Miscellany 15

MISCELLANY No 15

 

MRS BEETON ON THE VICTORIAN BABY: SUNDRY ILLNESSES AND (VICTORIAN) REMEDIES

 

THRUSH, AND ITS TREATMENT.

2523. This is a disease to which infants are peculiarly subject, and in whom alone it may be said to be a disease; for when thrush shows itself in adult or advanced life, it is not as a disease proper, but only as a symptom, or accessory, of some other ailment, generally of a chronic character, and should no more be classed as a separate affection than the petechae, or dark-coloured spots that appear in malignant measles, may be considered a distinct affection.

2524. Thrush is a disease of the follicles of the mucous membrane of the alimentary canal, whereby there are formed small vesicles, or bladders, filled with a thick mucous secretion, which, bursting, discharge their contents, and form minute ulcers in the centre of each vessel. To make this formal but unavoidable description intelligible, we must beg the reader's patience while we briefly explain terms that may appear to many so unmeaning, and make the pathology of thrush fully familiar.

2525. The whole digestive canal, of which the stomach and bowels are only a part, is covered, from the lips, eyes, and ears downwards, with a thin glairy tissue, like the skin that lines the inside of an egg, called the mucous membrane; this membrane is dotted all over, in a state of health, by imperceptible points, called follicles, through which the saliva, or mucous secreted by the membrane, is poured out.

2526. These follicles, or little glands, then, becoming enlarged, and filled with a congealed fluid, constitute thrush in its first stage; and when the child's lips and mouth appear a mass of small pearls, then, as these break and discharge, the second stage, or that of ulceration, sets in.

2527. Symptoms.—Thrush is generally preceded by considerable irritation, by the child crying and fretting, showing more than ordinary redness of the lips and nostrils, hot fetid breath, with relaxed bowels, and dark feculent evacuations; the water is scanty and high-coloured; whilst considerable difficulty in swallowing, and much thirst, are the other symptoms, which a careful observation of the little patient makes manifest.

2528. The situation and character of thrush show at once that the cause is some irritation of the mucous membrane, and can proceed only from the nature and quality of the food. Before weaning, this must be looked for in the mother, and the condition of the milk; after that time, in the crude and indigestible nature of the food given. In either case, this exciting cause of the disease must be at once stopped. When it proceeds from the mother, it is always best to begin by physicking the infant through the parent; that is to say, let the parent first take the medicine, which will sufficiently affect the child through the milk: this plan has the double object of benefiting the patient and, at the same time, correcting the state of the mother, and improving the condition of her milk. In the other case, when the child is being fed by hand, then proceed by totally altering the style of aliment given, and substituting farinaceous food, custards, blanc-mange, and ground-rice puddings.

2529. As an aperient medicine for the mother, the best thing she can take is a dessert-spoonful of carbonate of magnesia once or twice a day, in a cup of cold water; and every second day, for two or three times, an aperient pill.

2530. As the thrush extends all over the mouth, throat, stomach, and bowels, the irritation to the child from such an extent of diseased surface is proportionately great, and before attempting to act on such a tender surface by opening medicine, the better plan is to soothe by an emollient mixture; and, for that purpose, let the following be prepared. Take of

  Castor oil 2 drachms.
  Sugar 1 drachm.
  Mucilage, or powdered gum Arabic half a drachm.

Triturate till the oil is incorporated, then add slowly—

  Mint-water One ounce and a half
  Laudanum Ten drops

Half a teaspoonful three times a day, to an infant from one to two years old; a teaspoonful from two to three years old; and a dessertspoonful at any age over that time. After two days' use of the mixture, one of the following powders should be given twice a day, accompanied with one dose daily of the mixture:—

  Grey powder 20 grains.
  Powdered rhubarb 15 grains.
  Scammony 10 grains. Mix.

Divide into twelve powders, for one year; eight powders, from one to two; and six powders, from two to six years old. After that age, double the strength, by giving the quantity of two powders at once.

2531. It is sometimes customary to apply borax and honey to the mouth for thrush; but it is always better to treat the disease constitutionally rather than locally. The first steps, therefore, to be adopted are, to remove or correct the exciting cause—the mother's milk or food; allay irritation by a warm bath and the castor-oil mixture, followed by and conjoined with the powders.

2532. To those, however, who wish to try the honey process, the best preparation to use is the following:-Rub down one ounce of honey with two drachms of tincture of myrrh, and apply it to the lips and mouth every four or six hours.

2533. It is a popular belief, and one most devoutly cherished by many nurses and elderly persons, that everybody must, at some time of their life, between birth and death, have an attack of thrush, and if not in infancy, or prime of life, it will surely attack them on their death-bed, in a form more malignant than if the patient had been affected with the malady earlier; the black thrush with which they are then reported to be affected being, in all probability, the petechae or purple spots that characterize the worst form, and often the last stage, of typhoid fever.

2534. In general, very little medicine is needed in this disease of the thrush—an alterative powder, or a little magnesia, given once or twice, being all, with the warm bath, that, in the great majority of cases, is needed to restore the mucous membrane to health. As thrush is caused by an excess of heat, or over-action in the lining membrane of the stomach and bowels, whatever will counteract this state, by throwing the heat on the surface, must materially benefit, if not cure, the disease: and that means every mother has at hand, in the form of a warm bath. After the application of this, a little magnesia to correct the acidity existing along the surface of the mucous membrane, is often all that is needed to throw the system into such a state as will effect its own cure. This favourable state is indicated by an excessive flow of saliva, or what is called "dribbling," and by a considerable amount of relaxation of the bowels-a condition that must not be mistaken for diarrhoea, and checked as if a disease, but rather, for the day or two it continues, encouraged as a critical evacuant.

2535. Should there be much debility in the convalescence, half a teaspoonful of stee wine, given twice a day in a little barley-water, will be found sufficient for all the purposes of a tonic. This, with the precaution of changing the child's food, or, when it lives on the mother, of correcting the quality of the milk by changing her own diet, and, by means of an antacid or aperient, improving the state of the secretion. Such is all the treatment that this disease in general requires.

2536. The class of diseases we are now approaching are the most important, both in their pathological features and in their consequences on the constitution, of any group or individual disease that assails the human body; and though more frequently attacking the undeveloped frame of childhood, are yet by no means confined to that period. These are called Eruptive Fevers, and embrace chicken-pox, cow-pox, small-pox, scarlet fever, measles, milary fever, and erysipelas, or St. Anthony's fire.

2537. The general character of all these is, that they are contagious, and, as a general rule, attack a person only once in his lifetime; that their chain of diseased actions always begins with fever, and that, after an interval of from one to four days, the fever is followed by an eruption of the skin.

CHICKEN-POX, OR GLASS-POX; AND COW-POX, OR VACCINATION.

2538. CHICKEN-POX, or GLASS-POX, may, in strict propriety, be classed as a mild variety of small-pox, presenting all the mitigated symptoms of that formidable disease. Among many physicians it is, indeed, classed as small-pox, and not a separate disease; but as this is not the place to discuss such questions, and as we profess to give only facts, the result of our own practical experience, we shall treat this affection of glass-pox or chicken-pox, as we ourselves have found it, as a distinct and separate disease.

2539. Chicken-pox is marked by all the febrile symptoms presented by small-pox, with this difference, that, in the case of chicken-pox, each symptom is particularly slight. The heat of body is much less acute, and the principal symptoms are difficulty of breathing, headache, coated tongue, and nausea, which sometimes amounts to vomiting. After a term of general irritability, heat, and restlessness, about the fourth day, or between the third and fourth, an eruption makes its appearance over the face, neck, and body, in its first two stages closely resembling small-pox, with this especial difference, that whereas the pustules in small-pox have flat and depressed centres—an infallible characteristic of small-pox—the pustules in chicken-pox remain globular, while the fluid in them changes from a transparent white to a straw-coloured liquid, which begins to exude and disappear about the eighth or ninth day, and, in mild cases, by the twelfth desquamates, or peels off entirely.

2540. There can be no doubt that chicken-pox, like small-pox, is contagious, and under certain states of the atmosphere becomes endemic. Parents should, therefore, avoid exposing young children to the danger of infection by taking them where it is known to exist, as chicken-pox, in weakly constitutions, or in very young children, may superinduce small-pox, the one disease either running concurrently with the other, or discovering itself as the other declines. This, of course, is a condition that renders the case very hazardous, as the child has to struggle against two diseases at once, or before it has recruited strength from the attack of the first.

2541. Treatment.—In all ordinary cases of chicken-pox—and it is very seldom it assumes any complexity—the whole treatment resolves itself into the use of the warm bath, and a course of gentle aperients. The bath should be used when the oppression of the lungs renders the breathing difficult, or the heat and dryness of the skin, with the undeveloped rash beneath the surface, shows the necessity for its use.

2542. As the pustules in chicken-pox very rarely run to the state of suppuration, as in the other disease, there is no fear of pitting or disfigurement, except in very severe forms, which, however, happen so seldom as not to merit apprehension. When the eruption subsides, however, the face may be washed with elder-flower water, and the routine followed which is prescribed in the convalescent state of small-pox.

2543. COW-POX, properly speaking, is an artificial disease, established in a healthy body as a prophylactic, or preventive agent, against the more serious attack of small-pox, and is merely that chain of slight febrile symptoms and local irritation, consequent on the specific action of the lymph of the vaccination, in its action on the circulating system of the body. This is not the place to speak of the benefits conferred on mankind by the discovery of vaccination, not only as the preserver of the human features from a most loathsome disfigurement, but as a sanitary agent in the prolongation of life.

2544. Fortunately the State has now made it imperative on all parents to have their children vaccinated before, or by the end of, the twelfth week; thus doing away, as far as possible, with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive; for though vaccination has been proved not to be always an infallible guard against small-pox, the attack is always much lighter, should it occur, and is seldom, if indeed ever, fatal after the precaution of vaccination. The best time to vaccinate a child is after the sixth and before the twelfth week, if it is in perfect health, but still earlier if small-pox is prevalent, and any danger exists of the infant taking the disease. It is customary, and always advisable, to give the child a mild aperient powder one or two days before inserting the lymph in the arm; and should measles, scarlet fever, or any other disease arise during the progress of the pustule, the child, when recovered, should be re-vaccinated, and the lymph taken from its arm on no account used for vaccinating purposes.

2545. The disease of cow-pox generally takes twenty days to complete its course; in other words, the maturity and declension of the pustule takes that time to fulfil its several changes. The mode of vaccination is either to insert the matter, or lymph, taken from a healthy child, under the cuticle in several places on both arms, or, which is still better, to make three slight scratches, or abrasions, with a lancet on one arm in this manner, ,,",, and work into the irritated parts the lymph, allowing the arm to dry thoroughly before putting down the infant's sleeve; by this means absorption is insured, and the unnecessary pain of several pustules on both arms avoided. No apparent change is observable by the eye for several days; indeed, not till the fourth, in many cases, is there any evidence of a vesicle; about the fifth day, however, a pink areola, or circle, is observed round one or all of the places, surrounding a small pearly vesicle or bladder. This goes on deepening in hue till the seventh or eighth day, when the vesicle is about an inch in diameter, with a depressed centre; on the ninth the edges are elevated, and the surrounding part hard and inflamed. The disease is now at its height, and the pustule should be opened, if not for the purpose of vaccinating other children, to allow the escape of the lymph, and subdue the inflammatory action. After the twelfth day the centre is covered by a brown scab, and the colour of the swelling becomes darker, gradually declining in hardness and colour till the twentieth, when the scab falls, off, leaving a small pit, or cicatrix, to mark the seat of the disease, and for life prove a certificate of successful vaccination.

2546. In some children the inflammation and swelling of the arm is excessive, and extremely painful, and the fever, about the ninth or tenth day, very high; the pustule, therefore, at that time, should sometimes be opened, the arm fomented every two hours with a warm bread poultice, and an aperient powder given to the infant.

MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH.

Measles.

2547. This much-dreaded disease, which forms the next subject in our series of infantine diseases, and which entails more evils on the health of childhood than any other description of physical suffering to which that age of life is subject, may be considered more an affection of the venous circulation, tending to general and local congestion, attended with a diseased condition of the blood, than either as a fever or an inflammation; and though generally classed before or after scarlet fever, is, in its pathology and treatment, irrespective of its after-consequences, as distinct and opposite as one disease can well be from another.

4548. As we have already observed, measles are always characterized by the running at the nose and eyes, and great oppression of breathing; so, in the mode of treatment, two objects are to be held especially in view; first, to unload the congested state of the lungs,—the cause of the oppressed breathing; and, secondly, to act vigorously, both during the disease and afterwards, on the bowels. At the same time it cannot be too strongly borne in mind, that though the patient in measles should on no account be kept unduly hot, more care than in most infantine complaints should be taken to guard the body from cold, or any abrupt changes of temperature. With these special observations, we shall proceed to give a description of the disease, as recognized by its usual—

2549. Symptoms, which commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, deduction or running at the eyes and nose, nausea, sometimes vomiting, thirst, a furred tongue; the pulse throughout is quick, and sometimes full and soft, at others hard and small, with other indications of an inflammatory nature.

2550. On the third day, small red points make their appearance, first on the face and neck, gradually extending over the upper and lower part of the body. On the fifth day, the vivid red of the eruption changes into a brownish hue; and, in two or three days more, the rash entirely disappears, leaving a loose powdery desquamation on the skin, which rubs off like dandriff. At this stage of the disease a diarrhoea frequently comes on, which, being what is called "critical," should never be checked, unless seriously severe. Measles sometimes assume a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes both doubtful and dangerous. In this condition the eruption comes out sooner, and only in patches; and often, after showing for a few hours, suddenly recedes, presenting, instead of the usual florid red, a dark purple or blackish hue; a dark brown fur forms on the gums and mouth, the breathing becomes laborious, delirium supervenes, and, if unrelieved, is followed by coma; a fetid diarrhoea takes place, and the patient sinks under the congested state of the lungs and the oppressed functions of the brain.

2551. The unfavourable symptoms in measles are a high degree of fever, the excessive heat and dryness of the skin, hurried and short breathing, and a particularly hard pulse. The sequels, or after-consequences, of measles are, croup, bronchitis, mesenteric disease, abscesses behind the ear, ophthalmia, and glandular swellings in other parts of the body.

2552. Treatment.—In the first place, the patient should be kept in a cool room, the temperature of which must be regulated to suit the child's feelings of comfort, and the diet adapted to the strictest principles of abstinence. When the inflammatory symptoms are severe, bleeding, in some form, is often necessary, though, when adopted, it must be in the first stage of the disease; and, if the lungs are the apprehended seat of the inflammation, two or more leeches, according to the age and strength of the patient, must be applied to the upper part of the chest, followed by a small blister; or the blister may be substituted for the leeches, the attendant bearing in mind, that the benefit effected by the blister can always be considerably augmented by plunging the feet into very hot water about a couple of hours after applying the blister, and kept in the water for about two minutes. And let it further be remembered, that this immersion of the feet in hot water may be adopted at any time or stage of the disease; and that, whenever the head or lungs are oppressed, relief will always accrue from its sudden and brief employment. When the symptoms commence with much shivering, and the skin early assumes a hot, dry character, the appearance of the rash will be facilitated, and all the other symptoms rendered milder, if the patient is put into a warm bath, and kept in the water for about three minutes. Or, where that is not convenient, the following process, which will answer quite as well, can be substituted:—Stand the child, naked, in a tub, and, having first prepared several jugs of sufficiently warm water, empty them, in quick succession, over the patient's shoulders and body; immediately wrap in a hot blanket, and put the child to bed till it rouses from the sleep that always follows the effusion or bath. This agent, by lowering the temperature of the skin, and opening the pores, producing a natural perspiration, and unloading the congested state of the lungs, in most cases does away entirely with the necessity both for leeches and a blister. Whether any of these external means have been employed or not, the first internal remedies should commence with a series of aperient powders and a saline mixture, as prescribed in the following formularies; at the same time, as a beverage to quench the thirst, let a quantity of barley-water be made, slightly acidulated by the juice of an orange, and partially sweetened by some sugar-candy; and of which, when properly made and cold, let the patient drink as often as thirst, or the dryness of the mouth, renders necessary.

2553. Aperient Powders.—Take of scammony and jalap, each 24 grains; grey powder and powdered antimony, each 18 grains. Mix and divide into 12 powders, if for a child between two and four years of age; into 8 powders, if for a child between four and eight years of ago; and into 6 powders for between eight and twelve years. One powder to be given, in a little jelly or sugar-and-water, every three or four hours, according to the severity of the symptoms.

2554. Saline Mixture.—Take of mint-water, 6 ounces; powdered nitre, 20 grains; antimonial wine, 3 drachms; spirits of nitre, 2 drachms; syrup of saffron, 2 drachms. Mix. To children under three years, give a teaspoonful every two hours; from that age to six, a dessertspoonful at the same times; and a tablespoonful every three or four hours to children between six and twelve.

2555. The object of these aperient powders is to keep up a steady but gentle action on the bowels; but, whenever it seems necessary to administer a stronger dose, and effect a brisk action on the digestive organs,—a course particularly imperative towards the close of the disease,—two of these powders given at once, according to the age, will be found to produce that effect; that is, two of the twelve for a child under four years, and two of the eight, and two of the six, according to the age of the patient.

2556. When the difficulty of breathing becomes oppressive, as it generally does towards night, a hot bran poultice, laid on the chest, will be always found highly beneficial. The diet throughout must be light, and consist of farinaceous food, such as rice and sago puddings, beef-tea and toast; and not till convalescence sets in should hard or animal food be given.

2557. When measles assume the malignant form, the advice just given must be broken through; food of a nutritious and stimulating character should be at once substituted, and administered in conjunction with wine, and even spirits, and the disease regarded and treated as a case of typhus. But, as this form of measles is not frequent, and, if occurring, hardly likely to be treated without assistance, it is unnecessary to enter on the minutiae of its practice here. What we have prescribed, in almost all cases, will be found sufficient to meet every emergency, without resorting to a multiplicity of agents.

2558. The great point to remember in measles is, not to give up the treatment with the apparent subsidence of the disease, as the after-consequences of measles are too often more serious, and to be more dreaded, than the measles themselves. To guard against this danger, and thoroughly purify the system, after the subsidence of all the symptoms of the disease, a corrective course of medicine, and a regimen of exercise, should be adopted for some weeks after the cure of the disease. To effect this, an active aperient powder should be given every three or four clays, with a daily dose of the subjoined tonic mixture, with as much exercise, by walking, running after a hoop, or other bodily exertion, as the strength of the child and the state of the atmosphere will admit, the patient being, wherever possible, removed to a purer air as soon as convalescence warrants the change.

2559. Tonic Mixture.—Take of infusion of rose-leaves, 6 ounces; quinine, 8 grains; diluted sulphuric acid, 15 drops. Mix. Dose, from half a teaspoonful up to a dessertspoonful, once a day, according to the ago of the patient.

Scarlatina, or Scarlet Fever.

2560. Though professional accuracy has divided this disease into several forms, we shall keep to the one disease most generally mot with, the common or simple scarlet fever, which, in all cases, is characterized by an excessive heat on the skin, sore throat, and a peculiar speckled appearance of the tongue.

2561. Symptoms.—Cold chills, shivering, nausea, thirst, hot skin, quick pulse, with difficulty of swallowing; the tongue is coated, presenting through its fur innumerable specks, the elevated papillae of the tongue, which gives it the speckled character, that, if not the invariable sign of scarlet fever, is only met with in cases closely analogous to that disease. Between the second and __third_ day, but most frequently on the third, a bright red efflorescence breaks out in patches on the face, neck, and back, from which it extends over the trunk and extremities, always showing thicker and deeper in colour wherever there is any pressure, such as the elbows, back, and hips; when the eruption is well out, the skin presents the appearance of a boiled lobster-shell. At first, the skin is smooth, but, as the disease advances, perceptible roughness is apparent, from the elevation of the rash, or, more properly, the pores of the skin. On the fifth and sixth days the eruption begins to decline, and by the eighth has generally entirely disappeared. During the whole of this period, there is, more or less, constant sore throat.

2562. The Treatment of scarlet fever is, in general, very simple. Where the heat is great, and the eruption comes out with difficulty, or recedes as soon as it appears, the body should be sponged with cold vinegar-and-water, or tepid water, as in measles, poured over the chest and body, the patient being, as in that disease, wrapped in a blanket and put to bed, and the same powders and mixture ordered in measles administered, with the addition of a constant hot bran poultice round the throat, which should be continued from the first symptom till a day or two after the declension of the rash. The same low diet and cooling drink, with the same general instructions, are to be obeyed in this as in the former disease.

2563. When the fever runs high in the first stage, and there is much nausea, before employing the effusions of water, give the patient an emetic, of equal, parts of ipecacuanha and antimonial wine, in doses of from a teaspoonful to a tablespoonful, according to age. By these means, nine out of every ten cases of scarlatina may be safely and expeditiously cured, especially if the temperature of the patient's room is kept at an even standard of about sixty degrees.

HOOPING-COUGH, CROUP, AND DIARRHOEA, WITH THEIR MODE OF TREATMENT.

Hooping-Cough.

2564. THIS is purely a spasmodic disease, and is only infectious through the faculty of imitation, a habit that all children are remarkably apt to fall into; and even where adults have contracted hooping-cough, it has been from the same cause, and is as readily accounted for, on the principle of imitation, as that the gaping of one person will excite or predispose a whole party to follow the same spasmodic example. If any one associates for a few days with a person who stammers badly, he will find, when released from his company, that the sequence of his articulation and the fluency of his speech are, for a time, gone; and it will be a matter of constant vigilance, and some difficulty, to overcome the evil of so short an association. The manner in which a number of school-girls will, one after another, fall into a fit on beholding one of their number attacked with epilepsy, must be familiar to many. These several facts lead us to a juster notion of how to treat this spasmodic disease. Every effort should, therefore, be directed, mentally and physically, to break the chain of nervous action, on which the continuance of the cough depends.

2565. Symptoms.—Hooping-cough comes on with a slight oppression of breathing, thirst, quick pulse, hoarseness, and a hard, dry cough. This state may exist without any change from one to two or three weeks before the peculiar feature of the disease-the hoop-sets in. As the characteristics of this cough are known to all, it is unnecessary to enter here, physiologically, on the subject. We shall, therefore, merely remark that the frequent vomiting and bleeding at the mouth or nose are favourable signs, and proceed to the

2566. Treatment, which should consist in keeping up a state of nausea and vomiting. For this purpose, give the child doses of ipecacuanha and antimonial wines, in equal parts, and quantities varying from half to one and a half teaspoonful once a day, or, when the expectoration is hard and difficult of expulsion, giving the following cough mixture every four hours. Take of

  Syrup of squills 1/2 ounce.
  Antimonial wine 1 ounce.
  Laudanum 15 drops.
  Syrup of Toulou 2 drachms.
  Water 1-1/2 ounce.

Mix. The dose is from half a spoonful to a dessertspoonful. When the cough is urgent, the warm bath is to be used, and either one or two leeches applied over the breastbone, or else a small blister laid on the lower part of the throat.

2567. Such is the medical treatment of hooping-cough; but there is a moral regimen, based on the nature of the disease, which should never be omitted. And, on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping, so the like means should be adopted with the hooping-cough patient; and, in the first stage, before the hooping has been added, the parent should endeavour to break the paroxysm of the cough by abruptly attracting the patient's attention, and thus, if possible, preventing the cough from reaching that height when the ingulp of air gives the hoop or crow that marks the disease; but when once that symptom has set in, it becomes still more necessary to endeavour, by even measures of intimidation, to break the spasmodic chain of the cough. Exercise in the open air, when dry, is also requisite, and charge of scene and air in all cases is of absolute necessity, and may be adopted at any stage of the disease.

Croup.

2568. This is by far the most formidable and fatal of all the diseases to which infancy and childhood are liable, and is purely an inflammatory affection, attacking that portion of the mucous membrane lining the windpipe and bronchial tubes, and from the effect of which a false or loose membrane is formed along the windpipe, resembling in appearance the finger of a glove suspended in the passage, and, consequently, terminating the life of the patient by suffocation; for, as the lower end grows together and becomes closed, no air can enter the lungs, and the child dies choked. All dull, fat, and heavy children are peculiarly predisposed to this disease, and those with short necks and who make a wheezing noise in their natural breathing. Croup is always sudden in its attack, and rapid in its career, usually proving fatal within three days; most frequently commences in the night, and generally attacking children between the ages of three and ten years. Mothers should, therefore, be on their guard who have children predisposed to this disease, and immediately resort to the means hereafter advised.

2569. Symptoms.—Languor and restlessness, hoarseness, wheezing, and short, dry cough, with occasional rattling in the throat during sleep, the child often plucking at its throat with its fingers; difficulty of breathing, which quickly becomes hard and laboured, causing great anxiety of the countenance, and the veins of the neck to swell and become knotted; the voice in speaking acquires a sharp, crowing, or croupy sound, while the inspirations have a harsh, metallic intonation. After a few hours, a quantity of thick, ropy mucus is thrown out, hanging about the mouth, and causing suffocating fits of coughing to expel.

2570. Treatment.—Place the child immediately in a hot bath up to the throat; and, on removal from the water, give an emetic of the antimonial or ipecacuanha wine, and, when the vomiting has subsided, lay a long blister down the front of the throat, and administer one of the following powders every twenty minutes to a child from three to six years of age.

2571. Take of calomel, 12 grains; tartar emetic, 2 grains; lump sugar, 30 grains. Mix accurately, and divide into 12 powders. For a child from six to twelve years, divide into 6 powders, and give one every half-hour.

2572. Should the symptoms remain unabated after a few hours, apply one or two leeches to the throat, and put mustard poultices to the foot and thighs, retaining them about eight minutes; and, in extreme cases, a mustard poultice to the spine between the shoulders, and at the same time rub mercurial ointment into the armpits and the angles of the jaws.

2573. Such is a vigorous and reliable system of treatment in severe cases of croup; but, in the milder and more general form, the following abridgment will, in all probability, be all that will be required:—First, the hot bath; second, the emetic; third, a mustard plaster round the throat for five minutes; fourth, the powders; fifth, another emetic in six hours, if needed, and the powders continued without intermission while the urgency of the symptoms continues. When relief has been obtained, these are to be discontinued, and a dose of senna tea given to act on the bowels.

Diarrhoea.

2574. The diarrhoea with which children are so frequently affected, especially in infancy, should demand the nurse's immediate attention, and when the secretion, from its clayey colour, indicates an absence of bile, a powder composed of 3 grains of grey powder and 1 grain of rhubarb, should be given twice, with an interval of four hours between each dose, to a child from one to two years, and, a day or two afterwards, an aperient powder containing the same ingredients and quantities, with the addition of 2 or 3 grains of scammony. For the relaxation consequent on an overloaded stomach, or acidity in the bowels, a little magnesia dissolved in milk should be employed two or three times a day.

2575. When much griping and pain attend the diarrhoea, half a teaspoonful of Dalby's Carminative (the best of all patent medicines) should be given, either with or without a small quantity of castor oil to carry off the exciting cause.

2576. For any form of diarrhoea that, by excessive action, demands a speedy correction, the most efficacious remedy that can be employed in all ages and conditions of childhood is the tincture of Kino, of which from 10 to 30 drops, mixed with a little sugar and water in a spoon, are to be given every two or three hours till the undue action has been checked. Often the change of diet to rice, milk, eggs, or the substitution of animal for vegetable food, or vice versa, will correct an unpleasant and almost chronic state of diarrhoea.

2577. A very excellent carminative powder for flatulent infants may be kept in the house, and employed with advantage, whenever the child is in pain or griped, by dropping 5 grains of oil of aniseed and 2 of peppermint on half an ounce of lump sugar, and rubbing it in a mortar, with a drachm of magnesia, into a fine powder. A small quantity of this may be given in a little water at any time, and always with benefit.

[It hardly needs saying that the very limited remedies available illustrate the state of medical knowledge at this period (1861). Any modern reader who has ever done any research into their family history will have been struck by the high number of miscarriages, stillbirths and infant deaths within their own family tree, and it should perhaps be noted that Isabella Beeton herself  had four children, two of whom died in infancy, and several miscarriages, and she herself died of  puerperal fever in February 1865 at the age of 28. Ed.]

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