Measles

child, strength, age, bronchitis, patient, care, children, dry, water and useful

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In children under two or three years of age bronchitis is a common complication. Here- the child's previous health is a point of very great importance. One danger in these cases is the occurrence of collapse of the lung, and this is predisposed to by the presence of rickets, or by gen eral weakness of the patient. If the child be the subject of marked rickets, and bronchitis supervene, his chances of recovery are small. Another danger is the tendency of the bronchial inflammation to spread into the finer bronchial tubes and air-vesicles, and give rise to catarrhal pneumonia. The occurrence of this accident greatly increases the gravity of the case ; but if the child be a healthy subject, and the epidemic be a mild one, the chances are in favour of recovery, for in measles catarrhal pneumonia tends to run a subacute course. If, however, the child be weakly, or the case occur in the midst of an epidemic of unusual severity, we should speak very guardedly of his hopes of escape.

Treatment.—In the early stage of measles the treatment is that of a severe cold on the chest. The child must be kept in bed, put upon a diet of milk and broth with dry toast, and take for medicine a saline with some unstimulating expectorants. While the cough is hard and the chest tight, the stimulating expectorants, such as ammonia, squill, and senega, should on no account be made use of, as they increase the tightness of the chest and make secretion more difficult than before. If vomiting be distressing, an emetic may be given to relieve the stomach of unhealthy secretions. Mustard, or sulphate of copper (gr. 4 to gr. 2 every ten minutes), is to be preferred for this purpose, as ipecacuanha has a very irritating effect upon the bowels of some children. If there be diarrhoea, a small dose of castor oil or of rhubarb and soda will be of service at the beginning of the attack ; but the aperient should not be repeated, for in measles the bowels are very susceptible to the action of purgatives. If the diarrhoea continue, a mix ture of aromatic chalk powder and rhubarb, five grains of each, may be given to a child three years of age every night for three nights ; or he may take oxide of zinc with glycerine (two grains three times a day), and either of these will usually arrest the purging. Still a moderate looseness should not be interfered with. It is better not to employ astringent remedies un less the stools are very watery, and threaten by their number to reduce the patient's strength.

The general management of the child must be conducted according to the rules already laid down for the nursing of febrile complaints (see Intro duction). In cases of measles special care should be taken to avoid draughts while insuring free ventilation of the room. A strong light hurts the reddened eyes, so care should be taken to keep the room in a half light, without making it actually dark. Due attention must be paid to cleanli ness. It is not necessary in cases of measles to keep the child dirty. The skin should be cleansed every morning ; using tepid water, and being care ful to wash and dry separately each part of the body, so that the whole surface may not be exposed at one time. The patient may be allowed to take fluid often, but he must be prevented from drinking large quantities at once. The best drink is pure filtered water, and if a small cup or glass be used, the child will be satisfied if allowed to drain it to the bottom.

The condition of the throat usually requires little treatment. A strip of lint wrung out of cold water may be applied closely round the neck, and be covered with oiled silk and flannel. This can be re-wetted as often as

-is necessary. The same application is useful if there be much iuflam mation of the larynx ; and if spasm occur with stridulous breathing, the throat may be fomented by applying below the chin a sponge dipped in water—hot, but not hot enough to scald.

A single convulsion does not require treatment; but if the fits are repeated, the child should be placed for a few minutes in a warm bath and then be returned to his bed. A hot bath is useful if capillary bronchitis or catarrhal pneumonia occur early, and interfere with the development of the rash. If they occur later during the subsidence of the eruption, the child's back should be dry-cupped, or be covered with a large poultice made of one part of mustard to five or six parts of linseed meal. This can be kept in position for eight or ten hours, and afterwards the front of the chest can be poulticed in the same way In cases where the danger is great, the dry cups are to be preferred to the more slowly acting poultice ; and I believe life may be often saved by the timely use of this energetic measure.

Stimulants are not required in ordinary cases of measles, but when the patient is of weakly habit of body or of distinct scrofulous type, or when he is suffering from an unusually severe attack of the disease, it may be necessary to support the strength by alcohol. The brandy-and-egg mix ture of the British Pharmacopoeia is very useful for this purpose, and may be given in such doses as the child's age and condition require. Children —even very young children—who are weakly or prostrated by illness re spond well to stimulants, and can take them in considerable quantities with great advantage. I have often seen an infant of eight or nine months of age greatly benefited by a teaspoonful of brandy-and-egg mixture given every hour Of this quantity a third part is pure brandy. If without the occurrence of any severe complication the patient seems to be getting into a typhoid state, with dry tongue and small rapid pulse, stimulants are urgently needed. Also, the presence of bronchitis or pneumonia will demand a recourse to the same remedy, or the child may sink and die with startling suddenness.

Food must also be given with care and judgment, taking pains not to overload the stomach, but to proportion duly the nourishment, both in quantity and quality, to the age and strength of the child. In all cases of weakness the milk should be diluted with half or a third part of barley water, so as to insure a proper division of the curd. In addition, it may be guarded by.fifteen or twenty drops of the saccharated solution of lime to prevent its turning acid upon the stomach. This must be given in small quantities at regular intervals. Strong beef-tea, or beef-essence made in the house, is also very useful when the strength is failing, but it must be given in very small doses at sufficient intervals. Brandy can be added if necessary.

When the rash begins to fade and the temperature falls, the child, if old enough, may take pounded meat, the yolk of an egg lightly boiled, and a little light pudding.

The chronic sequel must be treated according to the rules laid down in such cases, and the reader is referred to the chapters treating of these subjects. It may only be added that quinine is invariably required at the end of an attack of measles ; and bracing sea-air is very beneficial in has tening the return of health and strength. This is of especial importance in the case of scrofulous children, who will also require cod-liver oil as soon as their stomachs can bear it.

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