THE PARENT's GUIDE IN THE MANAGEMENT of CHILDREN IN THE MEASLES: AND The CARE needful to be taken of them afterwards, to prevent the fatal Consequences of that DISEASE; which carry off Numbers when they are supposed to be recover'd.
CONTAINING Plain DIRECTIONS for their Treatment in the several Stages, and under all Symptoms; and Receipts for the few Medicines needful in this DISTEMPER.
By a PHYSICIAN.
LONDON: Printed for R. DAVIS, in Piccadilly; and M. COOPER, in Pater-noster-Row. 1759.
[Price One Shilling and Six pence.]
DEDICATION TO Doctor SCHOMBERG.
PERMIT me to address this Treatise to your perusal: there needs a Patron whose Name may give the Sanction of Authority to what it contains; and 'tis necessary that Patron should be eminently skillfull and disinterested: To whom then should it be addressed but you?
The Author tho' he seeks no popular Applause; would be proud if the Work be found to merit your Approbation: Whose peculiar Success in the Treatment of this Disease, gives you the highest Right to judge.
The Attempt may perhaps be allowed some Praise, because such a Book is wanted: Parents generally take the Care of Distemper upon themselves; and you very will know low fataly they are deceived when they believe it attended with little Danger. You [Page]who have Benevolence will be pleased to see them inform'd of the necessary Care; and perhaps your Candour may allow some farther merit in the Author for his Attention, to those little Articles, and nice Distinctions, in appropriating, from the Variety of proper Medecines, such as while they serve the general Purpose, will from this Choice, hare a good Effect also on the particular Symptoms, that arise in any Case.
The great Point he has laboured is to explain to Parents the Use and Safety of Bleeding in this Disorder; the Advantages of which, Physicians sufficiently know; tho' there is a vulgar Prepossession against that Practice.
You will pardon the Omission of a Name where no Desire of Reputation has prompted the Undertaking; and permit me to subscribe to this Address, only that I am
THE PARENT's GUIDE FOR THE MANAGEMENT OF THE MEASLES.
The Occasion of this Treatise.
THE misfortune of an honourable family who lost an only child by this disease; perhaps from its unconquerable violence, but as I rather apprehend from a wrong management, has directed my attention to its nature, and the proper treatment. [Page 2]Being removed from the interests of the profession, I may perhaps be thought a fit person to write upon the subject usefully: and I shall be happy if by a fair detail of the circumstances, and the danger, and plain directions for avoiding it, I may be instrumental to the saving some at least of those lives which are lost continually by the consequences of the Measles, when the disease has been thought long over; and those who grieve for them, wonder of what they died.
WHAT I shall attempt is to lay the necessary information before the parents or relations of the diseased. It may be useful also to our apothecaries: whither or no the younger physicians want instruction, in this case, it may not become me to judge: I hope those who do want it will not be above receiving it. But there is a more essential reason why the needful advice should be directed to the parent: this is a disease in which medicines can do very little; and wherein all good is to be expected from a careful management.
IT cannot be deny'd that the lost child to whose dear memory this work is consecrated, had the assistance of respectable physicians; nor could it be overlooked, that while he perished under these skillful hands, the unattended children of the next damp cellar, got through the same disease with perfect safety.
LET it not be inferred from this, that medicines are hurtful, or that care is dangerous: facts should be understood before we reason from them; and the great rule of life is moderation. Some medicines may be useful, but we should know, not only what these are, but when they are to be given; and tho' ill applyed attendance may be destructive; yet there is no disease where a continual and judicious care is more required.
To apply these medicines; and to direct this care, is the design of the present treatise, the sole purpose of which is to be of service to mankind: the God of mercy grant it may be useful.
CHAP. I. Of the nature of the disease.
THE disease called the Measles is an inflammatory fever of a peculiar kind; attended with an eruption over the whole surface of the body; not gathering into pimples, or producing matter as the small pox, but only rising to a small heighth above the level of the skin; with heat, and a high red colour.
THESE eruptions are not consined to the surface of the body: they attack also the internal parts; and particularly the lungs.
THEY usually remain upon the child about four days; sometimes a little longer, sometimes less: and at the end of that time, dying away, the skin seems covered with a skurff like bran. The fever goes off at the same period; and what we distinctly call the Measles is thus at an end: but there are consequences yet behind very dangerous when they are not expected.
THE disease is communicated by infection; and most persons have it once in their lives: but it never attacks any one a second time. 'Tis thought to be originnally native of Africa and to have been carried thence into Aegypt, and from Aegypt into our part of the world: but, however that be, it appears frequently in parts of England, where there is no caus [...] to think it is brought by infection; no [...] can all the care of parents prevent their children from having the disease.
INDEED it would not be their interest to do this, if they could: for those who escape it in their infancy have it at a more advanced period of their lives; and it is then much more dangerous.
THE Measles may break out at any season of the year; but Spring and Autumn are the most usual times; and when the disease once appears in a place it soon spreads: not only because it is catching, but because the same state of the air, [Page 6]which caused it first to break out upon one person, has the like effect on more.
OF the two natural seasons for the Measles the Autumn generally produces the worst kind. An open Spring after a mild winter frequently makes the disease allmost univer [...]al; but it is at no part of the year attended with so little danger.
THE state of infancy is the most natural to this distemper; and the time of life at which it generally goes off best, is from three to four years old. In general infants earlier than this, do not throw out the eruptions so freely; and, when children are at an age to eat stronger food, the inflammation is apt to be greater and the state of the lungs more dangerous. In tender infants the great care is required to manage the time of the eruption; in children more advanced it is the consequences we are to regard most. Nature will generally take care of the eruption; but if great attention be not shewn, afterwards hectic fevers and consumptions follow.
The Measles are always attended with some danger to grown persons; and there are seasons which make them terrible to all ages: in the Autumn of the year 1672, the Measles raged in so universal and terrible a degree in London that they swept off the children like a plague: the Spring of the succeeding year shew'd the disease almost as universally in the country, but less dangerous. In the year 1701, there was such an other severe visitation; but fewer died; for a better method of treatment had been introduced, and particularly the free use of bleeding. Sydenham the oracle of physicians for many years, had not fallen upon this happy expedient; and Moreton who wrote with reputation on this disease, tho' his practice in it was not altogether successful, did not allow this help but in the first stage. The free use of bleeding at any period of the Measles when the symptoms called for it, was the discovery that took off the fatatality of the disease; and this we owe to Dr. Mead. In general those who have the Measles in a [Page 8]good air, get better over them than such as have them in London, and those children naturally are in most danger, which are of the fullest and grossest habits.
THE purpose of this treatise is utility; therefore it will be proper to add, as the result of the foregoing considerations that those parents may think themselves most happy, whose children take this disease in the country, in a mild Spring, when a favourable kind is about; when the age is from two year and a half to four and a half, and the child otherwise healthy and not gross.
WHEN we know what is to be wish'd, the next step is to endeavour to obtain it; and as this disease will probably come on at some time of life, and may be dangerous, I think a parent may wisely go so far toward inoculation in this case, as to take his child into the chamber where some one of a like age and habit has a favable kind.
CHAP. II. The symptoms of the Measles.
WHETHER nature, or the practice just recommended to the parent has brought on the Measles, we are next to consider how it should be treated; but to this end we must firs know the disease, and directly understand its symptoms. This is the more needful to those who have not taken their child into the way of infection, because a certain care is necessary from the first; and the attack cannot be known so early unless this be understood.
It will be useful to consider the disease in three stages; for the symptoms, the danger, and the necessary care differ according to these three periods. We may call them: 1. The attack. 2. The time of the eruption. 3. The decline of the disease.
§. 1. The symptoms of the attack.
THE first attack of the Measles usually comes on at the time of the child's [Page 10]waking in the morning; and this is more or less perceived as the assault is milder or more violent. The child is cross peevish and unwilling to get up; restless; full of uneasy motion; and tossing his head about: and soon after this he begins to cough and sneeze.
WHEN taken up and dressed he complains of his head, the cough grows worse, his eye-lids swell and lo [...]k red, and his nose runs: he is hot and cold by turns; and his eyes water.
AFTER a few hours more he grows drowsy; cannot hold up his head, lies down, cries, and the coughing and sneezing grow more violent. He will then not be easy 'till put to bed; and that is the best place for him. From this time he becomes more drowsy, but the cough interrupts his slumbers: and thus passes the first day.
THE second day his flesh is hotter; his eye-lids are more swell'd and enflam'd, and the tongue is furr'd, but moist; the eyes [Page 11]and nose run more; the breathing grows difficult; and a sickness at the stomach comes on, with a total loss of appetite, and a continual thirst. The sickness increasing the child generally vomits. Sometimes this symptom comes on at the very first attack; sometimes it does not happen at all; this, and other like variations depending on the degree of the disease, and condition of the body Sometimes a slight purging takes the place of the vomiting; and thus closes the first period of the disease.
§. 2. The symptoms of the Eruption.
THE eruption of the Measl [...]s naturally follows the state just described: the fever encreases, and the symptoms of the attack grow stro [...]ger 'till the eruption appears upon the skin; particularly the breath usually grows more difficult. The first appearance of the eruption is in small distinct red spots: they soon encrease in number and [...]igness, joining together, and forming irregular great blotches of an inflam'd [Page 12]colour; which over-spread the breast and face, and afterwards the whole body. These rise a little above the skin, as is easily percieved by drawing the hand gently over them; but they never swell up to any heighth.
THE cough becomes less violent as these eruptions come out; and the breath grows easier; but the swelling of the eye-lids and the running at the nose continue. This is the natural course of the eruption; and this period continues about three days.
§. 3. Of the decline of the disease.
WHEN the Measles have come to their full state of the eruption; they presently begin to decay and die away: the skin is then covered with a scurff where they were; and the disease goes off. This is perceived first on the face; and soon after that in all the rest of the Body.
LET not the parent suppose because the eruption is over, his care is at an end; [Page 13]for this is the time of greatest danger. The cough which had become easier while the Measles were out, now grows more violent; the fever is too apt to encrease at the same time; and the breath to grow more difficult. According to the mildness or violence of the disease these symptoms are greater or less in degree: but 'tis the constant method that they come out thus; and in common cases whether of a milder or severer kind, this is the general course of the disease.
PARTICULAR symptoms will sometimes arise in very bad cases, but of these we shall treat hereafter in considering the worst kind of the disease. In the usual course those which have been recounted are all that appear; and as we have divided the time of the continuance in the distemper into these three regular stages, or periods, it will be easy for the parent to understand the treatment proper in each.
CHAP. III. The management of a child in the first stage of the Measles.
WHEN the first symptoms of an att [...]ck of this disease appear, let the child be taken into his bed chamber, and the room be kept warm but not too hot or close: as long as he is able to keep up, let him; but when the symptoms encrease put him to bed, and let him lie warm, but not sweltered. Let the air of the room be often refreshed by opening the door; but defend the child carefully from the draught that comes in, by closing the curtains on that side.
AS soon as he is in bed let him be blooded in the arm; or back of the hand. The proper quantity is about [...]o [...]r ounces for a child of four years old: but a little more may be spared in gross habits, and in very tender ones, less will answer the intention.
IF he has had one stool that day it is sufficient; if not, it will be necessary to give him a glyster. This should be made of a quarter of a pint of broth of chickens guts, with a spoonful of oil of sweet almonds, a spoonful of powder sugar, and four spoonfulls of milk.
'TIS common to use olive oil in glysters; but it is wrong: there is salt added to all the olive oils before they are sent over; and this tends to irritate, which is not the intention. On such little circumstances as these the life of a child often depends. In the Measles the bowels must be kept open; but yet we are to fear a violent purging. Such a symptom often comes on in the natural course of the disease; and none is more dangerous. To stop it, is to kill the patient; yet if it continues uncheckd it often takes him off in the end; by remaining upon him when the disease is over, and bringing on a fatal decay, attended with an unconquerable hectic fever. This is one of the consequences against which we are to guard, [Page 16]even in the natural course of the Measles; let us therefore be very careful not to give a tendency that way by carelessness, or an ill choice of remedies.
THE child will have no appetite for food; nor will it be proper he should eat any thing. Yet a little nourishment may be given at times by the use of barley-water, with milk. The barley-water should be made of pearl barley; and about one fourth part milk added to it. Twice or three times a day he should have a little of this warm.
THE cough will be troublesome now tho' it will in some degree abate, as the eruption comes out more fully: it may be greatly eased at the present period by a pectoral infusion, and the same medicine properly prepared will also prevent an inflammation on the lungs, and will answer at the same time the needfull purpose of diluting.
TAKE raisins ston'd one ounce, liquorice root bruised a quarter of an ounce, [Page 17]half an ounce of the leaves of white hoarhound fresh gathered; nitre ten grains, and whole linseed a spoonful: put these into a clean stone jar, and pour upon them a quart of boiling water: let it stand covered up two hours, then strain it off without pressing; and let the child take half a tea cup full of it just warm'd once in three hours.
THE leaves of colts foot or scabious, are more commonly used than hoarhound, in pectoral infusions, but this herb is of a nature highly superior to them; it possesses the same virtue of easing a cough that those and the other pectoral herbs have, but it has beside a gentle, yet always prevalent quality of preventing obstructions in the viscera, and particularly of the lungs: there always is inflammation where there is obstruction; and wherever there is inflammation we have also a right to fear obstruction, this is a great danger in the Measles; indeed it is the great object of fear, tho' it do not wear a terrible form thus early. This herb in the pectoral infusion will do more than many medicines to prevent it. If the virtues of english [Page 18]herbs were more regarded, the practice of physick would be much more successful.
WITH these helps, the time from the first attack to the beginning of the eruption will pass without danger. Restlesness and a cough must be expected; but the child will have as much ease as the nature of the case will allow, and the parent may be secure that he is safe.
CHAP. III. The management in the second stage of the Measles.
WHEN the eruption begins to appear, the child must be kept a little warmer than before; but still there must be a free and pure air in the room. The great ca [...]e will now be to make him keep himself cove [...]ed in the bed, to the chin; and there is no way of doing this but by constant attendance: for children cannot be pesuaded; and nothing is worse than to check the eruption. The cough always becomes more violent upon any [Page 19]mismanagement of this kind, and all the troublesome symptoms encrease.
GREAT attention must now be had to the pulse, and to the condition of the bowells. Some degree of fever there must be, and this will raise the pulse; but if it be too full, as well as too quick, probably then another bleeding will be required. 'Tis natural to fear this would check the eruption; the physicians of the last age thought so; and from their practice and writings that opinion became universal: but it is an error. When there is this indication in the pulse, when the cough inencreases, and the breath grows more difficult, the necessity of another bleeding is evident; and instead of the effect of checking the eruptions, they will be seen to come out the fuller and more freely for it.
THE child should continue to have one stool in the day: if he have two there is no harm; but if more than this it is wrong in the other extream; aud some care must be taken on that head. If there have [Page 20]been no stool in the whole day, there must be a glyster given toward evening: this may be the same as before directed.
WITH regard to checking the too large number of stools, a great deal of caution is required; because of the opposite danger: and the first attempt must be to do it, in the course of those medicines which are taken for the cough.
AS the child will be now weaker, and less able to cough up, something will be necessary to ease that symptom beside the pectoral infusion; not that this is to be omitted, for it is a good diluter and has other excellent qualities, but with it must be joined something farther. A great ease and relief may be had at this period by an oily linctus; and nearly equal good by a mucilaginous one with gum tragacanth. One or other of these will be necessary and the condition of the bowells will give the direction which should be used; for the oil will tend to open them; and the [Page 21]mucilaginous one is in some degree of a contrary quality.
THEREFORE if the child have not one stool a day during the time of the eruption, let the following linctus be us'd.
RUB in a marble mortar a quarter of an ounce of loaf sugar to powder, put to this four spoonfulls of oil of sweet almonds and four spoonfulls of syrup of marshmallows, mix them well together, and put this in a cup. Bruise the end of a piece of clean liquorice root 'till it is shaggy like a brush, and let this be dipt into it, and and stirr'd about: some of the linctus will stick to it, which the child will suck off with great pleasure, let him thus take a little of it once in two or three hours, when the cough is most troublesome.
ON the other hand if the stools be more than two in a day, instead of this, make up the following. Take conserve of red roses one ounce, syrup of quinces an ounce and a half, compound powder of gumm [Page 22]tragacanth two scruples: mix these well together, and let this linctus be taken in the same manner as the other. Either of these will ease the cough, and there will be a great advantage in using one or the other, according to the habit of the body.
IN cases where the bowells are in a perfectly good state, a spermaceti emulsion may be given in the place of these. It will have as much power over the cough, and will no way effect the stools: it is made thus.
RUB to powder in a marble mortar three drachms of spermaceti, and the same quantity of treble refin'd sugar, put to these the yolk of an egg, and when they are well mixed add half a pint of common water and three quarters of an ounce of balsamick syrup. Let a spoonful of this be given every three or four hours, always shaking it well together.
IF the body is bound, and the use of the oily linctus do not answer the purpose [Page 23]of keeping up at least one stool a day, recourse must be had to the same glyster as was before directed, and it must be given every evening; for nothing more must be done by medicines. But in the other case, in a tendency to a purging, if the mucilaginous linctus does not take effect we may give hartshorn drink, carefully prepared and in a small quantity: it is to be made thus. Boil an ounce of hartshorn in powder in a quart of spring water for ten minutes; then let it stand to settle, strain it off and add half an ounce of the finest sugar. Let the child take two spoonfulls of this, just warm'd, once in three hours: this with the effect of the mucilaginous linctus, will probably check the disorder of the bowels.
HE must continue taking the pectoral infusion; and if these medicines do not surfficiently answer the purpose, it will be proper to add half a drachm of the gum tragacanth whole, to the other ingredients, the next time that infusion is [Page 24]made. This will not entirely dissolve; but it will greatly help the medecine.
IF the number of stools has weakened the child, he may have a jelly of hartshorn warm'd, and given him a little at a time to recruit his strength; but in the other case of the want of stools, this must not be allowed, nor will it be necessary.
WITH these assistances and a careful attendance, the eruptions will come out regularly, the face and breast will be first cover'd with them, then the back of the hands and the legs: all the time the child will be kept tolerably easy; and the pulse no more raised than is necessary to the good course of the disorder.
IF at any time the eruptions seem to deaden before it has come to the heighth a little more warmth in the room, and a free use of the pectoral infusion warm'd, will bring them out again fresh and full.
NO heating me [...]icines under the name of cordials, or with the mist ken intention of keeping them out, must be allowed: they will not be necessary; and they will certainly do hurt in the end. This caution is needful in all families, because the error is common. Apothecaries are apt to throw in hot medicines under the notion of sweats, and the good women are fond of saffron: both are wrong; they encrease the fever, and the tendency to inflammation, which is the great thing we have to fear: they always make the breathing difficult; and usually encrease the cough.
THE great danger is the distemper falling upon the lungs in its decline, and these he [...]ting medicines give an early tendency to that mischief. If the child be kept from tossing oss the cloaths, those warm diluting things we have ordered, will keep the skin moist; which is all that need be wish'd: and the air of the room may be kept warm enough for this, without stiffling the infant by shutting up all the doors and windows, which making the breathing [Page 26]difficult, will encrease both the cough and inflammation.
THE eyes will run, and the eyelids will swell and look red in this state of the disease it is to be expected: and it will give the child uneasiness whatever we can do: but this will be less, as the management is more careful in other respects; and it may be relieved by frequent washing the eyelids with a mixture, of two parts skim'd milk and one part rose water, made just warm. Thus he will be safely conducted thro' the second stage of the disease.
IN this course there is very little medicine needed, unless in a tendency to some bad symptom; and what are here directed in those cases are perfectly innocent; yet they will be found sufficient. A great deal of care is indeed directed; but why shoud that be refused? the disease is but of short continuance; and a neglect of this attendance during those few days may entail certain misery, or death upon the infant. [Page 27]We are not to suppose the children of the poor escape always, because we see them get safely, as we think, thro' the distemper. They often perish by coughs and hecticks, which are the consequences of the Measles, tho' not known to be so; and few diseases load our hospitals more than the effects of this.
CARE and a continual good management thro' this stage of the distemper is the great security; and let the parent see this care is taken. Children are very engaging to those who are about them, but all natures are not equally capable of tenderness: an affectionate servant to nurse them will be more than all medicines; but we shou'd see often that this attention is really shewn, and this care duly taken.
A nurse properly instructed would be better in this disease then an army of doctors; and if it were the custom to employ such, we should see the deaths from the age of six to nine decrease extremely in our bills of mortality.
CHAP. IV. Of the management of the child in the third stage of the disease.
THE third stage of the Measles which we call the decline, takes in the time from the compleat fullness of the eruption, till its going off from the whole body: This is usually the space of two days. The eruptions upon the face and breast keep out till those upon the legs are fully raised; when they are perfect, the whole body is cov [...]red with the Measles; and they begin immediately after to die away.
LET this period be attentively watched, for it requires care: as the eruption goes off, other symptoms often come on, especially when the disease has been carelesly or ignorantly treated; and these are more dangerous than the first.
THE first sign of the decay of eruptions, or the decline of the disease, is a [Page 29]whitish roughness on the chin and upper lip; then the eruptions upon the cheeks become rough and tade away; and those of the body, legs, and arms, go off next in the same manner.
OBSERVE whether the eyelids continue enflamed after the eruption on the face goe [...] off: if they do, it shews a necessity of immediate bleeding.
THE cough naturally encreases as the eruption goes away; especially when care has been wanting in the course of the disease; and this is another certain indication for immediate bleeding.
IF the breathing grow difficult, it is also an equal notice of the want of that assistance. These symptoms declare the necessity of doing it when the eruptions are dying off: it is always proper to be done after they are all gone: all the difference is that in this case it must be done one day sooner.
WHEN children have been in a good state of body, at the time of the attack, and the disease has been conducted without neglect or error, during the two preceding stages; the eruption goes off without any aggravation of the other symptoms, and the cough will by degrees grow milder. This is a state that should make the parent very happy: but let it not lull him into a false security. Still let the child be blooded: it will never do harm: and it is always necessary; though the necessity be not equally seen. The small remains of the cough will be taken off by one bleeding: which otherwise would have hung upon the child, and would have encreased with the first cold, and entailed great danger.
DURING the two days of the decline of the disease, the same attention must be had to the state of the body as throughout the rest of the illness. For 'tis an inflammation that we principally fear; and a costive habit will greatly tend to bring it on. The [Page 31]contrary danger of a purging succeeding the Measles, is now also to be guarded against with equal care: if the constitution shew that tendency.
LET the parent have in mind these two sources of succeeding mischief. He has been told the Measles are apt to fix in going off, either upon the lungs, or bowels, bringing on in the end a consumption, or a hectic; and let him now take care to avoid the first tendency to either of these diseases. This tendency to one or other of them, always appears in the two days now considered; and great evils are prevented by slight means, if they are apply'd in their beginnings. Now new medecine is needed at this period, except the slight change of oil for sperma ceti, in the linctus; nor any new care: only a choice of the most proper among those easy ones we have before mentioned, and a strict contrinuace of the attention.
ONE or two stools must be expected each of these days, and a choice must be [Page 32]made of the medicines directed in the preceding chapter for that purpose. If the day pa [...]s without a stool, the glyster must be given at night as usual.
To quiet the remainder of the cough after bleeding, a linctus of sperma ceti must be given. It will be as pleasant to the palate as either of the others; and as the taste is soon pall'd with oily medicines, this will be got down e [...]sier because of the variety. It is to be made thu [...]. Rub to powder in a marble mortar a quarter of an ounce of sperma ceti, put to this the yo [...]k of a new laid egg, mix them well, then add one spoonful of oil of sweet almonds, and two spoonfulls of syrup of bals [...]m. Let the ch [...]ld take a teaspoonful of this when ever the cough is troublesome. This is the general medecine to be given in the decline of the Measles; but in case of a purging coming on, it must not be allowed; but recourse must be had to the mucilaginous linctus directed in the preceding chapter.
IF the eyes continue sore, the same mixture of milk and rose water warm must be used frequently, to wash them, and the child must not be placed so as to face a strong light. If they are so bad as to be very painful, a piece of green silk shou'd be contrived to fall over them: and this with frequent gentle washing, will keep them easy 'till the next stage; the necessary management of which will carry off the inflammation entirely.
SOMETIMES the mouth is very sore at this period of the Measles, and in this case a pleasant gargle must be made up of syrup of mulberries and spring water, two spoonfuls of the syrup to a quarter of a pint of the water will be sufficient: the best way of using it is with a small syringe; but if the little patient can be taught to gargle his mouth himself and spit it out again, nothing can do better.
IF the child has not had the thrush before; it will be apt to come on after the [Page 34]Measles, especially if they have been violent. This first appears in a soreness of the mouth, and the parent will know it by the round form of the small sores with their white edges. In this case a violent purging usually follows: therefore the great caution must be in the choice of those medecines directed before, to prevent it. Astringents, or the common medicines for stoping a looseness, would in this be in the highest degree dangerous: bleeding has been declared necessary, in this stage of the disorder; and the sooner it is done upon such an appearance the better. It will go farther toward stoping the purging than any medecine whatsoever; and will make those safe and gentle ones before directed take their effect.
IT will be proper that for these two days of the decline of the disorder, the room be kept somewhat cooler than before; the purer the air is, the less labour have the lungs in breathing, and any obstruction will be apt to create inflammation, [Page 35]in a case where nature has too much tendency that way.
ON the first of these two days it will be proper to give the child a jelly, warmed, and taken a little at a time: on the second, his appetite will begin to return and he may be allowed a bread pudding. Let him be taken out of bed at noon, on the latter of these days; and sit up three or four hours: not longer; for this will refresh him, but more would fatigue him. Let his drink be only the pectoral infusion or the hartshorn decoction, according to the condition of his body; and let the utmost care be taken to put him on a warm dress for the hours he is to be up. Tho' tolerably pure air is necessary for his breathing easily, nothing would be so dangerous as catching cold.
When the child is laid in his bed again, on the evening of the second day of this stage, we may pronounce the Measles to be over: but there are consequences we have nam'd, which may be very terrible, [Page 36]and against which we are now to guard.
CHAP. V. Of the management of a child after the Measles.
THERE is always a tendency in the decline of the Measles to their falling either upon the lungs, or on the bowels. Sometimes this is apparent, and alarming; often it is so slight as to pass unregarded. The danger is more immediate, when the attack upon ei [...]her of these parts is violent; but perhaps it is more fatal when less perceived, because it will be strengthened by neglect. Probably the symptoms will be slight when a child has been treated during the course of the disease, according to r [...]gular method here l [...]id down; but let them not be for that reason over looked. Let not the parent who has preserved him. thro' the distemper, grow negligent of him afterwards: this will be worse than to have neglected him in the begining.
BLEEDING and purging are always necessary after the Measles. If the symptoms have required bleeding in the first and second stage, or in the first and third, this purpose will have been answered; and only the purging will now remain necessary under that head: but if the child has not been blooded at all; or only in the first stage, it is needful to repeat it after the decline.
LET the quantity taken away be about four ounces. The best time in this case, is the day after the disease is over; that is the morning following, the second day of the decline.
THE day following let him take a gentle purge. The most proper is rhubarb, because we are still to have a regard to the danger of a loseness coming on: it will be proper to guard also against those sharp humours, which often fall upon the stomach and bowels after this disease. Therefore let the purge be the following powder. Take powder of rhubarb ten [Page 38]grains, prepared oister shells fix grains, mix this in a little barley water and give it in the morning.
THE dose here directed, is what in general will answer the purpose for a child of the age, at which we have supposed the Measles to have come on; but in this respect there is no rule, but the particular constitution of every one. The quantity of rhubarb must be encreased if this is not found sufficient; or diminished if this prove more powerful than intended: but 'tis likely to err in this dose on the safe side; for it is less rather than more, than will usually be needed. The intent is, that it should give about four stools; and instead of barley water, the child should be allowed with this some very weak thin and clear mutton broth. This purge must be repeated every other, or every third day, according to the infants strength, 'till he has taken three doses.
WHETHER any thing more than this will be absolutely necessary, is not easy [Page 39]to say: probably in the milder cases there will not; but where any symptoms of a disorder of the lungs; when the cough remains; or the breathing is difficult, or when weakness, wasting of flesh, want of appetite, and a lurking fever follow; the country air and asses milk will be required. In all cases where the parents circumstances will permit the expence, these should be used; the seeds of future mischief often lie deep conceal'd, after this disease, and they will be as certain in that case to destroy the child at a distance of time afterwards, as the disorders, brought on immediately with more violent symptoms.
THEREFORE the best course is after he has taken two of the three doses of physick, to remove him into the country; chusing a dry situation and mild clear air.
WITHOUT so much caution the means used to preserve him, might be to themselves destructive; a damp house in the [Page 40]country will give colds as well as in London; and the sharp thin bleak air, of hilly and exposed places, will be too piercing for such a child: it will probably throw him into that hectic, which all the care was taken to avoid.
THE best situation is on arising ground; but not an absolute hill; defended from the north and north east; open to the fouth; and where there is not a great deal of timber growing, nor much standing water.
IN such a place let the child recruit his strength, and get over the last remains of the disease, by a regular diet and due exercise. With respect to food, he must be very slowly brought to butcher's meat: puddings and a little boiled chicken, shou'd be all, for the first eight or ten days: then by degrees broth, carefully made; and afterwards a little at a time, veal or lamb: nothing stronger must be allowed while he is under the course of this regimen.
EVERY morning three quarters of an hour before he gets up, give him a quarter of a pint of asses milk; and the same quantity in the afternoon.
IF the asses milk turns sour upon his stomach, a little prepared oister shell must be given with it, for the first two or three days: and if it has a tendency to run thro' him, and the same powder does not prevent it sufficiently, a little sugar of roses or the conserve, must be mix'd with it, 'till that symptom is over. If the cough continues, which is not likely with this regimen, he may take the sperma ceti emulsion as he did during the illness.
EXERCISE, and the free enjoyment of the sweet air of the country, are essential parts of this method; but the eye of the parent ought to be also there: otherwise much mischief may follow. A change of air takes the immediate effect of giving any person spirits, and children feel this more strongly than grown people: therefore if the little patient be not prevented, [Page 42]he will be apt to use more exercise than is proper.
HE must not be permitted to go out in the morning before the air is warm, and the ground thoroughly dry; nor to remain out 'till the cool and damp of the evening. The middle hours of the day are the wholesome ones; and by the assistance of gentle exercise and the free air of that period, he will presently recover.
A servant, or the parent himself shou'd have him by the hand, all the time he is out for the fist two or three days; for otherewise he will naturally run about, or use too much motion. The lungs are tender after this disease; and violent exercise quickens the breath, and puts them into a kind of convulsion. It must be by degrees they are brought to their strength; not thus disturbed whilst the disease is scarce over.
IN bad days the child must be kept entirely within doors: for once taking cold, [Page 43]will at this critical time spoil all that has been doing. With this care, about three weeks will perfectly restore him.
FOR those who cannot give their children the country air, asses milk should be very regularly given; and all the other cautions here directed, us'd exactly. After this the child may be determined to be perfectly cured; and to have escaped that danger from this disease, which takes off thousands unseen, for one who falls by it openly, and without the knowledge of his relations, that 'tis the Measles which destroy him.
THUS we may close the account of this disease as it usually appears: but particular cases afford peculiar circumstances, and from those arise uncommon symptoms. These we are to describe: for the parent shou'd not be left uninform'd of any thing; much less of those accidents which are less common and more dangerous than the usual appearances.
CHAP. IV. Of a bad kind of the Measles.
THIS is that state of the distemper when it rages with great violence, and is attended with more than usual danger. 'Tis sometimes general, the bad condition of the air occasioning it; sometimes it is occasioned by the particular state of the child We must attend the infant in this case with redoubled care; and watch the rising mis [...]hie [...]s.
CONVULSIONS are alarming symptoms in the Measles: they appear in the latter end of the first stage; when the eruptions shou'd be coming out. Let the parent frequently see his child at this time; sleeping as well as waking; and regard all his little mot [...]ons. Much tossing about shews a struggle of nature, and presages the distemper will be violent; and if there are twitchings▪ and absolute convulsions he must be prepared for worse symptoms.
IF the convulsions are violent, the eruption will not come out kindly 'till they [Page 45]are allayed. At their first appearance let proper medicines be given against them, and of these Tincture of Castor is the best.
MIX together rue water five ounces, syrup of piony flowers six drachms, and tincture of castor a drachm and a half, shake them up, and give too spoonfuls once in three hours; if the convulsed motions do not abate upon this, the addition of a little prepared oister shells will probably give it full effect. The mixture shou'd be made a fresh: and it will be a k [...]nd of pearl julep. To five ounces of rue water, add a quarter of an ounce of the finest sugar, and half a drachm of prepared oister shell with the same quantity of tincture of castor. Let it be taken as the other. All the time let the child be kept warm, and give him frequently some of the pectoral infusion. Probably the convulsions will go off after two or three doses, if he continues in a gentle state of perspiration; and the eruptions will then come out in their proper manner.
A violent purging sometimes rages, from the very beginning of this disease; and encreases hourly, so as to threaten death. This is a nice point to conduct: the means before directed have been naturally [Page 46]us'd, tho' without success; and absolute astringents would be immediate death: the course of the disorder also threatens destruction, as certain though not so sudden. The following decoction is perfectly safe; and yet with due management will prove effectual.
SLICE one ounce of fresh comfry roof, put it into three pints of spring water, add half a drachm of gumm tragacanth whole, half an ounce of burnt hartshorn; and a quarter of an ounce of prepared oister shells: let this boil five or six minutes, then strain it off while hot, thro' a flannel bag: set it to settle, and to the clear liquor, add half an ounce of sugar of roses. It must be given warm two spoonfuls after every stool.
IF this does not check the purging, bleeding at the arm must be repeated; and the child must be kept continually in a state of gentle perspiration. The medicine being then continued will seldom fail to take effect: then let the dose following be lessened, and the use of it left off by degrees. The intent is, to reduce the bowels to a state of affording two stools a day, and not more; and when this decoction once takes effect, it will be easy to bring them to that condition by its regulated use.
THIS disease is not so regular, but that the bad symptoms of one stage, may be shew themselves in another. Convulsions may come on during the time of the eruption; and so may the purging. The same means are to be used, as have been directed already: but there is a symptom in a manner peculiar to the second stage, and more alarming than any, this a difficulty of swallowing and of fetching breath. Children most liable to this, are those of gross habits, and such as have been costive during the first stage.
THEREFORE if the child be of a gross body, let five ounces of blood be taken away instead of four, at the time of the attack; and after this, if a high full pulse, a great quantity and high swelling of the eruptions, and a fiery aspect of the face appear tegether, let the bleeding be repeated on the second day of the eruption, but in a somewhat smaller quantity. The Measles will come out the more kindly, and it will prevent that suffocation which may else be expected toward their height. Two glysters should be given in the four and twenty hours, if nature does nothing that way herself; and a plentiful use of the pectoral infusion must keep the child constantly in a state of gentle perspiration.
IF notwithstanding these precautions, the breath grows more difficult, the face swells, and the eyelids look thick and red, this symptom is certainly to be expected toward the heighth: and it will be necessary to bleed again. There is no other alternative but that or death.
LET no one fear these bleedings: nature shews that she requires them; and the relief they give is like a miracle; for 'tis immediate, and certain. Those who have opposed the bleedings have often been convinced by this, and it would be happy if their example could also convince others.
IN this case more than the usual quantity of blood often is necessary to be taken away; five or six ounces however will at any time be sufficient: the strength of the child, and violence of the symptoms must direct; for there can be no general rule for the quantity; tho' the necessity of doing it, is without exception.
WHEN this frightful symptom is once t ken away, it rarely returns. However, all precautions should be used against such an accident. The bowels must be kept open; and the pectoral infusion drank very plentifully and the child must be kept most carefully from taking cold. If it should return, there [Page 49]will be no possible relief but by the repetition once more of the bleeding. This is far from a desireable thing, therefore let all possible caution be used to prevent the necessity.
AN inflammation of the eyes, as well as eyelids, sometimes appears at the height of the Measles, and becomes not only very painful but dangerous. The same state of the blood which in one child occasions the last nam'd symptoms, will in another bring on this; and therefore the relief must be the same. Bleeding is the certain remedy.
BY the frequent mention here made of bleeding, let not the parent suppose it is ordered to be so very often repeated in any one case. Those who cast a slight eye over these pages may be led to make this mistake, for being the great relief in almost all the bad symptoms, it cannot but have been nam'd under each of these heads. As to the quantity directed to be taken away, that is moderate; and in very mild kinds, once bleeding is sufficient; for being done in time it prevents those symptoms which wou'd otherwise make it necessary afterwards: in cases somewhat worse, twice will be sufficient; this takes away but eight ounces of blood, which a child may spare without hurt, in an inflammatory disorder. In the worst symptoms, a third bleeding may be needful: this is very rarely the case, and I have never seen a necessity for more. To speak with freedom, [Page 50]I never saw an instance wheren three bleedings were necess [...]ry from the absolute violence of the disease; tho' sometimes from ill management.
LET not the parent trifle in this case. All he can do is to put off an operation, which is better done soon; for the same state of the blood which inflames the eyes, at this period, will take a like effect upon the lungs in the decline.
THE fever which preceeded and accompanied the eruptions should go off when they die away, but sometimes it continues afterwards; and becomes of the hectic kind; and then without extreme care the child will be lost. This generally happens when the infant has been unhealthy before, or when the bowels have continued costive during the course of the disease, and bleeding has been omitted. A dry cough and a difficulty of breathing usually attend this fever. Bleeding is again the first requisite; and after this pectoral and balsamick medicines; and the country air. The sperma ceti emulsion, and the pectoral infusion must be continued. The purges should be repeated as the strength will allow; and then asses milk will compleat the cure.
CHAP. VII. Of the use of Opiates in the Measles.
PHYSICIANS are free with Opiates in the Measles: and it may appear singular that in the method of treating the disease [...]ere [...]id down they have been no where [Page 51]nam'd: but in what I have seen of the disease they have not been wanted; and there is reason to think they may be hurtful. I have usualy found this method, prevent those symptoms which opiates are given by others to mitigate; and there are some bad ones which those medicines may bring on. Sydenham supposed opiates necessary; but 'tis to later physicians we owe the true management of this disease. Among these Doctor Mead, the ornament, not of his profession alone, but of his country, deserves the first praise. If opiates ever can be needful, it must be in the latter end of the disease; but even then 'tis best to do without them, if possible. If the cough be violent, and no other method will allay it, a very small dose of an opiate will have a considerable effect: and when a purging can be asswaged by no other means, a few drops of liquid laudanum will probably assist the other medicines. In these extream necessities, I think opiates will do good; but I am perswaded those who shall take timely care, very rarely have occasion to use them.
CHAP. VIII. Of the care of the Eyes after bad kinds of the Measles.
THE eyes and eyelids are always affected by the Measles and in the worst kinds the soreness continues after the disease is over, usually the last bleeding brings them [Page 52]to themselves: or if this fails, they become perfectly well after the first dose of physick.
WHEN they continue sore after this, the cause is a natural weakness: a cold might have brought on the same disorder, therefore it is to be considered independ [...]nttly of the Measles, and the common remedies are to be us'd. The eyes must be defended from the light; and of a long time the child should not be permitted to walk in the sun, or fit facing the windows; and the cure must be compleated by washing the eyes frequently with the following mixture.
PICK off an ounce of the leaves of common Vervain, pour upon them a quart of boiling water; and let this stand all night: then strain off the liquor, and add two spoonfuls of Brandy, warm a little of this and mix with it one third part of skim'd milk. Wash the eyes with it morning and evening. The virtues of this plant deserve to be more regarded: great good is done with it by those who keep it a secret; but much more wou'd follow, if it were known universally.
I HAVE added this case of inflam'd eyes, tho' not a regular consequence of the Measles, yet as a complaint which sometimes follows that disease; being desirous the parent shou'd find here all needful direction, and the child all safety.