Advice to a Mother on the Management of Her Children

by Pye Henry Chavasse

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