One of the great follies of the present age is, children's parties, where they are allowed to be dressed up like grown-up women, stuck out in petticoats, and encouraged to eat rich cake and pastry, and to drink wine, and to sit up late at night! There is something disgusting and demoralising in all this. Their pure minds are blighted by it. Do not let me be misunderstood: there is not the least objection, but, on the contrary, great advantage, for friends' children to meet friends' children; but then let them be treated as children, and not as men and women!

180. Do you approve of public play-grounds for children?

It would be well, in every village, and in the outskirts of every town, if a large plot of ground were set apart for children to play in, and to go through regular gymnastic exercises. Play is absolutely necessary to a child's very existence, as much as food and sleep; but in many parts of England where is he to have it? Playgrounds and play are the best schools we have; they teach a great deal not taught elsewhere; they give lessons in health, which is the grandest wealth that can be bestowed—"for health is wealth;" they prepare the soil for the future schoolmaster; they clear the brain, and thus the intellect, they strengthen the muscles; they make the blood course merrily through the arteries; they bestow healthy food for the lungs; they give an appetite; they make a child, in due time, become every inch a man! Play-grounds and play are one of the finest institutions we possess. What would our large public schools be without their play and cricket grounds? They would be shorn of half their splendour and their usefulness!

There is so much talk now-a-days about useful knowledge, that the importance of play and play-grounds is likely to be forgotten. I cannot help thinking however, that a better state of things is dawning. "It seems to be found out that in our zeal for useful knowledge, that knowledge is found to be not the least useful which treat boys as active, stirring, aspiring, and ready." [Footnote: The Saturday Review, December 13, 1862.]

181. Do you approve of infant schools?

I do, if the arrangements be such that health is preferred before learning. [Footnote: "According to Aristotle, more care should be taken of the body than of the mind for the first seven years; strict attention to diet be enforced, &c. . . . . . The eye and ear of the child should be most watchfully and severely guarded against contamination of every kind, and unrestrained communication with servants be strictly prevented. Even his amusements should be under due regulation, and rendered as interesting and intellectual as possible."—The Rev John Williams, in his Life and Actions of Alexander the Great] Let children be only confined for three or four hours a day, and let what little they learn be taught as an amusement rather than as a labour. A play-ground ought to be attached to an infant school; where, in fine weather, for every half-hour they spend in-doors, they should spend one in the open air; and, in wet weather, they ought to have, in lieu of the play-ground, a large room to romp, and shout, and riot in. To develop the different organs, muscles, and other parts of the body, children require fresh air, a free use of their lungs, active exercise, and their bodies to be thrown into all manner of attitudes. Let a child mope in a corner, and he will become stupid and sickly. The march of intellect, as it is called, or rather the double quick march of intellect, as it should be called, has stolen a march upon health. Only allow the march of intellect and the march of health to take equal strides, and then we shall have "mens sana in corpore sano" (a sound mind in a sound body).

In the education of a young child, it is better to instruct him by illustration, by pictures, and by encouraging observation on things around and about him, than by books. It is surprising how much, without endangering his health, may be taught in this way. In educating your child, be careful to instil and to form good habits—they will then stick to him for life.

Children at the present day are too highly educated—their brains are over-taxed, and thus weakened. The consequence is, that as they grow up to manhood, if they grow up at all, they become fools! Children are now taught what formerly youths were taught. The chord of a child's life is ofttimes snapped asunder in consequence of over education:—

"Screw not the cord too sharply, lest it snap"—Tennyson.

You should treat a child as you would a young colt. Think only at first of strengthening his body. Let him have a perfectly free, happy life, plenty of food to eat, abundance of air to breathe, and no work to do; there is plenty of time to think of his learning—of giving him brain work. It will come sadly too soon; but do not make him old before his time.

182. At what age do you advise my child to begin his course of education—to have his regular lessons?

In the name of the prophet,—Figs! Fiddlesticks! about courses of education and regular lessons for a child! You may as well ask me when he, a child, is to begin Hebrew, the Sanscrit, and Mathematics! Let him have a course of education in play; let him go through regular lessons in foot-ball, bandy, playing at tic, hares and hounds, and such like excellent and really useful and health-giving lessons. Begin his lessons! Begin brain work, and make an idiot of him! Oh! for shame, ye mothers! You who pretend to love your children so much, and to tax, otherwise to injure, irreparably to injure their brains, and thus their intellects and their health, and to shorten their very days. And all for what? To make prodigies of them! Forsooth! to make fools of them in the end,

183. Well, then, as you have such a great objection to a child commencing his education early in life, at what age may he, with safety, commence his lessons? and which do you prefer—home or school education?

Home is far preferable to a school education. He is, if at home, under your own immediate observation, and is not liable to be contaminated by naughty children; for, in every school, there is necessarily a great mixture of the good and of the bad; and a child, unfortunately, is more likely to be led by the bad than by the good. Moreover, if he be educated at home, the mother can see that his brain is not over-worked. At school the brain is apt to be over-worked, and the stomach and the muscles to be under-worked.

Remember, as above stated, the brain must have but very little work until the child be seven years old; impress this advice upon your memory, and let no foolish ambition to make your child a clever child allow you, for one moment, to swerve from this advice.

Build up a strong, healthy body, and in due time the brain will bear a moderate amount of intellectual labour.

As I have given you so much advice, permit me, for one moment, to address a word to the father of your child:—

Let me advise you, then, Mr. Pater familias, to be careful how you converse, what language you use, while in the company of your child. Bear in mind, a child is very observant, and thinks much, weighs well, and seldom forgets all you say and all you do! Let no hasty word, then, and more especially no oath, or no impious language, ever pass your lips, if your child be within hearing. It is, of course, at all times wicked to swear; but it is heinously and unpardonably sinful to swear in the presence of your child! "Childhood is like a mirror, catching and reflecting images. One impious or profane thought, uttered by a parent's lip, may operate upon the young heart like a careless spray of water thrown upon polished steel, staining it with rust, which no after scouring can efface."

Never talk secrete before a child—"little pitchers have long ears;" if you do, and he disclose your secrets—as most likely he will—and thus make mischief, it will be cruel to scold him; you will, for your imprudence, have yourself only to blame. Be most careful, then, in the presence of your child, of what you say, and of whom you speak. This advice, if followed, might save a great deal of annoyance and vexation.

184. Are you an advocate for a child being taught singing?

I am: I consider singing a part of his education. Singing expands the walls of his chest, strengthens and invigorates his lungs, gives sweetness to his voice, improves his pronunciation, and is a great pleasure and amusement to him.

SLEEP.

185. Do you approve of a child sleeping on a FEATHER bed?

A feather bed enervates his body, and, if he be so predisposed, causes rickets, and makes him crooked. A horse-hair mattress is the best for a child to lie on. The pillow, too, should be made of horse-hair. A feather pillow often causes the bead to be bathed in perspiration, thus enervating the child, and making him liable to catch cold. If he be at all rickety, if he be weak in the neck, if he be inclined to stoop, or if he be at all crooked, let him, by all means, lie without a pillow.

186. Do you recommend a child, in the middle of the day, to be put to sleep?

Let him be put on his mattress awake, that he may sleep for a couple of hours before dinner, then he will rise both refreshed and strengthened for the remainder of the day. I said, let him be put down awake. He might, for the first few times, cry, but, by perseverance, he will without any difficulty fall to sleep. The practice of sleeping before dinner ought to be continued until he be three years old, and, if he can be prevailed upon, even longer. For if he do not have sleep in the middle of the day, he will all the afternoon and the evening be cross; and when he does go to bed, he will probably be too tired to sleep, or his nerves having been exhausted by the long wakefulness, he will fall into a troubled, broken slumber, and not into that sweet, soft, gentle repose, so characteristic of healthy, happy childhood!

187. At what hour ought a child to be put to bed in the evening?

At six in the winter, and at seven o'clock in the summer. Regularity ought to be observed, as regularity is very conducive to health. It is a reprehensible practice to keep a child up until nine or ten o'clock at night. If this be done, he will, before his time, become old, and the seeds of disease will be sown,

As soon as he can run, let him be encouraged, for half an hour before he goes to bed, to race either about the hall, or the landing, or a large room, which will be the best means of warming his feet, of preventing chilblains, and of making him sleep soundly.

188. Have you any directions to give me at to the placing of my child in his bed?

If a child lie alone, place him fairly on his aide in the middle of the bed; if it be winter time, see that his arms and hands be covered with the bed-clothes; if it be summer, his hands might be allowed to be outside the clothes. In putting him down to sleep, you should ascertain that his face be not covered with the bedclothes; if it be, he will he poisoned with his own breath—the breath constantly giving off carbonic acid gas; which gas must, if his face be smothered in the clothes; be breathed—carbonic acid gas being highly poisonous.

You can readily prove the existence of carbonic and gas in the breathing, by simply breathing into a little lime-water; after breathing for a few seconds into it, a white film will form on the top; the carbonic acid gas from the breath unites with the lime of the lime-water and the product of the white film is carbonate of lime.

189. Do you advise a bedroom to be darkened at night?

Certainly: a child sleeps sounder and sweeter in a dark than in a light room. There is nothing better for the purpose of darkening a bedroom, than Venetian blinds. Remember, then, a well-ventilated, but a darkened, chamber at night. The cot or the crib ought not to face the window, "as the light is best behind." [Footnote: Sir Charles Locock in a Letter to the Author. ]

190. Which is the beat position for a child when sleeping—on his back, or on his side?

His side: he ought to be accustomed to change about on the right side one night, on the left another; and occasionally, for a change, he should lie on his back. By adopting this plan, you will not only improve his figure, but likewise his health. Lying, night after night, in one position, would be likely to make him crooked.

191. Do you advise, in the winter time, that there should be a fire in the night nursery?

Certainly not, unless the weather be intensely cold. I dislike fires in bedrooms, especially for children; they are very enervating, and make a child liable to catch cold. Cold weather is very bracing, particularly at night "Generally speaking," says the Siecle, "during winter, apartments are too much heated. The temperature in them ought not to exceed 16 deg. Centigrade (59 deg. Fahrenheit); and even in periods of great cold scientific men declare that 12 deg. or 14 deg. had better not be exceeded. In the wards of hospitals, and in the chambers of the sick, care is taken not to have greater heat than 15 deg.. Clerks in offices, and other persons of sedentary occupations, when rooms in which they sit are too much heated, are liable to cerebral [brain] congestion and to pulmonary [lung] complaints. In bedrooms, and particularly those of children, the temperature ought to be maintained rather low; it is even prudent only rarely to make fires in them, especially during the night"

If "a cold stable make a healthy horse," I am quite sure that a moderately cold and well-ventilated bedroom helps to make a healthy child. But, still, in the winter time, if the weather be biting cold, a little fire in the bedroom grate is desirable. In bringing up children, we must never run into extremes—the coddling system and the hardening system are both to be deprecated; the coddling system will make the strong child weakly, while the hardening system will probably kill a delicate one.

A child's bed ought, of course, to be comfortably clothed with blankets—I say blankets, as they are much superior to coverlids; the perspiration will more readily pass through a blanket than a coverlid. A thick coverlid ought never to be used; there is nothing better, for a child's bed, than the old-fashioned patchwork coverlid, as the perspiration will easily escape through it.

192. Should a child be washed and dressed AS SOON AS HE AWAKE in the morning?

He ought, if he awake in anything like reasonable time; for if he doze after he be once awake, such slumber does him more harm than good. He should be up every morning as soon as it is light If, as a child, he be taught to rise early, it will make him an early riser for life, and will tend greatly to prolong both his existence and his happiness.

Never awake a child from his sleep to dress him, to give him medicine, or for any other purpose; let him always sleep as long as he can; but the moment he awakes let him be held out, and then let him be washed and dressed, and do not wait, as many a silly nurse does, until he have wet his bed, until his blood be chilled, and until he be cross, miserable, and uncomfortable! How many babes are made ill by such foolish practices!

The moment he leaves his bed, turn back to the fullest extent the clothes, in order that they may be thoroughly ventilated and sweetened. They ought to be exposed to the air for at least an hour before the bed be made. As soon as he leaves his room, be it winter or summer, throw open the windows.

193. Ought a child to lie alone?

He should, after he is weaned. He will rest more comfortably, and his sleep will be more refreshing.

194. Supposing a child should not sleep well, what ought to be done? Would you give him a dose of composing medicine?

Certainly not. Try the effects of exercise. Exercise in the open air is the best composing medicine in the world. Let the little fellow be well tired out, and there will be little fear of his not sleeping.

195. Have you any further observations to make on the subject of sleep?

Send a child joyful to bed. Do not, if you can possibly help it, let him go to bed crying. Let the last impressions he has at night be of his happy home, and of his loving father and mother and let his last thoughts be those of joy and gladness. He will sleep all the sounder if he be sent to bed in such a frame of mind, and he will be more refreshed and nourished in the morning by his sleep.

196. What are the usual causes of a child walking in his sleep, and what measures during such times, ought to be adopted to prevent his injuring himself?

A disordered stomach, in a child of nervous temperament, or worms, are usually the causes. The means to be adopted to prevent his throwing himself out of the window, are to have bars to his chamber present, and if that be not practicable, to have either nails or screws driven into the window sash to allow the window to open only for a sufficient space for ventilation, and to have a screw window fastening, in order that he cannot, without difficulty, open the window, to have a trusty person to sleep in his room, who should have directions given not to rouse him from his sleep, but to gently lead him back to his bed, which may frequently be done without awaking him, and to consult a medical man, who will adopt means to destroy the worms, to put his stomach into order, to brace his nerves, and to strengthen his general system. A trip to the coast and sea bathing, in such a case, is often of great service.

SECOND DENTITION.

197. When does a child commence to cut his SECOND set of teeth?

Generally at seven years old. He begins to cut them at about that time: but it should be borne in mind (so wonderful are the works of God) that the second crop of teeth, in embryo, is actually bred and formed from the very commencement of his life, under the first tier of teeth, but which remain in abeyance for years, and do not come into play until the first teeth, having done their duty, loosen and fall out, and thus make room for the more numerous, larger, stronger, and more permanent teeth, which latter have to last for the remainder of his existence. The first set is sometimes cut with a great deal of difficulty, and produces various diseases; the second, or permanent teeth, come easily, and are unaccompanied with any disorder. The following is the process:—One after another of the first set gradually loosen, and either drop out, or with little pain are readily pulled out; under these, the second—the permanent—teeth make their appearance, and fill up the vacant spaces. The fang of the tooth that has dropped out is nearly all absorbed or eaten away, leaving little more than the crown. The first set consists of twenty; the second (including the wise-teeth, which are not, generally cut until after the the age of twenty-seven) consists of thirty-two.

I would recommend you to pay particular attention to the teeth of your children; for, besides their being ornamental, their regularity and soundness are of great importance to the present as well as to the future health of your offspring. If there be any irregularity in the appearance of the second set, lose no time in consulting an experienced and respectable dentist.

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?