They consist simply in the following measures:—The careful protection of the child from cold or damp weather, particularly the north-east winds of spring following heavy rains. Croup is most prevalent in those seasons which are cold and moist, or when the alternations of temperature are sudden and remarkable. If the residence of the child is favourable to the production of croup, (for instance, near a large body of water, or in low damp spots,) he should, if possible, be removed to a healthier situation. Sponging or the shower-bath, with cold water and bay-salt, with considerable friction in drying the body, should be commenced in summer, and employed every morning upon the child's rising from bed. The clothing should be warm in the winter and spring, the neck always covered, and flannel worn next the skin throughout the year; but hot rooms, and much clothing when in bed, must be avoided. The diet must be light and nourishing; no beer or stimulant given; and the state of the bowels must be carefully watched.
The above precautions are of course particularly necessary to enforce immediately after a recovery from an attack, for there is a great tendency to relapse. If the attack takes place during the winter or spring months, the invalid must be kept, until milder weather, in the house, and in a room of an equable and moderately warm temperature. If in the summer, change of air, as soon as it can be safely effected, will be found very useful.
Sect. X.—WATER IN THE HEAD.
Water in the head is a formidable disease, and not unfrequent in its occurrence. It is often destructive to life, and the instances are numerous in which it has appeared again and again in the same family, carrying off one child after another, as they have successively arrived at the same age.
But notwithstanding its frequency and fearful character, a mother may do much to overcome a constitutional predisposition to this disease, and thus prevent its appearance; as also she may assist greatly in promoting its cure, when it does occur. Hence it is most important that a mother should be acquainted with the measures of prevention; and also, when it does manifest itself, that clear and accurate information should be possessed, upon what may be said to constitute the maternal management of the disorder.
ITS PREVENTION.—Whenever there is found to exist in a family a predisposition to this malady, one or more children having suffered from it, a mother must make up her mind, and in the strictest sense of the word, to be the guardian of the health of any child she may subsequently give birth to. And not only during the period of infancy, but during that of childhood also, must she continue the same careful and vigilant superintendence.
The infant must be brought up on the breast, and if the mother is not of a decidedly healthy and robust constitution, she must obtain a wet-nurse possessing such qualifications. The breast-milk, and nothing beside, must form the nutriment of the child for at least nine months; and if the infant is delicate or strumous, it will be prudent to continue it even six months longer. When the period arrives for the substitution of artificial food, it must be carefully selected; it must be appropriate to the advancing age of the child; nutritious and unirritating. Good air and daily exercise, and the bath or sponging, are of much importance; in short, all those general measures which have a tendency to promote and maintain the tone and general health of the system, and thus induce a vigorous and healthy constitution, and to which reference has been so fully made in the first chapter of this work, must be strictly regarded and followed out by the parent.
The condition of the digestive organs must be the mother's especial care. Costiveness must be guarded against; and if at any time the secretions from the bowels indicate the presence of derangement, the medical attendant must be applied to, that appropriate remedies may without delay be exhibited. Their disordered condition is frequently productive of head-disease. Again and again have I clearly traced the origin of the complaint, of which I am now writing, as more immediately resulting from disorder of the digestive apparatus. To a child thus predisposed to water in the head, the healthy state of these organs is not only of first consequence, but any deviation from health to be dreaded, to be immediately attended to, and guarded against in future; and, as there is a great liability to these attacks at the time of weaning, the above remarks especially apply to that period, when due attention must be particularly paid to the plan of diet adopted.
During teething the mother must be especially watchful, for it is at this time that the disease so commonly appears; the irritation produced by this process being a frequent exciting cause. Every thing, therefore, that will tend to allay excitement of the system, must be strictly enforced, as well as all causes avoided, which would produce derangement of the stomach and bowels. The head should be kept cool. For this purpose it must be sponged night and morning throughout the whole period of teething; a horse-hair pillow used in the cot; and nothing but a light straw hat should be worn, except in winter, The diet should be moderate, and carefully regulated after leaving the breast, and the child should be as much as possible in the open air. The mouth must be occasionally examined, and if the gums become hot or distended, they must be scarified or lanced, as may be advised. If the parent finds at any time an unusual heat about the head, the medical man must be at once consulted; or if there is watchfulness or indisposition to sleep at the proper periods, or frequent startings in the sleep, irritability of temper, and much crying, danger should be apprehended, and prompt and judicious means employed.
Eruptions about the head, or sores behind the ears, discharging more or less, will sometimes make their appearance just before the cutting of a tooth, and disappear after it is cut; or it will sometimes happen that, if not interfered with, they will continue throughout the whole period of dentition. Great caution should always be exercised in reference to these eruptions in all children; and when there is a predisposition to water in the head, it is dangerous to interfere with them at all, except they run to such an extent as to become very troublesome. The sudden healing of these cutaneous affections has again and again been followed by head-disease. They are unsightly in the eyes of a parent, but it must be recollected that they render the situation of such children much more safe; and when teething is completed they will generally disappear spontaneously; or, if they should not, they will readily do so by proper medical treatment. I have no doubt that many a child's life has been saved by the appearance and continuance of these eruptions; and so sensible are medical men of the benefit derived from them, that in individuals in whom they do not appear, and in whose family there exists a predisposition to the disease now under our consideration, an issue or seton, in the arm or neck, has sometimes been made, and had a remarkable influence in warding off this affection. Dr. Cheyne refers to the circumstance of ten children in one family having died of this disease; the eleventh, for whom this measure was employed, having been preserved.