741 Tht^ early diagnosis of these conditions will guard the health of the othci" children, because prompt isolation can be ensured. Scarlet fever and measles are, perhaps, the commonest fever rashes, and it is most important that they should be recognised. Scarlet fever may be of a very mild description, with the rash, perhaps, as the only characteristic feature. These cases are just as infectious as the more severe attacks, and a mother should always beware of any red rash which is of a scarlet fever description. Many cases are known of children having a red rash which has hardly been observed in the nursery until the typical " peeling " begins, by which time the infection has probably spread to others. The rash of scarlet fever is made up of minute red points, which generally appear in one or perhaps two days after the beginning of sickness, headache, and sore throat. The red points intend to run together until a uniform red rash may be all over the body. As the rash fades, peeling or desquamation appears, and the skin comes off in shreds for perhaps a few weeks. In scarlet fever the face, body, legs are all affected. In measles, on the other hand, the rash is not scarlet, but rather a dull mottling on the forehead, which gradually spreads downward over the MEDICAL body. The rash consists of crescent patches of a dull red colour, and the face may seem consider- ably swollen. Such a rash is associated with signs of an ordinary cold in the head. When a rash appears in the nursery it should have immediate attention. The mother who manages her children thoughtfully sees the skin of the body once a day, either in the morning or at night. Thus a rash is not allowed to pass unnoticed At its first appearance it is observed, and if at all suspicious a doctor should be called in. The first thing a mother should say to herself is, " What is the cause of this rash ? Is it due to improper feeding, to insect stings, to the irritation of rough clothes, or soaps ?" If to errors in diet, the food of the child must imme<li- ately be altered, and an aperient given. In simple cases simple remedies may be applied by the mother. Calamine lotion is always a safe and soothing application. Zinc ointment and boracic ointment are the best things to use in the nursery for skin blemishes. Unless immediate improvement follows a doctor should be con- sulted. If the child seems " ill," and such symptoms as headache, sickness„or fever appear, no time shoyld be lost in calling in a medical man. WINTER AII^MEHTS BRONCHITIS BRONCHITIS is one of the commonest chest ail- ments which may occur in the nursery. It is an inflammation of the air tubes of the lungs. In its commonest form it affects the large bronchi which are formed by the division of the windpipe in the upper part of the chest. In its more severe form the inflammation may be spread downwards CO the microscopic bronchi of the lungs, pro- ducing what is called capillary bronchitis, or broncho-pneumonia. Delicate or fragile children are more liable to attacks of bronchitis in winter, whilst bronchitis is one of the most common serious ailments which affect rickety children. A common cause of the condition is the spreading downwards of a severe cold from the nose and throat passages, a very usual occurrence during the winter and early spring. Some children seem peculiarly susceptible to bronchial colds, and have attacks of bronchitis regularly whenever the cold weather sets in. Whooping cough and measles are commonly associated with bronchitis, in the sense that bronchitis is an almost inevitable complication of these fevers in the case of delicate children. With care, however, bronchitis in the nursery could be prevented entirely, and it is the greatest mistake any mother can make to think that a child can suffer from several attacks of bronchitis and be none the worse. Every attack weakens the con- stitution and vitality, and makes the child more readily liable to consumption and chronic chest ailments. As a general rule, bronchitis comes on suddenly. The child may show signs of a severe cold, the temperature rises, the breathing is interfered with, and a cough appears. The cough is at first dry, but later becomes moist, and some expectora- tion may be present. Restlessness and discom- fort are sometimes very distressing symptoms, and the face may become livid from interference with breathing. Ordinary bronchitis generally lasts about a week or ten days. The risk of pneu- monia must be carefully guarded against. Other- wise, the illness may last for a long time, and, of course, is more serious than simple bronchitis. Treatment The child must be put to bed at once in a well- ventilated room, with a temperature of 60°. Good nursing is most important, and any careless- ness may have serious results, especially in the case of infants. If the cough is dry, a bronchitis kettle should be used to make the air of the room moist. The great danger with amateurs is that the air is made too moist, so that it is always as well to ask the doctor for definite instructions as to how long the kettle should be kept on the fire, and whether or not he may wish the child's bed to be covered with a tent, with the spout of the kettle inside. General directions as to this cannot very well be given, because the amount of moisture required depends upon the physical signs in the chest and the state of the cough. When a bronchitis kettle is not at hand, an ordinary kettle will do, if an artificial spout is made from a roll of thin cardboard. Poultices are most important, and these must be very well made, and changed frequently whenever they lose tlieir heat, otherwise they will do more harm than good. A linseetl meal poultice is generally used, which is mixed into a firm paste with boiling water. The making of poultices will form the subject of a subsequent article on nursing. It is most important to keep up the strength of the child, especially when he begins to recover, so as to guard against permanent chest weakness. In the early stages milk, beef- tea, gruel, and chicken broths are suitable foods. During convalescence food must be as nourishing as possible. A dose of cod-liver oil and some preparation of malt are advisable. It is only by keeping up the child's general health afterwards that further attacks of bronchitis can be pre- vented. The mother who follows carefully the directions as to child management, diet, hygiene, etc., given in this section will gradually acquire a knowledge of the subject. Thus she will be enabled to prevent bronchitis and all other winter ailments from appearing in her nursery.
