The Physical Training of Children

by Pye Henry Chavasse

An inveterate, long-continued and neglected case of curvature of the spine and bulging out of the ribs on one side might require mechanical appliances, but such a case can only be decided on by an experienced surgeon, who ought always, in the first place, to be consulted.

360. Is a slight spitting of blood to be looked upon as a dangerous symptom?

Spitting of blood is always to be looked upon with suspicion, even when a youth appears in other respects to be in good health; it is frequently the forerunner of consumption. It might be said that, by mentioning the fact, I am unnecessarily alarming a parent, but it would be a false kindness if I did not do so:

“I must be cruel only to be kind.”

Let me ask when is consumption to be cured? Is it at the onset, or is it when it is confirmed? If a mother had been more generally aware that spitting of blood was frequently the forerunner of consumption, she would, in the management of her offsprings, have taken greater precautions; she would have made everything give way to the preservation of their health; and, in many instances, she would have been amply repaid by having the lives of her children spared to her. We frequently hear of patients in confirmed consumption being sent to Menton, to Madeira, and to other foreign parts. Can anything be more cruel or absurd? If there be any disease that requires the comforts of home—and truly may an Englishman’s dwelling he called home!—and good nursing more than another, it is consumption.

361. What is the death-rate of Consumption in England? At what age does Consumption most frequently occur? Are girls more liable to it than boys? What are the symptoms of this disease?

It is asserted, on good authority, that there always are, in England, 78,000 cases of consumption, and that the yearly death-rate of this fell disease alone is 39,000! Consumption more frequently shows itself between the ages of fourteen and twenty-one: after then, the liability to the disease gradually diminishes, until at the age of forty-five it becomes comparatively rare. Boys are more prone to this complaint than girls. Some of the most important symptoms of pulmonary consumption are indicated by the stethoscope; but, as I am addressing a mother, it would, of course, be quite out of place to treat of such signs in Conversations of this kind. The symptoms it might be well for a parent to recognize, in order that she may seek aid early, I will presently describe. It is perfectly hopeless to expect to cure consumption unless advice be sought at the onset, as the only effectual good in this disease is to be done at first.

It might be well to state that consumption creeps on insidiously. One of the earliest symptoms of this dreadful scourge is a slight, dry, short cough, attended with tickling and irritation at the top of the throat. This cough generally occurs in the morning; but, after some time, comes on at night, and gradually throughout the day and the night. Frequently during the early stage of the disease a slight spitting of blood occurs. Now this is a most dangerous symptom; indeed, I may go so far as to say that, as a rule, it is almost a sure sign that the patient is in the first stage of a consumption.

There is usually hoarseness, not constant, but coming on if the patient be tired, or toward the evening; there is also a sense of lassitude and depression, shortness of breathing, a feeling of being quickly wearied—more especially on the slightest exertion. The hair of a consumptive person usually falls off, and what little remains is weak and poor; the joints of the fingers become enlarged, or clubbed as it is sometimes called; the patient loses flesh, and, after some time, night-sweats make their appearance; then we may know that hectic fever has commenced.

Hectic begins with chilliness, which is soon followed by flushings of the face, and by burning heat of the hands and feet, especially of the palms and the soles. This is soon succeeded by perspirations. The patient has generally, during the day, two decided paroxysms of hectic fever—the one at noon, which lasts about five hours, the other in the evening, which is more severe, and ends in violent perspirations, which perspirations continue the whole night through. He may, during the day, have several attacks of hectic flushes of the face, especially after eating; at one moment he complains of being too hot, and rushes to the cool air; the next moment he is too cold, and almost scorches himself by sitting too near the fire. Whenever the circumscribed hectic flush is on the cheek, it looks as though the cheek had been painted with vermilion, then is the time when the palms of the hands are burning hot.