger into the mouth of a child labouring under inflammation of the lungs, it is like putting your finger into a hot apple pie, the heat is so great.] if his urine be scanty and high-coloured, staining the napkin or the linen; if his breathing be short, panting, hurried, and oppressed; if there be a hard dry cough, and if his skin be burning hot;—then there is no doubt that inflammation of the lungs has taken place.

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

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

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

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

Make a Mixture. A tea-spoonful of the mixture to be taken every four hours.

Be careful that you go to a respectable chemist, in order that the totality of the Ipecacuanha Wine may be good, as the child's life may depend upon it.

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

If the attack be very severe, in addition to the above medicine, at once apply a blister, not the common blister, but Smith's Tela Vesicatoria [Footnote: Manufactured by T. & H. Smith, chemists, Edinburgh, and may be procured of Southalls, chemists, Birmingham.]—a quarter of a sheet. If the child be a year old, the blister ought to be kept on for three hours, and then a piece of dry, soft linen rag should be applied for another three hours. At the end of which time—six hours—there will be a beautiful blister, which must then, with a pair of scissors, be cut, to let out the water, and then let the blister be dressed, night and morning, with simple cerate spread on lint.

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

If in a day or two the inflammation still continue violent, let another Tela Vesicatoria be applied, not over the old blister, but let a narrow strip of it be applied on each side of the old blister, and managed in the same manner as before directed.

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

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

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

205. Is Bronchitis a more frequent disease than Inflammation of the Lungs? Which is the most dangerous? What are the symptoms of Bronchitis?

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

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

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

206. How can I distinguish between Bronchitis and Inflammation of the Lungs?

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

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

207. How would you treat a case of Bronchitis?

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

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

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

If in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise, and put on the chest a Tela Vesicatoria, a quarter of a sheet.

The Ipecacuanha Wine and the Tela Vesicatoria are my sheet anchors in the bronchitis, both of infants and of children. They rarely, even in very severe cases, fail to effect a cure, provided the Tela Vesicatorina be properly applied, and the Ipecacuanha Wine be genuine and of good quality.

If there be any difficulty in procuring good Ipecacuanha Wine, the Ipecacuanha may be given in powder instead of the wine The following is a pleasant form—

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

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

The Ipecacuanha Powder will keep better than the Wine—an important
consideration to those living in country places, nevertheless, if the
Wine can be procured fresh and good, I far prefer the Wine to the
Powder.

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

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

208. What are the symptoms of Diphtheria, or, as it is sometimes called, Boulogne Sore-throat?

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

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

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

209. Is Diphtheria contagious?

Decidedly. Therefore, when practicable, the rest of the children ought instantly to be removed to a distance. I say children, for it is emphatically a disease of childhood. When adults have it, it is the exception and not the rule: "Thus it will be seen, in the account given of the Boulogne epidemic, that of 366 deaths from this cause, 341 occurred amongst children under ten years of age. In the Lincolnshire epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred amongst children under twelve years of age." [Footnote: Diphtheria: by Ernest Hart. A valuable pamphlet on the subject. Dr Wade of Birmingham has also written an interesting and useful monograph on Diphtheria. I am indebted to the above authors for much valuable information.]

210. What are the causes of Diphtheria?

Bad and imperfect drainage; [Footnote: "Now all my carefully conducted inquiries induce me to believe that the disease comes from drain-poison. All the cases into which I could fully inquire, have brought conviction to my mind that there is a direct law of sequence in some peculiar conditions of atmosphere between diphtheria and bad drainage; and, if this be proved by subsequent investigations, we may be able to prevent a disease which, in too many cases, our known remedies cannot cure."—W. Carr, Esq., Blackheath, British Medical Journal, December 7, 1861.] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air, and thus depresses the system, more especially if the weather be close and muggy; poor and, improper food; and last, though not least, contagion. Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.

211. What is the treatment of Diptheria?

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

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

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

Take of—Permanganate of Potash, pure, four grams,
Water eight ounces

To make a Gargle

Or,

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

To make a Gargle

The best medicine for the first few days of the attack, is the following mixture—

Take of—Chlorate of Potash two drachms,
Boiling Water seven ounces
Syrup of Red Poppy one ounce

To Make a mixture. A table spoonful to be taken every four hours.

Or the chlorate of potash might be given in the form of powder—

Take of—Chlorate of Potash two scruples,
Lump Sugar one drachm

Mix and divide into eight powders. One to be put into a dry tea spoon and then placed on the tongue every three hours, These powders are very useful in diphtheria; they are very cleansing to the tongue and throat. If they produce much smarting as where the mouth is very sore they sometimes do, let the patient, after taking one, drink plentifully of milk, indeed I have known these powders induce a patient to take nourishment, in the form of milk, which he otherwise would not have done, and thus to have saved him from dying of starvation, which, before taking the powders, there was every probability of his doing. An extensive experience has demonstrated to me the great value of these powders in diphtheria, but they must be put on the tongue dry.

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

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

Take of—Wine of Iron, one ounce and a half,
Sample Syrup, one ounce,
Water, three ounces and a half

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

Or,

Take of—Tincture of Perchloride of Iron, one drachm
Simple Syrup, one ounce,
Water, three ounces

To make a Mixture. A table spoonful to be taken three times a day.

If the disease should travel downwards, it will cause all the symptoms of croup, then it must be treated as croup, with this only difference, that a blister (Tela Vesicatoria) must not be applied, or the blistered surface may be attacked by the membrane of diphtheria, which may either cause death or hasten that catastrophe. In every other respect treat the case as croup, by giving an emetic, a tea spoonful of Ipecacuanha Wine every five minutes, until free vomiting be excited, and then administer smaller doses of Ipecacuanha Wine every two or three hours, as I recommended when conversing with you on the treatment of croup.

What NOT to do—Do not, on any account, apply either leeches or a blister. If the latter be applied, it is almost sure to be covered with the membrane of diphtheria, similar to that inside of the mouth and of the throat, which would be a serious complication. Do not give either calomel or emetic tartar. Do not depress the system by aperients, for diphtheria is an awfully depressing complaint of itself, the patient, in point of fact, is labouring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by faecal matter from either a privy or from a water-closet, by some horrid drain, by proximity to a pig-sty, by an overflowing privy, especially if vegetable matter be rotting at the same time in it, by bad ventilation, or by contagion. Diphtheria may generally be traced either to the one or to the other of the above causes, therefore let me urgently entreat you to look well into all these matters, and thus to stay the pestilence! Diphtheria might long remain in a neighbourhood if active measures be not used to exterminate it.

212. Have the goodness to describe the symptoms of Measles?

Measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a hoarse and peculiar ringing cough, which nurses call "measle-cough," and difficulty of breathing. These symptoms usually last three days before the eruption appears, on the fourth it (the eruption) generally makes its appearance, and continues for four days and then disappears, lasting altogether, from the commencement of the symptoms of cold to the decline of the eruption, seven days. It is important to bear in mind that the eruption consists of crescent-shaped—half moon-shaped—patches, that they usually appear first about the face and the neck, in which places they are the best marked; then on the body and on the arms; and, lastly, on the legs, and that they are slightly raised above the surface of the skin. The face is swollen, more especially the eye-lids which are sometimes for a few days closed.

Well, then, remember, the running at the nose, the, sneezing, the peculiar hoarse cough, and the half-moon-shaped patches, are the leading features of the disease, and point out for a certainty that it is measles.

213. What constitutes the principal danger in Measles?

The affection of the chest. The mucous or lining membrane of the bronchial tubes is always more or less inflamed, and the lungs themselves are sometimes affected.

214. Do you recommend "surfeit water" and saffron tea to throw out the eruption in Measles?

Certainly not. The only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "Surfeit water," saffron tea, and remedies of that class, are hot and stimulating. The only effect they can have, will be to increase the fever and the inflammation—to add fuel to the fire.

215. What is the treatment of Measles?

What to do.—The child ought to be confined both to his room and to his bed, the room being kept comfortably warm; therefore, if it be winter time, there should be a small fire in the grate; in the summer time, a fire would be improper. The child must not be exposed to draughts; notwithstanding, from time to time, the door ought to be left a little ajar in order to change the air of the apartment; for proper ventilation, let the disease be what it may, is absolutely necessary.

Let the child, for the first few days, be kept on a low diet, such as on milk and water, arrow-root, bread and butter, &c.

If the attack be mild, that is to say, if the breathing be not much affected (for in measles it always is more or less affected), and if there be not much wheezing, the Acidulated Infusion of Roses' Mixture [Footnote: See page 178] will be all that is necessary.

But suppose that the breathing is short, and that there is a great wheezing, then instead of giving him the mixture just advised, give him a tea-spoonful of a mixture composed of Ipecacuanha Wine, Syrup, and Water, [Footnote: See page 161] every four hours. And if, on the following day, the breathing and the wheezing be not relieved in addition to the Ipecacuanha Mixture, apply a Tola Vesicatoria, as advised under the head of Inflammation of the Lungs.

When the child is convalescing, batter puddings, rice, and sago puddings, in addition to the milk, bread and butter, &c, should be given, and, a few days later, chicken, mutton chops, &c.

The child ought not, even in a mild case of measles, and in favourable weather to be allowed to leave the house under a fortnight, or it might bring on an attack of bronchitis.

What NOT to do—Do not give either "surfeit water" or wine. Do not apply leeches to the chest. Do not expose the child to the cold air. Do not keep the bed room very hot, but comfortably warm. Do not let the child leave the house, even under favourable circumstances, under a fortnight. Do not, while the eruption is out, give aperients. Do not, "to ease the cough," administer either emetic tartar or paregoric—the former drug is awfully depressing, the latter will stop the cough, and will thus prevent the expulsion of the phlegm.

216. What is the difference between Scarlatina and Scarlet Fever?

They are indeed one and the same disease, scarlatina being the Latin for scarlet fever. But, in a popular sense, when the disease is mild, it is usually called scarlatina. The latter term does not sound so formidable to the ears either of patients or of parents.

217. Will you describe the symptoms of Scarlet Fever?

The patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. At the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself. The scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as Dr Elliotson accurately describes it,—"the tongue looks as if it had been slightly sprinkled with Cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." The eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. There is usually, after the first few days, great itching on the surface of the body. The skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it.

There are three forms of scarlet fever;—the one where the throat is little, if at all, affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is much affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is VERY dangerous), the malignant form.

218. Would it be well to give a little cooling, opening physic as soon as a child begins to sicken for Scarlet Fever?

On no account whatever. Aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. It is my firm conviction, that the administration of opening medicine, at such times, is one of the principal causes of scarlet fever being so frequently fatal. This is, of course, more applicable to the poor, and to those who are unable to procure a skilful medical man.

219. What constitutes the principal danger in Scarlet Fever?

The affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in anasarca (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying proper remedies.

When Scarlet Fever is complicated—as it sometimes is—with diphtheria, the diphtheric membrane is very apt to travel into the wind-pipe, and thus to cause diphtheric croup, it is almost sure, when such is the case, to end in death. When a child dies from such a complication, the death might truly be said to be owing to the diphtheric croup, and not to the Scarlet Fever, for if the diphtheric croup had not occurred, the child would, in all probability, have been saved. The deaths from diphtheria are generally from diphtheric croup, if there be no croup, there is, as a rule, frequent recovery.

220. How would you distinguish between Scarlet Fever and Measles?

Measles commences with symptoms of a common cold, scarlet fever does not. Measles has a peculiar hoarse cough, scarlet fever has not. The eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is not raised above the skin at all, and is one continued mass. The colour of the eruption is much more vivid in scarlet fever than in measles. The chest is the part principally affected in measles, and the throat in scarlet fever.

There is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. I myself have, in several instances, ascertained the truth of it—"For several years M Bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. The phenomenon in question is a white line, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. On drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. In this way the diagnosis of the disease may be very distinctly written on the skin; the word 'Scarlatina' disappears as the eruption regains its uniform tint."—Edinburgh Medical Journal.

221. Is it of so much importance, then, to distinguish between Scarlet fever and Measles?

It is of great importance, as in measles the patient ought to be kept moderately warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool—indeed, for the first few days, cold—and the beverages, such as spring-water, toast and water, &c., should be administered quite cold.

222. Do you believe in "Hybrid" Scarlet Fever—that is to say, in a cross between Scarlet Fever and Measles?

I never in my life saw a case of "hybrid" scarlet fever—nor do I believe in it. Scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "Hybrid" Scarlet fever is, in my opinion, an utter impossibility. In olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"—a cross between measles and scarlet fever—to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be.

223. What is the treatment of Scarlet Fever? [Footnote: On the 4th of March 1856, I had the honour to read a Paper on the Treatment of Scarlet Fever before the members of Queens College Medico-Chirugical Society, Birmingham—which Paper was afterwards published in the Association Journal (March 15 1856) and in Braithwaite's Retrospect of Medicine (January—June, 1856) and in Rankings Half Yearly Abstract of the Medical Sciences (July—December, 1856), besides in other publications. Moreover the Paper was translated into German, and published in Canstatts Jahresbericht, iv 456, 1859]

What to do—Pray pay attention to my rules, and carry out my directions to the letter—I can then promise, that if the scarlet fever be neither malignant nor complicated with diphtheria, the plan I am about to advise will, with God's blessing, be usually successful.

What is the first thing to be done? Send the child to bed, throw open the windows, be it winter or summer, and have a thorough ventilation, for the bedroom must be kept cool, I may say cold. Do not be afraid of fresh air, for fresh air, for the first few days, is essential to recovery. Fresh air, and plenty of it, in scarlet fever, is the best doctor a child can have let these words be written legibly on your mind. [Footnote: In the Times of Sept 4, 1863, is the following copied from the Bridgewater Mercury—

GROSS SUPERSTITION—In one of the streets of Taunton, there resides a man and his wife who have the care of a child This child was attacked with scarlatina, and to all appearance death was inevitable. A jury of matrons was as it were empanelled, and to prevent the child 'dying hard' all the doors in the house all the drawers, all the boxes all the cupboards were thrown wide open, the keys taken out and the body of the child placed under a beam, whereby a sure, certain, and easy passage into eternity could be secured. Watchers held their vigils throughout the weary night, and in the morning the child, to the surprise of all, did not die, and is now gradually recovering.

These old women—this jury of matrons—stumbled on the right remedy, "all the doors in the house….were thrown vide open," and thus they thoroughly ventilated the apartment. What was the consequence? The child who, just before the opening of the doors, had all the appearances "that death was inevitable," as soon as fresh air was let in showed symptoms of recovery, "and in the morning the child, to the surprise of all, did not die, and is now gradually recovering." There is nothing wonderful—there is nothing surprising to my mind—in all this. Ventilation—thorough ventilation—is the grand remedy for scarlatina! Oh, that there were in scarlet fever cases a good many such old women's—such a "jury of matrons'"—remedies! We should not then be horrified, as we now are, at the fearful records of death, which the Returns of the Registrar General disclose!]

If the weather be either intensely cold, or very damp, there is no objection to a small fire in the grate provided there be, at the same time, air—an abundance of fresh air—admitted into the room.

Take down the curtains of the bed, remove the valances. If it be summer time, let the child be only covered with a sheet. If it be winter time, in addition to the sheet, he should have one blanket over him.

Now for the throat—The best external application is a barm and oatmeal poultice How ought it to be made, and how applied? Put half a tea-cupful of barm into a saucepan, put it on the fire to boil; as soon as it boils, take it off the fire, and stir oatmeal into it, until it be of the consistence of a nice soft poultice; then place it on a rag, and apply it to the throat, carefully fasten it on with a bandage, two or three turns of the bandage going round the throat, and two or three over the crown of the head, so as nicely to apply the poultice where it is wanted—that is to say, to cover the tonsils. Tack the bandage: do not pin it. Let the poultice be changed three times a day. The best medicine is the Acidulated Infusion of Roses, sweetened with syrup:—

Take of—Dilated Sulphuric Acid, half a drachm;
Simple Syrup, one ounce and a half;
Acid Infusion of Roses, four ounces and a half:

To make a Mixture. A table-spoonful to be taken every four hours.

It is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleanses the throat and tongue of mucus, and is peculiarly efficacious in scarlet fever; as soon as the fever is abated it gives an appetite. My belief is that the sulphuric acid in the mixture is a specific in scarlet fever, as much as quinine is in ague, and sulphur in itch. I have reason to say so, for, in numerous cases I have seen its immense value.

Now, with regard to food.—If the child be at the breast, keep him entirely to it. If he be weaned, and under two years old, give him milk and water, and cold water to drink. If he be older, give him toast and water, and plain water from the pump, as much as he chooses; let it be quite cold—the colder the better. Weak black tea, or thin gruel, may be given, but not caring, unless he be an infant at the breast, if he take nothing but cold water. If the child be two years old and upwards, roasted apples with sugar, and grapes, will be very refreshing, and will tend to cleanse both the mouth and the throat Avoid broths and stimulants.

When the appetite returns, you may consider the patient to be safe. The diet ought now to be gradually improved. Bread and butter, milk and water, and arrowroot made with equal parts of new milk and water, should for the first two or three days be given. Then a light batter or rice pudding may be added, and in a few days, either a little chicken or a mutton chop.

The essential remedies, then, in scarlet fever, are, for the first few days—(1) plenty of fresh air and ventilation, (2) plenty of cold water to drink, (3) barm poultices to the throat, and (4) the Acidulated Infusion of Roses Mixture as a medicine.

Now, then, comes very important advice. After the first few days, probably five or six, sometimes as early as the fourth day—watch carefully and warily, and note the time, the skin will suddenly become cool, the child will say that he feels chilly; then is the time you must now change your tactics—instantly close the windows and put extra clothing, a blanket or two, on his bed. A flannel nightgown should, until the dead skin have peeled off, be now worn next to the skin, when the flannel nightgown should be discontinued. The patient ought ever after to wear, in the day time, a flannel waistcoat. [Footnote: On the importance—the vital importance—of the wearing of flannel next to the skin, see "Flannel Waistcoats.">[ His drinks must now be given with the chill off; he ought to have a warm cup of tea, and gradually his diet should, as I have previously advised, be improved.

There is one important caution I wish to impress upon you,—do not give opening medicine during the time the eruption is out. In all probability the bowels will be opened: if so, all well and good; but do not, on any account, for the first ten days, use artificial means to open them. It is my firm conviction that the administration of purgatives in scarlet fever is a fruitful source of dropsy, of disease, and death. When we take into consideration the sympathy there is between the skin and the mucous membrane, I think that we should pause before giving irritating medicines, such as purgatives. The irritation of aperients on the mucous membrane may cause the poison of the skin disease (for scarlet fever is a blood-poison) to be driven internally to the kidneys, to the throat, to the pericardium (bag of the heart), or to the brain. You may say, Do you not purge if the bowels be not open for a week? I say emphatically, No!

I consider my great success in the treatment of scarlet fever to be partly owing to my avoidance of aperients during the first ten days of the child's illness.

If the bowels, after the ten days, be not properly opened, a dose or two of syrup of senna should be given: that is to say, one or two tea-spoonfuls should be administered early in the morning, and should, if the first dose does not operate, be repeated in four hours.

In a subsequent Conversation, I shall strongly urge you not to allow your child, when convalescent, to leave the house under at least a month from the commencement of the illness; I, therefore, beg to refer you to that Conversation, and hope that you will give it your best and earnest consideration! During the last twenty years I have never had dropsy from scarlet fever, and I attribute it entirely to the plan I have just recommended, and in not allowing my patients to leave the house under the month—until, in fact, the skin that had peeled off has been renewed.

Let me now sum up the plan I adopt, and which I beg leave to designate as—Pye Chavasse's Fresh Air Treatment of Scarlet Fever:—

1. Thorough ventilation, a cool room, and scant clothes on the bed, for the first five or six days.

2. A change of temperature of the skin to be carefully regarded. As soon as the skin is cool, closing the windows, and putting additional clothing on the bed.

3. The Acidulated Infusion of Hoses with Syrup is the medicine for scarlet fever.

4. Purgatives to be religiously avoided for the first ten days at least, and even afterwards, unless there be absolute necessity.

5. Leeches, blisters, emetics, cold and tepid spongings, and painting the tonsils with caustic, inadmissible in scarlet fever.

6. A strict antiphlogistic (low) diet for the first few days, during which time cold water to be given ad libitum.

7. The patient not to leave the house in the summer under the month; in the winter, under six weeks.

What NOT to do.—Do not, then, apply either leeches or blisters to the throat; do not paint the tonsils with caustic; do not give aperients; do not, on any account, give either calomel or emetic tartar; do not, for the first few days of the illness, be afraid of cold air to the skin, and of cold water as a beverage; do not, emphatically let me say, do not let the child leave the house for at least a month from the commencement of the illness.

My firm conviction is, that purgatives, emetics, and blisters, by depressing the patient, sometimes cause ordinary scarlet fever to degenerate into malignant scarlet fever.

I am aware that some of our first authorities advocate a different plan to mine. They recommend purgatives, which I may say, in scarlet fever, are my dread and abhorrence. They advise cold and tepid spongings—a plan which I think dangerous, as it will probably drive the disease internally. Blisters, too, have been prescribed; these I consider weakening, injurious, and barbarous, and likely still more to inflame the already inflamed skin. They recommend leeches to the throat, which I am convinced, by depressing the patient, will lessen the chance of his battling against the disease, and will increase the ulceration of the tonsils. Again, the patient has not too much blood; the blood is only poisoned. I look upon scarlet fever as a specific poison of the blood, and one which will be eliminated from the system, not by bleeding, not by purgatives, not by emetics but by a constant supply of fresh and cool air, by the acid treatment, by cold water as a beverage, and for the first few days by a strict antiphlogistic (low) diet. Sydenham says that scarlet fever is oftentimes "fatal through the officiousness of the doctor." I conscientiously believe that a truer remark was never made; and that, under a different system to the usual one adopted, scarlet fever would not be so much dreaded. [Footnote: If any of my medical brethren should do me the honour to read these pages, let me entreat them to try my plan of treating scarlet fever, as my success has been great. I have given full and minute particulars, in order that they and mothers (if mothers cannot obtain medical advice) may give my plan a fair and impartial trial. My only stipulations are that they must begin with my treatment, and not mix any other with it, and carry out my plan to the very letter. I then, with God's blessing, provided the cases be neither malignant nor complicated with diphtheria, shall not fear the result. If any of my confreres have tried my plan of treatment of scarlet fever—and I have reason to know that many have—I should feel grateful to them if they would favour me with their opinion as to its efficacy. Address—"Pye Chavasse, 214 Hagley Road, Birmingham.">[

Dr Budd, of Bristol, recommends, in the British Medical Journal, that the body, including the scalp, of a scarlet fever patient, should, after about the fourth day, be anointed, every night and morning, with camphorated oil; this anointing to be continued until the patient is able to take a warm bath and use disinfectant soap: this application will not only be very agreeable to the patient's feelings, as there is usually great irritation and itching of the skin, but it will, likewise, be an important means of preventing the dead skin, which is highly infectious, and which comes off partly in flakes and partly floats about the air as dust, from infecting other persons. The plan is an excellent one, and cannot be too strongly recommended.

If the case be a combination of scarlet fever and of diphtheria, as it unfortunately now frequently is, let it be treated as a case of diphtheria.

224. I have heard of a case of Scarlet Fever, where the child, before the eruption showed itself, was suddenly struck prostrate, cold, and almost pulseless: what, in such a case, are the symptoms, and what immediate treatment do you advise?

There is an exceptional case of scarlet fever, which now and then occurs, and which requires exceptional and prompt treatment, or death will quickly ensue. We will suppose a case: one of the number, where nearly all the other children of a family are labouring under scarlet fever, is quite well, when suddenly—in a few hours, or even, in some cases, in an hour—utter prostration sets in, he is very cold, and is almost pulseless, and is nearly insensible—comatose.

Having sent instantly for a judicious medical man, apply, until he arrives, hot bottles, hot bricks, hot bags of salt to the patient's feet and legs and back, wrap him in hot blankets, close the window, and give him hot brandy and water—a tablespoonful of brandy to half a tumblerful of hot water—give it him by teaspoonfuls, continuously—to keep him alive; when he is warm and restored to consciousness, the eruption will probably show itself, and he will become hot and feverish; then your tactics must, at once, be changed, and my Fresh Air Treatment, and the rest of the plan I have before advised must in all its integrity, be carried out.

We sometimes hear of a child, before the eruption comes out and within twenty-four hours of the attack, dying of scarlet fever. When such be the case it is probably owing to low vitality of the system—to utter prostration—he is struck down, as though for death, and if the plan be not adopted of, for a few hours, keeping him alive by heat, and by stimulants, until, indeed, the eruption comes out, he will never rally again, but will die from scarlet fever poisoning and from utter exhaustion. These cases are comparatively rare, but they do, from time to time, occur, and, when they do, they demand exceptional and prompt and energetic means to save them from ending in almost immediate and certain death. "To be forewarned is to be forearmed." [Footnote: I have been reminded of this exceptional case of scarlet fever by a most intelligent and valued patient of mine, who had a child afflicted as above described, and whose child was saved from almost certain death, by a somewhat similar plan of treatment as advised in the text.]

225. How soon ought a child to be allowed to leave the house after an attack of Scarlet Fever?

He must not be allowed to go out for at least a month from the commencement of the attack, in the summer, and six weeks in the winter; and not even then without the express permission of a medical man. It might be said that this is an unreasonable recommendation: but when it is considered that the whole of the skin generally desquamates, or peels off, and consequently leaves the surface of the body exposed to cold, which cold flies to the kidneys, producing a peculiar and serious disease in them, ending in dropsy, this warning will not be deemed unreasonable.

Scarlet fever dropsy, which is really a formidable disease, generally arises from, the carelessness, the ignorance, and the thoughtlessness of parents in allowing a child to leave the house before the new skin be properly formed and hardened. Prevention is always better than cure.

Thus far with regard to the danger to the child himself. Now, if you please, let me show you the risk of contagion that you inflict upon families, in allowing your child to mix with others before a month at least has elapsed. Bear in mind, a case is quite as contagious, if not more so, while the skin is peeling off, as it was before. Thus, in ten days or a fortnight, there is as much risk of contagion as at the beginning of the disease, and when the fever is at its height. At the conclusion of the month, the old skin has generally all peeled off, and the new skin has taken its place; consequently there will then be less fear of contagion to others. But the contagion of scarlet fever is so subtle and so uncertain in its duration, that it is impossible to fix the exact time when it ceases.

Let me most earnestly implore you to ponder well on the above important facts. If these remarks should be the means of saving only one child from death, or from broken health, my labour will not have been in vain.

226. What means do you advise to purify a house, clothes, and furniture, from the contagion of Scarlet Fever?

Let every room in the house, together with its contents, and clothing and dresses that cannot be washed, be well fumigated with sulphur—taking care the while to close both windows and door; let every room be lime-washed and then be white-washed; if the contagion have been virulent, let every bedroom be freshly papered (the walls having been previously stripped of the old paper and then lime-washed); let the bed, the holsters, the pillows, and the mattresses be cleansed and purified; let the blankets and coverlids be thoroughly washed, and then let them be exposed to the open air—if taken into a field so much the better; let the rooms be well scoured; let the windows, top and bottom, be thrown wide open; let the drains be carefully examined; let the pump water be scrutinised, to see that it be not contaminated by faecal matter, either from the water-closet, from the privy, from the pig-stye, or from the stable; let privies be emptied of their contents—remember this is most important advice—then put, into the empty places, either lime and powdered charcoal or carbolic acid, for it is a well ascertained fact that it is frequently impossible to rid a house of the infection of scarlet fever without adopting such a course. "In St George's, Southwark, the medical officer reports that scarlatina 'has raged fatally, almost exclusively where privy or drain, smells are to be perceived in the houses.'" [Footnote: Quarterly Report of the Board of Health upon Sickness in the Metropolis.] Let the children, who have not had, or who do not appear to be sickening for scarlet fever, be sent away from home—if to a farm house so much the better. Indeed, leave no stone unturned, no means untried, to exterminate the disease from the house and from the neighbourhood. Remember the young are more prone to catch contagious diseases than adults; for

"in the morn and liquid dew of youth
Contagious blastments are most imminent."—Shakspeare.

227. Have you any further observations to offer on the precautions to be taken against the spread of Scarlet Fever?

Great care should be taken to separate the healthy from the infected. The nurses selected for attending scarlet fever patients should be those who have previously had scarlet fever themselves. Dirty linen should be removed at once, and be put into boiling water. Very little furniture should be in the room of a scarlet fever patient—the less the better—it only obstructs the circulation of the air, and harbours the scarlet fever poison. The most scrupulous attention to cleanliness should, in these cases, be observed. A patient who has recovered from scarlet fever, and before he mixes with healthy people, should, for three or four consecutive mornings, have a warm bath, and well wash himself, while in the bath, with soap; he will, by adopting this plan, get rid of the dead skin, and thus remove the infected particles of the disease. If scarlet fever should appear in a school, the school must for a time be broken up, in order that the disease might be stamped out There must be no half measures where such a fearful disease is in question. A house containing scarlet fever patients should, by parents, be avoided as the plague; it is a folly at any time to put one's head into the lion's mouth! Chloralum and carbolic acid, and chloride of lime, and Condy's fluid, are each and all good disinfectants; but not one is to be compared to perfect cleanliness and to an abundance of fresh and pure air—the last of which may truly par excellence be called God's disinfectant! Either a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid, or two tea-spoonfuls of Condy's fluid, or a tea-spoonful of chloride of lime in a pint of water, are useful to sprinkle the soiled handkerchiefs as soon as they be done with, and before the be washed, to put in the pot-de-chambre, and to keep in saucers about the room; but, remember, as I have said before, and cannot repeat too often, there is no preventative like the air of heaven, which should be allowed to permeate and circulate freely through the apartment and through the house: air, air, air is the best disinfectant, curative, and preventative of scarlet fever in the world!

I could only wish that my Treatment of Scarlet Fever were, in all its integrity, more generally adopted; if it were, I am quite sure that thousands of children would annually be saved from broken health and from death. Time still further convinces me that my treatment is based on truth as I have every year additional proofs of its value and of its success; but error and prejudice are unfortunately ever at work, striving all they can to defeat truth and common sense. One of my principal remedies in the treatment of scarlet fever is an abundance of fresh air; but many people prefer their own miserable complicated inventions to God's grand and yet simple remedies—they pretend that they know better than the Mighty Framer of the universe!

228. Will you describe the symptoms of Chicken pox?

It is occasionally, but not always, ushered in with a slight shivering fit; the eruption shows itself in about twenty-four hours from the child first appearing poorly. It is a vesicular [Footnote: Vesicles. Small elevations of the cuticle, covering a fluid which is generally clear and colourless at first, but afterwards whitish and opaque, or pearly.—Watson.] disease. The eruption comes out in the form of small pimples, and principally attacks the scalp, the neck, the back, the chest, and the shoulders, but rarely the face; while in small-pox the face is generally the part most affected. The next day these pimples fill with water, and thus become vesicles; on the third day they are at maturity. The vesicles are quite separate and distinct from each other. There is a slight redness around each of them. Fresh ones, whilst the others are dying away, make their appearance. Chicken-pox is usually attended with a slight itching of the skin; when the vesicles are scratched the fluid escapes, and leaves hard pearl-like substances, which, in a few days, disappear. Chicken-pox never leaves pit marks behind. It is a child's complaint; adults scarcely, if ever, have it.

229. Is there any danger in Chicken-pox; and what treatment do you advise?

It is not at all a dangerous, but, on the contrary, a trivial complaint. It lasts only a few days, and requires but little medicine. The patient ought, for three or four days, to keep the house, and should abstain from animal food. On the sixth day, but not until then, a dose or two of a mild aperient is all that will be required.

230. Is Chicken-pox infectious?

There is a diversity of opinion on this head, but one thing is certain—it cannot be communicated by inoculation.

231. What are the symptoms of Modified Small-pox?

The Modified Small-pox—that is to say, small-pox that has been robbed of its virulence by the patient having been either already vaccinated, or by his having had a previous attack of small-pox—is ushered in with severe symptoms, with symptoms almost as severe as though the patient had not been already somewhat protected either by vaccination or by the previous attack of small-pox—that is to say, he has a shivering fit, great depression of spirits and debility, malaise, sickness, headache, and occasionally delirium. After the above symptoms have lasted about three days, the eruption shows itself. The immense value of the previous vaccination, or the previous attack of small-pox, now comes into play. In a case of unprotected small-pox, the appearance of the eruption aggravates all the above symptoms, and the danger begins; while in the modified small-pox, the moment the eruption shows itself the patient feels better, and, as a rule, rapidly recovers. The eruption, of modified small-pox varies materially from the eruption of the unprotected small-pox. The former eruption assumes a varied character, and is composed, first, of vesicles (containing water); and, secondly, of pustules (containing matter), each of which pustules has a depression in the centre; and, thirdly, of several red pimples without either water or matter in them, and which sometimes assume a livid appearance. These "breakings-out" generally show themselves more upon the wrist, and sometimes up one or both of the nostrils. While in the latter disease—the unprotected small-pox—the "breaking-out" is composed entirely of pustules containing matter, and which pustules are more on the face than on any other part of the body. There is generally a peculiar smell in both diseases—an odour once smelt never to be forgotten.

Now, there is one most important remark I have to make,—the modified small-pox is contagious. This ought to be borne in mind, as a person labouring under the disease must, if there be children in the house, either be sent away himself, or else the children ought to be banished both the house and the neighbourhood. Another important piece of advice is,—let all in the house—children and adults, one and all—be vaccinated, even if any or all have been previously vaccinated.

Treatment.—Let the patient keep his room, and if he be very ill, his bed. Let the chamber be well ventilated. If it be winter time, a small fire in the grate will encourage ventilation. If it be summer, a fire is out of the question; indeed, in such a case, the window-sash ought to be opened, as thorough ventilation is an important requisite of cure, both in small-pox and in modified small-pox. While the eruption is out, do not on any account give aperient medicine. In ten days from the commencement of the illness a mild aperient may be given. The best medicine in these cases is, the sweetened Acidulated Infusion of Roses, [Footnote: See page 178] which ought to be given from the commencement of the disease, and should be continued until the fever be abated. For the first few days, as long as the fever lasts, the patient ought not to be allowed either meat or broth, but should be kept on a low diet, such as on gruel, arrow-root, milk-puddings, &c. As soon as the fever is abated he ought gradually to resume his usual diet. When he is convalescent, it is well, where practicable, that he should have change of air for a month.

232. How would you distinguish between Modified Small-pox and Chicken-pox?

Modified small-pox may readily be distinguished from chicken-pox, by the former disease being, notwithstanding its modification, much more severe and the fever much more intense before the eruption shows itself than chicken-pox; indeed, in chicken-pox there is little or no fever either before or after the eruption; by the former disease—the modified small-pox—consisting partly of pustules (containing matter), each pustule having a depression in the centre, and the favourite localities of the pustules being the wrists and the inside of the nostrils; while, in the chicken-pox, the eruption consists of vesicles (containing water), and not pustules (containing matter), and the vesicles having neither a depression in the centre, nor having any particular partiality to attack either the wrists or the inside of the nose. In modified small-pox each pustule is, as in unprotected small-pox, inflamed at the base; while in chicken-pox there is only very slight redness around each vesicle. The vesicles in chicken-pox are small—much smaller than the pustules in modified small-pox.

233. Is Hooping-cough an inflammatory disease?

Hooping-cough in itself is not inflammatory, it is purely spasmodic; but it is generally accompanied with more or less of bronchitis— inflammation of the mucous membrane of the bronchial tubes—on which account it is necessary, in all cases of hooping-cough, to consult a medical man, that he may watch the progress of the disease and nip inflammation in the bud.

234. Will you have the goodness to give the symptoms, and a brief history of, Hooping-cough?

Hooping-cough is emphatically a disease of the young; it is rare for adults to have it; if they do, they usually suffer more severely than children. A child seldom has it but once in his life. It is highly contagious, and therefore frequently runs through a whole family of children, giving much annoyance, anxiety, and trouble to the mother and the nurses; hence hooping-cough is much dreaded by them. It is amenable to treatment. Spring and summer are the best seasons of the year for the disease to occur. This complaint usually lasts from six to twelve weeks—sometimes for a much longer period, more especially if proper means are not employed to relieve it.

Hooping-cough commences as a common cold and cough. The cough, for ten days or a fortnight, increases in intensity; at about which time it puts on the characteristic "hoop." The attack of cough comes on in paroxysms. In a paroxysm, the child coughs so long and so violently, and expires so much air from the lungs without inspiring any, that at times he appears nearly suffocated and exhausted; the veins of his neck swell; his face is nearly purple; his eyes, with the tremendous exertion, almost seem to start from their sockets; at length there is a sudden inspiration of air through the contracted chink of the upper part of the wind-pipe—the glottis—causing the peculiar "hoop;" and after a little more coughing, he brings up some glairy mucus from the chest; and sometimes, by vomiting, food from the stomach; he is at once relieved, until the next paroxysm occur, when the same process is repeated, the child during the intervals, in a favourable case, appearing quite well, and after the cough is over, instantly returning either to his play or to his food. Generally, after a paroxysm he is hungry, unless, indeed, there be severe inflammation either of the chest or of the lungs. Sickness, as I before remarked, frequently accompanies hooping-cough; when it does, it might be looked upon as a good sign. The child usually knows when an attack is coming on; he dreads it, and therefore tries to prevent it; he sometimes partially succeeds; but, if he does, it only makes the attack, when it does come, more severe. All causes of irritation and excitement ought, as much as possible, to be avoided, as passion is apt to bring on a severe paroxysm.

A new-born babe—an infant of one or two months old—commonly escapes the infection; but if, at that tender age, he unfortunately catch hooping-cough, it is likely to fare harder with him than if he were older—the younger the child, the greater the risk. But still, in such a case, do not despair, as I have known numerous instances of new-born infants, with judicious care, recover perfectly from the attack, and thrive after it as though nothing of the kind had ever happened.

A new-born babe, labouring under hooping-cough, is liable to convulsions, which is in this disease one, indeed the great, source of danger. A child, too, who is teething, and labouring under the disease, is also liable to convulsions. When the patient is convalescing, care ought to be taken that he does not catch cold, or the "hoop" might return. Hooping-cough may either precede, attend, or follow an attack of measle.

235. What is the treatment of Hooping-cough?

We will divide the hooping-cough into three stages, and treat each stage separately,

What to do.—In the first stage, the commencement of hooping-cough: For the first ten days give the Ipecacuanha Wine Mixture, [Footnote: For the prescription of the Ipecacuanha Wine Mixture, see page 161.] a tea-spoonful three times a day. If the child be not weaned, keep him entirely to the breast, if he be weaned, to a milk and farinaceous diet. Confine him for the first ten days to the house, more especially if the hooping-cough be attended, as it usually is, with more or less bronchitis. But take care that the rooms be well ventilated; for good air is essential to the cure.

If the bronchitis attending the hooping-cough be severe, confine him to his bed, and treat him as though it were simply a case of bronchitis. [Footnote: For the treatment of bronchitis, see answer to 207th question.]

In the second stage, discontinue the Ipecacuanha Mixture, and give Dr Gibb's remedy—namely, Nitric Acid—which I have found to be an efficacious and valuable one in hooping-cough:—

Take of—Diluted Nitric Acid, two drachms;
Compound Tincture of Cardamons, half a drachm;
Simple Syrup, three ounces;
Water, two ounces and a half:

Make a Mixture. One or two tea-spoonfuls, or a table-spoonful, according to the age of the child—one tea-spoonful for an infant of six months, and two tea-spoonfuls for a child of twelve months, and one table-spoonful for a child of two years, every four hours, first shaking the bottle.

Let the spine and the chest be well rubbed every night and morning either with Roche's Embrocation, or with the following stimulating liniment (first shaking the bottle):—

Take of—Oil of Cloves, one drachm;
Oil of Amber, two drachms;
Camphorated Oil, nine drachms:

Make a Liniment.

Let him wear a broad band of new flannel, which should extend round from his chest to his back, and which ought to be changed every night and morning, in order that it may be dried before putting on again. To keep it in its place it should be fastened by means of tapes and with shoulder-straps.

The diet ought now to be improved—he should gradually return to his usual food; and, weather permitting, should almost live in the open air—fresh air being, in such a case, one of the finest medicines.

In the third stage, that is to say, when the complaint has lasted a month, if by that time the child is not well, there is nothing like change of air to a high, dry, healthy, country place. Continue the Nitric Acid Mixture, and either the Embrocation or the Liniment to the back and the chest, and let him continue to almost live in the open air, and be sure that he does not discontinue wearing the flannel until he be quite cured, and then let it be left off by degrees.

If the hooping-cough have caused debility, give him Cod-liver Oil—a tea-spoonful twice or three times a day, giving it him on a full stomach, after his meals. But, remember, after the first three or four weeks, change of air, and plenty of it, is for hooping-cough the grand remedy.

What NOT to do.—"Do not apply leeches to the chest, for I would rather put blood into a child labouring under hooping-cough than take it out of him—hooping-cough is quite weakening enough to the system of itself without robbing him of his life's blood; do not, on any account whatever, administer either emetic tartar or antimonial wine; do not give either paregoric or syrup of white poppies; do not drug him either with calomel or with grey-powder; do not dose him with quack medicine; do not give him stimulants, but rather give him plenty of nourishment, such as milk and farinaceous food, but no stimulants; do not be afraid, after the first week or two, of his having fresh air, and plenty of it—for fresh, pure air is the grand remedy, after all that can be said and done, in hooping-cough. Although occasionally we find that, if the child to labouring under hooping-cough, and is breathing a pure country air, and is not getting well so rapidly as we could wish, change of air to a smoky gas-laden town will sometimes quickly effect a cure; indeed, some persons go so far as to say that the best remedy for an obstinate case of hooping-cough is, for the child to live, the great part of every day, in gas-works!"

236. What is to be done during a paroxysm of Hooping-cough?

If the child be old enough, let him stand up; but if he be either too young or too feeble, raise his head, and bend his body a little forward; then support his back with one hand, and the forehead with the other. Let the mucus, the moment it be within reach, be wiped with a soft handkerchief out of his mouth.

237. In an obstinate case of Hooping-cough, what is the best remedy?

Change of air, provided there be no active inflammation, to any healthy spot. A farm-house, in a high, dry, and salubrious neighbourhood, is as good a place as can be chosen. If, in a short time, he be not quite well, take him to the sea-side: the sea breezes will often, as if by magic, drive away the disease.

238. Suppose my child should have a shivering fit, is it to be looked upon as an important symptom?

Certainly. Nearly all serious illnesses commence with a shivering fit: severe colds, influenza, inflammations of different organs, scarlet fever, measles, small-pox, and very many other diseases, begin in this way. If, therefore, your child should ever have a shivering fit, instantly send for a medical man, as delay might be dangerous. A few hours of judicious treatment, at the commencement of an illness, is frequently of more avail than days and weeks, nay months, of treatment, when disease has gained a firm footing. A serious disease often steals on insidiously, and we have perhaps only the shivering fit, which might be but a slight one, to tell us of its approach.

A trifling ailment, too, by neglecting the premonitory symptom, which, at first might only be indicated by a slight shivering fit, will sometimes become a mortal disorder:—

"The little rift within the lute, That by-and-by will make the music mute, And ever widening slowly silence all." [Footnote: The above extract from Tennyson is, in my humble opinion, one of the most beautiful pieces of poetry in the English language. It is a perfect gem, and a volume in itself, so truthful, so exquisite, so full of the most valuable reflections; for instance—(1.) "The little rift within the lute,"—the little tubercle within the lung "that by-and-by will make the music mute, and ever widening slowly silence all," and the patient eventually dies of consumption. (2.) The little rent—the little rift of a very minute vessel in the brain, produces an attack of apoplexy, and the patient dies. (3.) Each and all of us, in one form or another, sooner or later, will have "the little rift within the lute." But why give more illustrations?—a little reflection will bring numerous examples to my fair reader's memory.]

239. In case of a shivering fit, perhaps you will tell me what to do?

Instantly have the bed warmed, and put the child to bed. Apply either a hot bottle or a hot brick, wrapped in flannel, to the soles of his feet. Put an extra blanket on his bed, and give him a cup of hot tea. As soon as the shivering fit is over, and he has become hot, gradually lessen the extra quantity of clothes on his bed, and take away the hot bottle or the hot brick from his feet.

What NOT to do.—Do not give either brandy or wine, as inflammation of some organ might be about taking place. Do not administer opening medicine, as there might be some "breaking out" cooling out on the skin, and an aperient might check it.

240. My child, apparently otherwise healthy, screams out in the night violently in his sleep, and nothing for a time will pacify him: what is likely to be the cause, and what is the treatment?

The causes of these violent screamings in the night are various. At one time, they proceed from teething; at another, from worms; sometimes, from night-mare; occasionally, from either disordered stomach or bowels. Each of the above causes will, of course, require a different plan of procedure; it will, therefore, be necessary to consult a medical man on the subject, who will soon, with appropriate treatment, be able to relieve him.

241. Have the goodness to describe the complaint of children called Mumps.

The mumps, inflammation of the "parotid" gland, is commonly ushered in with a slight feverish attack. After a short time, a swelling, of stony hardness, is noticed before and under the ear, which swelling extends along the neck towards the chin. This lump is exceedingly painful, and continues painful and swollen for four or five days. At the end of which time it gradually disappears, leaving not a trace behind. The swelling of mumps never gathers. It may affect one or both sides of the face. It seldom occurs but once in a lifetime. It is contagious, and has been known to run through a whole family or school; but it is not dangerous, unless, which is rarely the case, it leaves the "parotid" gland, and migrates either to the head, to the breast, or to the testicle.

242. What is the treatment of Mumps?

Foment the swelling, four or five times a day, with a flannel wrung out of hot camomile and poppy-head decoction; [Footnote: Four poppy-heads and four ounces of camomile blows to be boiled in four pints of water for half an hour, and then strained to make the decoction.] and apply, every night, a barm and oatmeal poultice to the swollen gland or glands. Debar, for a few days, the little patient from taking meat and broth, and let him live on bread and milk, light puddings, and arrow-root. Keep him in a well-ventilated room, and shut him out from the company of his brothers, his sisters, and young companions. Give him a little mild, aperient medicine. Of course, if there be the slightest symptom of migration to any other part or parts, instantly call in a medical man.

243. What is the treatment of a Boil?

One of the best applications is a Burgundy-pitch plaster spread on a soft piece of wash leather. Let a chemist spread a plaster, about the size of the hand; and, from this piece, cut small plasters, the size of a shilling or a florin (according to the dimensions of the boil), which snip around and apply to the part. Put a fresh one on daily. This plaster will soon cause the boil to break; when it does break, squeeze out the contents—the core and the matter—and then apply one of the plasters as before, which, until the boil be well, renew every day.

The old-fashioned remedy for a boil—namely, common yellow soap and brown-sugar, is a capital one for the purpose. It is made with equal parts of brown sugar and of shredded yellow soap, and mixed by means of a table-knife on a plate, with a few drops of water, until it be all well blended together, and of the consistence of thick paste; it should then be spread either on a piece of wash-leather, or on thick linen, and applied to the boil, and kept in its place by means either of a bandage or of a folded handkerchief; and should he removed once or twice a day. This is an excellent application for a boil—soothing, comforting, and drawing—and will soon effect a cure. A paste of honey and flour, spread on linen rag, is another popular and good application for a boil.

If the boils should arise from the child being in a delicate state of health, give him cod-liver oil, meat once a day, and an abundance of milk and farinaceous food. Let him have plenty of fresh air, exercise, and play.

If the boil should arise from gross and improper feeding, then keep him for a time from meat, and let him live principally on a milk and farinaceous diet.

If the child be fat and gross, cod-liver oil would he improper; a mild aperient, such as rhubarb and magnesia, would then be the best medicine.

244. What are the symptoms of Ear-ache?

A young child screaming shrilly, violently, and continuously, is oftentimes owing to ear-ache; carefully, therefore, examine each ear, and ascertain if there be any discharge; if there be, the mystery is explained.

Screaming from ear-ache may be distinguished from the screaming from bowel-ache by the former (ear-ache) being more continuous—indeed, being one continued scream, and from the child putting his hand to his head; while, in the latter (bowel-ache), the pain is more of a coming and of a going character, and he draws up his legs to his bowels. Again, in the former (ear-ache), the secretions from the bowels are natural; while, in the latter (bowel-ache), the secretions from the bowels are usually depraved, and probably offensive. But a careful examination of the ear will generally at once decide the nature of the case.

213. What is the best remedy for Ear-ache?

Apply to the ear a small flannel bag, filled with hot salt—as hot as can be comfortably borne, or foment the ear with a flannel wrung out of hot camomile and poppy head decoction. A roasted onion, inclosed in muslin applied to the ear, is an old-fashioned and favourite remedy, and may, if the bag of hot salt, or if the hot fomentation do not relieve, be tried. Put into the ear, but not very far, a small piece of cotton wool, moistened with warm olive oil. Taking care that the wool is always removed before a fresh piece be substituted, as if it be allowed to remain in any length of time, it may produce a discharge from the ear. Avoid all cold applications. If the ear-ache be severe, keep the little fellow at home, in a room of equal temperature, but well-ventilated, and give him, for a day or two, no meat.

If a discharge from the ear should either accompany or follow the ear-ache, more especially if the discharge be offensive, instantly call in a medical man, or deafness for life may be the result.

A knitted or crotcheted hat, with woollen rosettes over the ears, is, in the winter time, an excellent hat for a child subject to ear-ache. The hat may be procured at any baby-linen warehouse.

246. What are the causes and the treatment of discharges from the Ear?

Cold, measles, scarlet fever, healing up of "breakings out" behind the ear; pellets of cotton wool, which had been put in the ear, and had been forgotten to be removed, are the usual causes of discharges from the ear. It generally commences with ear-ache.

The treatment consists in keeping the parts clean, by syringing the ear every morning with warm water, by attention to food—keeping the child principally upon a milk and a farmaceous diet, and by change of air—more especially to the coast. If change of air be not practicable, great attention should be paid to ventilation. As I have before advised, in all cases of discharge from the ear call in a medical man, as a little judicious medicine is advisable—indeed, essential; and it may be necessary to syringe the ear with lotions, instead of with warm water; and, of course, it is only a doctor who has actually seen the patient who can decide these matters, and what is best to be done in each case.

247. What is the treatment of a "stye" on the eye-lid?

Bathe the eye frequently with warm milk and water, and apply, every night at bedtime, a warm white-bread poultice.

No medicine is required; but, if the child be gross, keep him for a few days from meat, and let him live on bread and milk and farinaceous puddings.

248. If a child have large bowels, what would you recommend as likely to reduce their size?

It ought to be borne in mind, that the bowels of a child are larger in proportion than those of an adult. But, if they be actually larger than they ought to be, let them be well rubbed for a quarter of an hour at a time night and morning, with soap liniment, and then apply a broad flannel belt. "A broad flannel belt worn night and day, firm but not tight, is very serviceable." [Footnote: Sir Charles Locock, in a Letter to the Author.] The child ought to be prevented from drinking as much as he has been in the habit of doing; let him be encouraged to exercise himself well in the open air; and let strict regard be paid to his diet.

249. What are the best aperients for a child?

If it be actually necessary to give him opening medicine, one or two tea-spoonfuls of Syrup of Senna, repeated, if necessary, in four hours, will generally answer the purpose; or, for a change, one or two tea-spoonfuls of Castor Oil may be substituted. Lenitive Electuary (Compound Confection of Senna) is another excellent aperient for the young, it being mild in its operation, and pleasant to take; a child fancying it is nothing more than jam, and which it much resembles both in appearance and in taste. The dose is half or one tea-spoonful early in the morning occasionally. Senna is an admirable aperient for a child, and is a safe one, which is more than can be said of many others. It is worthy of note that "the taste of Senna may be concealed by sweeting the infusion, [Footnote: Infusion of Senna may be procured of any respectable druggist. It will take about one or two table-spoonfuls, or even more, of the infusion (according to the age of the child, and the obstinacy of the bowels), to act as an aperient. Of course, you yourself will be able, from time to time, as the need arises, to add the milk and the sugar, and thus to make it palatable. It ought to be given warm, so as the more to resemble tea.] adding milk, and drinking as ordinary tea, which, when thus prepared, it much resembles" [Footnote: Waring's Manual of Practical Therapeutics.] Honey, too, is a nice aperient for a child—a tea-spoonful ought to be given either by itself, or spread on a slice of bread.

Some mothers are in the habit of giving their children jalap gingerbread. I do not approve of it, as jalap is a drastic, griping purgative; besides, jalap is very nasty to take—nothing will make it palatable.

Fluid Magnesia—Solution of Carbonate of Magnesia—is a good aperient for a child; and, as it has very little taste, is readily given, more especially if made palatable by the addition either of a little syrup or of brown sugar. The advantages which it has over the old solid form are, that it is colourless and nearly tasteless, and never forms concretions in the bowels, as the solid magnesia, if persevered in for any length of time, sometimes does. A child of two or three years old may take one or two table-spoonfuls of the fluid; either by itself or in his food, repeating it every four hours until the bowels be open. When the child is old enough to drink the draught off immediately, the addition of one or two tea-spoonfuls of Lemon Juice to each dose of the Fluid Magnesia, makes a pleasant effervescing draught, and increases its efficacy as an aperient.

Bran-bread [Footnote: One-part of bran to three parts of flour, mixed together and made into bread.] and treacle will frequently open the bowels; and as treacle is wholesome, it may be substituted for butter when the bowels are inclined to be costive. A roasted apple, eaten with raw sugar, is another excellent mild aperient for a child. Milk gruel—that is to say, milk thickened with oatmeal—forms an excellent food for him, and often keeps his bowels regular, and thus (which is a very important consideration) supersedes the necessity of giving him an aperient. An orange (taking care he does not eat the peel or the pulp), or a fig after dinner, or a few Muscatel raisins, will frequently regulate the bowels.

Stewed prunes is another admirable remedy for the costiveness of a child. The manner of stewing them is as follows:—Put a pound of prunes in a brown jar, add two table-spoonfuls of raw sugar, then cover the prunes and the sugar with cold water; place them in the oven, and let them stew for four hours. A child should every morning eat half a dozen or a dozen of them, until the bowels be relieved, taking care that he does not swallow the stones. Stewed prunes may be given in treacle—treacle increasing the aperient properties of the prunes.

A suppository is a mild and ready way of opening the bowels of a child. When he is two or three years old and upwards, a Candle suppository is better than a Soap suppository. The way of preparing it is as follows:—Cut a piece of dip-tallow candle—the length of three inches—and insert it as you would a clyster pipe, about two inches up the fundament, allowing the remaining inch to be in sight, and there let the suppository remain until the bowels be opened.

Another excellent method of opening a child's bowels is by means of an enema of warm water,—from half a tea-cupful to a tea-cupful, or even more, according to the age of the child. I cannot speak too highly of this plan as a remedy for costiveness, as it entirely, in the generality of cases, prevents the necessity of administering a particle of aperient medicine by the mouth. The fact of its doing so stamps it as a most valuable remedy—opening physic being, as a rule, most objectionable, and injurious to a child's bowels. Bear this fact—for it is a fact—in mind and let it be always remembered.

450. What are the most frequent causes of Protrusion of the lower-bowel?

The too common and reprehensible practice of a parent administering frequent aperients, especially calomel and jalap, to her child. Another cause, is allowing him to remain for a quarter of an hour or more at a time on his chair; this induces him to strain, and to force the gut down.

251. What are the remedies?

If the protrusion of the bowel have been brought on by the abase of aperients, abstain, for the future from giving them; but if medicine be absolutely required, give the mildest—such as either Syrup of Senna or Castor Oil—and the less of those the better.

If the external application of a purgative will have the desired effects it will in such cases, be better than the internal administration of aperients. Castor Oil used as a Liniment is a good one for the purpose. Let the bowels be well rubbed, every night and morning, for five minutes at a time with the oil.

A wet compress to the bowels will frequently open them, and will thus do away with the necessity of giving an aperient—a most important consideration. Fold a napkin in six thicknesses, soak it in cold water, and apply it to the bowels; over which put either a thin covering or sheet of gutta-percha, or a piece of oiled-silk; keep it in its place with a broad flannel roller; and let it remain on the bowels for three or four hours, or until they be opened.

Try what diet will do, as opening the bowels by a regulated diet is far preferable to the giving of aperients. Let him have either bran-bread or Robinson's Patent Groats, or Robinson's Pure Scotch Oatmeal made into gruel with new milk, or Du Barry's Arabica Revalenta, or a slice of Huntly and Palmer's lump gingerbread. Let him eat stewed prunes, stewed rhubarb, roasted apples, strawberries, raspberries, the inside of grapes and gooseberries, figs, &c. Give him early every morning a draught of cold water.

Let me, again, urge you not to give aperients in these cases, or in any case, unless you are absolutely compelled. By following my advice you will save yourself an immense deal of trouble, and your child a long catalogue of misery. Again, I say, look well into the matter, and whenever it be practicable avoid purgatives.

Now, with regard to the best manner of returning the bowel, lay the child upon the bed on his face and bowels, with his hips a little raised; then smear lard on the forefinger of your right hand (taking care that the nail be cut close), and gently with, your fore-finger press the bowel into its proper place. Remember, if the above methods be observed, you cannot do the slightest injury to the bowel; and the sooner it be returned, the better it will be for the child; for if the bowel be allowed to remain long down, it may slough or mortify, and death may ensue. The nurse, every time he has a motion, must see that the bowel does not come down, and if it does, she ought instantly to return it. Moreover, the nurse should be careful not to allow the child to remain on his chair more than two or three minutes at a time.

Another excellent remedy for the protrusion of the lower bowel, is to use every morning a cold salt and water sitz bath. There need not be more than a depth of three inches of water in the bath; a small handful of table salt should be dissolved in the water; a dash of warm water in the winter time must be added, to take off the extreme chill; and the child ought not to be allowed to sit in the bath for more than one minute, or whilst the mother can count a hundred; taking care, the while, to throw either a square of flannel or a small shawl over his shoulders. The sitz bath ought to be continued for months, or until the complaint be removed. I cannot speak in too high praise of these baths.

252. Do you advise me, every spring and fall, to give my child brimstone to purify and sweeten his blood, and as a preventive medicine?

Certainly not; if you wish to take away his appetite, and to weaken and depress him, give brimstone! Brimstone is not a remedy fit for a child's stomach. The principal use and value of brimstone is as an external application in itch, and as an internal remedy, mixed with other laxatives, in piles—piles being a complaint of adults. In olden times poor unfortunate children were dosed, every spring and fall, with brimstone and treacle to sweeten their blood! Fortunately for the present race, there is not so much of that folly practised, but still there is room for improvement. To dose a healthy child with physic is the grossest absurdity. No, the less physic a delicate child has the better it will be for him, but physic to a healthy child is downright poison! And brimstone of all medicines! It is both weakening and depressing to the system, and by opening the pores of the skin and by relaxing the bowels, is likely to give cold, and thus to make a healthy, a sickly child. Sweeten his blood! It is more likely to weaken his blood, and thus to make his blood impure! Blood is not made pure by drugs, but by Nature's medicine; by exercise, by pure air, by wholesome diet, by sleep in a well-ventilated apartment, by regular and thorough ablution. Brimstone a preventive medicine! Preventive medicine—and brimstone especially in the guise of a preventive medicine—is "a mockery, a delusion, and a snare."

253. When a child is delicate, and his body, without any assignable cause, is gradually wasting away, and the stomach rejects all food that is taken, what plan can be adopted likely to support his strength, and thus probably be the means of saving his life?

I have seen, in such a case, great benefit to arise from half a tea-cupful of either strong mutton-broth or of strong beef-tea, used as an enema every four hours. [Footnote: An enema apparatus is an important requisite in every nursery; it may be procured of any respectable surgical instrument maker. The India-rubber Enema Bottle is, for a child's use, a great improvement on the old syringe, as it is not so likely to get out of order, and, moreover, is more easily used.] It should be administered slowly, in order that it may remain in the bowel. If the child be sinking, either a dessert-spoonful of brandy, or half a wine-glassful of port wine, ought to be added to each enema.

The above plan ought only to be adopted if there be no diarrhoea. If there be diarrhoea, an enema must not be used. Then, provided there be great wasting away, and extreme exhaustion, and other remedies having failed, it would be advisable to give, by the mouth, raw beef of the finest quality, which ought to be taken from the hip bone, and should be shredded very fine. All fat and skin must be carefully removed. One or two tea-spoonfuls (according to the age of the child) ought to be given every four hours. The giving of raw meat to children in exhaustive diseases, such as excessive long-standing diarrhoea, was introduced into practice by a Russian physician, a Professor Wiesse of St Petersburg. It certainly is, in these cases, a most valuable remedy, and has frequently been the means of snatching such patients from the jaws of death. Children usually take raw meat with avidity and with a relish.

254. If a child be naturally delicate, what plan would you recommend to strengthen him?

I should advise strict attention to the rules above mentioned, and change of air—more especially, if it be possible, to the coast. Change of air, sometimes, upon a delicate child, acts like magic, and may restore him to health when all other means have failed. If a girl be delicate, "carry her off to the farm, there to undergo the discipline of new milk, brown bread, early hours, no lessons, and romps in the hay-field."—Blackwood. This advice is, of course, equally applicable for a delicate boy, as delicate boys and delicate girls ought to be treated alike. Unfortunately in these very enlightened days there is too great a distinction made in the respective management and treatment of boys and girls.

The best medicines for a delicate child will be the wine of iron and cod-liver oil. Give them combined in the manner I shall advise when speaking of the treatment of Rickets.

In diseases of long standing, and that resist the usual remedies, there is nothing like change of air. Hippocrates, the father of medicine, says—

"In longis morbis solum mutare."
(In tedious diseases to change the place of residence.)

A child who, in the winter, is always catching cold, whose life during half of the year is one continued catarrh, who is in consequence, likely, if he grow up at all, to grow up a confirmed invalid, ought, during the winter months, to seek another clime; and if the parents can afford the expense, they should at the beginning of October, cause him to bend his steps to the south of Europe—Mentone being as good a place as they could probably fix upon.

255. Do you approve of sea bathing for a delicate young child?

No: he is frequently so frightened by it that the alarm would do him more harm than the bathing would do him good. The better plan would be to have him every morning well sponged, especially his back and loins, with sea water; and to have him as much as possible carried on the beach, in order that he may inhale the sea breezes. When he be older, and is not frightened at being dipped, sea bathing will be very beneficial to him. If bathing is to do good, either to an adult or to a child, it must be anticipated with pleasure, and neither with dread nor with distaste.

256. What is the best method for administering medicine to a child?

If he be old enough, appeal to his reason; for, if a mother endeavour to deceive her child, and he detect her, he will for the future suspect her. If he be too young to be reasoned with, then, if he will not take his medicine, he must be compelled. Lay him across your knees, let both his hands and his nose be tightly held, and then, by means of the patent medicine-spoon, or, if that be not at hand, by either a tea or a dessert-spoon, pour the medicine down his throat, and he will be obliged to swallow it.

It may be said that this is a cruel procedure; but it is the only way to compel an unruly child to take physic, and is much less cruel than running the risk of his dying from the medicine not having been administered. [Footnote: If any of my medical brethren should perchance read these Conversations, I respectfully and earnestly recommend them to take more pains in making medicines for children pleasant and palatable. I am convinced that, in the generality of instances, provided a little more care and thought were bestowed on the subject, it may be done; and what an amount of both trouble and annoyance it would save! It is really painful to witness the struggles and cries of a child when nauseous medicine is to be given; the passion and excitement often do more harm than the medicine does good.]

257. Ought a sick child to be roused from his sleep to give him physic, when it is time for him to take it?

On no account, as sleep, being a natural restorative, must not be interfered with. A mother cannot be too particular in administering the medicine, at stated periods, whilst he is awake.

258. Have you any remarks to make on the management of a sick-room, and have you any directions to give on the nursing of a child?

In sickness select a large and lofty room; if in the town, the back of the house will be preferable—in order to keep the patient free from noise and bustle—as a sick-chamber cannot be kept too quiet. Be sure that there be a chimney in the room—as there ought to be in every room in the house—and that it be not stopped, as it will help to carry off the impure air of the apartment. Keep the chamber well ventilated, by, from time to time, opening the window. The air of the apartment cannot be too pure; therefore, let the evacuations from the bowels be instantly removed, either to a distant part of the house, or to an out-house or to the cellar, as it might be necessary to keep them for the medical man's inspection.

Before using either the night-commode, or the pot-de-chambre, let a little water, to the depth of one or two inches, be put in the pan, or pot; in order to sweeten the motion, and to prevent the faecal matter from adhering to the vessel.

Let there be frequent change of linen, as in sickness it is even more necessary than in health, more especially if the complaint be fever. In an attack of fever, clean sheets ought, every other day, to be put on the bed; clean body-linen every day. A frequent change of linen in sickness is most refreshing.

If the complaint be fever, a fire in the grate will not be necessary. Should it be a case either of inflammation of the lungs or of the chest, a small fire in the winter time is desirable, keeping the temperature of the room as nearly as possible at 60 degrees Fahrenheit. Bear in mind that a large fire in a sick-room cannot be too strongly condemned; for if there be fever—and there are scarcely any complaints without—a large fire only increases it. Small fires, in cases either of inflammation of the lungs or of the chest, in the winter time, encourage ventilation of the apartment, and thus carry off impure air. If it be summer time, of course fires would be improper. A thermometer is an indispensable requisite in a sick-room.

In fever, free and thorough ventilation is of vital importance, more especially in scarlet fever; then a patient cannot have too much air; in scarlet fever, for the first few days the windows, be it winter or summer, must to the widest extent be opened. The fear of the patient catching cold by doing so is one of the numerous prejudices and baseless fears that haunt the nursery, and the sooner it is exploded the better it will he for human life. The valances and bed-curtains ought to be removed, and there should be as little furniture in the room as possible.

If it be a case of measles, it will be necessary to adopt a different course; then the windows ought not to be opened, but the door must from time to time be left ajar. In a case of measles, if it be winter time, a small fire in the room will be necessary. In inflammation of the lungs or of the chest, the windows should not be opened, but the door ought occasionally to be left unfastened, in order to change the air and to make it pure. Remember, then, that ventilation, either by open window or by open door, is in all diseases most necessary. Ventilation is one of the best friends a doctor has.

In fever, do not load the bed with clothes; in the summer a sheet is sufficient, in winter a sheet and a blanket.

In fever, do not be afraid of allowing the patient plenty either of cold water or of cold toast and water; Nature will tell him when he has had enough. In measles, let the chill be taken off the toast and water.

In croup, have always ready a plentiful supply of hot water, in case a warm bath might he required.

In child-crowing, have always in the sick-room a supply of cold water, ready at a moment's notice to dash upon the face.

In fever, do not let the little patient lie on the lap; he will rest more comfortably on a horse-hair mattress in his crib or cot. If he have pain in the bowels, the lap is most agreeable to him; the warmth of the body, either of the mother or of the nurse, soothes him; besides, if he be on the lap, he can be turned on his stomach and on his bowels, which, often affords him great relief and comfort. If he be much emaciated, when he is nursed, place a pillow upon the lap and let him lie upon it.

In head affections, darken the room with a green calico blind; keep the chamber more than usually quiet; let what little talking is necessary be carried on in whispers, but the less of that the better; and in head affections, never allow smelling salts to be applied to the nose, as they only increase the flow of blood to the head, and consequently do harm.

It is often a good sign for a child, who is seriously ill, to suddenly become cross. It is then he begins to feel his weakness and to give vent to his feelings. "Children are almost always cross when recovering from an illness, however patient they may have been during its severest moments, and the phenomenon is not by any means confined to children."—Geo. McDonald.

A sick child must not be stuffed with much food at a time. He will take either a table-spoonful of new milk or a table-spoonful of chicken broth every half hour with greater advantage than a tea-cupful of either the one or the other every four hours, which large quantity would very probably be rejected from his stomach, and may cause the unfortunately treated child to die of starvation!

If a sick child be peevish, attract his attention either by a toy or by an ornament; if he be cross, win him over to good humour by love, affection, and caresses, but let it be done gently and without noise. Do not let visitors see him; they will only excite, distract, and irritate him, and help to consume the oxygen of the atmosphere, and thus rob the air of its exhilarating health-giving qualities and purity; a sick-room, therefore, is not a proper place, either for visitors or for gossips.

In selecting a sick-nurse, let her be gentle, patient, cheerful, quiet, and kind, but firm withal; she ought to be neither old nor young: if she be old she is often garrulous and prejudiced, and thinks too much of her trouble; if she he young, she is frequently thoughtless and noisy; therefore choose a middle-aged woman. Do not let there be in the sick-room more than, besides the mother, one efficient nurse; a greater number can he of no service—they will only be in each other's way, and will distract the patient.

Let stillness, especially if the head be the part affected, reign in a sick-room. Creaking shoes [Footnote: Nurses at these times ought to wear slippers, and not shoes. The best slippers in sick-rooms are those manufactured by the North British Rubber Company, Edinburgh; they enable nurses to walk in them about the room without causing the slightest noise; indeed, they might truly be called "the noiseless slipper," a great desideratum in such cases, more especially in all head affections of children. If the above slippers cannot readily be obtained, then list slippers—soles and all bring made of list—will answer the purpose equally as well.] and rustling silk dresses ought not to be worn in sick-chambers—they are quite out of place there. If the child be asleep, or if he be dozing, perfect stillness must he enjoined, not even a whisper should be heard:—

"In the sick-room be calm,
More gently and with care.
Lest any jar or sudden noise,
Come sharply unaware.

You cannot tell the harm.
The mischief it may bring,
To wake the sick one suddenly,
Besides the suffering.

The broken sleep excites
Fresh pain, increased distress;
The quiet slumber undisturb'd
Soothes pain and restlessness.

Sleep is the gift of God:
Oh! bear these words at heart,
'He giveth His beloved sleep,'
And gently do thy part."

[Footnote: Household verses on Health and Happiness. London: Jarrold and Sons. A most delightful little volume.]

If there be other children, let them be removed to a distant part of the house; or, if the disease be of an infectious nature, let them be sent away from home altogether.

In all illnesses—and bear in mind the following is most important advice—a child must be encouraged to try and make water, whether he ask or not, at least four times during the twenty-four hours; and at any other time, if he express the slightest inclination to do so. I have known a little fellow to hold his water, to his great detriment, for twelve hours, because either the mother bad in her trouble forgotten to inquire, or the child himself was either too ill or too indolent to make the attempt.

See that the medical man's directions are, to the very letter, carried out. Do not fancy that you know better than he does, otherwise you have no business to employ him. Let him, then, have your implicit confidence and your exact obedience. What you may consider to be a trifling matter, may frequently be of the utmost importance, and may sometimes decide whether the case shall end either in life or death!

Lice.—It is not very poetical, as many of the grim facts of every-day life are not, but, unlike a great deal of poetry, it is unfortunately too true that after a severe and dangerous illness, especially after a bad attack of fever, a child's head frequently becomes infested with vermin—with lice. It therefore behoves a mother herself to thoroughly examine, by means of a fine-tooth comb, [Footnote: Which fine-tooth comb ought not to be used at any other time except for the purpose of examination, as the constant use of a fine-tooth comb would scratch the scalp, and would encourage a quantity of scurf to accumulate.] her child's head, in order to satisfy her mind that there be no vermin there. As soon as he be well enough, he ought to resume his regular ablutions—that is to say, that he must go again regularly into his tub, and have his head every morning thoroughly washed with soap and water. A mother ought to be particular in seeing that the nurse washes the hair-brush at least once every week; if she does not do so, the dirty brush which had during the illness been used, might contain the "nits"—the eggs of the lice—and would thus propagate the vermin, as they will, when on the head of the child, soon hatch. If there be already lice on the head, in addition to the regular washing every morning with the soap and water, and after the head has been thoroughly dried, let the hair be well and plentifully dressed with camphorated oil—the oil being allowed to remain on until the next washing on the following morning. Lice cannot live in oil (more especially if, as in camphorated oil, camphor be dissolved in it), and as the camphorated oil will not, in the slightest degree, injure the hair, it is the best application that can be used. But as soon as the vermin have disappeared, let the oil be discontinued, as the natural oil of the hair is, at other times, the only oil that is required on the head.

The "nit"—the egg of the louse—might be distinguished from scurf (although to the naked eye it is very much like it in appearance) by the former fastening firmly on one of the hairs as a barnacle would on a rock, and by it not being readily brushed off as scurf would, which latter (scurf) is always loose.

259. My child, in the summer time, is much tormented with fleas: what are the best remedies?

A small muslin bag, filled with camphor, placed in the cot or bed, will drive fleas away. Each flea-bite should, from time to time, be dressed by means of a camel's hair brush, with a drop or two of Spirit of Camphor; an ounce bottle of which ought, for the purpose, to be procured from a chemist. Camphor is also an excellent remedy to prevent bugs from biting. Bugs and fleas have a horror of camphor; and well they might, for it is death to them!

There is a famous remedy for the destruction of fleas manufactured in France, entitled "La Poudre Insecticide," which, although perfectly harmless to the human economy, is utterly destructive to fleas. Bugs are best destroyed either by Creosote or by oil of Turpentine: the places they do love to congregate in should be well saturated by means of a brush, with the creosote or with the oil of turpentine. A few dressings will effectually destroy both them and their young ones.

260. Is not the pulse a great sign either of health or of disease?

It is, and every mother should have a general idea of what the pulse of children of different ages should be both in health and in disease. "Every person should know how to ascertain the state of the pulse in health; then, by comparing it with what it is when he is ailing, he may have some idea of the urgency of his case. Parents should know the healthy pulse of each child, since now and then a person is born with a peculiarly slow or fast pulse, and the very case in hand may be of such peculiarity. An infant's pulse is 140, a child of seven about 80, and from 20 to 60 years it is 70 beats a minute, declining to 60 at fourscore. A healthful grown person beats 70 times in a minute, declining to 60 at fourscore. At 60, if the pulse always exceeds 70, there is a disease; the machine working itself out, there is a fever or inflammation somewhere, and the body is feeding on itself, as in consumption, when the pulse is quick."

261. Suppose a child to have had an attack either of inflammation of the lungs or of bronchitis, and to be much predisposed to a return: what precautions would you take to prevent either the one or the other for the future?

I would recommend him to wear fine flannel instead of lawn shirts; to wear good lamb's-wool stockings above the knees, and good, strong, dry shoes to his feet; to live, weather permitting, a great part of every day in the open air; to strengthen his system by good nourishing food—by an abundance of both milk and meat (the former especially); to send him, in the autumn, for a couple of months, to the sea-side; to administer to him, from time to time, cod-liver oil; in short, to think only of his health, and to let learning, until he be stronger, be left alone. I also advise either table salt or bay salt, or Tidman's Sea Salt, to be added to the water in which the child is washed with in the morning, in a similar manner as recommended in answer to a previous question.

262. Then do you not advise such a child to be confined within doors?

If any inflammation be present, or if he have but just recovered from one, it would be improper to send him into the open air, but not otherwise, as the fresh air would be a likely means of strengthening the lungs, and thereby of preventing an attack of inflammation for the future. Besides, the more a child is coddled within doors, the more likely will he be to catch cold, and to renew the inflammation. If the weather be cold, yet neither wet nor damp, he ought to be sent out, but let him be well clothed; and the nurse should have strict injunctions not to stand about entries or in any draughts—indeed, not to stand about at all, but to keep walking about all the time she is in the open air. Unless you have a trustworthy nurse, it will be well for you either to accompany her in her walk with your child, or merely to allow her to walk with him in the garden, as you can then keep your eye upon both of them.

263. If a child be either chicken-breasted, or if he be narrow-chested, are there any means of expanding and of strengthening his chest?

Learning ought to be put out of the question, attention must be paid to his health alone, or consumption will probably mark him as its own! Let him live as much as possible in the open air; if it be country, so much the better. Let him rise early in the morning, and let him go to bed betimes; and if he be old enough to use the dumb-bells, or what is better, an India-rubber chest-expander, he should do so daily. He ought also to be encouraged to use two short sticks, similar to, but heavier than, a policeman's staff, and to go, every morning, through regular exercises with them. As soon as he is old enough, let him have lessons from a drill-sergeant and from a dancing master. Let him be made both to walk and to sit upright, and let him be kept as much as possible upon a milk diet, [Footnote: Where milk does not agree, it may generally be made to do so by the addition of one part of lime water to seven parts of new milk. Moreover, the lime will be of service in hardening his bones, and, in these cases, the bones require hardening.] and give him as much as he can eat of fresh meat every day. Cod liver oil, a tea-spoonful or a dessert-spoonful, according to his age, twice a day, is serviceable in these cases. Stimulants ought to be carefully avoided. In short, let every means be used to nourish, to strengthen, and invigorate the system, without, at the same time, creating fever. Such a child should be a child of nature, he ought almost to live in the open air, and throw his books to the winds. Of what use is learning without health? In such a case as this you cannot have both.

264. If a child be round-shouldered, or if either of his shoulder-blades have "grown out," what had better be done?

Many children have either round shoulders, or have their shoulder blades grown out, or have their spines twisted, from growing too fast, from being allowed to slouch in their gait, and from not having sufficient nourishing food, such as meat and milk, to support them while the rapid growth of childhood is going on.

If your child be affected as above described, nourish him well on milk and on farinaceous food, and on meat once a day, but let milk be his staple diet; he ought, during the twenty four hours, to take two or three pints of new milk. He should almost live in the open air, and must have plenty of play. If you can so contrive it, let him live in the country. When tired, let him lie, for half an hour, two or three times daily, flat on his back on the carpet. Let him rest at night on a horse-hair mattress, and not on a feather bed.

Let him have every morning, if it be summer, a thorough cold water ablution, if it be winter, let the water be made tepid. Let either two handfuls of table salt or a handful of bay salt be dissolved in the water. Let the salt and water stream well over his shoulders and down his back and loins. Let him be well dried with a moderately coarse towel, and then let his back be well rubbed, and his shoulders be thrown back-exercising them much in the same manner as in skipping, for five or ten minutes at a time. Skipping, by-the-by, is of great use in these cases, whether the child be either a boy or a girl-using, of course, the rope backwards, and not forwards.

Let books be utterly discarded until his shoulders have become strong, and thus no longer round, and his shoulder-blades have become straight. It is a painful sight to see a child stoop like an old man.

Let him have, twice daily, a tea-spoonful or a dessert-spoonful (according to his age) of cod-liver oil, giving it him on a full and not on an empty stomach.

When he is old enough, let the drill-sergeant give him regular lessons, and let the dancing-master be put in requisition. Let him go through regular gymnastic exercises, provided they are not of a violent character.

But, bear in mind, let there be in these cases no mechanical restraints—no shoulder-straps, no abominable stays. Make him straight by natural means—by making him strong. Mechanical means would only, by weakening and wasting the muscles, increase the mischief, and thus the deformity. In this world of ours there is too much reliance placed on artificial, and too little on natural means of cure.

265. What are the causes of Bow Legs in a child; and what is the treatment?

Weakness of constitution, poor and insufficient nourishment, and putting a child, more especially a fat and heavy one, on his legs too early.

Treatment.—Nourishing food, such as an abundance of milk, and, if he be old enough, of meat; iron medicines; cod-liver-oil; thorough ablution, every morning of the whole body; an abundance of exercise, either on pony, or on donkey, or in carriage, but not, until his legs be stronger, on foot. If they are much bowed, it will be necessary to consult an experienced surgeon.

266. If a child, while asleep, "wet his bed" is there any method of preventing him from doing so?

Let him be held out just before he himself goes to bed, and again when the family retires to rest. If, at the time, he be asleep, he will become so accustomed to it, that he will, without awaking, make water. He ought to be made to lie on his side; for, if he be put on his back, the urine will rest upon an irritable part of the bladder, and, if he be inclined to wet his bed, he will not be able to avoid doing so. He must not be allowed to drink much with his meals, especially with his supper. Wetting the bed is an infirmity with some children—they cannot help it. It is, therefore, cruel to scold and chastise them for it. Occasionally, however, wetting the bed arises from idleness; in which case, of course, a little wholesome correction might be necessary.

Water-proof Bed-sheeting—one yard by three-quarters of a yard—will effectually preserve the bed from being wetted, and ought always, on these occasions, to be used.

A mother ought, every morning, to ascertain for herself, whether a child have wet his bed; if he have, and if, unfortunately, the water-proof cloth have not been used, the mattress, sheets, and blankets must be instantly taken to the kitchen fire and be properly dried. Inattention to the above has frequently caused a child to suffer either from cold, from a fever, or from an inflammation; not only so, but, if they be not dried, he is wallowing in filth and in an offensive effluvium. If both mother and nurse were more attentive to their duties—in frequently holding a child out, whether he ask or not—a child wetting his bed would be the exception, and not, as it frequently is, the rule. If a child be dirty, you may depend upon it, the right persons to blame are the mother and the nurse, and not the child!

267. If a child should catch Small-pox, what are the best means to prevent pitting?

He ought to be desired neither to pick nor to rub the pustules. If he be too young to attend to these directions, his hands must be secured in bags (just large enough to hold them), which bags should he fastened round the wrists. The nails must be cut very close.

Cream smeared, by means of a feather, frequently in the day, on the pustules, affords great comfort and benefit. Tripe liquor (without salt) has, for the same purpose, been strongly recommended. I myself, in several cases, have tried it, and with the happiest results. It is most soothing, comforting, and healing to the skin.

268. Can you, tell me of any plan to prevent Chilblaine, or, if a child be suffering from them, to cure them?

First, then, the way to prevent them.—Let a child, who is subject to them, wear, in the winter time, a square piece of wash-leather over the toes, a pair of warm lamb's-wool stockings, and good shoes; but, above all, let him be encouraged to run about the house as much as possible, especially before going to bed; and on no account allow him either to warm has feet before the fire, or to bathe them in hot water. If the feet be cold, and the child be too young to take exercise, then let them be well rubbed with the warm hand. If adults suffer from chilblains, I have found friction, night and morning, with horse-hail flesh-gloves, the best means of preventing them.

Secondly, the way to cure them.—If they be unbroken: the old-fashioned remedy of onion and salt is one of the best of remedies. Cut an onion in two; take one-half of it, dip it in table salt and well rub, for two or three minutes, the chilblain with it. The onion and salt is a famous remedy to relieve that intolerable itching which sometimes accompanies chilblains: then let them be covered with a piece of lint, over which a piece of wash-leather should be placed.

If they be broken, let a piece of lint be spread with spermaceti-cerate, and be applied, every morning, to the part, and let a white-bread poultice be used every night.

269. During the winter time my child's hands, legs, &c., chap very much; what ought I to do?

Let a tea-cupful of bran be tied up in a muslin bag, and be put, over the night, into either a large water-can or jug of rain water; [Footnote: Rain water ought always to be used in the washing of a child; pump water is likely to chap the skin, and to make it both rough and irritable.] and let this water from the can or jug be the water he is to be washed with on the following morning, and every morning until the chaps be cured. As often as water is withdrawn, either from the water-can or from the jog, let fresh rain water take its place, in order that the bran may be constantly soaking in it. The bran in the bag should be renewed about twice a week.

Take particular care to dry the skin well every time he be washed; then, after each ablution, as well as every night at bed-time, rub a piece of deer's suet over the parts affected: a few dressings will perform a cure. The deer's suet may be bought at any of the shops where venison is sold. Another excellent remedy is glycerine, [Footnote: Glycerine prepared by Price's Patent Candle Company is by far the best. Sometimes, if the child's skin be very irritable, the glycerine requires diluting with water—say, two ounces of glycerine to be mixed in a bottle with four ounces of rain water—the bottle to be well shaken just before using it.] which should be smeared, by means of the finger or by a camel's hair brush, on the parts affected, two or three times a day. If the child be very young, it might be necessary to dilute the glycerine with rose-water; fill a small bottle one-third with glycerine, and fill up the remaining two-thuds of the bottle with rose-water—shaking the bottle every time just before using it. The best soap to use for chapped hands is the glycerine soap: no other being required.

270. What is the best remedy for Chapped Lips?

Cold-cream (which may be procured of any respectable chemist) is an excellent application for chapped lips. It ought, by means of the finger, to be frequently smeared on the parts affected.

271. Have the goodness to inform me of the different varieties of Worms that infest a child's bowels?

Principally three—1, The tape-worm; 2, the long round-worm; and 3, the most frequent of all, the common thread or maw-worm. The tape-worm infests the whole course of the bowels, both small and large: the long round-worm, principally the small bowels, occasionally the stomach; it sometimes crawls out of the child's mouth, causing alarm to the mother; there is, of course, no danger in its doing so: the common thread-worm or maw-worm infests the rectum or fundament.

272. What are the causes of Worms?

The causes of worms are: weak bowels; bad and improper food, such as unripe, unsound, or uncooked fruit, and much green vegetables; pork, especially underdone pork; [Footnote: One frequent, if not the most frequent, cause of tape-worm is the eating of pork, more especially if it be underdone. Underdone pork is the most unwholesome food that can he eaten, and is the most frequent cause of tape-worm known. Underdone beef also gives tape-worm; let the meat, therefore, be well and properly cooked. These facts ought to be borne in mind, as prevention is always better than cure.] an abundance of sweets; the neglecting of giving salt in the food.

273. What are the symptoms and the treatment of Worms?

The symptoms of worms are—emaciation; itching and picking of the nose; a dark mark under the eyes; grating, during sleep, of the teeth; starting in the sleep; foul breath; furred tongue; uncertain appetite—sometimes voracious, at other times bad, the little patient sitting down very hungry to his dinner, and before scarcely tasting a mouthful, the appetite vanishing; large bowels; colicky pains of the bowels; slimy motions; itching of the fundament. Tape-worm and round-worm, more especially the former, are apt, in children, to produce convulsions. Tape-worm is very weakening to the constitution, and usually causes great emaciation and general ill-health; the sooner, therefore, it is expelled from the bowels the better it will be for the patient.

Many of the obscure diseases of children arise from worms. In all doubtful cases, therefore, this fact should be borne in mind, in order that a thorough investigation may be instituted.

With regard to treatment, a medical man ought, of course, to be consulted. He will soon use means both to dislodge them, and to prevent a future recurrence of them.

Let me caution a mother never to give her child patent medicines for the destruction of worms. There is one favourite quack powder, which is composed principally of large doses of calomel, and which is quite as likely to destroy the patient as the worms! No, if your child have worms, put him under the care of a judicious medical man, who will soon expel them, without, at the same tune, injuring health or constitution!

274. How may worms be prevented from infesting a child's bowels?

Worms generally infest weak bowels; hence, the moment a child becomes strong worms cease to exist. The reason why a child is so subject to them is owing to the improper food which is usually given to him. When he be stuffed with unsound and with unripe fruits, with much sweets, with rich puddings, and with pastry, and when he is oftentimes allowed to eat his meat without salt, and to bolt his food without chewing it, is there any wonder that he should suffer from worms? The way to prevent them is to avoid such things, and, at the same time, to give him plenty of salt to his fresh and well-cooked meat. Salt strengthens and assists digestion, and is absolutely necessary to the human economy. Salt is emphatically a worm destroyer. The truth of this statement may be readily tested by sprinkling a little salt on the common earth-worm. "What a comfort and real requisite to human life is salt! It enters into the constituents of the human blood, and to do without it is wholly impossible."—The Grocer. To do without it is wholly impossible! These are true words. Look well to it, therefore, ye mothers, and beware of the consequences of neglecting such advice, and see for yourselves that your children regularly eat salt with their food. If they neglect eating salt with their food, they must of necessity have worms, and worms that will eventually injure them, and make them miserable. All food, then, should be "flavoured with salt;" flavoured, that is to say, salt should be used in each and every kind of food—not in excess, but in moderation.

275. You have a great objection to the frequent administration of aperient medicines to a child: can you advise any method to prevent their use?

Although we can scarcely call constipation a disease, yet it sometimes leads to disease. The frequent giving of aperients only adds to the stubbornness of the bowels.

I have generally found a draught, early every morning, of cold pump water, the eating either of Huntley and Palmer's loaf ginger-bread, or of oatmeal gingerbread, a variety of animal and vegetable food, ripe sound fruit, Muscatel raisins, a fig, or an orange after dinner, and, when he be old enough, coffee and milk instead of tea and milk, to have the desired effect, more especially if, for a time, aperients be studiously avoided.

276. Have you any remarks to make on Rickets?

Rickets is owing to a want of a sufficient quantity of earthy matter in the bones; hence the bones bend and twist, and lose their shape, causing deformity. Rickets generally begins to show itself between the first and second years of a child's life. Such children are generally late in cutting their teeth, and when the teeth do come they are bad, deficient of enamel, discoloured, and readily decay. A rickety child is generally stunted in stature; he has a large head, with overhanging forehead, or what nurses call a watery-head-shaped forehead. The fontanelles, or openings of the head, as they are called, are a long time in closing. A rickety child is usually talented; his brain seems to thrive at the expense of his general health. His breast-bone projects out, and the sides of his chest are flattened; hence he becomes what is called chicken-breasted or pigeon-breasted; his spine is usually twisted, so that he is quite awry, and, in a bad case, he is hump-backed; the ribs, from the twisted spine, on one side bulge out; he is round-shouldered; the long bones of his body, being soft, bend; he is bow-legged, knock-kneed, and weak-ankled.

Rickets are of various degrees of intensity, the humpbacked being among the worst There are many mild forms of rickets; weak ankles, knocked-knees, bowed-legs, chicken-breasts, being among the latter number. Many a child, who is not exactly hump-backed, is very round-shouldered, which latter is also a mild species of rickets.

Show me a child that is rickety, and I can generally prove that it is owing to poor living, more especially to poor milk. If milk were always genuine, and if a child had an abundance of it, my belief is that rickets would be a very rare disease. The importance of genuine milk is of national importance. We cannot have a race of strong men and women unless, as children, they have had a good and plentiful supply of milk. It is utterly impossible. Milk might well be considered one of the necessaries of a child's existence. Genuine, fresh milk, then, is one of the grand preventatives, as well as one of the best remedies, for rickets. Many a child would not now have to swallow quantities Of cod-liver oil if previously he had imbibed quantities of good genuine milk. An insufficient and a poor supply of milk in childhood sows the seeds of many diseases, and death often gathers the fruit. Can it be wondered at, when there is so much poor and nasty milk in England, that rickets in one shape or another is so prevalent?

When will mothers arouse from their slumbers, rub their eyes, and see clearly the importance of the subject? When will they know that all the symptoms of rickets I have just enumerated usually proceed from the want of nourishment, more especially from the want of genuine, and of an abundance of, milk? There are, of, course, other means of warding off rickets besides an abundance of nourishing food, such as thorough ablution, plenty of air, exercise, play, and sunshine; but of all these splendid remedies, nourishment stands at the top of the list.

I do not mean to say that rickets always proceeds from poorness of living—from poor milk. It sometimes arises from scrofula, and is an inheritance of one or of both the parents.

Rickety children, if not both carefully watched and managed, frequently, when they become youths, die of consumption.

A mother, who has for some time neglected the advice I have just given, will often find, to her grievous cost, that the mischief has, past remedy, been done, and that it is now "too late!—too late!"

277. How may a child be prevented from becoming rickety? or, if he be rickety, how ought he to be treated?

If a child be predisposed to be rickety, or if he be actually rickety, attend to the following rules:—

Let him live well, on good nourishing diet, such as on tender rump-steaks, cut very fine, and mixed with mashed potatoes, crumb of bread, and with the gravy of the meat. Let him have, as I have before advised, an abundance of good new milk—a quart or three pints during every twenty-four hours. Let him have milk in every form—as milk gruel, Du Barry's Arabica Revalenta made with milk, batter and rice puddings, suet puddings, bread and milk, etc.

To harden the bones, let lime water be added to the milk (a table-spoonful to each tea-cupful of milk.)

Let him have a good supply of fresh, pure, dry air. He must almost live in the open air—the country, if practicable, in preference to the town, and the coast in summer and autumn. Sea bathing and sea breezes are often, in these cases, of inestimable value.

He ought not, at an early age, to be allowed to bear his weight upon his legs. He must sleep on a horse-hair mattress, and not on a feather bed. He should use every morning cold baths in the summer and tepid baths in the winter, with bay salt (a handful) dissolved in the water.

Friction with the hand must, for half an hour at a time, every night and morning, be sedulously applied to the back and to the limbs. It is wonderful how much good in these cases friction does.

Strict attention ought to be paid to the rules of health as laid down in these Conversations. Whatever is conducive to the general health is preventive and curative of rickets.

Books, if he be old enough to read them, should be thrown aside; health, and health alone, must be the one grand object.

The best medicines in these cases are a combination of cod-liver oil and the wine of iron, given in the following manner:—Put a tea-spoonful of wine of iron into a wine-glass, half fill the glass with water, sweeten it with a lump or two of sugar, then let a tea-spoonful of cod-liver oil swim on the top; let the child drink it all down together, twice or three times a day. An hour after a meal is the best time to give the medicine, as both iron and cod-liver oil sit better on a full than on an empty stomach. The child in a short time will become fond of the above medicine, and will be sorry when it is discontinued.

A case of rickets requires great patience and steady perseverance; let, therefore, the above plan have a fair and long-continued trial, and I can then promise that there will be every probability that great benefit will be derived from it.

278. If a child be subject to a scabby eruption about the mouth, what is the best local application?

Leave it to nature. Do not, on any account, apply any local application to heal it; if you do, you may produce injury; you may either bring on an attack of inflammation, or you may throw him into convulsions. No! This "breaking-out" is frequently a safety-valve, and must not therefore be needlessly interfered with. Should the eruption be severe, reduce the child's diet; keep him from butter, from gravy, and from fat meat, or, indeed, for a few days from meat altogether; and give him mild aperient medicine; but, above all things, do not quack him either with calomel or with grey-powder.

279. Will you have the goodness to describe the eruption on the face and on the head of a young child, called Milk-Crust or Running Scall?

Milk-crust is a complaint of very young children—of those who are cutting their teeth—and, as it is a nasty looking complaint, and frequently gives a mother a great deal of trouble, of anxiety, and annoyance, it will be well that you should know its symptoms, its causes, and its probable duration.

Symptoms.—When a child is about nine months or a year old, small pimples are apt to break out around the ears, on the forehead, and on the head. These pimples at length become vesicles (that is to say, they contain water), which run into one large one, break, and form a nasty dirty-looking yellowish, and sometimes greenish, scab, which scab is moist, indeed, sometimes quite wet, and gives out a disagreeable odour, and which is sometimes so large on the head as actually to form a skullcap, and so extensive on the face as to form a mask. These, I am happy to say, are rare cases. The child's beauty is, of, course, for a time completely destroyed, and not only his beauty, but his good temper; for as the eruption causes great irritation and itching, he is constantly clawing himself, and crying with annoyance the great part of the day, and sometimes also of the night—the eruption preventing him from sleeping. It is not contagious, and soon after he has cut the whole of his first set of teeth it will get well, provided it has not been improperly interfered with.

Causes.—Irritation from teething; stuffing him with overmuch meat, thus producing a humour, which Nature tries to get rid of by throwing it out on the surface of the body; the safest place she could fix on for the purpose; hence the folly and danger of giving medicines and applying external applications to drive the eruption in. "Diseased nature oftentimes breaks forth in strange eruptions," and cures herself in this way, if she be not too much interfered with, and if the eruption be not driven in by injudicious treatment. I have known in such cases disastrous consequences to follow over-officiousness and meddlesomeness. Nature is trying all she can to drive the humour out, while some wiseacres are doing all they can to drive the humour in.

Duration.—As milk-crust is a tedious affair, and will require a variety of treatment, it will be necessary to consult an experienced medical man; and although he will be able to afford great relief, the child will not, in all probability, be quite free from the eruption until he have cut the whole of his first set of teeth—until he be upwards of two years and a half old—when, with judicious and careful treatment, it will gradually disappear, and eventually leave not a trace behind.

It will be far better to leave the case alone—to get well of itself—rather than to try to cure the complaint either by outward applications or by strong internal medicines; "the remedy is often worse than the disease," of this I am quite convinced.

280. Have you any advice to give me as to my conduct towards my medical man?

Give him your entire confidence. Be truthful and be candid with him. Tell him the truth, the whole truth, and nothing but the truth. Have no reservations; give him, as near as you can, a plain, unvarnished statement of the symptoms of the disease. Do not magnify, and do not make too light of any of them. Be prepared to state the exact time the child first showed symptoms of illness. If he have had a shivering fit, however slight, do not fail to tell your medical man of it. Note the state of the skin; if there be a "breaking-out"—be it ever so trifling—let it be pointed out to him. Make yourself acquainted with the quantity and with the appearance of the urine, taking care to have a little of it saved, in case the doctor may wish to see and examine it. Take notice of the state of the motions—their number during the twenty-four hours, their colour, their smell, and their consistence, keeping one for his inspection. Never leave any of these questions to be answered by a servant; a mother is the proper person to give the necessary and truthful answers, which answers frequently decide the fate of the patient. Bear in mind, then, a mother's untiring care and love, attention and truthfulness, frequently decide whether, in a serious illness, the little fellow shall live or die! Fearful responsibility!

A medical man has arduous duties to perform; smooth, therefore, his path as much as you can, and you will be amply repaid by the increased good he will be able to do your child. Strictly obey a doctor's orders—in diet, in medicine, in everything. Never throw obstacles in his way. Never omit any of his suggestions; for, depend upon it that if he be a sensible man, directions, however slight, ought never to be neglected; bear in mind, with a judicious medical man,

"That nothing walks with aimless feet."—Tennyson.

If the case be severe, requiring a second opinion, never of your own accord call in a physician, without first consulting and advising with your own medical man. It would be an act of great discourtesy to do so. Inattention to the foregoing advice has frequently caused injury to the patient, and heart-burnings and ill-will among doctors.

Speak, in the presence of your child, with respect and kindness of your medical man, so that the former may look upon the latter as a friend—as one who will strive, with God's blessing, to relieve his pain and suffering. Remember the increased power of doing good the doctor will have if the child be induced to like, instead of dislike, him. Not only be careful that you yourself speak before your child, respectfully and kindly of the medical man, but see that your domestics do so likewise; and take care that they are never allowed to frighten your child, as many silly servants do, by saying that they will send for the doctor, who will either give him nasty medicine, or will perform some cruel operation upon him. A nurse-maid should, then, never for one moment be permitted to make a doctor an object of terror or of dislike to a child.

Send, whenever it be practicable, for your doctor early in the morning, as he will then make his arrangements accordingly, and can by daylight better ascertain the nature of the complaint, more especially if it be a skin disease. It is utterly impossible for him to form a correct opinion of the nature of a "breaking-out" either by gas or by candle light. If the illness come on at night, particularly if it be ushered in either with a severe shivering, or with any other urgent symptom, no time should be lost, be it night or day, in sending for him,

"A little fire is quietly trodden out,
Which, being sufier'd, rivers cannot quench."

Shakespeare.