2543. COW-POX, properly speaking, is an artificial disease, established in a healthy body as a prophylactic, or preventive agent, against the more serious attack of small-pox, and is merely that chain of slight febrile symptoms and local irritation, consequent on the specific action of the lymph of the vaccination, in its action on the circulating system of the body. This is not the place to speak of the benefits conferred on mankind by the discovery of vaccination, not only as the preserver of the human features from a most loathsome disfigurement, but as a sanitary agent in the prolongation of life.
2544. Fortunately the State has now made it imperative on all parents to have their children vaccinated before, or by the end of, the twelfth week; thus doing away, as far as possible, with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive; for though vaccination has been proved not to be always an infallible guard against small-pox, the attack is always much lighter, should it occur, and is seldom, if indeed ever, fatal after the precaution of vaccination. The best time to vaccinate a child is after the sixth and before the twelfth week, if it is in perfect health, but still earlier if small-pox is prevalent, and any danger exists of the infant taking the disease. It is customary, and always advisable, to give the child a mild aperient powder one or two days before inserting the lymph in the arm; and should measles, scarlet fever, or any other disease arise during the progress of the pustule, the child, when recovered, should be re-vaccinated, and the lymph taken from its arm on no account used for vaccinating purposes.
2545. The disease of cow-pox generally takes twenty days to complete its course; in other words, the maturity and declension of the pustule takes that time to fulfil its several changes. The mode of vaccination is either to insert the matter, or lymph, taken from a healthy child, under the cuticle in several places on both arms, or, which is still better, to make three slight scratches, or abrasions, with a lancet on one arm in this manner, ,,",, and work into the irritated parts the lymph, allowing the arm to dry thoroughly before putting down the infant's sleeve; by this means absorption is insured, and the unnecessary pain of several pustules on both arms avoided. No apparent change is observable by the eye for several days; indeed, not till the fourth, in many cases, is there any evidence of a vesicle; about the fifth day, however, a pink areola, or circle, is observed round one or all of the places, surrounding a small pearly vesicle or bladder. This goes on deepening in hue till the seventh or eighth day, when the vesicle is about an inch in diameter, with a depressed centre; on the ninth the edges are elevated, and the surrounding part hard and inflamed. The disease is now at its height, and the pustule should be opened, if not for the purpose of vaccinating other children, to allow the escape of the lymph, and subdue the inflammatory action. After the twelfth day the centre is covered by a brown scab, and the colour of the swelling becomes darker, gradually declining in hardness and colour till the twentieth, when the scab falls, off, leaving a small pit, or cicatrix, to mark the seat of the disease, and for life prove a certificate of successful vaccination.
2546. In some children the inflammation and swelling of the arm is excessive, and extremely painful, and the fever, about the ninth or tenth day, very high; the pustule, therefore, at that time, should sometimes be opened, the arm fomented every two hours with a warm bread poultice, and an aperient powder given to the infant.
MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH.
Measles.
2547. This much-dreaded disease, which forms the next subject in our series of infantine diseases, and which entails more evils on the health of childhood than any other description of physical suffering to which that age of life is subject, may be considered more an affection of the venous circulation, tending to general and local congestion, attended with a diseased condition of the blood, than either as a fever or an inflammation; and though generally classed before or after scarlet fever, is, in its pathology and treatment, irrespective of its after-consequences, as distinct and opposite as one disease can well be from another.
4548. As we have already observed, measles are always characterized by the running at the nose and eyes, and great oppression of breathing; so, in the mode of treatment, two objects are to be held especially in view; first, to unload the congested state of the lungs,—the cause of the oppressed breathing; and, secondly, to act vigorously, both during the disease and afterwards, on the bowels. At the same time it cannot be too strongly borne in mind, that though the patient in measles should on no account be kept unduly hot, more care than in most infantine complaints should be taken to guard the body from cold, or any abrupt changes of temperature. With these special observations, we shall proceed to give a description of the disease, as recognized by its usual—
2549. Symptoms, which commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, deduction or running at the eyes and nose, nausea, sometimes vomiting, thirst, a furred tongue; the pulse throughout is quick, and sometimes full and soft, at others hard and small, with other indications of an inflammatory nature.
2550. On the third day, small red points make their appearance, first on the face and neck, gradually extending over the upper and lower part of the body. On the fifth day, the vivid red of the eruption changes into a brownish hue; and, in two or three days more, the rash entirely disappears, leaving a loose powdery desquamation on the skin, which rubs off like dandriff. At this stage of the disease a diarrhoea frequently comes on, which, being what is called "critical," should never be checked, unless seriously severe. Measles sometimes assume a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes both doubtful and dangerous. In this condition the eruption comes out sooner, and only in patches; and often, after showing for a few hours, suddenly recedes, presenting, instead of the usual florid red, a dark purple or blackish hue; a dark brown fur forms on the gums and mouth, the breathing becomes laborious, delirium supervenes, and, if unrelieved, is followed by coma; a fetid diarrhoea takes place, and the patient sinks under the congested state of the lungs and the oppressed functions of the brain.