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+*** START OF THE PROJECT GUTENBERG EBOOK 10383 ***
+
+THE
+
+MATERNAL MANAGEMENT
+
+OF
+
+CHILDREN,
+
+IN HEALTH AND DISEASE.
+
+
+
+
+By Thomas Bull, M.D.
+
+
+
+
+Physician Accoucheur To The Finsbury Midwifery
+
+Institution, And Lecturer On Midwifery,
+
+And On The Diseases Of Women
+
+And Children;
+
+
+
+Author Of "Hints To Mothers On The
+
+Management Of Their Health."
+
+
+
+
+1840.
+
+
+
+
+PREFACE.
+
+
+
+This little book has been written for the young and inexperienced
+mother. It is intended to furnish her with that information which the
+experience and observation of some years convince the author, young
+mothers, almost without any exception, do not possess; and yet, from
+ignorance of which, the constitution of many an infant has received
+irretrievable injury, and life itself but too frequently fallen a
+sacrifice.
+
+In the first chapters, devoted to the general management of the child
+in health, the author has endeavoured to teach the young mother, that
+the prevention of disease is her province, not its cure; that to this
+object all her best efforts must be directed; and, moreover, that to
+tamper with medicine, when disease has actually commenced, is to hazard
+the life of her offspring.
+
+In the fourth chapter it has been attempted to point out, how the
+first symptoms of disease may be early detected by the parent. The
+subject has been felt to be a difficult one, and to give particular
+directions quite out of the question; but it is hoped that the
+suggestions thrown out will, in some measure, answer the purpose
+intended. On the advantage of an early and prompt application of
+remedies in the diseases of childhood, generally so active in their
+progress and severe in their character, it is unnecessary to offer any
+observation.
+
+The latter part of the work, consisting of the maternal management of
+disease, the author regards as a subject of high and serious moment.
+Small as is the attention which has been hitherto paid to it, yet, in
+the diseases of infancy and childhood, how invaluable is a careful and
+judicious maternal superintendence to give effect to the measures
+prescribed by the physician.
+
+The author has endeavoured to arrange the contents of the work in a
+manner which shall be most easily understood and readily available; and
+he now publishes it with the desire to supply, in some degree, a
+deficiency in this important department of knowledge.
+
+
+
+Finsbury Place, June, 1840.
+
+
+
+
+
+CONTENTS.
+
+
+
+Chapter I.
+
+
+ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
+
+
+
+Sect. - Page
+
+
+
+I. On the Dietetics of Infancy - 2
+
+1. Maternal Nursing - 3
+
+Plan of Suckling - 3
+
+Deficiency of Milk - 11
+
+The injurious Effects to Mother and Infant of undue and protracted
+Suckling - 15
+
+Mothers who ought never to suckle - 20
+
+
+2. Wet-nurse Suckling - 27
+
+Choice of a Wet-nurse - 28
+
+Diet and Regimen of a Wet-nurse - 31
+
+
+3. Artificial Feeding, (bringing up by hand) - 34
+
+The Kind of artificial Food before the sixth Month - 35
+
+The Kind of artificial Food after the sixth Month to the completion of
+first Dentition - 44
+
+The Kind of artificial Food most suitable under the different
+Complaints to which Infants are liable - 48
+
+
+
+II. Weaning - 51
+
+The Time when - 51
+
+The Mode - 52
+
+The drying up of the Mother's Milk - 54
+
+
+
+III. On the Dietetics of Childhood - 54
+
+General Directions, and of animal Food - 55
+
+Sugar - 60
+
+Salt - 61
+
+Fruits - 62
+
+Water - 63
+
+Wine, Beer, and Spirits - 63
+
+
+
+IV. Sleep - 66
+
+During Infancy - 66
+
+During Childhood - 69
+
+
+
+V. Bathing and Cleanliness - 72
+
+During Infancy - 72
+
+During Childhood - 75
+
+
+
+VI. Clothing - 78
+
+During Infancy - 78
+
+During Childhood - 81
+
+
+
+VII. Air and Exercise - 83
+
+In Infancy - 83
+
+In Childhood - 89
+
+
+
+
+Chap. II.
+
+
+ON THE USE AND ABUSE OF CERTAIN REMEDIES.
+
+
+I. Aperient Medicine - 97
+
+Castor Oil - 99
+
+Manna - 101
+
+Magnesia and Rhubarb - 102
+
+The Lavement - 105
+
+The Aperient Liniment - 107
+
+
+
+II. Calomel - 107
+
+
+
+III. Opiates - 110
+
+
+
+IV. Leeching - 113
+
+
+
+V. Blisters and Poultices - 114
+
+
+
+VI. Baths - 117
+
+
+The Cold-water Plunge Bath - 118
+
+Sea Bathing - 120
+
+The Shower Bath - 123
+
+Ablution, or Sponging - 125
+
+The Warm Bath - 188
+
+
+
+
+Chap. III.
+
+
+ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.
+
+
+I. On Teething. - 134
+
+The Manner in which the temporary or milk Teeth appear - 134
+
+The Management of the Infant when Teething is without difficulty - 136
+
+The Management of the Infant in difficult Teething - 139
+
+
+
+II. Hints on the permanent or adult Teeth - 148
+
+The Manner in which they appear - 248
+
+Their Value and Importance - 152
+
+Their Management and Preservation - 154
+
+
+
+
+Chap. IV.
+
+
+HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.
+
+
+I. Signs of Health - 163
+
+
+II. Signs of Disease - 164
+
+Of the Countenance - 165
+
+Of the Gestures - 169
+
+Of the Sleep - 171
+
+Of the Stools - 172
+
+Of the Breathing and Cough - 175
+
+
+
+III. Other Circumstances which will assist in the early Detection of
+Disease - 178
+
+The Influence of the Seasons in producing particular Forms of Disorder
+- 178
+
+The Influence of an hereditary Predisposition to certain Diseases - 179
+
+
+
+
+Chap. V.
+
+
+ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
+
+
+I. Accidents and Diseases which may occur to the Infant at Birth, or
+soon after - 187
+
+
+1. Still-born - 187
+
+2. Injuries received during Birth - 193
+
+3. Retention of Urine - 194
+
+4. Swelling of the Breasts - 195
+
+5. Inflammation of the Eyes - 196
+
+6. Hare-lip - 199
+
+7. Bleeding from the Navel-string - 201
+
+8. Ulceration or imperfect Healing of the Navel - 20l
+
+9. Bleeding from the Navel - 203
+
+10. Jaundice - 204
+
+11. Tongue-tied - 205
+
+12. Moles and Marks on the Skin, etc. - 206
+
+
+
+II. Disorders of the Stomach and Bowels; viz., Indigestion -
+Flatulence - Vomiting - Griping and Looseness - 208
+
+
+1. In the Infant at the Breast - 21O
+
+2. At the period of Weaning - 217
+
+3. In the child brought up by Hand - 221
+
+
+Maternal Treatment - 222
+
+
+
+III. Costiveness - 229
+
+In Infancy - 229
+
+In Childhood - 231
+
+
+
+IV. Worms - 234
+
+Not so frequent as popularly supposed; an error productive of mischief
+- 234
+
+How produced and how best prevented - 237
+
+
+
+V. Scarlet Fever - 239
+
+Mild Form - 239
+
+With Sore Throat - 242
+
+Scarlet Fever compared with Measles - 245
+
+Maternal Management - 246
+
+
+
+VI. Measles - 253
+
+Description - 253
+
+Compared with Scarlet Fever and Small Pox - 255
+
+Maternal Management - 256
+
+
+
+VII. Small-Pox - 262
+
+Natural Small-Pox - 263
+
+Small-Pox in the Vaccinated - 266
+
+Maternal Management - 268
+
+VIII. Hooping Cough - 275
+
+Description - 276
+
+Maternal Management - 279
+
+
+
+IX. Croup - 286
+
+Signs of its Approach - 286
+
+Maternal Management - 289
+
+Its prevention - 289
+
+
+
+X. Water in the Head - 291
+
+Its Prevention - 292
+
+Maternal Management - 298
+
+
+
+
+
+THE MATERNAL MANAGEMENT OF CHILDREN.
+
+
+
+Chapter I.
+
+
+
+ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
+
+
+
+The line of demarcation made between infancy and childhood, both by
+ancient and modern writers, has always been arbitrary. I would draw the
+line between the two, at a period of time which appears to me to be the
+most natural, the most simple, and least likely to lead the reader into
+the danger of misapplying any part of the practical directions of this,
+or any future chapter of the work. We will consider, then, that--
+
+Infancy, commencing with birth, extends to about the end of the second
+year, when the first dentition is completed.
+
+Childhood extends from about the second, to the seventh or eighth
+year, when the second dentition is commenced.
+
+
+
+Sect. I. DIETETICS OF INFANCY.
+
+
+
+In the early months of infancy the organs of digestion are unsuited to
+any other food than that derived from the breast of the mother. So
+little capable are they, indeed, to digest any other, even of the
+blandest and most digestible kind, that probably not more than one
+infant in six or seven ever arrives at the more advanced periods of
+life when deprived of the kind of nourishment nature intended for this
+epoch.
+
+It is not every parent, however, who is able to become a nurse; and
+with many this office would not only be highly injurious to their own
+health, but materially so to that of their offspring. This may arise
+from various causes, hereafter to be noticed, but whenever they exist a
+wet-nurse is demanded.
+
+Again, the latter resource is not always attainable, so that the
+hazardous experiment of an artificial diet, or bringing up by hand, as
+it is then termed, is obliged to be resorted to.
+
+Thus, infantile dietetics naturally divides itself into Maternal
+Nursing, Wet-Nurse Suckling, And Artificial Feeding.
+
+
+
+1. MATERNAL NURSING.
+
+PLAN OF SUCKLING.
+
+
+
+From the first moment the infant is applied to the breast, it must be
+nursed upon a certain plan. This is necessary to the well-doing of the
+child, and will contribute essentially to preserve the health of the
+parent, who will thus be rendered a good nurse, and her duty at the
+same time will become a pleasure.
+
+This implies, however, a careful attention on the part of the mother
+to her own health; for that of her child is essentially dependent upon
+it. Healthy, nourishing, and digestible milk can be procured only from
+a healthy parent; and it is against common sense to expect that, if a
+mother impairs her health and digestion by improper diet, neglect
+of exercise, and impure air, she can, nevertheless, provide as
+wholesome and uncontaminated a fluid for her child, as if she were
+diligently attentive to these important points. Every instance of
+indisposition in the nurse is liable to affect the infant.
+
+And this leads me to observe, that it is a common mistake to suppose
+that, because a woman is nursing, she ought therefore to live very
+fully, and to add an allowance of wine, porter, or other fermented
+liquor, to her usual diet. The only result of this plan is, to cause an
+unnatural degree of fulness in the system, which places the nurse on
+the brink of disease, and which of itself frequently puts a stop to the
+secretion of the milk, instead of increasing it. The right plan of
+proceeding is plain enough; only let attention be paid to the ordinary
+laws of health, and the mother, if she have a sound constitution, will
+make a better nurse than by any foolish deviation founded on ignorance
+and caprice.
+
+The following case proves the correctness of this statement:--
+
+A young married lady, confined with her first child, left the lying-in-
+room at the expiration of the third week, a good nurse, and in perfect
+health. She had had some slight trouble with her nipples, but this was
+soon overcome.
+
+The porter system was now commenced, and from a pint to a pint and a
+half of this beverage was taken in the four and twenty hours. This was
+resorted to, not because there was any deficiency in the supply of
+milk, for it was ample, and the infant thriving upon it; but because,
+having become a nurse, she was told that it was usual and necessary,
+and that without it her milk and strength would ere long fail.
+
+After this plan had been followed for a few days, the mother became
+drowsy and disposed to sleep in the daytime; and headach, thirst, a hot
+skin, in fact, fever supervened; the milk diminished in quantity, and,
+for the first time, the stomach and bowels of the infant became
+disordered. The porter was ordered to be left off; remedial measures
+were prescribed; and all symptoms, both in parent and child, were after
+a while removed, and health restored.
+
+Having been accustomed, prior to becoming a mother, to take a glass or
+two of wine, and occasionally a tumbler of table beer, she was advised
+to follow precisely her former dietetic plan, but with the addition of
+half a pint of barley-milk morning and night. Both parent and child
+continued in excellent health during the remaining period of suckling,
+and the latter did not taste artificial food until the ninth month, the
+parent's milk being all-sufficient for its wants.
+
+No one can doubt that the porter was in this case the source of the
+mischief. The patient had gone into the lying-in-room in full health,
+had had a good time, and came out from her chamber (comparatively) as
+strong as she entered it. Her constitution had not been previously worn
+down by repeated child-bearing and nursing, she had an ample supply of
+milk, and was fully capable, therefore, of performing the duties which
+now devolved upon her, without resorting to any unusual stimulant or
+support. Her previous habits were totally at variance with the plan
+which was adopted; her system became too full, disease was produced,
+and the result experienced was nothing more than what might be expected.
+
+The plan to be followed for the first six months.-Until the breast-
+milk is fully established, which may not be until the second or third
+day subsequent to delivery (almost invariably so in a first
+confinement), the infant must be fed upon a little thin gruel, or upon
+one third water and two thirds milk, sweetened with loaf sugar.
+
+After this time it must obtain its nourishment from the breast alone,
+and for a week or ten days the appetite of the infant must be the
+mother's guide, as to the frequency in offering the breast. The stomach
+at birth is feeble, and as yet unaccustomed to food; its wants,
+therefore, are easily satisfied, but they are frequently renewed. An
+interval, however, sufficient for digesting the little swallowed, is
+obtained before the appetite again revives, and a fresh supply is
+demanded.
+
+At the expiration of a week or so it is essentially necessary, and
+with some children this may be done with safety from the first day of
+suckling, to nurse the infant at regular intervals of three or four
+hours, day and night. This allows sufficient time for each meal to be
+digested, and tends to keep the bowels of the child in order. Such
+regularity, moreover, will do much to obviate fretfulness, and that
+constant cry, which seems as if it could be allayed only by constantly
+putting the child to the breast. A young mother very frequently runs
+into a serious error in this particular, considering every expression
+of uneasiness as an indication of appetite, and whenever the infant
+cries offering it the breast, although ten minutes may not have elapsed
+since its last meal. This is an injurious and even dangerous practice,
+for, by overloading the stomach, the food remains undigested, the
+child's bowels are always out of order, it soon becomes restless and
+feverish, and is, perhaps, eventually lost; when, by simply attending
+to the above rules of nursing, the infant might have become healthy and
+vigorous.
+
+For the same reason, the infant that sleeps with its parent must not
+be allowed to have the nipple remaining in its mouth all night. If
+nursed as suggested, it will be found to awaken, as the hour for its
+meal approaches, with great regularity. In reference to night-nursing,
+I would suggest suckling the babe as late as ten o'clock p. m., and not
+putting it to the breast again until five o'clock the next morning.
+Many mothers have adopted this hint, with great advantage to their own
+health, and without the slightest detriment to that of the child. With
+the latter it soon becomes a habit; to induce it, however, it must be
+taught early.
+
+The foregoing plan, and without variation, must be pursued to the
+sixth month.
+
+
+AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a
+large supply of good and nourishing milk, and her child is healthy and
+evidently flourishing upon it, no change in its diet ought to be made.
+If otherwise, however, (and this will but too frequently be the case,
+even before the sixth month[FN#1],) the child may be fed twice in the
+course of the day, and that kind of food chosen which, after a little
+trial, is found to agree best.
+
+
+
+[FN#1]  See Deficiency of Milk, p. 11.
+
+
+
+Leman's tops and bottoms, steeped in hot water, with the addition of a
+little fresh milk, and sweetened or not with loaf sugar, is one of the
+best description.
+
+If the stomach reject this, farinaceous food boiled in water, and
+mixed with a small quantity of milk, may be employed. Or weak mutton or
+veal broth, or beef tea, clear and free from fat, and mixed with an
+equal quantity of farinaceous food.
+
+If this artificial diet is used before the sixth month, it must be
+given through the sucking-bottle; after this period with a spoon: in
+either case it must be previously passed through a sieve.
+
+When the large or grinding teeth have appeared, the same food is still
+to be continued, but need not any longer be expressed through the sieve.
+
+Such is the plan of nursing to be followed by the mother until she
+wean her infant altogether from the breast. The period when this ought
+to take place, as also the manner of accomplishing it, are detailed
+in the section on "Weaning."[FN#2]
+
+
+
+[FN#2]  See page 51.
+
+
+
+The diet from weaning to the termination of infancy is pointed out
+under "Artificial Feeding."[FN#3]
+
+
+
+[FN#3]  See page 34.
+
+
+
+DEFICIENCY OF MILK.
+
+
+
+If this deficiency exist from the earliest weeks after delivery, and
+it is not quickly remedied by the means presently to be pointed out, a
+wet-nurse must be obtained. It will be of no avail partially to nurse,
+and partially to feed the infant at this period and under such
+circumstances, for if it is not soon lost, it will only live for a few
+months, or a year at most, and be an object of the greatest anxiety and
+grief to its parent. This condition arises from the unwholesomeness of
+the mother's milk, united with the artificial food; for when the milk
+is deficient from the first, and continues so notwithstanding the means
+used for its increase, it is invariably unhealthy in its quality.
+
+This deficiency, however, may exist, and even at a very early period
+after delivery, and yet be removed. This, however, is not to be
+accomplished by the means too frequently resorted to; for it is the
+custom with many, two or three weeks after their confinement, if the
+supply of nourishment for the infant is scanty, to partake largely of
+malt liquor for its increase. Sooner or later this will be found
+injurious to the constitution of the mother: but how, then, is this
+deficiency to be obviated? Let the nurse keep but in good health, and
+this point gained, the milk, both as to quantity and quality, will be
+as ample, nutritious, and good, as can be produced by the individual.
+
+I would recommend a plain, generous, and nutritious diet; not one
+description of food exclusively, but, as is natural, a wholesome,
+mixed, animal, and vegetable diet, with or without wine or malt liquor,
+according to former habit; and, occasionally, where malt liquor has
+never been previously taken, a pint of good sound ale may be taken
+daily with advantage, if it agree with the stomach. Regular exercise in
+the open air is of the greatest importance, as it has an extraordinary
+influence in promoting the secretion of healthy milk. Early after
+leaving the lying-in room, carriage exercise, where it can be
+obtained, is to be preferred, to be exchanged, in a week or so, for
+horse exercise, or the daily walk. The tepid, or cold salt-water shower
+bath, should be used every morning; but if it cannot be borne, sponging
+the body withsalt-water must be substituted.
+
+By adopting with perseverance the foregoing plan, a breast of milk
+will be obtained as ample in quantity, and good in quality, as the
+constitution of the parent can produce, as the following case proves:
+
+On the 17th September, 1839, I attended a lady twenty-four years of
+age, a delicate, but healthy woman, in her first confinement. The
+labour was good. Every thing went on well for the first week, except
+that, although the breasts became enlarged, and promised a good supply
+of nourishment for the infant, at its close there was merely a little
+oozing from the nipple. During the next fortnight a slight, but very
+gradual increase in quantity took place, so that a dessert spoonful
+only was obtained about the middle of this period, and perhaps double
+this quantity at its expiration. In the mean time the child was
+necessarily fed upon an artificial diet, and as a consequence its
+bowels became deranged, and a severe diarrhoea followed. A wet-nurse
+was advised for the child as the only means of saving its life, and
+change of air for the mother as the most likely expedient (in
+connection with the general treatment pointed out above) for obtaining
+a good breast of milk. Accordingly, on the 5th October, the patient,
+taking with her the infant and a wet-nurse, went a few miles from town.
+
+For three or four days it was a question whether the little one would
+live, for so greatly had it been reduced by the looseness of the bowels
+that it had not strength to grasp the nipple of its nurse; the milk,
+therefore, was obliged to be drawn, and the child fed with it from a
+spoon. After the lapse of a few days, however, it could obtain the
+breast-milk for itself; and, to make short of the case, on the 25th of
+the same month, the mother and child returned home, the former having a
+very fair proportion of healthy milk in her bosom, and the child
+perfectly recovered and evidently thriving fast upon it.
+
+Where, however, there has been an early deficiency in the supply of
+nourishment, it will most frequently happen that, before the sixth or
+seventh month, the infant's demands will be greater than the mother can
+meet. The deficiency must be made up by artificial food, which must be
+of a kind generally employed before the sixth month, and given through
+the bottle. If, however, this plan of dieting should disagree, the
+child must, even at this period, have a wet-nurse.
+
+Women who marry comparatively late in life, and bear children,
+generally have a deficiency of milk after the second or third month:
+artificial feeding must in part be here resorted to.
+
+
+
+THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED
+SUCKLING.
+
+
+
+UPON THE MOTHER.--The period of suckling is generally one of the most
+healthy of a woman's life. But there are exceptions to this as a
+general rule; and nursing, instead of being accompanied by health, may
+be the cause of its being materially, and even fatally, impaired. This
+may arise out of one of two causes, either, a parent continuing to
+suckle too long; or, from the original powers or strength not being
+equal to the continued drain on the system.
+
+Examples of the first class I am meeting with daily. I refer to poor
+married women, who, having nursed their infants eighteen months, two
+years, or even longer than this, from the belief that by so doing they
+will prevent pregnancy, call to consult me with an exhausted frame and
+disordered general health, arising solely from protracted nursing,
+pursued from the above mistaken notion.
+
+I most frequently meet with examples of the second class in the
+delicate woman, who, having had two or three children in quick
+succession, her health has given way, so that she has all the symptoms
+arising from undue suckling, when perhaps the infant at her breast is
+not more than two or three months old.
+
+Since the health of the mother, then, will suffer materially from this
+circumstance, she ought not to be ignorant of the fact; so that, when
+the first symptoms manifest themselves, she may be able to recognise
+their insidious approach; and tracing them to their real cause, obtain
+medical advice before her health be seriously impaired.
+
+
+SYMPTOMS.--The earliest symptom is a dragging sensation in the back
+when the child is in the act of sucking, and an exhausted feeling of
+sinking and emptiness at the pit of the stomach afterwards. This is
+soon followed by loss of appetite, costive bowels, and pain on the left
+side; then, the head will be more or less affected, sometimes with much
+throbbing, singing in the ears, and always some degree of giddiness,
+with great depression of spirits.
+
+Soon the chest becomes affected, and the breathing is short,
+accompanied by a dry cough and palpitation of the heart upon the
+slightest exertion. As the disease advances, the countenance becomes
+very pale, and the flesh wastes, and profuse night perspirations, great
+debility, swelling of the ankles, and nervousness ensue. It is
+unnecessary, however, to enter into a more full detail of symptoms.
+
+
+TREATMENT.--All that it will be useful to say in reference to
+treatment, is this; that, although much may be done in the first
+instance by medicine, change of air, cold and sea bathing, yet the
+quickest and most effectual remedy is to wean the child, and thus
+remove the cause.
+
+
+THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful
+reason why the child should be weaned, or rather, have a young and
+healthy wet-nurse, if practicable. The effects upon the infant, suckled
+under such circumstances, will be most serious. Born in perfect health,
+it will now begin to fall off in its appearance, for the mother's milk
+will be no longer competent to afford it due nourishment; it will be
+inadequate in quantity and quality. Its countenance, therefore, will
+become pale; its look sickly and aged; the flesh soft and flabby; the
+limbs emaciated; the belly, in some cases, large, in others, shrunk;
+and the evacuations fetid and unnatural; and in a very few weeks, the
+blooming healthy child will be changed into the pale, sickly, peevish,
+wasted creature, whose life appears hardly desirable.
+
+The only measure that can save the life, and recover an infant from
+this state, is that which would previously have prevented it a healthy
+wet-nurse.
+
+If the effects upon the infant should not be so aggravated as those
+just described, and it subsequently live and thrive, there will be a
+tendency in such a constitution to scrofula and consumption, to
+manifest itself at some future period of life, undoubtedly acquired
+from the parent, and dependent upon the impaired state of her health at
+the time of its suckling. A wet-nurse early resorted to, will prevent
+this.
+
+It will be naturally asked, for how long a period a mother ought to
+perform the office of a nurse? No specific time can be mentioned, and
+the only way in which the question can be met is this: no woman, with
+advantage to her own health, can suckle her infant beyond twelve or
+eighteen months; and at various periods between the third and twelfth
+month, many women will be obliged partially or entirely to resign the
+office.[FN#4]
+
+
+
+[FN#4]  See "Weaning," p. 51.
+
+
+
+The monthly periods generally reappear from the twelfth to the
+fourteenth month from delivery; and when established, as the milk is
+found invariably to diminish in quantity, and also to deteriorate in
+quality, and the child is but imperfectly nourished, it is positively
+necessary in such instances at once to wean it.
+
+
+
+OF MOTHERS WHO OUGHT NEVER TO SUCKLE.
+
+
+
+There are some females who ought never to undertake the office of
+suckling, both on account of their own health, and also that of their
+offspring.
+
+
+THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the
+infant born of such a parent there will be a constitutional
+predisposition to the same disease; and, if it is nourished from her
+system, this hereditary predisposition will be confirmed.
+
+"No fact in medicine is better established than that which proves the
+hereditary transmission from parents to children of a constitutional
+liability to pulmonary disease, and especially to consumption; yet no
+condition is less attended to in forming matrimonial engagements. The
+children of scrofulous and consumptive parents are generally
+precocious, and their minds being early matured, they engage early in
+the business of life, and often enter the married state before their
+bodily frame has had time to consolidate. For a few years every thing
+seems to go on prosperously, and a numerous family gathers around them.
+All at once, however, even while youth remains, their physical powers
+begin to give way, and they drop prematurely into the grave, exhausted
+by consumption, and leaving children behind them, destined, in all
+probability, either to be cut off as they approach maturity, or to run
+through the same delusive but fatal career as that of the parents from
+whom they derived their existence."[FN#5] There is scarcely an
+individual who reads these facts, to whom memory will not furnish some
+sad and mournful example of their truth; though they perhaps may have
+hitherto been in ignorance of the exciting cause.
+
+
+
+[FN#5]  Combe's Principles of Physiology applied to the Preservation of
+Health, etc.
+
+
+
+It is, however, with the mother as a nurse that I have now to do, and
+I would earnestly advise every one of a consumptive or strumous habit
+(and if there is any doubt upon this point, the opinion of a medical
+adviser will at once decide it) never to suckle her offspring; her
+constitution renders her unfit for the task. And, however painful it
+may be to her mind at every confinement to debar herself this
+delightful duty, she must recollect that it will be far better for her
+own health, and infinitely more so for that of the child, that she
+should not even attempt it; that her own health would be injured, and
+her infant's, sooner or later, destroyed by it.
+
+The infant of a consumptive parent, however, must not be brought up by
+hand. It must have a young, healthy, and vigorous wet-nurse; and in
+selecting a woman for this important duty very great care must be
+observed.[FN#6] The child should be nursed until it is twelve or fifteen
+months old. In some cases it will be right to continue it until the
+first set of teeth have appeared, when it will be desirable that a
+fresh wet-nurse should be obtained for the last six months.[FN#7] If
+the child is partially fed during the latter months (from
+necessity or any other cause), the food should be of the lightest
+quality, and constitute but a small proportion of its nutriment.
+
+
+
+[FN#6]  See "Choice of a Wet-nurse," p. 28.
+
+[FN#7]  One that has been confined about six weeks or two months.
+
+
+
+But not only must the nourishment of such a child be regarded, but the
+air it breathes, and the exercise that is given to it; as also, the
+careful removal of all functional derangements as they occur, by a
+timely application to the medical attendant, and maintaining,
+especially, a healthy condition of the digestive organs. All these
+points must be strictly followed out, if any good is to be effected.
+
+By a rigid attention to these measures the mother adopts the surest
+antidote, indirectly, to overcome the constitutional predisposition to
+that disease, the seeds of which, if not inherited from the parent,
+are but too frequently developed in the infant during the period of
+nursing; and, at the same time, she takes the best means to engender a
+sound and healthy constitution in her child. This, surely, is worth any
+sacrifice.
+
+If the infant derives the disposition to a strumous constitution
+entirely from the father, and the mother's health be unexceptionable,
+then I would strongly advise her to suckle her own child.
+
+
+THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There
+are other women who ought never to become nurses. The mother of a
+highly nervous temperament, who is alarmed at any accidental change she
+may happen to notice in her infant's countenance, who is excited and
+agitated by the ordinary occurrences of the day; such a parent will do
+her offspring more harm than good by attempting to suckle it. Her milk
+will be totally unfit for its nourishment: at one time it will be
+deficient in quantity, at another, so depraved in its quality, that
+serious disturbance to the infant's health, will ensue. The young and
+inexperienced mother, who is a parent for the first time, and
+altogether ignorant of the duties of her office, and at the same time
+most anxious to fulfil them faithfully, is but too frequently an
+instance in point; although at a future period she will generally make
+a good nurse. The following is an illustration:--
+
+In December, 1838, I attended a young married lady in her first
+confinement, and in excellent health. She gave birth to a fine, plump,
+healthy boy. Every thing went on well for three weeks, the mother
+having an abundant supply of milk, and the infant evidently thriving
+upon it. About this time, however, the child had frequent fits of
+crying; the bowels became obstinately costive;--the motions being
+lumpy, of a mixed colour, quite dry, and passed with great pain. It
+became rapidly thin, and after a while its flesh so wasted, and became
+so flabby, that it might be said literally to hang on the bones. The
+fits of crying now increased in frequency and violence, coming on every
+time after the little one left the breast, when it would commence
+screaming violently, beat the air with its hands and feet, and nothing
+that was done could appease it. Having lasted for half an hour or more,
+it would fall asleep quite exhausted; the fit recurring again, when
+again it had been to the breast.
+
+It was very evident that the infant's hunger was not satisfied, as it
+was also but too evident its body was not nourished by the parent's
+milk, which, although abundant in quantity (the breast being large and
+full of milk), was at this time seriously deteriorated in its nutritive
+quality. This was caused, I believe, from great anxiety of mind. Her
+nurse became suddenly deranged, and the whole responsibility and care
+of the child thus devolved upon the mother, of the duties connected
+with which she was entirely ignorant.
+
+A wet-nurse was obtained. In a very few hours after this change was
+effected, the screaming ceased, the child had quiet and refreshing
+sleep, and in twelve hours a healthy motion was passed. The child
+gained flesh almost as quickly as it had previously lost it, and is now
+as fine and healthy an infant as it promised to be when born.
+
+Whenever there has existed previously any nervous or mental affection
+in the parent, wet-nurse suckling is always advisable; this, with
+judicious management of childhood, will do much to counteract the
+hereditary predisposition.
+
+
+THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE
+OUGHT NOT.--The mother who cannot make up her mind exclusively to
+devote herself to the duties of a nurse, and give up all engagements
+that would interfere with her health, and so with the formation of
+healthy milk, and with the regular and stated periods of nursing her
+infant, ought never to suckle. It is unnecessary to say why; but I
+think it right, for the child's sake, to add, that if it does not
+sicken, pine, and die, disease will be generated in its constitution,
+to manifest itself at some future period.
+
+The child, then, under all the foregoing circumstances, must be
+provided with its support from another source, and a wet-nurse is the
+best.
+
+
+
+2. WET-NURSE SUCKLING.
+
+
+
+Ill health and many other circumstances may prevent a parent from
+suckling her child, and render a wet-nurse necessary. Now, although she
+will do wisely to leave the choice of one to her medical attendant,
+still, as some difficulty may attend this, and as most certainly the
+mother herself ought to be acquainted with the principal points to
+which his attention is directed in the selection of a good nurse, it
+will be well to point out in what they consist.
+
+
+
+CHOICE OF A WET-NURSE.
+
+
+
+The first thing to which a medical man looks, is the general health of
+the woman; next, the condition of her breast, the quality of her milk
+its age and her own; whether she is ever unwell while nursing; and,
+last of all, the condition and health of the child.
+
+
+IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the
+marks of a sound constitution, and ought to be free from all suspicion
+of a strumous character; her tongue clean, and digestion good; her
+teeth and gums sound and perfect; her skin free from eruption, and her
+breath sweet.
+
+
+WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and
+well formed; its size not dependent upon a large quantity of fat, which
+will generally take away from its firmness, giving it a flabby
+appearance, but upon its glandular structure, which conveys to the
+touch a knotted, irregular, and hard feel; and the nipple must be
+perfect, of moderate size, but well developed.
+
+
+WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish-
+white colour; sweet to the taste; and when allowed to stand, should
+throw up a considerable quantity of cream.
+
+
+WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely
+expired, the wet-nurse to be hired ought certainly not to have reached
+her second month. At this time, the nearer the birth of the child, and
+the delivery of its foster-parent, the better: the reason for which
+is, that during the first few weeks the milk is thinner and more watery
+than it afterwards becomes. If, consequently, a new-born infant be
+provided with a nurse, who has been delivered three or four months, the
+natural relation between its stomach and the quality of the milk is
+destroyed, and the infant suffers from the oppression of food too heavy
+for its digestive power.
+
+On the other hand, if you are seeking a wet-nurse for an infant of
+four or five months old, it would be very prejudicial to transfer the
+child to a woman recently delivered; the milk would be too watery for
+its support, and its health in consequence would give way.
+
+
+THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from
+twenty-one to thirty admits of no question. And the woman who has had
+one or two children before is always to be preferred, as she will be
+likely to have more milk, and may also be supposed to have acquired
+some experience in the management of infants.
+
+
+INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her
+at once. You will have no difficulty in ascertaining this point; for
+this class of persons have an idea that their milk is renewed, as they
+term it, by this circumstance, monthly; and, therefore, that it is a
+recommendation, rendering their milk fitter for younger children than
+it would otherwise have been. It produces, however, quite a contrary
+effect; it much impairs the milk, which will be found to disagree with
+the child, rendering it at first fretful,--after a time being vomited
+up, and productive of frequent watery dark green motions.
+
+
+Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the
+sprightly appearance of health, to bear the marks of being well
+nourished, its flesh firm, its skin clean and free from eruptions. It
+should be examined in this respect, particularly about the head, neck,
+and gums.
+
+If a medical man finds that both mother and child answer to the above
+description, he has no hesitation in recommending the former as likely
+to prove a good wet-nurse.
+
+
+
+DIET AND REGIMEN OF A WET-NURSE.
+
+
+
+The regimen of a wet-nurse should not differ much from that to which
+she has been accustomed; and any change which it may be necessary to
+make in it should be gradual. It is erroneous to suppose that women
+when nursing require to be much more highly fed than at other times: a
+good nurse does not need this, and a bad one will not be the better for
+it. The quantity which many nurses eat and drink, and the indolent life
+which they too often lead, have the effect of deranging their digestive
+organs, and frequently induce a state of febrile excitement, which
+always diminishes, and even sometimes altogether disperses, the milk.
+
+It will be necessary then to guard against the nurse overloading her
+stomach with a mass of indigestible food and drink. She should live as
+much as possible in the manner to which she has been accustomed; she
+should have a wholesome, mixed, animal and vegetable diet, and a
+moderate and somewhat extra quantity of malt liquor, provided it agree
+with her system.
+
+A very prevailing notion exists that porter tends to produce a great
+flow of milk, and in consequence the wet-nurse is allowed as much as
+she likes; a large quantity is in this way taken, and after a short
+time so much febrile action excited in the system, that instead of
+increasing the flow of milk, it diminishes it greatly. Some parents,
+however, aware of this fact, will go into an opposite extreme, and
+refuse the nurse even that which is necessary. Either excess is of
+course wrong. It is difficult in general terms to say what ought to be
+considered a proper daily allowance, but some is in general necessary;
+and whenever a woman has been used to drink malt-liquor, she will
+rarely make a good wet-nurse if she is denied a reasonable quantity of
+that beverage. Good sound ale sometimes agrees better than porter. It
+may be well here to remark, that in London, I frequently meet with
+severe cases of diarrhoea in infants at the breast, fairly traceable to
+bad porter, which vitiating the quality of the milk, no medical
+treatment cures the disease, until this beverage is left off or
+changed, when it at once disappears.
+
+The nurse should take exercise daily in the open air. Nothing tends
+more directly to maintain a good supply of healthy milk, than air and
+exercise; and the best wet-nurse would soon lose her milk, if
+constantly kept within doors. Sponging the whole body also with cold
+water with bay-salt in it every morning, should be insisted upon, if
+possible: it preserves cleanliness, and greatly invigorates the health.
+United with this, the nurse should rise early, and also be regularly
+employed during the day in some little portion of duty in the family, an
+attendance upon the wants of the child not being alone sufficient.
+
+An amiable disposition and good temper are very desirable. A violent
+fit of passion may exert so peculiar an influence in changing the
+natural properties of the milk, that a child has been known to be
+attacked with a fit of convulsions after being suckled by a nurse while
+labouring under the effects of a fit of anger. The depressing passions
+frequently drive the milk away altogether. It is hence of no small
+moment, that a wet-nurse be of a quiet and even temper, and not
+disposed to mental disturbance.
+
+
+
+3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.
+
+
+
+Extreme delicacy of constitution, diseased condition of the frame,
+defective secretion of milk, and other causes, may forbid the mother
+suckling her child; and unless she can perform this office with safety
+to herself, and benefit to her infant, she ought not to attempt it. In
+this case a young and healthy wet-nurse is the best substitute; but
+even this resource is not always attainable. Under these circumstances,
+the child must be brought up on an artificial diet "by hand,"--as it is
+popularly called.
+
+To accomplish this with success requires the most careful attention on
+the part of the parent, and at all times is attended with risk to the
+life of the child; for although some children, thus reared, live and
+have sound health, these are exceptions to the general rule, artificial
+feeding being in most instances unsuccessful.
+
+
+
+THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.
+
+
+
+It should be as like the breast-milk as possible. This is obtained by
+a mixture of cow's milk, water, and sugar, in the following
+proportions:--
+
+
+Fresh cow's milk, two thirds;
+Boiling water, or thin barley water, one third;
+Loaf sugar, a sufficient quantity to sweeten.
+
+
+This is the best diet that can be used for the first six months, after
+which some farinaceous food may be combined.
+
+In early infancy, mothers are too much in the habit of giving thick
+gruel, panada, biscuit-powder, and such matters, thinking that a diet
+of a lighter kind will not nourish. This is a mistake; for these
+preparations are much too solid; they overload the stomach, and cause
+indigestion, flatulence, and griping. These create a necessity for
+purgative medicines and carminatives, which again weaken digestion,
+and, by unnatural irritation, perpetuate the evils which render them
+necessary. Thus many infants are kept in a continual round of
+repletion, indigestion, and purging, with the administration of
+cordials and narcotics, who, if their diet were in quantity and quality
+suited to their digestive powers, would need no aid from physic or
+physicians.
+
+In preparing this diet, it is highly important to obtain pure milk,
+not previously skimmed, or mixed with water; and in warm weather just
+taken from the cow. It should not be mixed with the water or sugar
+until wanted, and not more made than will be taken by the child at the
+time, for it must be prepared fresh at every meal. It is best not to
+heat the milk over the fire, but let the water be in a boiling state
+when mixed with it, and thus given to the infant tepid or lukewarm.
+
+As the infant advances in age, the proportion of milk may be gradually
+increased; this is necessary after the second month, when three parts
+of milk to one of water may be allowed. But there must be no change in
+the kind of diet if the health of the child is good, and its appearance
+perceptibly improving. Nothing is more absurd than the notion, that in
+early life children require a variety of food; only one kind of food is
+prepared by nature, and it is impossible to transgress this law without
+marked injury.
+
+If cow's milk disagree with an infant--and this is sometimes
+unfortunately the case, even from its birth ass's milk,--diluted with
+one third its quantity of water, may be given as a substitute. I am now
+attending a lady in her fourth confinement, who is unable, from defect
+in her nipples, to suckle her children. The first child had a healthy
+wet-nurse, and has grown a fine healthy lad. The second, a girl, was
+unfortunate in her nurse, she being of a strumous and unhealthy
+constitution, although to a casual observer bearing the appearance of
+health. The child lived only three months, and the nurse died of a
+rapid consumption shortly after. This discouraged the mother from
+adopting wet-nurse suckling for the third child (a great error); and an
+artificial diet of cow's milk was resorted to. The third day from
+commencing this plan, flatulence, griping, purging, and vomiting came
+on, one symptom quickly following the other; the child wasted, and on
+the sixth day had several convulsive fits. The diet was immediately
+changed for ass's milk, and in less than twelve hours the sickness and
+purging ceased; the flatulence was relieved; the motions, from being
+green, watery, and passed with great violence and pain, became of a
+healthy consistence and colour, and the screaming ceased. The symptoms
+did not return, the child thrived, very soon consuming regularly one
+quart of the ass's milk daily, and is now a fine healthy girl two years
+old. A fortnight since the parent was confined with a fourth child.
+Cow's milk was given to it for two or three days (from the difficulty
+of obtaining that of the ass), the same train of symptoms, precisely,
+came on with which the third child had been affected, which again gave
+way upon following up the same plan of diet--the substitution of the
+ass's milk for that of the cow. The evident conclusion from this is,
+that the breast-milk of a healthy woman is incomparably the most
+suitable diet for the infant; but that, if she be not of a healthy
+constitution, it may be destructive to the child; and that where this
+cannot be obtained, and cow's milk is found to disagree, ass's milk may
+sometimes be resorted to with the happiest results.[FN#8]
+
+
+
+[FN#8]  An infant will generally consume a quart, or a little more, of
+ass's milk in the four and twenty hours; and as this quantity is
+nearly as much as the animal will give, it is best to purchase an ass
+for the express purpose. The foal must be separated from the mother,
+and the forage of the latter carefully attended to, or the milk will
+disagree with the child.
+
+
+
+Sometimes the mother's breast, and every description of milk, is
+rejected by the child; in which case recourse must be had to veal or
+weak mutton broth, or beef tea, clear and free from fat, mixed with a
+very small quantity of farinaceous food, carefully passed through a
+sieve before it is poured into the sucking-bottle.
+
+
+THE MODE OF ADMINISTERING IT.--There are two ways--by the spoon, and by
+the nursing-bottle. The first ought never to be employed at this
+period, inasmuch as the power of digestion in infants is very weak,
+and their food is designed by nature to be taken very slowly into the
+stomach, being procured from the breast by the act of sucking, in which
+act a great quantity of saliva is secreted, and being poured into the
+mouth, mixes with the milk, and is swallowed with it. This process of
+nature, then, should be emulated as far as possible; and food (for this
+purpose) should be imbibed by suction from a nursing-bottle: it is thus
+obtained slowly, and the suction employed secures the mixture of a due
+quantity of saliva, which has a highly important influence on digestion.
+
+Too much care cannot be taken to keep the bottle perfectly sweet. For
+this purpose there should always be two in the nursery, to be used
+alternately; and, if any food remain after a meal, it must be emptied
+out. The bottle must always be scalded out after use. The flat glass
+nursing-bottle itself is too well known to need description; it may be
+well, however, to say a word about the teat that covers its narrow
+neck, and through which the infant sucks the food. If the artificial
+or prepared cow's teat is made use of, it should be so attached to the
+bottle that its extremity does not extend beyond its apex more than
+half or three quarters of an inch; for if it projects more than this,
+the child will get the sides of the teat so firmly pressed together
+between its gums, that there will be no channel for the milk to flow
+through. This remark applies equally to the teat made of soft wash-
+leather, which many ladies prefer to that of the cow, and it is a good
+substitute; but then a fresh piece of leather must be made use of
+daily, otherwise the food will be tainted, and the child's bowels
+deranged. It is also necessary that both of these, when used, should
+have a small conical piece of sponge inclosed.
+
+The most cleanly and convenient apparatus is a cork nipple, upon the
+plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork,
+being of a particularly fine texture, is supple and elastic, yielding
+to the infant's lips while sucking, and is much more durable than the
+teats ordinarily used.
+
+
+
+[FN#9]  Sold by Weiss et Son, 62. Strand,
+
+
+
+Whatever kind of bottle or teat is used, however, it must never be
+forgotten that cleanliness is absolutely essential to the success of
+this plan of rearing children.
+
+
+THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.--This must be regulated
+by the age of the child, and its digestive power. A little experience
+will soon enable a careful and observing mother to determine this
+point.--As the child grows older the quantity of course must be
+increased.
+
+The chief error in rearing the young is overfeeding; and a most
+serious one it is; but which may be easily avoided by the parent
+pursuing a systematic plan with regard to the hours of feeding, and
+then only yielding to the indications of appetite, and administering
+the food slowly, in small quantities at a time. This is the only way
+effectually to prevent indigestion, and bowel complaints, and the
+irritable condition of the nervous system, so common in infancy, and
+secure to the infant healthy nutrition, and consequent strength of
+constitution. As has been well observed, "Nature never intended the
+infant's stomach to be converted into a receptacle for laxatives,
+carminatives, antacids, stimulants, and astringents; and when these
+become necessary, we may rest assured that there is something faulty in
+our management, however perfect it may seem to ourselves."
+
+
+THE FREQUENCY OF GIVING FOOD.--This must be determined, as a general
+rule, by allowing such an interval between each meal as will insure the
+digestion of the previous quantity; and this may be fixed at about
+every three or four hours. If this rule be departed from, and the child
+receives a fresh supply of food every hour or so, time will not be
+given for the digestion of the previous quantity, and as a consequence
+of this process being interrupted, the food passing on into the bowel
+undigested, will there ferment and become sour, will inevitably produce
+cholic and purging, and in no way contribute to the nourishment of the
+child.
+
+
+THE POSTURE OF THE CHILD WHEN FED.--It is important to attend to this.
+It must not receive its meals lying; the head should be raised on the
+nurse's arm, the most natural position, and one in which there will be
+no danger of the food going the wrong way, as it is called. After each
+meal the little one should be put into its cot, or repose on its
+mother's knee, for at least half an hour. This is essential for the
+process of digestion, as exercise is important at other times for the
+promotion of health.
+
+
+
+THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION
+OF FIRST DENTITION.
+
+
+
+As soon as the child has got any teeth,--and about this period one or
+two will make their appearance,--solid farinaceous matter boiled in
+water, beaten through a sieve, and mixed with a small quantity of milk,
+may be employed. Or tops and bottoms, steeped in hot water, with the
+addition of fresh milk and loaf sugar to sweeten. And the child may
+now, for the first time, be fed with a spoon.
+
+When one or two of the large grinding teeth have appeared, the same
+food may be continued, but need not be passed through a sieve. Beef tea
+and chicken broth may occasionally be added; and, as an introduction to
+the use of a more completely animal diet, a portion, now and then, of a
+soft boiled egg; by and by a small bread pudding, made with one egg in
+it, may be taken as the dinner meal.
+
+Nothing is more common than for parents during this period to give
+their children animal food. This is a great error. "To feed an infant
+with animal food before it has teeth proper for masticating it, shows a
+total disregard to the plain indications of nature, in withholding such
+teeth till the system requires their assistance to masticate solid
+food. And the method of grating and pounding meat, as a substitute for
+chewing, may be well suited to the toothless octogenarian, whose
+stomach is capable of digesting it; but the stomach of a young child is
+not adapted to the digestion of such food, and will be disordered by
+it."[FN#10]
+
+
+
+[FN#10]  Sir James Clarke on Consumption.
+
+
+
+"If the principles already laid down be true, it cannot reasonably be
+maintained that a child's mouth without teeth, and that of an adult,
+furnished with the teeth of carnivorous and graminivorous animals, are
+designed by the Creator for the same sort of food. If the mastication
+of solid food, whether animal or vegetable, and a due admixture of
+saliva, be necessary for digestion, then solid food cannot be proper,
+when there is no power of mastication. If it is swallowed in large
+masses it cannot be masticated at all, and will have but a small chance
+of being digested; and in an undigested state it will prove injurious
+to the stomach and to the other organs concerned in digestion, by
+forming unnatural compounds. The practice of giving solid food to a
+toothless child, is not less absurd, than to expect corn to be ground
+where there is no apparatus for grinding it. That which would be
+considered as an evidence of idiotism or insanity in the last instance,
+is defended and practised in the former. If, on the other hand, to
+obviate this evil, the solid matter, whether animal or vegetable, be
+previously broken into small masses, the infant will instantly swallow
+it, but it will be unmixed with saliva. Yet in every day's observation
+it will be seen, that children are so fed in their most tender age; and
+it is not wonderful that present evils are by this means produced, and
+the foundation laid for future disease."[FN#11]
+
+
+
+[FN#11]  Dr. John Clarke's Commentaries.
+
+
+
+The diet pointed out, then, is to be continued until the second year.
+Great care, however, is necessary in its management; for this period of
+infancy is ushered in by the process of teething, which is commonly
+connected with more or less of disorder of the system. Any error,
+therefore, in diet or regimen is now to be most carefully avoided. 'Tis
+true that the infant, who is of a sound and healthy constitution, in
+whom, therefore, the powers of life are energetic, and who up to this
+time has been nursed upon the breast of its parent, and now commences
+an artificial diet for the first time, disorder is scarcely
+perceptible, unless from the operation of very efficient causes. Not
+so, however, with the child who from the first hour of its birth has
+been nourished upon artificial food. Teething under such circumstances
+is always attended with more or less of disturbance of the frame, and
+disease of the most dangerous character but too frequently ensues. It
+is at this age, too, that all infectious and eruptive fevers are most
+prevalent; worms often begin to form, and diarrhoea, thrush, rickets,
+cutaneous eruptions, etc. manifest themselves, and the foundation of
+strumous disease is originated or developed. A judicious management of
+diet will prevent some of these complaints, and mitigate the violence
+of others when they occur.
+
+
+
+THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT
+COMPLAINTS TO WHICH INFANTS ARE LIABLE.
+
+
+
+Artificial food, from mismanagement and other causes, will now and
+then disagree with the infant. The stomach and bowels are thus
+deranged, and medicine is resorted to, and again and again the same
+thing occurs.
+
+This is wrong, and but too frequently productive of serious and
+lasting mischief. Alteration of diet, rather than the exhibition of
+medicine, should, under these circumstances, be relied on for remedying
+the evil. Calomel, and such like remedies, "the little powders of the
+nursery," ought not to be given on every trivial occasion. More
+mischief has been effected, and more positive disease produced, by the
+indiscriminate use of the above powerful drug, either alone or in
+combination with other drastic purgatives, than would be credited.
+Purgative medicines ought at all times to be exhibited with caution to
+an infant, for so delicate and susceptible is the structure of its
+alimentary canal, that disease is but too frequently caused by that
+which was resorted to in the first instance as a remedy. The bowels
+should always be kept free; but then it must be by the mildest and
+least irritating means.
+
+It is a very desirable thing, then, to correct the disordered
+conditions of the digestive organs of an infant, if possible, without
+medicine; and much may be done by changing the nature, and sometimes
+by simply diminishing the quantity, of food.
+
+A diarrhoea, or looseness of the bowels, may frequently be checked by
+giving, as the diet, sago thoroughly boiled in very weak beef-tea, with
+the addition of a little milk. The same purpose is frequently to be
+answered by two thirds of arrow-root with one third of milk, or simply
+thin arrow-root made with water only; or, if these fail, baked flour,
+mixed with boiled milk.
+
+Costiveness of the bowels may frequently be removed by changing the
+food to tops and bottoms steeped in hot water, and a small quantity of
+milk added, or prepared barley,--mixed in warm water and unboiled milk.
+
+Flatulence and griping generally arise from an undue quantity of food,
+which passing undigested into the bowels, they are thus irritated and
+disturbed. This may be cured by abstinence alone. The same state of
+things may be caused by the food not being prepared fresh at every
+meal, or even from the nursing-bottle or vessel in which the food is
+given not having been perfectly clean. In this case weak chicken-broth,
+or beef-tea freed from fat, and thickened with soft boiled rice or
+arrow-root, may be given.
+
+
+
+Sect. II. WEANING.
+
+
+
+THE TIME WHEN TO TAKE PLACE.--The time when weaning is to take place
+must ever depend upon a variety of circumstances, which will regulate
+this matter, independently of any general rule that might be laid down.
+The mother's health may, in one case, oblige her to resort to weaning
+before the sixth month, and, in another instance, the delicacy of the
+infant's health, to delay it beyond the twelfth. Nevertheless, as a
+general rule, both child and parent being in good health, weaning ought
+never to take place earlier than the ninth (the most usual date), and
+never delayed beyond the twelfth month.
+
+I should say further, that if child and parent are both in vigorous
+health, if the infant has cut several of its teeth, and been already
+accustomed to be partially fed, weaning ought to be gradually
+accomplished at the ninth month. On the other hand, that if the child
+is feeble in constitution, the teeth late in appearing, and the mother
+is healthy, and has a sufficient supply of good milk, especially if it
+be the autumnal season, it will be far better to prolong the nursing
+for a few months. In such a case, the fact of the on-appearance of the
+teeth indicates an unfitness of the system for any other than the
+natural food from the maternal breast.
+
+And again, if the infant is born of a consumptive parent, and a
+healthy and vigorous wet-nurse has been provided, weaning should most
+certainly be deferred beyond the usual time, carefully watching,
+however, that neither nurse nor child suffer from its continuance.
+
+
+THE MODE.--It should be effected gradually. From the sixth month most
+children are fed twice or oftener in the four-and-twenty hours; the
+infant is in fact, therefore, from this time in the progress of
+weaning; that is to say, its natural diet is partly changed for an
+artificial one, so that when the time for complete weaning arrives, it
+will be easily accomplished, without suffering to the mother, or much
+denial to the child.
+
+It is, however, of the greatest importance to regulate the quantity
+and quality of the food at this time. If too much food is given (and
+this is the great danger) the stomach will be overloaded, the digestive
+powers destroyed, and if the child is not carried off suddenly by
+convulsions, its bowels will become obstinately disordered; it will
+fall away from not being nourished, and perhaps eventually become a
+sacrifice to the overanxious desire of the parent and its friends to
+promote its welfare.
+
+The kind of food proper for this period, and the mode of administering
+it, is detailed in the previous section, on "Artificial Feeding."[FN#12]
+
+
+
+[FN#12]  The kind of food after the sixth month to the completion of
+first dentition, p. 44.
+
+
+
+Much exercise in the open air (whenever there is no dampness of
+atmosphere) is highly necessary and beneficial at this time; it tends
+to invigorate the system, and strengthens the digestive organs, and
+thus enables the latter to bear without injury the alteration in diet.
+
+
+THE DRYING UP OF THE MOTHER'S MILK.--This will generally be attended
+with no difficulty. When the weaning is effected gradually, the milk
+will usually go away of itself without any measures being resorted to.
+If, however, the breasts should continue loaded, or indeed painfully
+distended, a gentle aperient should be taken every morning, so that the
+bowels are kept slightly relaxed; the diet must be diminished in
+quantity, and solid nourishment only taken. The breast, if painfully
+distended, must be occasionally drawn, but only just sufficiently to
+relieve the distention. In either case they must be rubbed for five or
+ten minutes, every four or five hours, with the following liniment,
+previously warmed:--
+
+Compound soap liniment, one ounce and a half;
+Laudanum, three drachms.
+
+
+
+Sect. III. DIETETICS OF CHILDHOOD.
+
+
+
+Childhood, as has been before intimated, extends from about the second
+to the seventh or eighth year, when the second dentition is commenced.
+
+No precise rules of diet can be laid down for this period, as this
+requires to be adapted in every case to the particular constitution
+concerned. There are, however, certain general principles which must be
+acted upon, and which can be easily modified by a judicious and
+observant parent, as circumstances and constitution may require.
+
+
+GENERAL DIRECTIONS, AND OF ANIMAL FOOD.--The diet of the latter months
+of infancy is still to be continued, but with the important addition of
+animal food, which the child has now got teeth to masticate. This must
+be given in small quantity; it should be of the lightest quality, only
+allowed on alternate days, and even then its effects must be carefully
+watched, as all changes in the regimen of children should be gradual.
+
+A child at this age, then, should have its meals at intervals of about
+four hours:--thus its breakfast between seven and eight o'clock, to
+consist of tops and bottoms, steeped in hot water, a little milk added,
+and the whole sweetened with sugar; or bread may be softened in hot
+water, the latter drained off, and fresh milk and sugar added to the
+bread. Its dinner about twelve o'clock, to consist, every other day, of
+a small quantity of animal food (chicken, fresh mutton, or beef, being
+the only meats allowed) with a little bread and water; on the alternate
+days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow-
+root pudding, containing one egg; or farinaceous food, with beef-tea.
+Its afternoon mealy about four o'clock, the same diet as formed the
+breakfast. At seven, a little arrow-root, made with a very small
+proportion of milk, or a biscuit, or crust of bread, after which the
+child should be put to bed.
+
+The child must be taught to take its food slowly, retain it in it's
+mouth long, and swallow it tardily. Nothing must be given in the
+intervals of the meals. The stomach requires a period of repose after
+the labour of digestion; and if the child is entertained by its nurse,
+and its mind occupied, there will be no difficulty in following out
+this important direction.
+
+As the child grows older, the quantity at each meal should be
+increased; the tops and bottoms changed for bread and pure milk, boiled
+or not; meat may be taken daily, except circumstances forbid it; and a
+small quantity of vegetable also.
+
+If a child, then, be of a sound constitution, with healthy bowels, a
+cool skin, and clean tongue, the diet may be liberal, and provided it
+is sufficiently advanced in age, animal food may be taken daily. Too
+low a diet would stint the growth of such a child, and induce a state
+of body deficient in vigour, and unfit for maintaining full health:
+scrofula and other diseases would be induced. At the same time let the
+mother guard against pampering, for this would lead to evils no less
+formidable, though of a different character. And as long as the general
+health of this child is unimpaired, the body and mind active, and no
+evidence present to mark excess of nutriment, this diet may be
+continued. But if languor at any time ensue, fever become manifested,
+the skin hotter than natural, the tongue white and furred, and the
+bowels irregular, then, though these symptoms should bebonly in slight
+degree, and unattended with any specific derangement amounting to what
+is considered disease, not only should the parent lower the diet, and
+for a time withdraw the animal part, but the medical adviser should be
+consulted, that measures may be taken to correct the state of repletion
+which has been suffered to arise. For some time after its removal, care
+should also be taken to keep the diet under that, which occasioned the
+constitutional disturbance.
+
+But if the child be of a delicate and weakly constitution (and this is
+unfortunately the more common case), it will not bear so generous a
+diet as the foregoing. During the three or four earliest years, it
+should be restricted chiefly to a mild farinaceous diet, with a small
+allowance only of meat on alternate days. The constant endeavour of the
+parent now should be, to seek to increase the digestive power and
+bodily vigour of her child by frequent exercise in the open air, and by
+attention to those general points of management detailed in the after-
+part of this chapter. This accomplished, a greater proportion of animal
+food may be given, and, in fact, will become necessary for the growth
+of the system, while at the same time there will be a corresponding
+power for its assimilation and digestion.
+
+A great error in the dietetic management of such children is but too
+frequently committed by parents. They suppose that because their child
+is weakly and delicate, that the more animal food it takes the more it
+will be strengthened, and they therefore give animal food too early,
+and in too great quantity. It only adds to its debility. The system, as
+a consequence, becomes excited, nutrition is impeded, and disease
+produced, ultimately manifesting itself in scrofula, disease in the
+abdomen, head, or chest. The first seeds of consumption are but too
+frequently originated in this way. A child so indulged will eat
+heartily enough, but he remains thin notwithstanding. After a time he
+will have frequent fever, will appear heated and flushed towards
+evening, when he will drink greedily, and more than is usual in
+children of the same age; there will be deranged condition of the
+bowels, and headach,--the child will soon become peevish, irritable, and
+impatient; it will entirely lose the good humour so natural to
+childhood, and that there is something wrong will be evident enough,
+the parent, however, little suspecting the real cause and occasion of
+all the evil. In such a child, too, it will be found that the ordinary
+diseases of infancy, scarlet fever, measles, small pox, etc., will be
+attended with an unusual degree of constitutional disturbance; that it
+will not bear such active treatment as other children, or so quickly
+rally from the illness.
+
+"Strength is to be obtained not from the kind of food which contains
+most nourishment in itself, but from that which is best adapted to the
+condition of the digestive organs at the time when it is taken."
+
+
+SUGAR.--This is a necessary condiment for the food of children, and it
+is nutritious, and does not injure the teeth, as is generally imagined.
+"During the sugar season," observes Dr. Dunglison, "the negroes of
+the West India islands drink copiously of the juice of the cane, yet
+their teeth are not injured; on the contrary, they have been praised by
+writers for their beauty and soundness; and the rounded form of the
+body, whilst they can indulge in the juice, sufficiently testifies to
+the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats,
+on the other hand, are most indigestible, and seriously injurious.
+
+
+
+[FN#13]  Elements of Hygiem. Philadephia, 1835.
+
+
+
+SALT.--This is necessary for the health of a child; it acts as a
+stimulant to the digestive organs, and if not allowed in sufficient
+quantity with the food, worms will result.[FN#14] It may, therefore, be
+added in small quantity, and with advantage, even to the farinaceous
+food of infants. Salted meats, however, should never be permitted to
+the child; for by the process of salting the fibre of the meat is so
+changed, that it is less nutritive, as well as less digestible.
+
+
+
+[FN#14]  Lord Sommerville, in his Address to the Board of Agriculture,
+gave an interesting account of the effects of a punishment which
+formerly existed in Holland. "The ancient laws of the country ordained
+men to be kept on bread alone, un-mixed with salt, as the severest
+punishment that could be inflicted upon them in their moist climate.
+The effect was horrible: these wretched criminals are said to have been
+devoured by worms engendered in their own stomachs."
+
+"The wholesomeness and digestibility of our bread are undoubtedly
+much promoted by the addition of the salt which it so universally
+receives. A pound of salt is generally added to each bushel of flour.
+Hence it may be presumed, that every adult consumes two ounces of salt
+per week, or six pounds and a half per annum, in bread alone."
+
+Dr. Paris on Diet.
+
+
+
+FRUITS.--These, and of all kinds whether fresh or dried, a delicate
+child is better without; except the orange, which when perfectly ripe
+may be allowed to any child, but the white or inner skin should be
+scrupulously rejected, as it is most indigestible.
+
+A healthy child may be permitted to partake of most fresh fruits. Of
+the stone-fruits, the ripe peach, the apricot, and nectarine, are the
+most wholesome; but cherries, from the stones being but too frequently
+swallowed, had better not be allowed. Apples and pears, when ripe and
+well masticated, are not unwholesome; and the apple when baked affords
+a pleasant repast, and where there is a costive habit, it is useful as
+a laxative. The small-seeded fruits, however, are by far the most
+wholesome. Of these, the ripe strawberry and raspberry deserve the
+first rank. The grape is also cooling and antiseptic, but the husks and
+seeds should be rejected. The gooseberry is less wholesome on account
+of the indigestibility of the skin, which is too frequently swallowed.
+
+Dried fruits a child should never be permitted to eat.
+
+
+WATER.--This should be the only beverage throughout childhood. Toast-
+and-water, if the child prefer it, which is rendered slightly more
+nutritive than the more simple fluid. The water employed in its
+preparation, however, must be at a boiling temperature, and it ought to
+be drunk as soon as it has sufficiently cooled; for by being kept, it
+acquires a mawkish and unpleasant flavour.
+
+
+WINE, BEER, etc.--The practice of giving wine, or, indeed, any
+stimulant, to a healthy child, is highly reprehensible; it ought never
+to be given but medicinally.
+
+The circulation in infancy and childhood is not only more rapid than
+in the adult, but easily excited to greater vehemence of action; the
+nervous system, too, is so susceptible, that the slightest causes of
+irritation produce strong and powerful impressions: the result in
+either case is diseased action in the frame, productive of fever,
+convulsions, etc.; wine, accordingly, is detrimental to children.
+
+An experiment made by Dr. Hunter upon two of his children illustrates,
+in a striking manner, the pernicious effects of even a small portion of
+intoxicating liquors in persons of this tender age. To one of the
+children he gave, every day after dinner, a full glass of sherry: the
+child was five years of age, and unaccustomed to the use of wine. To
+the other child, of nearly the same age, and equally unused to wine, he
+gave an orange. In the course of a week, a very marked difference was
+perceptible in the pulse, urine, and evacuations from the bowels of the
+two children. The pulse of the first was raised, the urine high
+coloured, and the evacuations destitute of their usual quantity of
+bile. In the other child, no change whatever was produced. He then
+reversed the experiment, giving to the first the orange, and to the
+second the wine, and the results corresponded: the child who had the
+orange continued well, and the system of the other got straightway
+into disorder, as in the first experiment.[FN#15]
+
+
+
+[FN#15]  Marcellin relates an instance of seven children in a family
+whose bowels became infested with worms, from the use of stimulants.
+They were cured by substituting water for the pernicious beverage.
+
+
+
+In this town, spirits, particularly gin, are given to infants and
+children to a frightful extent. I have seen an old Irish woman give
+diluted spirits to the infant just born. A short time since one of
+those dram-drinking children, about eight years of age, was brought
+into one of our hospitals. The attendants, from its emaciated
+appearance, considered the child was dying from mere starvation; which
+was true enough in a certain sense. Food was accordingly offered and
+pressed upon it, but the boy would not even put it to his lips. The
+next day it was discovered that the mother brought the child very
+nearly a pint of gin, every drop of which before night he had consumed.
+
+It is easy to discover when children have been fed upon spirits: they
+are always emaciated; have a lean, yellow, haggard look: the eyes
+sunk, the lips pale, and the teeth discoloured, the cadaverous aspect
+of the countenance being most fearful. They are continually suffering
+from bowel complaints and convulsive disorders; which, under these
+circumstances, terminate invariably in an early death.
+
+
+
+Sect. IV. SLEEP.
+
+
+
+DURING INFANCY.--For three or four weeks after birth the infant sleeps
+more or less, day and night, only waking to satisfy the demands of
+hunger; at the expiration of this time, however, each interval of
+wakefulness grows longer, so that it sleeps less frequently, but for
+longer periods at a time.
+
+This disposition to repose in the early weeks of the infant's life
+must not be interfered with; but this period having expired, great care
+is necessary to induce regularity in its hours of sleep, otherwise too
+much will be taken in the day-time, and restless and disturbed nights
+will follow. The child should be brought into the habit of sleeping in
+the middle of the day, before its dinner, and for about two hours,
+more or less. If put to rest at a later period of the day, it will
+invariably cause a bad night.
+
+At first the infant should sleep with its parent. The low temperature
+of its body, and its small power of generating heat, render this
+necessary. If it should happen, however, that the child has disturbed
+and restless nights, it must immediately be removed to the bed and care
+of another female, to be brought to its mother at an early hour in the
+morning, for the purpose of being nursed. This is necessary for the
+preservation of the mother's health, which through sleepless nights
+would of course be soon deranged, and the infant would also suffer from
+the influence which such deranged health would have upon the milk.
+
+When a month or six weeks has elapsed, the child, if healthy, may
+sleep alone in a cradle or cot, care being taken that it has a
+sufficiency of clothing, that the room in which it is placed is
+sufficiently warm, viz. 60 degrees, and the position of the cot itself
+is not such as to be exposed to currents of cold air. It is essentially
+necessary to attend to these points, since the faculty of producing
+heat, and consequently the power of maintaining the temperature, is
+less during sleep than at any other time, and therefore exposure to
+cold is especially injurious. It is but too frequently the case that
+inflammation of some internal organ will occur under such
+circumstances, without the true source of the disease ever being
+suspected. Here, however, a frequent error must be guarded against,--
+that of covering up the infant in its cot with too much clothing
+throwing over its face the muslin handkerchief--and, last of all,
+drawing the drapery of the bed closely together. The object is to keep
+the infant sufficiently warm with pure air; it therefore ought to have
+free access to its mouth, and the atmosphere of the whole room should
+be kept sufficiently warm to allow the child to breathe it freely: in
+winter, therefore, there must always be a fire in the nursery.
+
+The child up to two years old, at least, should sleep upon a feather
+bed, for the reasons referred to above. The pillow, however, after the
+sixth month, should be made of horsehair; for at this time teething
+commences, and it is highly important that the head should be kept cool.
+
+
+DURING CHILDHOOD.--Up to the third or fourth year the child should be
+permitted to sleep for an hour or so before its dinner. After this time
+it may gradually be discontinued; but it must be recollected, that
+during the whole period of childhood more sleep is required than in
+adult age. The child, therefore, should be put to rest every evening
+between seven and eight; and if it be in health it will sleep soundly
+until the following morning. No definite rule, however, can be laid
+down in reference to the number of hours of sleep to be allowed; for
+one will require more or less than another.[FN#16] Regularity as to
+the time of going to rest is the chief point to attend to; permit
+nothing to interfere with it, and then only let the child sleep without
+disturbance, until it awakes of its own accord on the following
+morning, and it will have had sufficient rest.
+
+
+
+[FN#16]  The amount of sleep necessary to preserve health varies
+according to the state of the body, and the habits of the individual.
+As already observed, infants pass much the greater portion of their
+time in sleep. Children sleep twelve or fourteen hours. The schoolboy
+generally ten. In youth, a third part of the twenty-four hours is spent
+in sleep. Whilst, in advanced age, many do not spend more than four,
+five, or six hours in sleep.
+
+
+
+It is a cruel thing for a mother to sacrifice her child's health that
+she may indulge her own vanity, and yet how often is this done in
+reference to sleep. An evening party is to assemble, and the little
+child is kept up for hours beyond its stated time for retiring to rest,
+that it may be exhibited, fondled, and admired. Its usual portion of
+sleep is thus abridged, and, from the previous excitement, what little
+he does obtain, is broken and unrefreshing, and he rises on the morrow
+wearied and exhausted.
+
+Once awake, it should not be permitted to lie longer in bed, but
+should be encouraged to arise immediately. This is the way to bring
+about the habit of early rising, which prevents many serious evils to
+which parents are not sufficiently alive, promotes both mental and
+corporeal health, and of all habits is said to be the most conducive to
+longevity.
+
+A child should never be suddenly aroused from sleep; it excites the
+brain, quickens the action of the heart, and, if often repeated,
+serious consequences would result. The change of sleeping to waking
+should always be gradual.
+
+The bed on which the child now sleeps should be a mattress: at this
+age a feather bed is always injurious to children; for the body,
+sinking deep into the bed, is completely buried in feathers, and the
+unnatural degree of warmth thus produced relaxes and weakens the
+system, particularly the skin, and renders the child unusually
+susceptible to the impressions of cold. Then, instead of the bed being
+made up in the morning as soon as vacated, and while still saturated
+with the nocturnal exhalations from the body, the bed-clothes should be
+thrown over the backs of chairs, the mattress shaken well up, and the
+window thrown open for several hours, so that the apartment shall be
+thoroughly ventilated. It is also indispensably requisite not to allow
+the child to sleep with persons in bad health, or who are far advanced
+in life; if possible, it should sleep alone.
+
+
+
+Sect. V. BATHING AND CLEANLINESS.
+
+
+
+
+DURING INFANCY.--Too much attention cannot be paid to cleanliness; it
+is essential to the infant's health. The principal points to which
+especial attention must be paid by the parent for this purpose are the
+following:--
+
+
+TEMPERATURE OF THE WATER.--At first the infant should be washed daily
+with warm water; and a bath every night, for the purpose of thoroughly
+cleaning the body, is highly necessary. To bathe a delicate infant of a
+few days or even weeks old in cold water with a view "to harden" the
+constitution (as it is called), is the most effectual way to undermine
+its health and entail future disease. By degrees, however, the water
+with which it is sponged in the morning should be made tepid, the
+evening bath being continued warm enough to be grateful to the feelings.
+
+A few months having passed by, the temperature of the water may be
+gradually lowered until cold is employed, with which it may be either
+sponged or even plunged into it, every morning during summer. If
+plunged into cold water, however, it must be kept in but a minute; for
+at this period, especially, the impression of cold continued for any
+considerable time depresses the vital energies, and prevents that
+healthy glow on the surface which usually follows the momentary and
+brief action of cold, and upon which its usefulness depends. With some
+children, indeed, there is such extreme delicacy and deficient reaction
+as to render the cold bath hazardous; no warm glow over the surface
+takes place when its use inevitably does harm: its effects, therefore,
+must be carefully watched.
+
+
+DRYING THE SKIN.--The surface of the skin should always be carefully
+and thoroughly rubbed dry with flannel,--indeed, more than dry, for the
+skin should be warmed and stimulated by the assiduous gentle friction
+made use of. For this process of washing and drying must not be done
+languidly, but briskly and expeditiously; and will then be found to be
+one of the most effectual means of strengthening the infant. It is
+especially necessary carefully to dry the arm-pits, groins, and nates;
+and if the child is very fat, it will be well to dust over these parts
+with hair-powder or starch: this prevents excoriations and sores, which
+are frequently very troublesome. Soap is only required to those parts
+of the body which are exposed to the reception of dirt.
+
+
+NAPKINS.--The frequency of the discharges from the bowels and bladder
+requires a frequent change of napkins. A nurse cannot be too careful of
+this duty from the first, so that she may be enabled to discover the
+periods when those discharges are about to take place, that she may not
+only anticipate them, but teach the child, at a very early age, to give
+intelligent warning of its necessities. Thus a habit of regularity with
+regard to those functions will be established, which will continue
+through life, and tend greatly to the promotion of health. As the child
+grows older, the system of cleanliness must in no particular be
+relaxed, and it will be found the best preservative against those
+eruptive disorders which are so frequent and troublesome during the
+period of infancy.
+
+
+DURING CHILDHOOD.--When this period arrives, or shortly after, bathing
+is but too frequently left off; the hands and face of the child are
+kept clean, and with this the nurse is satisfied; the daily ablution of
+the whole body, however, is still necessary, not only for the
+preservation of cleanliness, but because it promotes in a high degree
+the health of the child.
+
+
+PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.--A child of a
+vigorous constitution and robust health, as he rises from his bed
+refreshed and active by his night's repose, should be put into the
+shower-bath, or, if this excites and alarms him too much, must be
+sponged from head to foot with salt water. If the weather be very cold,
+the water may be made slightly tepid, but if his constitution will bear
+it, the water should be cold throughout the year. Then the body should
+be speedily dried, and hastily but well rubbed with a somewhat coarse
+towel, and the clothes put on without any unnecessary delay. This
+should be done every morning of the child's life.
+
+If such a child is at the sea-side, advantage should be taken of this
+circumstance, and seabathing should be substituted. The best time is
+two or three hours after breakfast; but he must not be fatigued
+beforehand, for if so, the cold bath cannot be used without danger.
+Care must be taken that he does not remain in too long, as the animal
+heat will be lowered below the proper degree, which would be most
+injurious. In boys of a feeble constitution, great mischief is often
+produced in this way. It is a matter also of great consequence in
+bathing children that they should not be terrified by the immersion,
+and every precaution should be taken to prevent this. The healthy and
+robust boy, too, should early be taught to swim, whenever this is
+practicable, for it is attended with the most beneficial effects; it is
+a most invigorating exercise, and the cold bath thus becomes doubly
+serviceable.
+
+
+PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.--If a child is of a
+delicate and strumous constitution, the cold bath during the summer
+is one of the best tonics that can be employed; and if living on the
+coast, sea-bathing will be found of singular benefit. The effects,
+however, of sea-bathing upon such a constitution must be particularly
+watched, for unless it is succeeded by a glow,--a feeling of increased
+strength,--and a keen appetite, it will do no good, and ought at once
+to be abandoned for the warm or tepid bath. The opinion that warm baths
+generally relax and weaken, is erroneous; for in this case, as in all
+cases when properly employed, they would give tone and vigour to the
+whole system; in fact, the tepid bath is to this child what the cold
+bath is to the more robust.
+
+In conclusion: if the bath in any shape cannot from circumstances be
+obtained, then cold saltwater sponging must be used daily, and all the
+year round, so long as the proper reaction or glow follows its use; but
+when this is not the case, and this will generally occur, if the child
+is delicate and the weather cold, tepid vinegar and water, or tepid
+salt water, must be substituted.
+
+
+
+Sect. VI. CLOTHING.
+
+
+
+IN INFANCY.--Infants are very susceptible of the impressions of cold; a
+proper regard, therefore, to a suitable clothing of the body, is
+imperative to their enjoyment of health. Unfortunately, an opinion is
+prevalent in society, that the tender child has naturally a great power
+of generating heat and resisting cold; and from this popular error has
+arisen the most fatal results. This opinion has been much strengthened
+by the insidious manner in which cold operates on the frame, the
+injurious effects not being always manifest during or immediately after
+its application, so that but too frequently the fatal result is traced
+to a wrong source, or the infant sinks under the action of an unknown
+cause.
+
+The power of generating heat in warm-blooded animals is at its minimum
+at birth, and increases successively to adult age; young animals,
+instead of being warmer than adults, are generally a degree or two
+colder, and part with their heat more readily; facts which cannot be
+too generally known. They show how absurd must be the folly of that
+system of "hardening" the constitution (to which reference has been
+before made), which induces the parent to plunge the tender and
+delicate child into the cold bath at all seasons of the year, and
+freely expose it to the cold, cutting currents of an easterly wind,
+with the lightest clothing.
+
+The principles which ought to guide a parent in clothing her infant
+are as follows:--
+
+The material and quantity of the clothes should be such as to preserve
+a sufficient proportion of warmth to the body, regulated therefore by
+the season of the year, and the delicacy or strength of the infant's
+constitution. In effecting this, however, the parent must guard against
+the too common practice of enveloping the child in innumerable folds of
+warm clothing, and keeping it constantly confined to very hot and close
+rooms; thus running into the opposite extreme to that to which I have
+just alluded: for nothing tends so much to enfeeble the constitution,
+to induce disease, and render the skin highly susceptible to the
+impression of cold; and thus to produce those very ailments which it
+is the chief intention to guard against.
+
+In their make they should be so arranged as to put no restrictions to
+the free movements of all parts of the child's body; and so loose and
+easy as to permit the insensible perspiration to have a free exit,
+instead of being confined to and absorbed by the clothes, and held in
+contact with the skin, till it gives rise to irritation.
+
+In their quality they should be such as not to irritate the delicate
+skin of the child. In infancy, therefore, flannel is rather too rough,
+but is desirable as the child grows older, as it gives a gentle
+stimulus to the skin, and maintains health.
+
+In its construction the dress should be so simple as to admit of being
+quickly put on, since dressing is irksome to the infant, causing it to
+cry, and exciting as much mental irritation as it is capable of
+feeling. Pins should be wholly dispensed with, their use being
+hazardous through the carelessness of nurses, and even through the
+ordinary movements of the infant itself.
+
+The clothing must be changed daily.--It is eminently conducive to good
+health that a complete change of dress should be made every day. If
+this is not done, washing will, in a great measure, fail in its object,
+especially in insuring freedom from skin diseases.
+
+
+IN CHILDHOOD.--The clothing of the child should possess the same
+properties as that of infancy. It should afford due warmth, be of such
+materials as do not irritate the skin, and so made as to occasion no
+unnatural constriction.
+
+In reference to due warmth, it may be well again to repeat, that too
+little clothing (that state of semi-nudity which the vanity of some
+parents encourage) is frequently productive of the most sudden attacks
+of active disease; and that children who are thus exposed with naked
+breasts and thin clothing in a climate so variable as ours are the
+frequent subjects of croup, and other dangerous affections of the air-
+passages and lungs. On the other hand, it must not be forgotten, that
+too warm clothing is a source of disease,--sometimes even of the same
+diseases which originate in exposure to cold,--and often renders the
+frame more susceptible of the impressions of cold, especially of cold
+air taken into the lungs. Regulate the clothing, then, according to the
+season; resume the winter dress early; lay it aside late; for it is in
+spring and autumn that the vicissitudes in our climate are greatest,
+and congestive and inflammatory complaints most common.
+
+With regard to material (as was before observed), the skin will at
+this age bear flannel next to it; and it is now not only proper, but
+necessary. It may be put off with advantage during the night, and
+cotton maybe substituted during the summer, the flannel being resumed
+early in the autumn. If from very great delicacy of constitution it
+proves too irritating to the skin, fine fleecy hosiery will in general
+be easily endured, and will greatly conduce to the preservation of
+health.
+
+It is highly important that the clothes of the boy should be so made
+that no restraints shall be put on the movements of the body or limbs,
+nor injurious pressure made on his waist or chest. All his muscles
+ought to have full liberty to act, as their free exercise promotes both
+their growth and activity, and thus insures the regularity and
+efficiency of the several functions to which these muscles are
+subservient.
+
+The same remarks apply with equal force to the dress of the girl; and
+happily, during childhood, at least, no distinction is made in this
+matter between the sexes. Not so, however, when the girl is about to
+emerge from this period of life; a system of dress is then adopted
+which has the most pernicious effects upon her health, and the
+development of the body, the employment of tight stays, which impede
+the free and full action of the respiratory organs, being only one of
+the many restrictions and injurious practices from which in latter
+years they are thus doomed to suffer so severely.
+
+
+
+Sect. VII. AIR AND EXERCISE.
+
+
+
+IN INFANCY.--The respiration of a pure air is at all times, and under
+all circumstances, indispensable to the health of the infant. The
+nursery therefore should be large, well ventilated, in an elevated part
+of the house, and so situated as to admit a free supply both of air
+and light. For the same reasons, the room in which the infant sleeps
+should be large, and the air frequently renewed; for nothing is so
+prejudicial to its health as sleeping in an impure and heated
+atmosphere. The practice, therefore, of drawing thick curtains closely
+round the bed is highly pernicious; they only answer a useful purpose
+when they defend the infant from any draught of cold air.
+
+The proper time for taking the infant into the open air must, of
+course, be determined by the season of the year, and the state of the
+weather. "A delicate infant born late in the autumn will not generally
+derive advantage from being carried into the open air, in this climate,
+till the succeeding spring; and if the rooms in which he is kept are
+large, often changed, and well ventilated, he will not suffer from the
+confinement, while he will, most probably, escape catarrhal affections,
+which are so often the consequence of the injudicious exposure of
+infants to a cold and humid atmosphere."[FN#17] If, however, the child
+is strong and healthy, no opportunity should be lost of taking it into
+the open air at stated periods, experience daily proving that it has
+the most invigorating and vivifying influence upon the system. Regard,
+however, must always be had to the state of the weather; and to a damp
+condition of the atmosphere the infant should never be exposed, as it
+is one of the most powerful exciting causes of consumptive disease. The
+nurse-maid, too, should not be allowed to loiter and linger about, thus
+exposing the infant unnecessarily, and for an undue length of time;
+this is generally the source of all the evils which accrue from taking
+the babe into the open air.
+
+
+
+[FN#17]  Sir James Clark on Consumption.
+
+
+
+Exercise, also, like air, is essentially important to the health of
+the infant. Its first exercise, of course, will be in the nurse's arms.
+After a month or two, when it begins to sleep less during the day, it
+will delight to roll and kick about on the sofa: it will thus use its
+limbs freely; and this, with carrying out into the open air, is all
+the exercise it requires at this period. By and by, however, the child
+will make its first attempts to walk. Now it is important that none of
+the many plans which have been devised to teach a child to walk, should
+be adopted--the go-cart, leading-strings, etc.; their tendency is
+mischievous; and flatness of the chest, confined lungs, distorted
+spine, and deformed legs, are so many evils which often originate in
+such practices. This is explained by the fact of the bones in infancy
+being comparatively soft and pliable, and if prematurely subjected by
+these contrivances to carry the weight of the body, they yield just
+like an elastic stick bending under a weight, and as a natural
+consequence become curved and distorted.
+
+It is highly necessary that the young and experienced mother should
+recollect this fact, for the early efforts of the little one to walk
+are naturally viewed by her with so much delight, that she will be apt
+to encourage and prolong its attempts, without any thought of the
+mischief which they may occasion; thus many a parent has had to mourn
+over the deformity which she has herself created.
+
+It may be as well here to remark, that if such distortion is timely
+noticed, it is capable of correction, even after evident curvature has
+taken place. It is to be remedied by using those means that shall
+invigorate the frame, and promote the child's general health (a daily
+plunge into the cold bath, or sponging with cold salt water, will be
+found signally efficacious), and by avoiding the original cause of the
+distortion--never allowing the child to get upon his feet. The only way
+to accomplish the latter intention, is to put both the legs into a
+large stocking; this will effectually answer this purpose, while, at
+the same time, it does not prevent the free and full exercise of the
+muscles of the legs. After some months pursuing this plan, the limbs
+will be found no longer deformed, the bones to have acquired firmness
+and the muscles strength; and the child may be permitted to get upon
+his feet again without any hazard of perpetuating or renewing the evil.
+
+The best mode of teaching a child to walk, is to let it teach itself,
+and this it will do readily enough. It will first crawl about: this
+exercises every muscle in the body, does not fatigue the child, throws
+no weight upon the bones, but imparts vigour and strength, and is thus
+highly useful. After a while, having the power, it will wish to do
+more: it will endeavour to lift itself upon its feet by the aid of a
+chair, and though it fail again and again in its attempts, it will
+still persevere until it accomplish it. By this it learns, first, to
+raise itself from the floor; and secondly, to stand, but not without
+keeping hold of the object on which it has seized. Next it will balance
+itself without holding, and will proudly and laughingly show that it
+can stand alone. Fearful, however, as yet of moving its limbs without
+support, it will seize a chair or anything else near it, when it will
+dare to advance as far as the limits of its support will permit. This
+little adventure will be repeated day after day with increased
+exultation; when, after numerous trials, he will feel confident of his
+power to balance himself, and he will run alone. Now time is required
+for this gradual self-teaching, during which the muscles and bones
+become strengthened; and when at last called upon to sustain the weight
+of the body, are fully capable of doing so.
+
+
+IN CHILDHOOD.--When the child has acquired sufficient strength to take
+active exercise, he can scarcely be too much in the open air; the more
+he is habituated to this, the more capable will he be of bearing the
+vicissitudes of the climate. Children, too, should always be allowed to
+amuse themselves at pleasure, for they will generally take that kind
+and degree of exercise which is best calculated to promote the growth
+and development of the body. In the unrestrained indulgence of their
+youthful sports, every muscle of the body comes in for its share of
+active exercise; and free growth, vigour, and health are the result.
+
+If, however, a child is delicate and strumous, and too feeble to take
+sufficient exercise on foot,--and to such a constitution the respiration
+of a pure air and exercise are indispensable for the improvement of
+health, and without them all other efforts will fail,--riding on a
+donkey or pony forms the best substitute. This kind of exercise will
+always be found of infinite service to delicate children; it amuses the
+mind, and exercises the muscles of the whole body, and yet in so
+gentle a manner as to induce little fatigue.
+
+The exercises of horseback, however, are most particularly useful
+where there is a tendency in the constitution to pulmonary consumption,
+either from hereditary or accidental causes. It is here beneficial, as
+well through its influence on the general health, as more directly on
+the lungs themselves. There can be no doubt that the lungs, like the
+muscles of the body, acquire power and health of function by exercise.
+Now during a ride this is obtained, and without much fatigue to the
+body. The free and equable expansion of the lungs by full inspiration,
+necessarily takes place; this maintains their healthy structure, by
+keeping all the air-passages open and pervious; it prevents congestion
+in the pulmonary circulation, and at the same time provides more
+completely for the necessary chemical action on the blood, by changing,
+at each act of respiration, a sufficient proportion of the whole air
+contained in the lungs,--all objects of great importance, and all
+capable of being promoted, more or less, by the means in question.
+
+And be it remembered that these remarks apply with equal force to the
+girl as to the boy. She should be allowed, and even encouraged, to take
+the same active exercise. Fortunately, this course is followed during
+childhood; not so, unfortunately (in the majority of cases, at least),
+after this period. Young females are then subjected to those unnatural
+restraints, both in exercise and dress, which fashion and vanity
+impose, to be followed by effects which, though not immediately
+obvious, are capable of laying the foundation of evils that cannot
+afterwards be remedied.
+
+A good carriage is the point aimed at (and to which I particularly
+refer), and the means adopted for its cultivation fail, after all, in
+their end, just in proportion to their rigid employment. For this
+purpose the head is kept erect, and the shoulders drawn back, and they
+are to be kept in this position not for an hour or so, but continually.
+To preserve, however, this unnatural and constrained position, requires
+considerable muscular powers, such as no girl can exercise without
+long, painful, and injurious training; nor even by this, unless other
+measures be resorted to in aid of her direct endeavours. For instead of
+the muscles obtaining increased power and strength by these efforts (to
+enforce a good carriage), they are enfeebled, and soon become more and
+more incapable of performing what is required of them. This fact soon
+becomes perceptible; weakness is noticed; but instead of correcting
+this by the only rational mode, that of invigorating the weakened
+muscles, mechanical aid is called in to support them, and laced
+waistcoats are resorted to. These undoubtedly give support--nay, they
+may be so used as almost wholly to supersede the muscular efforts, with
+the advantage of not tiring, however long or continuously employed.
+Improvement of carriage is manifested, the child is sensible of relief
+from a painful exertion, the mother is pleased with the success of her
+management, and this success appears to superficial observation fully
+to confirm the judgment which superintends it. Yet what are the
+consequences to which her measures tend, and which such measures are
+daily and hourly producing? The muscles of the back and chest,
+restrained in their natural and healthful exercise by the waistcoat
+called in to aid them, and more signally, in after-life, by the tightly-
+laced stays or corsets, become attenuated, and still further enfeebled,
+until at length they are wholly dependent on the mechanical aid, being
+quite incapable of dispensing with it for any continuance.
+
+By and by a taper waist becomes an object of ambition, and the stays
+are laced more closely than ever. This is still done gradually, and, at
+first, imperceptibly to the parties. The effect, however, though slow,
+is sure; and the powers of endurance thus exercised come in time to
+bear, almost unconsciously, what, if suddenly or quickly attempted, no
+heroism could possibly sustain. This increased pressure impedes the
+motion of the ribs. For perfect respiration these motions should be
+free and unrestrained, and perfect respiration is necessary to those
+changes in the blood which fit it for nutrition, and the other purposes
+of the animal frame. In proportion as respiration is impeded, is the
+blood imperfectly vitalised, and in the same ratio are the nutrient and
+other functions dependent on the blood inadequately performed. Here,
+then, is one source of debility, which affects the whole frame,
+reducing every part below the standard of healthful vigour. Quickened
+respiration soon ensues, the heart becomes excited, the pulse
+accelerated, and palpitation is in time superadded.
+
+There are still further evils produced by tight lacing. For the
+pressure being chiefly made on the lower part of the chest, the stomach
+and liver are necessarily compressed, to the great disturbance of their
+functions; and being pressed downwards too, these trespass on that
+space which the other abdominal viscera require, superinducing still
+further derangements. Thus almost every function of the body becomes
+more or less impeded.
+
+And again, the girl not being able always to have her body cased in
+the tight-laced stays, some relaxation must take place. Under it the
+muscles of the back, deprived of their accustomed support, and
+incapable of themselves to sustain the incumbent weight, yield, and the
+column of the spine bends, at first anteriorly, causing round shoulders
+and an arched back; but eventually inclines to one or other side,
+giving rise to the well-known and too frequently occurring state of
+lateral curvature. This last change most frequently commences in the
+sitting posture, such females being, through general debility, much
+disposed to sedentary habits. Such, though but very slightly sketched,
+are a few of the evils attending this baneful practice.
+
+But how, then, is a good carriage to be obtained; which is not only
+pleasing to the eye, but is, when natural, absolutely conducive itself
+to health? To insure a good carriage, the only rational way is to give
+the necessary power, especially to the muscles chiefly concerned; and
+this is to be done, not by wearying those muscles by continual and
+unrelieved exertion, but by invigorating the frame generally, and more
+especially by strengthening the particular muscles through varied
+exercise alternated with due repose. Attention to general health,
+suitable diet, regular bowels, moderate but regular exercise, not of
+particular muscles only, but of the whole frame, cold-bathing or
+sponging, and other such measures, will maintain a good carriage, by
+giving that power which the more direct means so generally practised
+serve but to exhaust.[FN#18]
+
+
+
+[FN#18]  The above remarks on "good carriage" are almost wholly taken
+from a valuable article of Dr. Barlow's, in the "Cyclopaedia of
+Practical Medicine."
+
+
+
+Chap. II.
+
+
+
+ON THE USE AND ABUSE OF CERTAIN REMEDIES.
+
+
+Sect. I.--APERIENT MEDICINE.
+
+
+
+One of the greatest errors of the nursery is the too frequent and
+indiscriminate exhibition by the mother or nurse of purgative medicine
+to the infant. Various are the forms in which it is given; perhaps the
+little powders obtained from the chemist is the most frequent, as it is
+certainly the most injurious, form, their chief ingredient being
+calomel.
+
+The choice of the aperient, or the dose, or the exact condition of the
+health of the infant, or whether it is an aperient at all that is
+required, are points entirely overlooked: a little medicine is thought
+necessary, because the child appears unwell, and a purgative, or a
+little white powder, is forthwith given. The great art of
+medicine is the proper application of the proper medicine, in the
+proper dose, at the proper time; points never considered in the
+nursery. For example, I have known a large dose of magnesia given by a
+nurse to an infant, that had been suffering from a diarrhoea of some
+days' standing, and very quickly cause death. Now, magnesia is one of
+the most useful and harmless medicines that can be given to an infant
+when indicated; when prescribed in a dose suited to its age, and when
+the proper time is fixed upon for its exhibition; in the foregoing
+case, however, every thing forbad its use, but none of these points
+were considered.
+
+Aperient medicine, too, is sometimes unwittingly repeated to remove
+those symptoms which it has itself produced. Some incidental pain and
+uneasiness, some slightly greenish appearance of the motions, leads the
+mother to believe that more purging is necessary, when, in fact, both
+circumstances have probably been induced by the irritation caused by
+the purgatives already too freely administered. How frequently is this
+the case, during the first week or ten days of the infant's life, when
+the nurse doses the child with tea-spoonful after tea-spoonful of
+castor oil, for the relief of pain, which her repeated doses of
+medicine have alone created.
+
+The bowels of an infant in health should be relieved two, three, or
+four times in the twenty-four hours. The stools should be of the
+consistence of thin mustard, and of a lightish yellow colour, having
+little smell, free from lumps or white curdy matter, and passed without
+pain, or any considerable quantity of wind. And a parent is only
+justified in giving aperient medicine, when any deviation from these
+conditions exists; and only then, when what may be called healthy
+costiveness is present, viz. either the stools less frequent than they
+ought to be, or lumpy and partially solid. Then, the only purgative
+medicines that can be given with safely to an infant, without medical
+sanction, are, castor oil, manna, rhubarb, and magnesia; the
+application of the lavement, and the aperient liniment.
+
+
+
+CASTOR OIL
+
+
+This is one of the mildest aperients, prompt in its action, and
+effective in clearing out the contents of the bowels; it is a
+medicine, therefore, particularly applicable to infants.
+
+During teething there is generally much torpor of the bowels; here,
+then, castor oil is a very appropriate and useful artificial means of
+increasing the frequency of the alvine discharges.
+
+Then, again, no purgative can be so much relied on for overcoming
+habitual costiveness as castor oil; it may for this purpose be given
+daily for some weeks, gradually reducing the dose until only a few
+drops be taken; after which the bowels generally continue to act
+without further artificial assistance. Even its occasional
+administration leaves the bowels in a relaxed state; a great advantage
+over other purgatives, which generally cause, after their action is
+passed off, a confined state.
+
+The proper dose will depend upon the age, and the known effect of
+aperient medicine upon the childsome requiring more, others less:
+
+Under one year, one small tea-spoonful.
+
+Under three years, two ditto.
+
+Under six years, three ditto.
+
+Under ten years and upwards, a table spoonful. The quantity being more
+or less according to the facility with which the bowels are purged.
+
+It may be given in various ways; poured upon a little mint water, or
+blended with a little moist sugar;--or, if the stomach is unusually
+delicate, the oil may be made into an emulsion with some aromatic
+water, by the intervention of the yolk of an egg and a little syrup of
+roses or sugar combined with it. The following proportions make an
+elegant and not at all a disagreeable mixture, of which a desert-
+spoonful (or more, according to the age,) may be repeated every hour
+until it operate:
+
+Castor oil, six drachms;
+The yolk of an egg;
+Mix well together, and add
+Dill water, two ounces,
+Syrup of roses, two drachms.
+
+
+
+MANNA.
+
+
+This also may be given with impunity to the youngest infant; it is
+sweet to the taste, and mild in its operation. It should be exhibited
+in doses of one to two drachms in a little warm milk; or if it cause
+flatulence in this form, in some aromatic water, a desert spoonful of
+carraway-seed or dill water. For children above two years, it must
+always be given with some other aperient: thus, it may be combined with
+castor oil by the medium of mucilage or the yolk of an egg; in fact, it
+might be substituted for the syrup of roses in the previous
+prescription for castor oil.
+
+
+
+MAGNESIA AND RHUBARB.
+
+
+Magnesia, besides being a laxative, allays irritability of the
+stomach; it is consequently useful during dentition, at which period
+there is both much irritability and a prevailing acescency of the
+stomach. The dose is from five grains to ten for an infant, increasing
+the quantity to fifteen grains or twenty to children of nine or ten
+years of age. When taken alone the best vehicle is hot milk, which
+greatly quickens its aperient operation. And whenever the bowels are
+distended with wind, the pure magnesia is preferable to the carbonate.
+
+It is well to mention here, that when the infant throws up the nurse's
+milk it is generally curdled; a fact which leads the inexperienced
+mother to infer that the child is suffering from acidity; and to
+counteract the supposed evil magnesia is given again and again. This is
+a useless and pernicious practice, for curdling or coagulation of the
+milk always takes place in the stomach, and is produced by the gastric
+juice, and is so far from being a morbid process, that milk cannot be
+properly digested without it.
+
+Rhubarb, it should always be recollected, has an astringent as well as
+purgative property, according to the extent of the dose in which it is
+administered; the former of which never opposes or interferes with the
+energy of the latter, since it only takes effect when the substance is
+administered in small doses, or, if given in larger ones, not until it
+has ceased to operate as a cathartic. This latter circumstance renders
+it particularly eligible in cases of diarrhoea, as it evacuates the
+offending matter before it operates as an astringent upon the bowels.
+
+As a purgative it operates mildly, and may be given to the youngest
+infant; if from two to twelve months old, from three to six grains; for
+children above that age, the dose may range from ten grains to twenty.
+Its operation, however, is much quickened by the addition of magnesia;
+both of which are more effective when thus united than when given
+separately. The following form, in a costive and flatulent state of the
+bowels, will be found useful[FN#19]; a tea-spoonful or more may be given
+every three or four hours until the desired effect is obtained:--
+
+
+Powdered rhubarb, half a drachm;
+
+Magnesia, two scruples;
+
+Compound spirits of ammonia, twenty drops;
+
+Dill water, two ounces;
+
+Simple syrup, two drachms.
+
+
+
+[FN#19]  This may be made up and kept in the nursery for a long time
+without spoiling.
+
+
+
+Rhubarb, mixed with flour and warm water, may be made into a poultice,
+and applied to the abdomen of a child that obstinately refuses to
+swallow medicine, and it will be found to produce the same effect as if
+the medicine had been taken into the stomach; it will purge briskly.
+
+
+
+THE LAVEMENT.
+
+
+This is an excellent nursery remedy when the bowels are obstinately
+costive. It may then be employed as a substitute for medicine, a
+protracted and frequent use of which (even of the mildest aperients) is
+apt to injure the digestive functions, and to give rise to some degree
+of intestinal irritation. Lavements, however, like aperient medicine,
+must not be resorted to for a long time together; for whilst the latter
+irritate, the former most certainly tend, after a long continued use,
+to debilitate the bowels, and thus render them less than ever disposed
+to act for themselves. They are an excellent occasional remedy.
+
+The simplest form of an aperient enema, is warm water; but barley-
+water, or thin gruel, or even milk and water, are to be preferred at
+all times, as they are of a more bland and less irritating nature. If
+it be desirable to increase the strength of the injection, castor oil
+may be added. The proportions of fluid which are necessary for the
+different stages of life, under ordinary circumstances, maybe stated
+as follows:--An infant at its birth requires about one fluid ounce; a
+child between the age of one and five years, from three to four fluid
+ounces; and a youth of ten or fifteen, from six to eight fluid ounces.
+
+The mode of administering an injection to an infant deserves
+particular attention, as injury might be caused by its being performed
+in a careless or unskilful manner. A gum elastic pipe should be always
+used instead of the hard ivory tube. Having smeared this over with
+lard, and placed the infant on its left side, with its knees bent up in
+the lap of the nurse, it is to be passed a couple of inches into the
+bowel, in a direction not parallel to the axis of the body, but rather
+inclined to the left. The latter circumstance should never be
+neglected, for if not attended to, there will be difficulty in
+administering the injection. The fluid must then be propelled very
+gradually, or it will be instantly rejected; on the whole being thrown
+up (the pipe carefully and slowly withdrawn), the child must be kept
+quietly reposing on its nurse's lap, and in the same posture for some
+little time.
+
+
+
+THE APERIENT LINIMENT.
+
+
+A liniment to be rubbed on the stomach is another resource in cases of
+habitual costiveness, and will frequently be attended with great
+success when repeated purgatives have been resisted.
+
+Olive or castor oil may be used for this purpose; they must be warmed
+and rubbed over the abdomen night and morning, for five or ten minutes.
+Perhaps the best form of liniment that can be made use of is the
+following:--
+
+Compound soap liniment, one ounce;
+Compound tincture of aloes, half an ounce.
+
+
+
+Sect. II.--CALOMEL.
+
+
+
+Calomel is one of the most useful medicines we possess; but though
+powerful for good, it is by no means powerless for mischief, and pages
+might be written upon the evil effects which have resulted from its
+indiscriminate use in the nursery; medical men are daily and hourly
+witnessing this fact. It is particularly eligible in the diseases of
+children; but then it is quite impossible for unprofessional persons to
+judge when it may be appropriately exhibited. And it cannot be too
+generally known, that the effect of this medicine upon the evacuations
+is always to make them appear unnatural. From ignorance of this fact,
+calomel is often repeated again and again to relieve that very
+condition which it has itself produced, causing, but too frequently, a
+degree of irritation in the delicate lining membrane of the bowel,
+which it may be very difficult for a medical man to remove, and perhaps
+a source of misery to the child as long as it lives.
+
+Its frequent exhibition has also another evil attending it, for "the
+immoderate use of mercury in early infancy produces more, perhaps, than
+any other similar cause, that universal tendency to decay, which, in
+many instances, destroys almost every tooth at an early age."[FN#20]
+
+
+
+[FN#20]  Bell on the Teeth.
+
+
+
+In the diseases of childhood it is often administered by the mother or
+nurse with a degree of careless excess which ultimately, if not
+immediately, produces severe and irremediable injury. I have met with
+such cases; but Mr. Bell details a remarkable instance in point: "A
+child, about three years of age, was brought to me, having a most
+extensive ulceration in the gum of the lower jaw, by which the alveolar
+process (that portion of the jaw which forms the sockets of the teeth)
+was partially denuded. The account given by the mother was, that the
+child had some time previously been the subject of measles, for which a
+chemist, whom she consulted, gave her white powders, one of which was
+ordered to be taken every four hours. It appears by the result, that
+this must have been calomel; for, after taking it for two or three
+days, profuse salivation was produced, with swollen tongue, inflamed
+gums, etc., followed by ulceration of the gum, lips, and cheek. On
+examining the denuded alveolar process, I found that a considerable
+necrosis (death of the bone) had taken place, including the whole
+anterior arch of the jaw from the first double tooth on the left side
+to the eye-tooth on the right. By degrees the dead portion of bone was
+raised, and became loose, when I found that the mischief was not
+confined to the alveolar process, but comprised the whole substance of
+the bone within the space just mentioned," etc. Surely the knowledge of
+such a case as this would induce every prudent mother to exclude
+calomel from her list of domestic nursery medicines.
+
+
+
+Sect. III.--OPIATES.
+
+
+
+This class of medicine is often kept in the nursery, in the forms of
+laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's
+cordial.
+
+The object with which they are generally given is to allay pain by
+producing sleep; they are, therefore, remedies of great convenience to
+the nurse; and I am sorry to be obliged to add, that, so exhibited,
+they are but too often fatal to the little patient.
+
+The fact is, that in the hands of the physician, there is no medicine
+the administration of which requires greater caution and judgment than
+opiates, both from the susceptibility of infants to their narcotic
+influence, and their varying capability of bearing it; the danger,
+therefore, with which their use is fraught in the hands of a nurse
+should for ever exclude them from the list of domestic nursery
+medicines.
+
+Dalby's carminative and Godfrey's cordial are, perhaps, more
+frequently used than any other forms; and some striking cases,
+illustrative of the fatal results of exhibiting them indiscriminately,
+and without medical sanction, are on record.[FN#21] The late Dr.
+Clark, in his "Commentaries," mentions a case which he saw, where
+"forty drops of Dolly's carminative destroyed an infant." Dr. Merriman
+gives the following in a note in Underwood, "On the Diseases of
+Children:"--
+
+
+
+[FN#21]  Two or three fatal cases, and upon which coroners' inquests
+were held, have occurred within the last two years.
+
+
+
+"A woman, living near Fitzroy Square, thinking her child not quite
+well, gave it a dose of Godfrey's cordial, which she purchased at a
+chemist's in the neighbourhood. In a very short time after taking it
+the child fell into convulsions, and soon died. In less than a month
+the child of another woman in the same house was found to be ill with
+disordered bowels. The first woman, not at all suspecting that the
+Godfrey's cordial had produced the convulsions in her infant, persuaded
+her friend to give the same medicine to her child. A dose from the same
+bottle was given, and this child was likewise attacked almost
+immediately with convulsions, and also died."
+
+Convulsions and epilepsy, without such fatal results as the foregoing,
+are not uncommon as the effect of a single dose of an opiate given
+unadvisedly; and by their continued and habitual use (and the form of
+syrup of poppies is but too often administered by an indiscreet and
+lazy nurse, unknown by the parent), a low, irritative, febrile state is
+produced, gradually followed by loss of flesh, the countenance becoming
+pallid, sallow, and sunken, the eyes red and swollen, and the
+expression stupid and heavy, and the powers of the constitution at last
+becoming completely undermined. Such an object is to be seen daily
+among the poorer classes,--the miniature of a sickly aged person: death
+soon follows here.
+
+
+
+Sect. IV.--LEECHING.
+
+
+
+Difficulty sometimes arises in putting a stop to the bleeding from
+leech-bites; a matter of considerable importance in the case of a
+delicate infant. The following measures may be resorted to for this
+purpose:--
+
+1. Expose the surface of the part to the external air, so that a
+coagulum of blood may form at the orifice: this simple mode will
+frequently arrest it.
+
+2. If this fail, make compression upon the part: this is one of the
+most effectual means of restraining haemorrhage. It is to be effected
+by taking a piece of lint folded three or four thicknesses, and the
+size of the finger-nail, to be steadily pressed upon the open orifice
+with the point of the finger until the blood has ceased to flow. The
+pledget of lint, however, must not be removed for some hours
+afterwards, or the bleeding will break out afresh.
+
+3. If the compression fails in stopping the bleeding, or from the
+situation of the leech-bites it cannot be adopted, because there is no
+firm point of resistance upon which to make pressure, the part may be
+dusted with starch or gum arabic powder, or, if this is of no avail,
+the wound may be touched with lunar caustic.
+
+If none of these measures are successful, the assistance of the
+medical attendant must be obtained; and if firm pressure be made upon
+the part, no serious loss of blood can ensue before his arrival.
+
+Leeches should never be resorted to by a parent for any of the
+diseases of infancy, without medical direction.
+
+
+
+Sect. V.--BLISTERS AND POULTICES.
+
+
+
+A blister should never be applied for any infantile disease, except
+when ordered by a medical man, as its injudicious use might greatly
+aggravate the complaint.
+
+There are also one or two precautions in reference to the mode of the
+application of a blister, which it is always right for a parent to
+attend to. From the great irritability of the skin, it should never be
+allowed to remain on longer than from two to four hours. At the
+expiration of this time, the surface will usually become red and
+inflamed; and, if the blister is removed, and the part dressed with
+fresh spermaceti ointment spread on lint, or with a soft bread and
+water poultice, a full blister will soon be raised: the little patient
+is thus saved much suffering, and a very troublesome sore prevented. A
+piece of tissue or silver paper, interposed between the blister and the
+skin, will answer the same purpose; the blister will act well, and the
+evils before alluded to will be prevented.
+
+After a blister has been two or three hours applied, its edge should
+be carefully raised, to ascertain the effect produced; and if the
+surface be much inflamed, more particularly if little points of
+vesication (watery bladders) are present, it should be removed, and the
+above directions attended to.
+
+Mustard poultices are invaluable in some of the diseases of infancy
+and childhood, and therefore frequently ordered.
+
+A mustard poultice is made by mixing two thirds of mustard flour and
+one third of wheaten flour with warm water or vinegar, in sufficient
+quantity to render the powder of the consistence of paste. It is then
+spread on linen from the size of a half-crown to that of the palm of
+the hand, according to the effect intended, and placed on the skin. How
+long it is to be kept on will depend upon the individual sensibility of
+the skin of the child; but, in general, from fifteen to twenty minutes
+will be found amply sufficient. The application, however, must at all
+times be carefully watched; for if it remain on too long, ulceration,
+and death of the part, might ensue; therefore, directly the skin is
+found tolerably red, the poultice should be removed. After its removal,
+the part may be exposed, or, if very painful, smeared over with fresh
+cream or common cerate.
+
+A bread and water poultice, although one of the commonest applications
+in use, is rarely well made or properly applied. It thus becomes
+injurious rather than useful; adding to the inflammation or irritation
+of the part, instead of soothing and allaying it. Nothing, however, is
+more simple than the mode of its preparation.
+
+Cut slices of stale bread of sufficient quantity, scald out a bason,
+put the bread into it, pour upon it boiling water, cover it over, and
+let it stand for ten minutes; next strain the water oft, gently squeeze
+the saturated bread in a thin cloth, so that the poultice shall not be
+too moist, and then spread it upon a cloth so that it shall be in
+thickness half an inch, and of a size large enough to cover the whole
+of the inflamed part, and a little more. Apply it just warm enough to
+be borne, and cover it well with oiled silk. A poultice thus made, will
+act as a local tepid bath to the inflamed part; and the oiled silk
+preventing evaporation, it will be found, when taken off, as moist as
+the first moment that it was put on.
+
+
+
+Sect. VI.--BATHS.
+
+
+
+Baths are much resorted to during infancy and childhood, both in
+health and in disease. In the former state, they constitute an
+important measure of hygeiene (this has been briefly alluded to under
+the section "Bathing"), and in the latter, a valuable remedial agent.
+Their indiscriminate use, however, might be followed by serious
+consequences; it is therefore important to point out a few rules for
+their judicious employment.
+
+
+
+THE COLD WATER PLUNGE BATH.
+
+
+
+It consists of water in its natural degree of heat; its temperature
+varying, according to the season of the year or other circumstances,
+from 30 degrees to 60 degrees.
+
+The phenomena produced upon a strong and healthy boy plunging into
+this bath will be as follows:--He will first experience a sensation of
+cold, followed by slight shuddering, and, if the immersion has been
+sudden, a peculiar impression in the nervous system, called a shock.
+Almost immediately after the shock, the feeling of cold will vanish,
+and give place to a sensation of warmth, speedily diffusing itself over
+the whole frame. If the boy leaves the bath at this time, or, at all
+events, before the warmth of the body goes off, and quickly dresses
+himself, a renewal of the reaction which had followed the shock of
+immersion will be experienced; he will be in a most delightful glow,--
+there will be a general feeling of enjoyment, accompanied by a sensible
+increase of animal power, and invigoration of the whole system. But, on
+the other hand, if the boy greatly prolong his stay in the water, no
+reaction will ensue, and he will become chilly, which will gradually
+increase to a strong and general shivering;--his feet and legs will
+become benumbed, and the whole body will soon be languid, exhausted,
+and powerless. The same result will happen to the young and delicate
+infant, if plunged into this bath; the same sensations will be
+produced; except that here the shock is scarcely followed by any
+reaction, and therefore from the first moment of the immersion, the
+shivering and consequent train of sensations occur. This arises from
+the infant at birth having less power of producing heat than when
+further advanced in age.
+
+From the foregoing remarks, then, it will be seen, that, in early
+infancy, the cold bath is inadmissible, and water of a higher
+temperature than that which feels cool to the hand of the nurse should
+always be used at this age. But that, as the child grows older,--if of
+a healthy and vigorous constitution,--the cold bath is unquestionably
+most desirable; and, if used in a proper manner, will be found to act
+as a most powerful tonic to the system. The summer is of course the
+only period of the year when the cold plunging bath can be resorted to
+for the child.
+
+
+
+SEA BATHING.
+
+
+
+When sea bathing can be obtained, it is even more conducive to the
+health of the child than the fresh water plunge bath; for the sea water
+is more tonic, stimulant, and bracing, than fresh. The period of the
+year best adapted for sea bathing is the summer and autumn. The best
+time of the day for bathing is two or three hours after breakfast;
+except in very hot weather, when an earlier hour must be chosen.
+Exercise is always useful previously to the bath; but it must be
+gentle, so as not to induce fatigue or much perspiration, Then the bath
+must be entered suddenly, with a plunge, inasmuch as an instantaneous
+immersion produces a greater reaction than a gradual immersion.[FN#22]
+The length of time of remaining in will depend upon circumstances. One
+dip only is enough at the first bath. Subsequently the time of
+remaining in the water may be prolonged, but this must be increased
+gradually; the positive necessity of leaving the bath while there still
+remains sufficient power of reaction being always kept in mind.
+Exercise in the water, particularly that of swimming, is highly useful.
+The body should be speedily and well dried, immediately upon coming
+out; a rough jack towel is an excellent means of accomplishing this
+purpose, while at the same time it insures considerable friction of the
+surface of the skin. If the boy is in sound health, he may bathe daily.
+
+
+
+[FN#22]  It is a matter of importance in bathing children, that they
+should not be terrified by the immersion, and every precaution should
+be taken to prevent this.
+
+
+
+As a remedy, sea bathing is highly serviceable. Its employment,
+however, requires much caution, and great mischief is sometimes
+committed by its indiscriminate use.
+
+The child of a strumous habit may be greatly benefited by sea bathing,
+united with a few years' residence on the coast. Indeed, by carefully
+following up a course of sea bathing, a suitable diet, and a judicious
+mode of living, the very temperament of the individual may be all but
+changed, and a power and activity imparted to the system, productive
+eventually of comparatively strong and robust health. A parent will do
+wisely, therefore, to send a child of such a habit to a school on the
+coast. Great caution, however, must be observed when bathing is
+commenced, lest the shock be too powerful for the energies of the
+system, and be not followed by the necessary degree of reaction. It
+will be prudent to begin with the tepid bath (85 degrees to 92
+degrees), and gradually reduce the temperature until the open sea can
+be resorted to without fear. The measures already mentioned for
+promoting reaction--exercise previous to immersion; the immersion at
+first only momentary, and followed by strong friction--must be
+diligently regarded in such a case.
+
+In the child of a delicate and feeble habit, much out of health, whose
+general debility is dependent on some organic disease, sea bathing is
+not only improper, but dangerous. Instead of being strengthened, such a
+child will be rendered more weak and debilitated. On the other hand,
+when the child is of a weak and relaxed habit, but free from organic
+disease, the cold bath will be highly useful, provided sufficient power
+of reaction exist in the system. In this case the skin and flesh of the
+child is relaxed and flabby; there is a great tendency to warm
+perspirations in bed, capricious appetite, confined or relaxed bowels,
+indisposition to exertion, and weariness from the slightest effort.
+
+
+
+THE SHOWER BATH.
+
+
+
+The effects of the shower bath are, on the whole, similar to those of
+the plunge bath of the same degree of temperature, except that the
+immediate shock of the shower bath is in general felt to be greater
+than that from simple immersion. This, however, may be met by putting
+warm water into the bottom of the bath in sufficient quantity to cover
+the ankles of the individual taking the bath, which tends at once to
+lessen the shock, and to increase the reaction.
+
+The apprehension and alarm experienced by young children in entering
+this kind of bath is easily overcome, by using at first a modification
+of it, lately brought into use. It consists of a tin vessel in the form
+of a large bottle, pierced at the bottom like a colander, and
+terminating in the upper part in a narrow tube, with an open mouth.
+When put into water it becomes filled, which is retained by closing the
+mouth of the tube with the finger; on removing which the water flows
+gradually out of the sieve-like bottom in a gentle shower. This may be
+used to the youngest child. At first the quantity of water employed
+should be small, and its temperature warm; as, however, the child grows
+older and accustomed to the bath, the former may be increased, and the
+latter lowered. Its tonic effect may be augmented by the addition
+ofbay salt, and by much active rubbing.
+
+As the child gets older the common form of shower bath may be used,
+and throughout the year, if he enjoy robust health; during the winter
+season, however, the water should be made tepid. This bath should be
+taken immediately upon rising from bed.
+
+
+
+ABLUTION, OR SPONGING.
+
+
+
+By ablution is meant the process of applying water to the surface of
+the body by means of a sponge or towel. It is one of the best
+substitutes for the cold bath; and if done quickly and thoroughly,
+produces a glow and invigoration of frame almost equal to the former.
+It is also the surest preventive against catching cold.
+
+Every child in health ought to be obliged, every morning of its life
+(when other means of bathing cannot be obtained), upon rising, and
+while the body still retains all the warmth of the bed, to sponge the
+whole body. If too young to do it for himself, it must be done for him.
+Salt or vinegar should be added to the water; and if the boy be robust,
+cold water may be used throughout the year; if not, in the winter
+season it must be made tepid.
+
+As a remedy, cold water sponging, and the application of ice and iced
+water, are often ordered under certain states of disease by the medical
+attendant, and frequently followed by delightful results. But it is
+necessary that they should be properly applied to do good.
+
+Cold water sponging is a convenient and grateful method of moderating
+febrile heat of the surface, provided undoubted powers of reaction be
+present in the system. It is frequently ordered, therefore, to be
+employed in eruptive fevers, as measles, scarlet fever, smallpox, and
+other fevers; and also in some local inflammations, particularly of the
+brain. Vinegar may be added to the water under these circumstances
+with advantage. It should at first be used tepid or cool, but
+afterwards cold. As a general rule, the more dry and parched the heat
+of the surface, the more urgent the necessity for the application of
+the cold, and the more frequently and fearlessly ought it to be
+renewed,--every hour or half-hour not being too often. Should the child
+fall asleep during the process, and begin to perspire, it must be
+intermitted, but resumed again on a recurrence of the parching heat.
+
+Ice and iced water are most frequently employed in affections of the
+brain. The former is most conveniently applied in a well-cleaned pig's
+bladder, which should be half filled with broken fragments of the ice.
+The bladder prevents moisture about the clothes, and, from its smooth
+and pliant nature, readily accommodates itself to every part of the
+child's head. If iced water is used, care must be taken that the cloths
+are sufficiently large to cover the whole of the head, and they should
+be doubled to prevent their getting rapidly warm. Indeed, in applying
+cold locally, as in inflammation of the brain, one rule it is of the
+utmost importance to observe, viz. that the application of the cold
+shall be continuous; therefore a second set of cold cloths or bags of
+ice should be applied before the former has become warm. This plan,
+especially pursued during the night, along with judicious internal
+treatment, will save many children from perishing under the most
+insidious and fatal disease of childhood--water on the brain.
+
+If neither water of a sufficiently low temperature, nor ice, can be
+procured, then recourse may be had to refrigerating mixtures, of which
+the following is a good form:--
+
+Common water, five pints;
+Vinegar, two pints;
+Nitre, eight ounces;
+Sal ammoniac, four ounces.
+
+
+
+THE WARM BATH.
+
+
+
+The warm bath judiciously prescribed is one of the most valuable
+remedial agents we possess; but although powerful for good, when
+misapplied, it is equally powerful for mischief. For instance, in
+active inflammatory affections, before the loss of blood, the use of
+the warm bath would greatly aggravate the disease; and yet, for an
+infant with active inflammation of the respiratory organs, it is
+continually resorted to. Again, nothing is more common than for a
+child, when attacked with convulsions, to be put immediately in the
+warm bath; and, generally speaking, it is extremely beneficial in this
+class of diseases; but it is sometimes no less prejudicial, when
+applied without due examination of the peculiarities of individual
+cases. For, in plethoric and gross children, the local abstraction of
+blood from the head, and the complete unloading of the alimentary
+canal, are often necessary to render such a measure beneficial, or even
+free from danger. In convulsions, however, and particularly when
+arising from teething, a parent may, without hesitation, at any time
+immerse the feet of the infant in water as warm as can be borne, at the
+same time that cloths wet with cold water are applied to the head and
+temples.
+
+As a preventive, where there is a tendency to disease, the warm bath
+may be employed without scruple, and will be found most serviceable.
+Its value in this point of view is very great, and it is to be
+regretted that it is not sufficiently appreciated and used. For
+example, a severe cold has been taken, and inflammation of the air-
+tubes is threatened: only put the child into a warm bath, and, with the
+common domestic remedies, a very serious attack may be warded off.
+Again, in the commencement of a diarrhoea, a warm bath, and
+discontinuing the cause of the attack, will alone suffice to cure; and,
+more-over, in the protracted diarrhoea attendant upon teething, where,
+after various remedies have been tried in vain, the child has lost
+flesh and strength to an apparently hopeless degree, Recovery has been
+brought about by the simple use of the warm bath.
+
+In the treatment of scrofulous children, warm and tepid bathing is of
+great value. In such cases, a course of warm sea bathing, with active
+friction over the whole surface after each bath, will at once relieve
+that abdominal fulness which is generally present, improve the
+functions of the skin, and give tone and vigour to the whole system.
+Towards the termination of such a course of baths, their temperature
+must be gradually reduced till they become tepid (85 degrees to 92
+degrees).
+
+The opinion that warm baths generally relax is erroneous: they are, no
+doubt, debilitating when used by persons of a weak and relaxed
+constitution, or when continued too long; but, on the contrary, they
+invariably give tone when employed in the cases to which they are
+properly applicable.
+
+A partial warm bath, such as the foot-bath, is of much service in
+warding off many complaints. If a child get the feet wet, plunging them
+into warm water will often prevent any ill consequences; and even when
+the first chill and slight shiverings which usher in colds, fevers, and
+other inflammatory complaints, have been complained of, the disease may
+be cut short by the use of a foot-bath, continued till free
+perspiration occurs.
+
+
+
+RULES FOR THE USE OF THE WARM BATH.
+
+
+
+TEMPERATURE OF THE WATER.--When the warm bath is used as a measure of
+hygeiene, as a general rule, any degree of temperature may be chosen
+between 92 degrees and 98 degrees, which appears to be most agreeable
+to the child; but on no account must 98 degrees be exceeded. When
+ordered as a remedial measure, the temperature will of course be fixed
+by the medical attendant.
+
+The same degree of temperature must be kept up during the whole period
+of immersion. For this purpose the thermometer must be kept in the
+bath, and additions of warm water made as the temperature is found to
+decrease. These additions of warm water, however, must be regulated by
+the indications of the thermometer, and not by the feelings of the
+child.
+
+
+PERIOD OF REMAINING IN THE BATH.--This must depend upon circumstances.
+As a measure of hygeiene, it must be varied according to the age of the
+child. For the first four or five weeks, the infant should not be kept
+in beyond three or four minutes; and the duration must afterwards be
+gradually prolonged as the child advances in age, until it extends to a
+quarter of an hour, a period which may be allowed after it has attained
+the age of four years.
+
+When the bath is employed as a remedial agent, the time of immersion
+must be prolonged; this will be determined by the medical adviser.
+Speaking generally, a quarter of an hour may be said to be the shortest
+period, an hour the longest, and half an hour the medium.
+
+When in the bath, care must be taken that the child's body is immersed
+up to the shoulders or neck, otherwise that part of the body which is
+out of the bath (the shoulders, arms, and chest), being exposed to the
+cooler temperature of the air, will be chilled.
+
+When the infant or child is taken out of the bath, the general
+surface, especially the feet, must be carefully rubbed dry with towels
+previously warmed; and when one of the objects of the bath is to excite
+much perspiration, the child should be immediately wrapped in flannel
+and put to bed. When, however, the object is not to excite
+perspiration, the child may be dressed in his ordinary clothing, but
+should not be allowed to expose himself to the open air for at least an
+hour.
+
+
+TIME OF USING THE BATH.--When resorted to for sudden illness, the bath
+must of course be employed at any time needed. When used for any
+complaint of long standing, or a measure of hygeiene, as a general
+rule, it should be taken between breakfast and dinner, about two hours
+after the former, or an hour and a half before the latter. This implies
+that the infant should never be put into the bath after having been
+freely nourished at the breast. Neither should it ever be used when the
+child is in a state of free perspiration from exercise, or on awaking
+from sleep.
+
+
+
+Chap. III.
+
+OF TEETHING, AND HINTS ON THE PERMANENT OR ADULT TEETH.
+
+
+
+The infant at birth has no teeth visible: the mouth is toothless. It
+possesses, however, hidden in the jaw, the rudiments of two sets. The
+first of these which makes its appearance, are called the Temporary or
+Milk Teeth; the second, the Permanent or Adult Teeth, and these come up
+as the former fall out, and so gradually replace them.
+
+
+
+Sect. I.--ON TEETHING.
+
+
+
+THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set
+of teeth, or milk-teeth as they are called, are twenty in number; they
+usually appear in pairs, and those of the lower jaw generally precede
+the corresponding ones of the upper. The first of the milk-teeth is
+generally cut about the sixth or seventh month, and the last of the set
+at various periods from the twentieth to the thirtieth months. Thus the
+whole period occupied by the first dentition may be estimated at from a
+year and a half to two years. The process varies, however, in different
+individuals, both as to its whole duration, and as to the periods and
+order in which the teeth make their appearance. It is unnecessary,
+however, to add more upon this point.
+
+Their developement is a natural process. It is too frequently,
+however, rendered a painful and difficult one, by errors in the
+management of the regimen and health of the infant, previously to the
+coming of the teeth, and during the process itself.
+
+Thus, chiefly in consequence of injudicious management, it is made the
+most critical period of childhood. Not that I believe the extent of
+mortality fairly traceable to it, is by any means so great as has been
+stated; for it is rated as high as one sixth of all the children who
+undergo it. Still, no one doubts that first dentition is frequently a
+period of great danger to the infant. It therefore becomes a very
+important question to an anxious and affectionate mother, how the
+dangers and difficulties of teething can in any degree be diminished,
+or, if possible, altogether prevented. A few hints upon this subject,
+then, may be useful. I shall consider, first, the management of the
+infant, when teething is accomplished without difficulty;--and,
+secondly, the management of the infant when it is attended with
+difficulty.
+
+
+
+MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.
+
+
+
+In the child of a healthy constitution, which has been properly, that
+is, naturally, fed, upon the milk of its mother alone, the symptoms
+attending teething will be of the mildest kind, and the management of
+the infant most simple and easy.
+
+
+SYMPTOMS.--The symptoms of natural dentition (which this may be fairly
+called) are, an increased flow of saliva, with swelling and heat of the
+gums, and occasionally flushing of the cheeks. The child frequently
+thrusts its fingers, or any thing within its grasp, into its mouth. Its
+thirst is increased, and it takes the breast more frequently, though,
+from the tender state of the gums, for shorter periods than usual. It
+is fretful and restless; and sudden fits of crying and occasional
+starting from sleep, with a slight tendency to vomiting, and even
+looseness of the bowels, are not uncommon. Many of these symptoms often
+precede the appearance of the tooth by several weeks, and indicate that
+what is called "breeding the teeth" is going on. In such cases, the
+symptoms disappear in a few days, to recur again when the tooth
+approaches the surface of the gum.
+
+
+TREATMENT.--The management of the infant in this case is very simple,
+and seldom calls for the interference of the medical attendant. The
+child ought to be much in the open air, and well exercised: the bowels
+should be kept freely open with castor oil; and be always gently
+relaxed at this time. Cold sponging employed daily, and the surface of
+the body rubbed dry with as rough a flannel as the delicate skin of the
+child will bear; friction being very useful. The breast should be given
+often, but not for long at a time; the thirst will thus be allayed, the
+gums kept moist and relaxed, and their irritation soothed, without the
+stomach being overloaded. The mother must also carefully attend, at
+this time, to her own health and diet, and avoid all stimulant food or
+drinks.
+
+From the moment dentition begins, pressure on the gums will be found
+to be agreeable to the child, by numbing the sensibility and dulling
+the pain. For this purpose coral is usually employed, or a piece of
+orris-root, or scraped liquorice root; a flat ivory ring, however, is
+far safer and better, for there is no danger of its being thrust into
+the eyes or nose. Gentle friction of the gums, also, by the finger of
+the nurse, is pleasing to the infant; and, as it seems to have some
+effect in allaying irritation, may be frequently resorted to. In
+France, and in this country also, it is very much the practice to dip
+the liquorice-root, and other substances, into honey, or powdered
+sugar-candy; and in Germany, a small bag, containing a mixture of sugar
+and spices, is given to the infant to suck, whenever it is fretful and
+uneasy during teething. The constant use, however, of sweet and
+stimulating ingredients must do injury to the stomach, and renders
+their employment very objectionable.
+
+
+
+THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.
+
+
+
+In the child which has been partly or altogether brought up by hand,
+or who is of a feeble and delicate constitution, or imbued with any
+hereditary taint, the process of dentition will be attended with more
+or less difficulty, and not unfrequendy with danger.
+
+
+SYMPTOMS.--The symptoms of difficult dentition are of a much more
+aggravated description than those which attend the former case; and it
+is right that a mother should, to a certain extent, be acquainted
+with their character, that she may early request that medical aid,
+which, if judiciously applied, will mitigate, and generally quickly
+remove them.
+
+Difficult dentition will be attended with painful inflammation and
+swelling of the gum, which is hotter, of a deeper red, than natural,
+and intolerant of the slightest pressure. There is often great
+determination of blood to the head, which a mother may recognise by the
+cheeks being red, hot, and swollen; the eyes red, irritable, and
+watery; and the saliva running from the mouth profusely. The fever is
+great, and the thirst extreme. The child is at one time restless and
+irritable, and at another heavy and oppressed: the sleep will be
+broken, and the infant frequently awake suddenly and in alarm from its
+short slumbers. Such are the chief symptoms of difficult teething, and
+which will be present to a greater or less degree.
+
+
+TREATMENT.--As most of the above symptoms are induced by the painful
+tension of the gum, it would seem that the most rational mode of
+attempting their relief is by freely lancing the swollen part. Great
+prejudices, however, still exist in the minds of some parents against
+this operation. They think it gives great pain, and, if the tooth is
+not very near, makes its coming through the gum subsequently the more
+difficult.
+
+With regard to the first objection, the lancet is carried through the
+gum so quickly, that this is hardly possible; and the fact that the
+infant will often smile in your face after it is done, although
+previously crying from pain, is sufficient evidence that it is not a
+very painful operation. In reference to the second, that the scar which
+ensues, opposes, by its hardness, the subsequent progress of the tooth,
+it is quite groundless; for cicatrices, like all other new-formed
+parts, are much more easily absorbed than the original structure.
+
+Of the practical utility and perfect safety of this operation we have
+ample proof in its daily performance with impunity, and in the instant
+relief which it often affords to all the symptoms.
+
+Mere scarifying the gums is sometimes all that is required, and will
+afford great relief. This operation, therefore, should not be opposed
+by the mother. She, at the same time, should be acquainted with its
+precise object, lest the speedy return of the symptoms, and the non-
+appearance of the expected tooth, might tend to bring the operation of
+lancing the gums into disrepute.
+
+The parental management of the infant, then, and by which much of the
+pain and difficulty of teething may be removed or alleviated, consists
+in attending to the following directions:--
+
+
+FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of
+the mother's duty to pay especial attention; and, by so doing, she will
+save her child much suffering. The condition of the mouth should be
+carefully inspected from time to time; and should a swollen gum be
+discovered, it should immediately be attended to, not waiting till
+constitutional symptoms appear before she employs proper aid for her
+child. For this purpose the mother should make herself familiar with
+the appearances of the gum under distention and inflammation; a matter
+of no difficulty, accompanied, as this condition usually is, by a
+profuse secretion of saliva, heat of mouth, and at a time when the age
+of the child justifies the supposition that it is about to cut its
+first tooth, or, if it have some teeth, that others are about to appear.
+
+
+SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it
+should always have its quantity of nourishment diminished. If it is
+being fed, as well as nursed at the breast, at the time, the former
+should be immediately withheld: if it is being fed alone, the only
+kind of food that should be allowed is milk and water. These cases are
+much aggravated by the not uncommon habit of parents giving the infant
+food whenever it cries from the irritation attending upon the process;
+and thus a slightly difficult dentition is converted into serious
+disease.
+
+
+THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched,
+that they may not become confined; it being necessary that they should
+be gently relaxed at this time. If a slight diarrhoea is present, it
+must not be checked; if it pass beyond this, however, medicine must be
+had recourse to, and great benefit will also arise from putting the
+child into a warm hip-bath, and warmly clothing the body, but keeping
+the head cool.
+
+
+FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold
+water night and morning, and no other covering than that which nature
+has provided should be put upon it when within doors or asleep; and on
+no occasion should warm felt or velvet hats be worn during mild or warm
+weather, straw or white hats being much lighter and cooler. The child
+should be much in the open air.
+
+The sponging of the infant's body daily, either with cold or tepid
+water, must depend upon the season of the year and constitution of the
+child, as well as upon other circumstances. Sponging the head with cold
+water night and morning is almost invariably atttended with great
+benefit, and may be resorted to in every case without fear; and now and
+then the use of the warm hip-bath, for several days together, will be
+ordered by the physician, which, by acting upon the skin, diminishes
+the determination of blood to the head, and thus forms an important
+source of relief.
+
+
+FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not
+unfrequently excited by difficult teething, and then give great alarm
+to the parent, relief will be afforded by immersing the hips, legs,
+and feet of the infant in water as warm as can be borne, and at the
+same time applying over the head and temples a piece of flannel wet
+with cold water. I have also often cut the fit short by sprinkling cold
+water in the child's face while in the bath. The gums should always be
+looked to, and if they appear swollen, and painful, at once lanced. I
+have known the most formidable convulsions to cease immediately after
+this operation.
+
+
+SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses
+to administer narcotics to quiet infants while teething. It is not only
+objectionable, but, from the uncertain effects of sedatives upon
+infants, a very dangerous practice, and they ought never to be given,
+except at the suggestion of a medical man. It is far better, if the
+child is restless at night, to have it frequently taken out of its cot,
+and carried about in an airy room; for the cool air, and change of
+posture, will do much to allay the feverishness and restlessness of the
+child.
+
+
+From these few hints, it must have been seen how much the sufferings
+from teething may be mitigated by judicious management. That, if the
+parent is able to support her infant upon the breast alone, teething
+will be found comparatively an easy process, and unattended with
+danger; the mother thus reaping a delightful reward for all the
+anxieties and privations nursing necessarily involves. That the child
+brought up partially, or entirely, by hand will always pass through
+dentition with more or less of pain and difficulty; but that even here,
+if the diet has been properly regulated, much less suffering and
+inconvenience will arise than when less attention has been paid to it.
+And, lastly, that, when teething is difficult, how highly important it
+is to call in proper aid at an early period, and to carry out fully the
+directions of the medical attendant, allowing no foolish prejudices to
+interfere with his prescriptions and management.
+
+If I stood in need of any argument to impress upon the mind of a
+parent the importance of attending to the last injunction, I would
+simply state, that its neglect is but too frequently the cause of
+disease of the brain, terminating in death, or a state of idiotcy far
+worse than death, of which I know more than one living instance.
+
+It may be as well to add, that eruptions about the ears, head, face,
+and various parts of the body, very frequently appear during the
+process of the first teething.[FN#23] If they are slight, they should
+be left alone, being rather useful than otherwise; if they are
+troublesome, they must receive that kind of attention from the parent
+which will be pointed out under the chapter on diseases. The same
+remark applies to enlargements of the glands of the neck, which
+frequently appear at this time.
+
+
+
+[FN#23]  In some infants a rash always precedes the cutting a tooth.
+Sometimes it appears in the form of hard elevated pimples as large as
+peas; in other instances in the form of red patches, of the size of a
+shilling, upon the arms, shoulders, and back of the neck. They are
+always harmless, require no particular attention, and prevent, I doubt
+not, more serious complaints.
+
+
+
+SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.
+
+
+
+Parents are not sufficiently alive to the importance of attending to
+the condition of the mouth of their children at the period of changing
+the first for the second set of teeth; they do not seem to be aware
+how much the comfort, appearance, and future health of the child
+depends upon it. Nor do they subsequently impress upon the minds of
+their children how necessary, on their part, is the observance of
+certain rules for the preservation of the teeth, and how distressing
+are the effects which result from their neglect. It is proposed, here,
+to say a few words for the information and guidance of the parent upon
+this subject.
+
+
+
+THE MANNER IN WHICH THEY APPEAR.
+
+
+
+The change of the temporary for the permanent or adult teeth
+commences, in the majority of instances, at about seven years of age;
+occasionally it occurs as early as five, and as late as eight years and
+a half. The necessity which exists for this change, and the mode by
+which it is effected, are striking and beautiful; it is, however, not
+our object to enter fully upon its consideration here.
+
+It has already been observed, that the infant is born with the
+rudiments of two sets of teeth in the jaw, although neither make their
+appearance till long after birth. The time when, and the manner in
+which the first set appear has been pointed out. Now although these
+admirably answer the purposes for which they were given up to the
+seventh year, after this period they fail to do so: they are not
+sufficiently numerous,--in their structure they are not strong or
+durable,--nor is their power of mastication sufficiently great.
+
+They are not sufficiently large or numerous. If the mouth of a child
+at this age is examined, it will be seen, that a considerable interval
+has taken place between the teeth in consequence of the growth and
+expansion of the face; hence a larger set has become necessary to fill
+the arch. But it may be asked, do not the teeth grow with the growth of
+the body? and if not, why is it so? They do not, and for this reason:
+the important office which these organs are destined to perform requires
+that they should be composed of a substance too dense and of too low
+an organization to allow of any subsequent growth and enlargement. Thus
+the size of the teeth is determined and acquired before they make their
+appearance through the gums. This being the case, it will be readily
+seen, that the teeth which would be of appropriate size in the mouth of
+the infant, would be quite inadequate to the enlarged dimensions of the
+adult; hence the necessity of a second set, exceeding in number, and
+size the teeth of the first.
+
+That a necessity also exists at this age, that the weak and delicate
+teeth of childhood should be exchanged for a set stronger and more
+durable in their structure, more robust and more powerful, will be
+sufficiently apparent, if we only recollect the great change which has
+gradually been taking place in the nature of the food of the two epochs
+of childhood and adult age.
+
+The second set, or permanent teeth, then, lying under the milk-teeth
+and hidden in the jaw, undergo in this situation their full
+developement, before they appear above the gum. This occurrence
+commences about seven years of age, at which period the first set
+begin to fall out from their roots becoming absorbed, and no longer
+retaining their hold of the jaw; to be entirely replaced in the course
+of a few years by the permanent set, which thus succeeds them. The
+first teeth of this set which make their appearance are the large
+double teeth, which emerge from the gum immediately behind the last of
+the temporary set. Next the two front teeth of the lower jaw fall out,
+and are succeeded by two others of similar character and form, but of
+larger size; then the two corresponding teeth of the upper row are cast
+off, and their place supplied; shortly after the teeth immediately
+adjoining these; then the double teeth of the first set are exchanged
+for their smaller successors of the second. The eye-teeth after a time
+begin to make their appearance; and then more double teeth; making in
+all twenty-eight teeth, and occupying in their developement from the
+seventh to the fourteenth year of age. They are not, however, yet
+complete; for between the latter date and the twenty-first year four
+more teeth appear, called the wisdom teeth, making the adult set or
+permanent teeth to amount in all to thirty-two teeth. It should be
+observed, that whilst this is the most usual course in which this set
+appear, the line of succession is sometimes different.
+
+
+
+THEIR VALUE AND IMPORTANCE.
+
+
+
+It would seem almost unnecessary to say a word upon so self-evident a
+truth, and yet perhaps the full extent of this statement is not
+generally appreciated. It has not, perhaps, occurred to the minds of
+all, that upon the right position and arrangement of the teeth the
+beauty and expression of the countenance much depends. But so it is;
+for however regular and perfect the general features, if the teeth are
+irregular or deficient, an unpleasing expression, proportionate to the
+extent of the displacement, is inevitably produced. Now every mother
+should be alive to this fact, that she may early apply to the dentist
+to have any error of the above nature rectified, before it is too late.
+
+On their complete and entire state also depends the perfection of
+utterance and articulation. The child, for instance, makes no attempt
+at articulation until it has acquired several teeth; this faculty
+becomes also exceedingly imperfect during the process of changing them;
+from this time it continues to improve, until again it is permanently
+impaired in old age, when they are finally lost. And so again, if a
+child lose merely a single tooth from the front of its mouth, lisping
+will result; or if a supernumerary or irregular tooth be present, the
+articulation will be abrupt and imperfect:--the former plainly showing
+the importance of the entireness of the series, and the latter, the
+necessity of regularity in their arrangement and position.
+
+The teeth, however, are chiefly important in relation to the part they
+sustain in connection with digestion, viz. the mastication of the food.
+By this act the food, after being received into the mouth, is mixed
+with the saliva and broken down, till it becomes of an uniform pulpy
+consistence, fit for being easily swallowed, and acted upon by the
+gastric juice on its arrival in the stomach. That due mastication of
+the food is essential to healthy digestion, which will be promoted or
+retarded in exact proportion as it approaches or falls short of this
+point, is a fact so generally known as scarcely to need comment.
+Suffice it to add, that, if food be introduced into the stomach
+unmasticated, the gastric juice will only act upon its surface; and
+after a number of hours it will be either rejected by vomiting, or pass
+on into the intestine, to give rise to cholic, bowel complaints, or
+flatulence, and very frequently in children to a serious attack of
+convulsions.
+
+
+
+THEIR MANAGEMENT AND PRESERVATION.
+
+
+
+IRREGULARITY OF ARRANGEMENT AND POSITION.--Every parent ought to have
+the mouth of her child inspected occasionally, during the advance of
+the permanent teeth, that any irregularity in their position or
+arrangement may be prevented. And it is equally her duty to see to it,
+that she choose a competent person to do this, since great mistakes are
+not unfrequently made in this matter, and which themselves become the
+source of evils far more serious than those they are intended to
+obviate. "I have known," says Mr. Bell, "no less than eight or even ten
+firm teeth forcibly removed from the jaws of a child at once, when
+there was not the slightest reason to apprehend any evil result from
+their being left alone." Here there was a most cruel, because
+unnecessary, infliction of pain, as well as great hazard incurred of
+seriously injuring the permanent teeth by interfering with the
+secretion of their enamel. And besides all this there is another and
+yet greater evil, for, if the temporary teeth be removed, before the
+permanent ones are so advanced as to be ready to occupy their
+situation, the arch of the jaw will assuredly contract, and when,
+subsequently, the permanent teeth are fully formed, there will not be
+room for them to range in their proper situation. Thus the operation
+which was intended to prevent irregularity becomes the cause of its
+occurrence, and that in its very worst form, producing a want of
+accordance between the size of the teeth and that of the jaw.
+
+The eye-teeth generally occasion most anxiety to a parent, from the
+prominent position in which they present themselves; but in the
+majority of cases nothing but time is required to reduce them to their
+proper station. But, whatever may be the peculiarities of each
+individual case, the dentist will decide what may be required; only, I
+would again repeat, do not neglect the occasional inspection of the
+mouth at this age, if you regard the future comfort and appearance of
+your child.
+
+
+THEIR PRESERVATION.--The preservation of the teeth requires attention to
+several points; the first and principal of which is, to enforce the
+habit in the child of thoroughly cleaning the teeth by means of water
+and a brush night and morning, and rinsing out the mouth after each
+meal. The brush should not be very hard, as it will not only be more
+difficult to clean the interstices between the teeth, the
+part in which the tartar[FN#24] is most likely to be deposited, but by
+its friction, will occasion the gradual absorption of the gum and the
+exposure of the neck of the teeth. The hair of the brush should be firm
+and elastic, and not too closely set.
+
+
+
+[FN#24]  A sort of calcareous substance, which becomes deposited at
+the roots of the teeth, from a want of proper attention to
+cleanliness; and, if allowed to remain, will destroy first their
+beauty, and then the organ itself.
+
+
+
+TARTAR.--If there is a tendency to the formation of tartar, then it will
+be necessary to have recourse to some tooth-powder. Tooth-powders,
+however, must be chosen with care, as many of them are composed of
+substances highly injurious to the teeth. "Many of the tooth-powders
+which are offered for sale, with the promise of rendering the teeth
+beautifully white, perform, for a time, all that is promised, at the
+expense of permanent and irremediable injury to the teeth; for they
+often contain a quantity of tartaric or other acid, which effects a
+gradual decomposition of the enamel."[FN#25] Prepared chalk is one of
+the simplest and best tooth-powders.
+
+
+
+[FN#25]  Bell on the Teeth.
+
+
+
+The following form, also, may be used with advantage:--
+
+Prepared chalk, three ounces;
+Orris root, powdered, half an ounce;
+Powdered myrrh, half an ounce;
+Cuttle fish, powdered, one ounce;
+Essential oil of cinnamon, four drops.--Mix.
+
+The best preservative, then, against the formation of tartar, is to
+see that the child cleans his teeth thoroughly night and morning with
+the brush, powder, and water, and also (if possible) that he rinses out
+the mouth after each meal.
+
+If the gums should be tender, irritable, and bleed (as is frequently
+the case when an individual gets out of health, or the tartar
+accumulates) the mouth may be washed night and morning with a tumbler of
+tepid water, containing from ten to twenty drops of the tincture of
+myrrh, and the same quantity of spirits of camphor; or the following
+form may be used:--
+
+Alum, one drachm and a half;
+Tincture of myrrh, two drachms;
+Camphor mixture, five ounces and a half.--Mix.
+
+
+ACIDS.--The use of acids to the teeth cannot be too strongly deprecated:
+they decompose their substance, and lead to their rapid decay. Hence
+the whiteness produced by acid tooth-powders and washes is not less
+deceitful than ruinous in its consequences. As has been just observed,
+they perform all that their vendors promise, causing the teeth, for a
+little while, to become very white and beautiful in their appearance,
+but, at the same time, injuring them irremediably: the enamel becomes
+gradually decomposed, the bone of the tooth exposed, and its death is
+the inevitable consequence.
+
+It is therefore of great importance when acid medicines are ordered
+for children that they should be taken through a glass tube, to prevent
+their coming in contact with the teeth. From a want of this precaution,
+I know a lady (and there are many such instances) who once had as sound
+and fine a set of teeth as any one could boast of, but from this cause
+has had nearly the whole of the upper row destroyed. She was in
+delicate health: it was judged requisite that she should take for a
+considerable time (with other medicines) sulphuric acid; but the glass
+tube was not thought of, and the consequences followed which have been
+described.
+
+
+CALOMEL.--This medicine, as it is frequently given, alone, or in the
+little white powders, in infancy and childhood, by mothers and nurses,
+is productive of serious and indeed irremediable injury to the teeth.
+"The immoderate use of mercury in early infancy produces, more perhaps
+than any other similar cause, that universal tendency to decay, which,
+in many instances, destroys almost every tooth at an early age. It is
+certainly not unimportant to bear this fact in mind, in the
+administration of this sovereign remedy, this panacea, as many appear
+to consider it, in infantile diseases."[FN#26]
+
+
+
+[FN#26]  Bell on the Teeth.
+
+
+
+HEAT AND COLD.--The teeth are exceedingly apt to suffer from sudden
+variations of temperature. Fluids, therefore, should never be taken
+into the mouth so hot or so cold as to produce the slightest pain; and,
+for the same reason, the water with which the mouth is cleansed should
+in winter be always warm or tepid. When ices are taken, the precaution
+of placing them in the centre of the mouth, so as to prevent contact
+with the teeth, should be carefully observed.
+
+There are many other causes which might be mentioned as tending to
+induce decay of the teeth, but their consideration here is purposely
+avoided.
+
+It is hoped that enough has been said to draw the parent's attention
+to the subject of the teeth, to prevent their neglect, and yet at the
+same time to induce a cautious management.
+
+
+
+CHAP. IV.
+
+
+HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER.
+
+
+
+Life is soon extinguished in infancy. At this epoch any disease is
+formidable, and must be met most promptly. It is either sudden and
+active in its assaults, or comes with slow and insidious approach. The
+first signs of its coming on are not always visible to an unpractised
+eye: it may have made dangerous advances before the mother's mind is
+awakened to its presence; and medical aid may be solicited when
+remedies and advice are no longer of any avail.
+
+It is therefore highly important that a mother should possess such
+information as will enable her to detect disease at its first
+appearance, and thus insure for her child timely medical assistance.
+This knowledge it will not be difficult for her to obtain. She has only
+to bear in mind what are the indications which constitute health, and
+she will at once see that all deviations from it must denote the
+presence of disorder, if not of actual disease. With these changes she
+must to a certain extent make herself acquainted.
+
+
+
+Sect. I.--SIGNS OF HEALTH.
+
+
+
+The signs of health are to be found, first, in the healthy performance
+of the various functions of the body; the regular demands made for its
+supply, neither in excess or deficiency; and a similar regularity in
+its excretions both in quantity and appearance.
+
+If the figure of the healthy infant is observed, something may be
+learnt from this. There will be perceived such an universal roundness
+in all parts of the child's body, that there is no such thing as an
+angle to be found in the whole figure; whether the limbs are bent or
+straight, every line forms a portion of a circle. The limbs will feel
+firm and solid, and unless they are bent, the joints cannot be
+discovered.
+
+The tongue, even in health, is always white, but it will be free from
+sores,--the skin cool,--the eye bright,--the complexion clear,--the head
+cool,--and the abdomen not projecting too far,--the breathing regular,
+and without effort.
+
+When awake, the infant will be cheerful and sprightly, and, loving to
+be played with, will often break out into its merry, happy, laugh;
+whilst, on the other hand, when asleep, it will appear calm, every
+feature composed, its countenance displaying an expression of
+happiness, and frequently, perhaps, lit up with a smile.
+
+
+
+Sect. II. SIGNS OF DISEASE.
+
+
+
+Just in proportion as the above appearances are present and entire,
+health may be said to exist; and just in proportion to their partial or
+total absence disease will have usurped its place.
+
+We will, however, for the sake of clearness examine the signs of
+disease as they are manifested separately by the countenance,--the
+gestures,--in sleep,--in the stools,--and by the breathing and cough.
+
+
+
+OF THE COUNTENANCE.
+
+
+
+In health the countenance of a thild is expressive of serenity in mind
+and body; but if the child be unwell, this expression will be changed,
+and in a manner which, to a certain extent, will indicate what part of
+the system is at fault.
+
+The brows will be contracted, if there is pain, and its seat is in the
+head. This is frequently the very first outward sign of any thing being
+wrong, and will occur at the very onset of disease; if therefore
+remarked at an early period, and proper remedies used, its notice may
+prevent one of the most fearful of infantile complaints--"Water in the
+Head."
+
+If this sign is passed by unheeded, and the above disease be
+threatened, soon the eyes will become fixed and staring,--the head hot,
+and moved uneasily from side to side upon the pillow, or lie heavily
+upon the nurse's arm,--the child will start in its sleep, grinding its
+teeth, and awake alarmed and screaming,--its face will be flushed,
+particularly the cheeks (as if rouged),--its hands hot,--but feet cold,
+its bowels obstinately costive, or its motions scanty, dark-coloured,
+and foul.
+
+If the lips are drawn apart, so as to show the teeth or gums, the seat
+of the pain is in the belly. This sign, however, will only be present
+during the actual existence of suffering; if, therefore, there be any
+doubt whether it exist, press upon the stomach, and watch the eifect on
+the expression of the countenance.
+
+If the pain arise simply from irritation of the bowels excited from
+indigestion, it will be temporary, and the sign will go and come just
+as the spasm may occur, and slight remedial measures will give relief.
+
+If, however, the disease be more serious, and inflammation ensue, this
+sign will be more constantly present, and soon the countenance will
+become pale, or sallow and sunken,--the child will dread motion, and
+lie upon its back with the knees bent up to the belly,--the tongue will
+be loaded,--and in breathing, while the chest will be seen to heave
+with more than usual effort, the muscles of the belly will remain
+perfectly quiescent.
+
+If the nostrils are drawn upwards and in quick motion, pain exists in
+the chest. This sign, however, will generally be the accompaniment of
+inflammation of the chest, in which case the countenance will be
+discoloured,--the eyes more or less staring, and the breathing will be
+difficult and hurried; and if the child's mode of respiring be watched,
+the chest will be observed to be unmoved, while the belly quickly
+heaves with every inspiration.
+
+Convulsions are generally preceded by some changes in the countenance.
+The upper lip will be drawn up, and is occasionally bluish or livid.
+Then there may be slight squinting, or a singular rotation of the eye
+upon its own axis; alternate flushing or paleness of the face; and
+sudden animation followed by languor.
+
+These signs will sometimes manifest themselves many hours, nay days,
+before the attack occurs; may be looked upon as premonitory; and if
+timely noticed, and suitable medical aid resorted to, the occurrence of
+a fit may be altogether prevented.
+
+The state of the eyes should always be attended to. In health they are
+clear and bright, but in disease they become dull, and give a heavy
+appearance to the countenance; though after long continued irritation
+they will assume a degree of quickness which is very remarkable, and a
+sort of pearly brightness which is better known from observation than
+it can be from description.
+
+The direction of the eyes, too, should be regarded, for from this we
+may learn something. When the infant is first brought to the light,
+both eyes are scarcely ever directed to the same object: this occurs
+without any tendency to disease, and merely proves, that regarding one
+object with both eyes is only an acquired habit. But when the child has
+come to that age when the eyes are by habit directed to the same
+object, and afterwards it loses that power, this circumstance alone may
+be looked upon as a frequent prelude to disease affecting the head.
+
+
+
+OF THE GESTURES.
+
+
+
+The gestures of a healthy child are all easy and natural; but in
+sickness those deviations occur, which alone will often denote the
+nature of the disease.
+
+Suppose an infant to have acquired the power to support itself, to
+hold its head erect; let sickness come, its head will droop
+immediately, and this power will be lost, only to be regained with the
+return of health; and during the interval every posture and movement
+will be that of languor.
+
+The little one that has just taught itself to run alone from chair to
+chair, having two or three teeth pressing upon and irritating the gums,
+will for a time be completely taken off its feet, and perhaps lie
+languidly in its cot, or on its nurse's arm.
+
+The legs being drawn up to the belly, and accompanied by crying, are
+proofs of disorder and pain in the bowels. Press upon this part, and
+your pressure will increase the pain. Look to the secretions from the
+bowels themselves, and by their unhealthy character your suspicions, in
+reference to the seat of the disorder, are at once confirmed.
+
+The hands of a child in health are rarely carried above its mouth; but
+let there be any thing wrong about the head and pain present, and the
+little one's hands will be constantly raised to the head and face.
+
+Sudden starting when awake, as also during sleep, though it occur from
+trifling causes, should never be disregarded. It is frequently
+connected with approaching disorder of the brain. It may forebode a
+convulsive fit, and such suspicion is confirmed, if you find the thumb
+of the child drawn in and firmly pressed upon the palm, with the
+fingers so compressed upon it, that the hand cannot be forced open
+without difficulty. The same condition will exist in the toes, but not
+to so great a degree; there may also be a puffy state of the back of the
+hands and feet, and both foot and wrist bent downwards.
+
+There are other and milder signs threatening convulsions and connected
+with gesture, which should be regarded:--the head being drawn rigidly
+backwards,--an arm fixed firmly to the side, or near to it,--as also one
+of the legs drawn stifly upwards. These signs, as also those enumerated
+above, are confirmed beyond all doubt, if there be present certain
+alterations in the usual habits of the child:--if the sleep is
+disturbed,--if there be frequent fits of crying,--great peevishness of
+temper,--the countenance alternately flushed and pale,--sudden animation
+followed by as sudden a fit of languor,--catchings of the breath
+followed by a long and deep inspiration,--all so many premonitory
+symptoms of an approaching attack.
+
+
+
+OF THE SLEEP.
+
+
+
+The sleep of the infant in health is quiet, composed, and refreshing.
+In very early infancy, when not at the breast, it is for the most
+part asleep in its cot; and although as the months advance it sleeps
+less, yet when the hour for repose arrives, the child is no sooner laid
+down to rest, than it drops off into a quiet, peaceful slumber.
+
+Not so, if ill. Frequently it will be unwilling to be put into its cot
+at all, and the nurse will be obliged to take the infant in her arms;
+it will then sleep but for a short time, and in a restless and
+disturbed manner.
+
+If it suffer pain, however slight, the countenance will indicate it;
+and, as when awake, so now, if there is any thing wrong about the head,
+the contraction of the eye-brow and grinding of the teeth will appear;
+if any thing wrong about the belly, the lips will be drawn apart,
+showing the teeth or gums,--and in both instances there will be great
+restlessness and frequent startings.
+
+
+
+OF THE STOOLS.
+
+
+
+In the new-born infant the motions are dark coloured, very much like
+pitch both in consistence and appearance. The first milk, however,
+secreted in the mother's breast, acts as an aperient upon the infant's
+bowels, and thus in about four-and-twenty hours it is cleansed away; or
+if it should not, a tea-spoonful of castor oil accomplishes this
+purpose.
+
+From this time, and through the whole of infancy, the stools will be
+of a lightish yellow colour, the consistence of thin mustard, having
+little smell, smooth in appearance, and therefore free from lumps or
+white curded matter, and passed without pain or any considerable
+quantity of wind. And as long as the child is in health, it will have
+daily two or three, or even four, of these evacuations. But as it grows
+older, they will not be quite so frequent; they will become darker in
+colour, and more solid, though not so much so as in the adult.
+
+Any deviation, then, from the above characters, is of course a sign of
+something wrong; and as a deranged condition of the bowels is
+frequently the first indication we have of coming disease, the nurse
+should daily be directed to watch the evacuations. Their appearance,
+colour, and the manner in which discharged, are the points principally
+to be looked to. If the stools have a very curdy appearance, or are too
+liquid, or green, or dark-coloured, or smell badly, they are unnatural.
+And in reference to the manner in which they are discharged, it should
+be borne in mind, that, in a healthy child, the motion is passed with
+but little wind, and as if squeezed out, but in disease, it will be
+thrown out with considerable force, which is a sign of great
+irritation. The number, too, of stools passed within the four-and-
+twenty hours it is important to note, so that if the child does not
+have its accustomed relief, (and it must not be forgotten that
+children, although in perfect health, differ as to the precise number,)
+a little castor oil may be at once exhibited, and thus mischief be
+prevented.
+
+This, however, is not the place to discuss the question of disordered
+bowels, but simply to point out how this circumstance may be
+known.[FN#27]
+
+
+
+[FN#27]  See section on Disorders of the Stomach and Bowels, p. 208.
+
+
+
+OF THE BREATHING AND COUGH.
+
+
+
+The breathing of a child in health is formed of equal inspirations and
+expirations, and it breathes quietly, regularly, inaudibly, and without
+effort. But let inflammation of the air-tubes or lungs take place, and
+the inspiration will become in a few hours so quickened and hurried,
+and perhaps audible, that the attention has only to be directed to the
+circumstance to be at once perceived.
+
+Now all changes which occur in the breathing from its healthy
+standard, however slight the shades of difference may be, it is most
+important should be noticed early. For many of the complaints in the
+chest, although very formidable in their character, if only seen early
+by the medical man, may be arrested in their progress; but otherwise,
+may be beyond the control of art. A parent, therefore, should make
+herself familiar with the breathing of her child in health, and she
+will readily mark any change which may arise.
+
+Of cough I should not have said any thing in this chapter, as it can
+never fail to be noticed, except that it is highly necessary to throw
+out one caution. Whenever a child has the symptoms of a common cold,
+attended by hoarseness and a rough cough, always look upon it with
+suspicion, and never neglect seeking a medical opinion. Hoarseness does
+not usually attend a common cold in the child, and these symptoms may
+be premonitory of an attack of "croup;" a disease excessively rapid in
+its progress, and which, from the importance of the parts affected,
+carrying on, as they do, a function indispensably necessary to life,
+requires the most prompt and decided treatment.
+
+The following observations of Dr. Cheyne are so strikingly
+illustrative, and so pertinent to my present purpose, that I cannot
+refrain inserting them:--"In the approach of an attack of croup, which
+almost always takes place in the evening, probably of a day during
+which the child has been exposed to the weather, and often after
+catarrhal symptoms have existed for several days, he may be observed to
+be excited, in variable spirits, more ready than usual to laugh than to
+cry, a little flushed, occasionally coughing, the sound of the cough
+being rough, like that which attends the catarrhal stage of the
+measles. More generally, however, the patient has been for some time in
+bed and asleep, before the nature of the disease with which he is
+threatened is apparent; then, perhaps, without waking, he gives a very
+unusual cough, well known to any one who has witnessed an attack of the
+croup; it rings as if the child had coughed through a brazen trumpet;
+it is truly a tussis clangosa; it penetrates the walls and floor of the
+apartment, and startles the experienced mother,--'Oh! I am afraid our
+child is taking the croup!' She runs to the nursery, finds her child
+sleeping softly, and hopes she may be mistaken. But remaining to tend
+him, before long the ringing cough, a single cough, is repeated again
+and again; the patient is roused, and then a new symptom is remarked;
+the sound of his voice is changed; puling, and as if the throat were
+swelled, it corresponds with the cough," etc.
+
+How important that a mother should be acquainted with the above signs
+of one of the most terrific complaints to which childhood is subject;
+for, if she only send for medical assistance during its first stage,
+the treatment will be almost invariably successful; whereas, if this
+"golden opportunity" is lost, this disease will seldom yield to the
+influence of measures, however wisely chosen or perseveringly employed.
+
+
+
+SECT. III.--OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION
+OF DISEASE.
+
+
+
+1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF
+DISORDER.--The recollection of the fact, that at the different seasons
+of
+the year some diseases are more prevalent than at other periods, will
+greatly aid a judicious parent in the early detection of the presence
+of disorder, and its kind, in her child.
+
+Thus, in the early part of the winter, what is called catarrh, viz. an
+increased secretion of mucus from the membranes of the nose, fauces,
+and air-tubes, with fever, and attended with sneezing and cough,
+thirst, lassitude, and want of appetite, is generally prevalent.
+
+As the winter advances, the air-tubes of the lungs, and the lungs
+themselves, are liable to become the seat of disorder; and those signs
+will present themselves, which have been pointed out in the previous
+section as characteristic of such attacks.
+
+In the spring, we have still the same diseases prevalent, and in
+addition, measles, scarlet fever, small-pox, and chicken pox, which
+increase in liability towards the close of this season, and with the
+first weeks of summer.
+
+In the summer, disease is less prevalent than at any other period of
+the year; but towards its middle and close, and through the whole of
+the autumnal months, bowel complaints may be expected, in the forms of
+diarrhoea, cholera, and dysentery.
+
+
+2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.--
+Without entering into this subject at large, still it may be useful to
+remark, that in some families there is a predisposition to some
+diseases, which, occurring in the first child, will, as each succeeding
+child is born, attack at the same age. Amongst other diseases of this
+class are, croup, hooping-cough, and water in the head.
+
+This observation should not only lead a mother to be alive to the
+possibility of the successional occurrence of these diseases in her
+family, and so early note their appearance, and seek medical advice,
+but should at the same time make her most anxious, on the one hand, to
+shield her child from all their exciting causes, and on the other, to
+adopt those measures which may contribute indirectly to overcome the
+constitutional predisposition to them.
+
+
+Of the scrofulous constitution, I will merely mention here, that it is
+of the greatest importance, where a predisposition to this disease
+exists in a family, that a mother should immediately attend to any
+alteration in the gait or contour of her child, and give prompt
+attention also to any complaint made of swelling about a joint,
+although it may be unattended with pain. The importance of this remark
+will be seen by contrasting the result of the following cases which
+occurred in children of the same family.
+
+
+
+Case I.
+
+
+A. B., a female child, having blue eyes, light hair, and a fair
+complexion, in the early part of the year 1838, being then two years of
+age, had an enlargement of the left knee joint. For some weeks previous
+to this time, there had been a degree of heat about the part; but as no
+pain apparently existed, it was not regarded as of any consequence, and
+nothing was done. The child, living in the neighbourhood of London, was
+afterwards placed under medical treatment. Two or three months having
+elapsed, it was brought to town, and shown to me, in consequence of a
+slight tumefaction over the lower part of the spine. This soon
+disappeared under the measures employed, and eventually the disease of
+the knee (evidently scrofulous) was arrested, so that now the case
+promises to be cured; but the joint will for ever be stiff, and the
+limb thus affected shorter than the other.
+
+
+
+Case II.
+
+
+G. B., the brother of the above, a handsome boy, with light hair, fine
+blue eyes,--indeed, very much like his little sister,--in the year
+1836, had enlargements of the glands in his neck, which were relieved
+by the treatment resorted to.
+
+In April, 1839, being then eight years old, he was observed by his
+mother to limp slightly in walking, but complained of little or no
+pain. From the caution, however, which had been given to the parent at
+the time I was consulted about the previous case, to notice at an early
+period any symptom of this nature in her children, the fact was
+immediately attended to. The affection was evidently in the hip; there
+was imperfection in the gait, and pain upon pressing over the joint. A
+blister was applied, perfect rest to the limb enjoined, and steel
+medicines ordered; and in a fortnight the motions of the joint were
+restrained more effectually by the application of strips of soap
+plaster and a bandage. In three months the child was ordered to the sea-
+side, and eventually was able to walk without the slightest limp or
+pain, and may be said to be quite well.
+
+I would not say that in the first case, if the disease had been
+discovered early, and at that time met by judicious medical treatment,
+a stiff knee and shortened limb would have been prevented, although
+this is my belief; but in reference to the latter case, I have no
+hesitation in saying, that without the disease had been early detected
+by the mother, and as promptly attended to by her, the remedial
+measures might have failed,--certainly the result would not have been
+so highly satisfactory as it was.
+
+
+
+Chap. V.
+
+
+ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
+
+
+
+The especial province of the mother is the prevention of disease, not
+its cure. To the establishment and carrying out of this principle,
+every word contained in the preceding pages has directly or indirectly
+tended.
+
+This, however, is not all. When disease attacks the child, the mother
+has then a part to perform, which it is especially important during the
+epochs of infancy and childhood should be done well. I refer to those
+duties which constitute the maternal part of the management of disease.
+
+Medical treatment, for its successful issue, is greatly dependent upon
+a careful, pains-taking, and judicious maternal superintendence. No
+medical treatment can avail at any time, if directions be only
+partially carried out, or be negligently attended to; and will most
+assuredly fail altogether, if counteracted by the erroneous prejudices
+of ignorant attendants. But to the affections of infancy and childhood,
+this remark applies with great force; since, at this period, disease is
+generally so sudden in its assaults, and rapid in its progress, that
+unless the measures prescribed are rigidly and promptly administered,
+their exhibition is soon rendered altogether fruitless.
+
+The amount of suffering, too, may be greatly lessened by the
+thoughtful and discerning attentions of the mother. The wants and
+necessities of the young child must be anticipated; the fretfulness
+produced by disease, soothed by kind and affectionate persuasion; and
+the possibility of the sick and sensitive child being exposed to harsh
+and ungentle conduct, carefully provided against.
+
+Again, not only is a firm and strict compliance with medical
+directions in the administration of remedies, of regimen, and general
+measures, necessary, but an unbiased, faithful, and full report of
+symptoms to the physician, when he visits his little patient, is of
+the first importance. An ignorant servant or nurse, unless great
+caution be exercised by the medical attendant, may, by an unintentional
+but erroneous report of symptoms, produce a very wrong impression upon
+his mind, as to the actual state of the disease. His judgment may, as a
+consequence, be biased in a wrong direction, and the result prove
+seriously injurious to the welldoing of the patient. The medical man
+cannot sit hour after hour watching symptoms; hence the great
+importance of their being faithfully reported. This can alone be done
+by the mother, or some person equally competent.
+
+There are other weighty considerations which might be adduced here,
+proving how much depends upon efficient maternal management in the time
+of sickness; but they will be severally dwelt upon, when the diseases
+with which they are more particularly connected are spoken of.
+
+
+
+Sect. 1.--ACCIDENTS AND DISEASES WHICH MAY OCCUR TO THE INFANT AT
+BIRTH, OR SOON AFTER.
+
+
+STILL-BORN.
+
+
+
+Sometimes the child comes into the world apparently dead, and, unless
+the most active exertions are made by the attendants, is lost. The
+superintendence of the means used devolves upon the medical man; but it
+would be often well if his assistants were already acquainted with the
+measures pursued under these circumstances, for they would be more
+likely to be carried into effect with promptitude and success, than
+they now frequently are. And again, the still-born child is frequently
+in this state from having been born very rapidly, and before the
+medical man can have arrived, it will be more especially useful in
+such a case, that the attendants in the lying-in-room should know how
+to proceed.
+
+The various causes producing this condition it is unnecessary to
+mention.
+
+The condition itself may exist in a greater or less degree: the infant
+may be completely stillborn, with no indication of life, except,
+perhaps, the pulsation of the cord, or a feeble action of the heart;--or
+it may make ineffectual efforts at breathing, or even cry faintly, and
+yet subsequently perish for want of strength to establish perfectly the
+process of respiration. Under all these circumstances, a good deal can
+often be effected by art. In every instance, therefore, in which we
+have not positive evidence of the child being dead, in the existence of
+putrefaction, or of such malformation as is incompatible with life, it
+is our duty to give a fair trial to the means for restoring suspended
+animation; and as long as the slightest attempt at motion of the
+respiratory organs is evinced, or the least pulsation of the heart
+continues, we have good grounds for persevering and hoping for ultimate
+success.
+
+The measures to be employed to restore a still-born child will be a
+little modified by the circumstances present.
+
+
+IF THERE IS NO PULSATION--NO BEATING IN THE CORD, when the child comes
+into the world, it may at once be separated from the mother. This is
+to be effected by first tying the navel-string with common sewing
+thread (three or four times doubled), about two inches from the body of
+the child, and again two inches from the former ligature, and then
+dividing the cord with a pair of scissors between the two. And now the
+means for its restoration are to be made use of, which are detailed
+below, viz. inflation of the lungs, and perhaps the warm bath. If, with
+the above circumstances, the child's face be livid and swollen, some
+drops of blood should previously be allowed to escape before the
+ligature is applied to that part of the navel-string which is now only
+attached to the child.
+
+
+IF THERE IS PULSATION IN THE CORD, BUT RESPIRATION IS NOT FULLY
+ESTABLISHED, it must not be divided; and as long as pulsation
+continues, and the child does not breathe perfectly and regularly, no
+ligature should be applied. The first thing to be done here, is to pass
+the finger, covered with the fold of a handkerchief or soft napkin, to
+the back of the child's mouth, to remove any mucus which might obstruct
+the passage of air into the lungs, and at the same time to tickle
+those parts, and thereby excite respiratory movements. The chest
+should then be rubbed by the hand, and a gentle shock given to the body
+by slapping the back. If these means fail, the chest and soles of the
+feet must next be rubbed with spirits, the nostrils and back of the
+throat irritated with a feather previously dipped in spirits of wine,
+and ammonia or hartshorn may be held to the nose.
+
+
+INFLATION OF THE LUNGS.--These means not having been successful, and
+the pulsation in the cord having ceased, the infant must be separated,
+and inflation of the lungs resorted to. This is to be effected gently
+and cautiously as follows:--
+
+The child, wrapped in flannel, is to be laid on its back upon a table
+placed near the fire. Its head is to be slightly extended, and the
+nostrils held between the fingers and thumb of one hand, whilst with
+the fingers of the other slight pressure is to be made upon the pit of
+the stomach, so as to prevent the air from passing into that organ. The
+lungs of the child are now to be filled with air, by the operator
+applying his own lips--with a fold of silk or muslin intervening, for
+the sake of cleanliness--to those of the child, and then simply blowing
+in its mouth, he is to propel the air from his own chest into that of
+the infant. Previously, however, to his doing this, he should make
+several deep and rapid inspirations, and, finally, a full inspiration,
+in order to obtain greater purity of air in his own lungs.
+
+When the chest of the child has been thus distended, it is to be
+compressed gently with the hand, so as to empty the lungs; and then the
+inflation, with the alternately compressing the chest, must be repeated
+again and again, until either the commencement of natural respiration
+is announced by a sneeze or deep sigh, or until after long-continued,
+steady, persevering, but unavailing, efforts to effect this object
+shall have removed all ground of hope for a successful issue.
+
+Whilst these efforts are being made, some other individual must
+endeavour to maintain or restore the warmth of the infant's body, by
+gently but constantly pressing and rubbing its limbs between his warm
+hands. And after respiration is established, the face must still be
+freely exposed to the air, whilst the warmth of the limbs and body is
+carefully sustained.
+
+It will sometimes happen--and to this circumstance the operator should
+be fully alive--that when the child begins to manifest symptoms of
+returning animation, its tongue will be drawn backwards and upwards
+against the roof of the mouth, filling up the passage to the throat,
+and preventing further inflation of the lungs. This is to be remedied
+by the introduction of the fore-finger to the upper and back part of
+the child's tongue, and gently pressing it downwards and forwards, by
+which the difficulty will be removed, and the air again passes.
+
+
+THE WARM BATH.--More reliance may be placed upon the above measure to
+restore animation, than upon the warm bath. Still this is sometimes
+useful, and therefore must not be neglected. Whilst inflation is going
+on, the bath may be got ready, then resorted to, and if unsuccessful,
+inflation may and ought again to be followed up.[FN#28] If the bath is
+useful at all, it will be so immediately upon putting the infant into
+it; respiration will be excited, followed by a cry; and if this does
+not occur at once, it would be wrong to keep the child longer in the
+bath, as it would be only losing valuable time which ought to be
+devoted to other efforts. The temperature of the bath should be about
+100 degrees; and if, upon plunging the infant into it, it fortunately
+excite the respiratory effort, it should then be taken out, rubbed with
+dry but hot flannels, and, when breathing is fully established, laid in
+a warm bed, or, what is still better, in its mother's bosom; letting
+it, however, have plenty of air.
+
+
+
+[FN#28]  We should not relinquish our endeavours at resuscitation
+under two or three hours, or even longer; and if ultimately
+successful, the state of the infant should be carefully watched for two
+or three days.
+
+
+
+INJURIES RECEIVED DURING BIRTH.
+
+If a labour be long and tedious, the head and body of the child may be
+bruised and disfigured.
+
+The shape of the head is frequently altered by the compression it has
+undergone, so that it may be elongated, and measure from the chin to
+the back of the head as much as six or seven inches. This always
+excites surprise, sometimes apprehension, in the minds of the
+attendants: there is no ground for it. It must be allowed to regain its
+natural shape without interference.
+
+Tumours or swellings upon the head are very common. They arise from
+pressure upon the part during the labour. The only treatment that is
+required, or safe, is, freedom from all pressure, and the application
+of cold lotions composed of brandy or vinegar and water. The swelling
+will gradually subside. It will be right to direct the attention of the
+medical man to this circumstance.
+
+The face may be frightfully disfigured from the above cause,
+exceedingly black, and the features distorted. Nothing is necessary
+here; in a few days the face will recover its proper appearance.
+
+
+
+RETENTION OF URINE.
+
+
+
+Occasionally an infant will not pass any urine for many hours after
+its birth. This most frequently arises from the fact of none being
+secreted. In the last case of this kind that I was called to, three
+days had elapsed since birth, and no urine had been passed; it proved
+that none had been secreted. Sometimes, however, it is the effect of
+another cause, which the use of the warm bath will be found to remove,
+which should always therefore be employed four and twenty hours after
+the birth of the infant, if it has not by that time passed any water.
+
+It now and then happens, but fortunately very rarely, that some
+physical obstruction exists. It is always important, therefore, for the
+nurse to pay attention to the above point; and it is her duty to direct
+the attention of the medical man to the subject, if anything unusual or
+unnatural be present. The same observation applies to the bowel also;
+and if twelve hours pass without any motion, the parts should be
+examined.
+
+
+
+SWELLING OF THE BREASTS.
+
+
+
+At birth, or two or three days subsequently, the breasts of the infant
+will frequently be found swollen, hard, and painful, containing a fluid
+much resembling milk. Nurses generally endeavour to squeeze this out,
+and thus do great mischief; for by this means inflammation is excited
+in the part, and sometimes abscess is the result.
+
+If the breasts are simply slightly enlarged, it is unnecessary to do
+any thing more than rub them occasionally and very gently with warm
+almond oil, and a little time will restore them to their proper size.
+
+If, however, they are inflamed, hot, painful, with a red surface, and
+unusually large, a bread and water poultice must be applied every three
+or four hours, which will generally prevent either the formation of
+matter, or any other unpleasant consequence. In a few days, under this
+treatment, they will usually subside, and be quite well.
+
+
+
+INFLAMMATION OF THE EYES.
+
+
+
+ITS IMPORTANCE.--About the second or third day after the child's birth,
+an inflammation sometimes attacks the eye, which is of considerable
+consequence. The more so, from its commencing in a way not calculated
+to excite the attention, or alarm the fears, of the mother or nurse.
+The child cannot express its sensations, and the swelling of the eye
+conceals the progress of the disease, so that serious mischief is
+frequently done before the medical man sees the patient. In the first
+place, the inflammation is not immediately noticed; and, in the second,
+the measures employed are frequently insufficient to check its
+progress: hence it causes more blindness (I refer to the lower classes
+of society more particularly) than any other inflammatory disorder that
+happens to the eye; and the number of children is very considerable,
+whose sight is partially or completely destroyed by it. The parent or
+nurse is apt to suppose, when this inflammation first appears, that it
+is merely a cold in the eye, which will go off; and the consequences
+which I have just mentioned take place, in many cases, before they are
+aware of the danger, and before the medical man is resorted to for
+assistance.
+
+I only desire, in mentioning this complaint, to inform the attendants
+of the lying-in-room of its great importance, that it may not be
+trifled with, that upon its first approach the physician may be
+informed of it, and that the treatment he directs for its cure may be
+sedulously and rigidly followed.
+
+
+SYMPTOMS.--The inflammation commonly comes on about three days after
+birth, but it may take place at a later period. It may be known by its
+commencing thus:--When the child wakes from sleep, the eyelids will be
+observed to stick together a little; their edges will be redder than
+natural, and especially at the corners; the child experiences pain from
+the access of light, and therefore shuts the eye against it. A little
+white matter will also be observed lying on the inside of the lower
+lid. After a short time, the lids swell, become red on their external
+surface, and a large quantity of matter is secreted, and constantly
+poured from the eye; the quantity of discharge increasing until it
+becomes very great.
+
+But enough has been said to point out the importance of the disease,
+and the signs by which it may be recognised at its first approach.
+
+TREATMENT.--Keeping the eye free from discharge, by the constant
+removal of the matter secreted, is what the medical attendant will
+chiefly insist upon; and without this is done, any treatment he may
+adopt will be useless; with it, there is no doubt of a successful issue
+of the case, provided his attention has only been called to it at a
+sufficiently early period.
+
+
+
+HARE-LIP.
+
+
+
+This is a blemish too well known to require a formal description. The
+questions most interesting to a mother in relation to it, are,--How is
+her child to be nourished, that is born with it? and when ought an
+operation to be performed for its removal?
+
+
+THE MODE OF FEEDING THE INFANT.--If the defect is but trifling, the
+infant will be able to suck, provided the mother's nipple is large, and
+the milk flows freely from it. If this is not the case, the difficulty
+may be obviated by using the cork nipple shield.[FN#29] I have known
+this to answer the purpose admirably, when the mother had previously
+despaired of nursing her infant, the nipple being too small for it to
+grasp.
+
+
+
+[FN#29]  See p. 41.
+
+
+
+If, however, the defect exists in a still greater degree, feeding by
+means of the spoon must be resorted to; the greatest care being
+necessary as to the quantity, quality, and preparation of the
+food.[FN#30]
+
+
+
+[FN#30]  See "Artificial Feeding," p. 34.
+
+
+
+CAUTION IN REFERENCE TO THE OPERATION.--With regard to the operation
+for the removal of this deformity, I would strongly warn parents
+against desiring its too early performance. Various considerations
+contribute to make the distressed parents anxious for this. But very
+seldom indeed--except the deformity be very great, and implicating other
+parts beside the lip--will the operation be required, or ought it to be
+resorted to, before the second year and a half of the infant's life;
+and for this very cogent reasons exist. For instance, convulsions may
+thus be induced, which often terminate fatally.
+
+The most proper age for removing this deformity by operation, is from
+that of two years and a half to four years.
+
+
+
+BLEEDING FROM THE NAVEL-STRING.
+
+
+
+Bleeding from the navel-string will sometime take place hours after it
+has been supposed to be carefully secured. This will arise, either from
+the cord being carelessly tied, or from its being unusually large at
+birth, and in a few hours shrinking so much that the ligature no
+longer sufficiently presses on the vessels. In either case, it is of
+importance that the attendants in the lying-in-room should understand
+how to manage this accident when it occurs, that it may not prove
+injurious or fatal to the child.
+
+
+THE MODE OF ARRESTING THE BLEEDING.--The clothes of the child and the
+flannel roller must be taken off;--the whole cord without delay must be
+unwrapped, and then a second ligature be applied below the original
+one, (viz. nearer to the body of the infant,) taking great care that
+it shall not cut through the cord when drawn very tight, but at the
+same time drawing it sufficiently tight to compress the vessels.
+
+The ligature should be composed of fine linen threads, three or four
+thicknesses, and not of tape or bobbin, or any substance of this
+nature, as it cannot be relied on for this purpose.
+
+
+
+ULCERATION OR IMPERFECT HEALING OF THE NAVEL.
+
+
+
+The cord separates from the navel generally some time between the
+fifth and fifteenth day from delivery, and the part usually heals
+without giving the slightest trouble.
+
+This, however, is not always the case, for sometimes a thin discharge
+will take place, which, if the part be examined, will be found to
+proceed from a small growth about the size, perhaps, of a pea, or even
+less. This must be removed by applying a little powdered alum,--or, if
+this fail, it should be once or twice slightly touched with blue-stone,
+and afterwards dressed with calamine cerate.
+
+At other times, though fortunately very rarely, excoriation of the
+navel and the parts around takes place, which quickly spreads, and
+assumes an angry and threatening character. If, however, the attention
+of the medical man is called to it early, it will always do well: until
+his directions are given, apply a nicely made bread and water poultice.
+
+
+
+BLEEDING FROM THE NAVEL.
+
+
+
+Sometimes, a day or two after the cord separates, or at the time of
+separation, bleeding takes place from the navel: fortunately, this very
+seldom occurs; indeed, it is very rarely met with; and I only mention
+it, to observe that, upon its occurrence, the point of the finger
+should be placed over the part, and pressure steadily applied until
+medical assistance is obtained.
+
+Now and then, in these cases, a growth sprouts up and bleeds. Let this
+be touched with lunar caustic, or any other astringent application, or
+let pressure be employed, still it will bleed,--not freely or in a
+stream, but there will be a constant drain from the part, and the
+infant, as a consequence, will waste, and be brought to death's door.
+Excise it, it will only make matters worse. The treatment in this case
+consists in simply winding a piece of very narrow tape round the
+growth, and then leaving it untouched. The bleeding will soon cease;
+the fungus will sprout over the upper margin of the tape; in a very
+short time it will, as it were, strangle the disease, which
+subsequently falling off, a complete cure is accomplished.
+
+
+
+JAUNDICE.
+
+
+
+It frequently happens, during the first or second week after birth,
+that the skin of the child becomes very yellow, and it has all the
+appearance of having the jaundice. This gives rise to great distress to
+the parent when she perceives it, and she becomes very anxious for the
+medical man's next visit.
+
+Now, ordinarily, it is of no consequence; commonly disappearing
+spontaneously, and requiring no medical treatment. If, however, it
+does not go off in two or three days, a tea-spoonful of castor oil
+should be given once, or oftener, if necessary.
+
+It is, of course, possible for an attack of real jaundice to occur at
+this early period, and a disease of a very serious nature will then
+have to be dealt with; but, except as a consequence of malformation (a
+very infrequent occurrence), it is not likely to arise; and therefore
+jaundice during the first and second week after delivery need not
+create alarm.
+
+
+
+Tongue-tied.
+
+
+
+FROM WHAT IT ARISES.--This arises from the bridle under the tongue being
+so short, or its attachment to the tongue extended so near the tip, as
+to interfere with the motions of the organ in sucking, and, in after
+years, in speaking. It is a rare occurrence, although nothing is more
+common than for medical men to have infants brought to them supposed to
+be labouring under the above defect.
+
+HOW ITS EXISTENCE MAY BE DETERMINED.--The best guide for a parent to
+determine whether it exist or not, is for her to watch whether the
+infant can protrude the tip of the tongue beyond the lips: if so, it
+will be able to suck a good nipple readily, and nothing need or ought
+to be done. No mother will unnecessarily expose her infant to an
+operation, which, unless very carefully performed, is not altogether
+unattended with danger; and, if she suspects any defect of this kind to
+exist, she has only to observe the circumstance mentioned above, to
+satisfy her mind upon the subject.
+
+
+
+MOLES AND MARKS ON THE SKIN, ETC.
+
+
+
+The supposed influence of the imagination of the mother, in the
+production of the above appearances in the texture of the skin of her
+infant, has been fully discussed in the author's work "Hints to
+Mothers, etc." This part of the subject is, however, foreign to the
+present inquiry, which chiefly has reference to the probable effect of
+their presence upon the health of the child.
+
+They may be divided into two classes: the brownish mole, and claret-
+stain; and small but somewhat elevated tumours, either of a dark blue,
+livid colour, or of a bright vermilion hue.
+
+
+MOLES AND STAINS.--They are of no importance, as far as the health of
+the infant is concerned. If situated in the face, however, they
+frequently cause great disfigurement, as the claret-stain, which may be
+seen sometimes to occupy nearly half the face. But they happily do not
+increase in size, remaining stationary through life; and as any
+operation that might be proposed for their removal, would only cause an
+equal, if not greater, deformity, they ought to be left alone.
+
+
+COLOURED SPOTS OR TUMOURS.--These vary in their number, size, and
+situation. The same child is sometimes born with many of them. They may
+be as small as a pea, or as large as a crown piece. They are not only
+found on the skin, but on the lips, in the mouth, etc. etc.
+
+These, also, sometimes remain stationary in their size, having no
+tendency to enlarge, unless, indeed, they are subjected to friction or
+pressure. But as they frequently require surgical aid, in which case,
+the earlier the application of remedial measures, the less severe in
+their kind, and the greater the probability of a speedy and successful
+result,--so is it always important for the mother early to obtain a
+medical opinion, that the measure of interference or non-interference
+may be decided.
+
+
+
+Sect. II. DISORDERS OF THE STOMACH AND BOWELS OF THE INFANT.
+
+
+
+INDIGESTION, FLATULENCE, VOMITING, GRIPING, AND LOOSENESS.
+
+
+
+Disorder of the stomach and bowels is one of the most fruitful sources
+of the diseases of infancy. Only prevent their derangement, and, all
+things being equal, the infant will be healthy and flourish, and need
+not the aid of physic or physicians. Experience daily proves, that a
+large proportion of the children who die in infancy are lost from
+derangement of these organs, as the primary cause.
+
+There are many causes which may give rise to these affections; many of
+them appertain to the mother's system, some to that of the infant. All
+are capable, to a great extent, of being prevented or remedied. It is,
+therefore, most important that a mother should not be ignorant or
+misinformed upon this subject. It is the prevention of these
+affections, however, that will be principally dwelt upon in this
+chapter; for let the mother ever bear in mind, and act upon the
+principle, that the prevention of disease alone belongs to her; the
+cure to the physician.
+
+For the sake of clearness and reference, these disorders will be
+spoken of as they occur:--
+
+To the infant at the breast.
+At the period of weaning.
+And to the infant brought up by hand.
+
+
+
+1. TO THE INFANT AT THE BREAST.
+
+
+
+UNHEALTHY MILK.--The infant's stomach and bowels may become deranged
+from the breast-milk becoming unwholesome.
+
+This may arise from the parent getting out of health, a circumstance
+which will be so manifest to herself, and to those more immediately
+interested in her welfare, that it is only necessary just to allude to
+it here. Suffice it to say, that there are many causes of a general
+kind to which it may owe its origin; but that the most frequent is
+undue lactation, a subject to which reference has already been made,
+and the effects both upon mother and child fully dwelt upon.[FN#31] To
+cure derangement of the bowels from this cause, a wet-nurse is the
+only remedy.
+
+
+
+[FN#31]  See page 15.
+
+
+
+Anxiety of mind in the mother will cause her milk to be unhealthy in
+its character, and deficient in quantity, giving rise to flatulence,
+griping, and sometimes even convulsions in the infant.[FN#32] A fit of
+passion in the nurse will frequently be followed by a fit of bowel
+complain in the child.[FN#33] These causes of course are temporary, and
+when removed the milk becomes a healthy and sufficient for the child as
+before.
+
+
+
+[FN#32]  See page 25.
+
+[FN#33]  See page 33.
+
+
+
+Sudden and great mental disturbance, however, will occasionally drive
+away the milk altogether, and in a few hours. A Mrs. S., aet. 21, a
+fine healthy woman, of a blonde complexion, was confined of a boy in
+October, 1836. She had a good time, and a plentiful supply of milk for
+the child, which she continued to suckle till the following January, a
+period of three months, when her milk suddenly disappeared. This
+circumstance puzzled the medical attendant, for he could not trace it
+to any physical ailment; but the milk never returned, and a wet-nurse
+became necessary. In the following spring the husband of this lady
+failed, an adversity which had been impending since the date when the
+breast-milk disappeared, upon which day the deranged state of the
+husband's affairs was made known to the wife,--a fact which at once
+explained the mysterious disappearance of the milk.
+
+Unwholesome articles of diet will affect the mother's milk, and
+derange the infant's bowels. On the 25th May, 1836, I was called to see
+an infant at the breast with diarrhoea. The remedial measures had but
+little effect so long as the infant was allowed the breast-milk; but
+this being discontinued, and arrow-root made with water only allowed,
+the complaint was quickly put a stop to. Believing that the mother's
+milk was impaired from some accidental cause which might now be passed,
+the infant was again allowed the breast. In less than four-and-twenty
+hours, however, the diarrhoea returned. The mother being a very healthy
+woman, it was suspected that some unwholesome article in her diet might
+be the cause. The regimen was accordingly carefully inquired into, when
+it appeared that porter from a neighbouring publican's had been
+substituted for their own for some little time past. This proved to be
+bad, throwing down, when left to stand a few hours, a considerable
+sediment; it was discontinued; good sound ale taken instead; the
+infant again put to the breast, upon the milk of which it flourished,
+and never had another attack.
+
+In the same way aperient medicine, taken by the mother, will act on
+the child's bowels, through the effect which it produces upon her milk.
+This, however, is not the case with all kinds of purgative medicine,
+nor does the same purgative produce a like effect upon all children. It
+is well, therefore, for a parent to notice what aperient acts thus
+through her system upon that of her child, and what does not, and when
+an aperient becomes necessary for herself, unless she desire that the
+infant's bowels be moved, to avoid the latter; if otherwise, she may
+take the former with good effect.
+
+Again; the return of the monthly periods whilst the mother is a nurse
+always affects the properties of the milk, more or less, deranging the
+stomach and bowels of the infant. It will thus frequently happen, that
+a few days before the mother is going to be unwell, the infant will
+become fretful and uneasy; its stomach will throw up the milk, and its
+motions will be frequent, watery, and greenish. And then, when the
+period is fully over, the milk will cease to purge. It is principally
+in the early months, however, that the infant seems to be affected by
+this circumstance; for it will be generally found that although the
+milk is certainly impaired by it, being less abundant and nutritious,
+still, after the third or fourth month it ceases to affect the infant.
+Is then a mother, because her monthly periods return after her
+delivery, to give up nursing? Certainly not, unless the infant's health
+is seriously affected by it; for she will generally find that, as the
+periods come round, by keeping the infant pretty much from the breast,
+during its continuance, and feeding him upon artificial food, she will
+prevent disorder of the child's health, and be able in the intervals to
+nurse her infant with advantage. It must be added, however, that a wet-
+nurse is to be resorted to rather than any risk incurred of injuring
+the child's health; and that, in every case, partial feeding will be
+necessary at a much earlier period than when a mother is not thus
+affected.
+
+The milk may also be rendered less nutritive, and diminished in
+quantity, by the mother again becoming pregnant. In this case,
+however, the parent's health will chiefly suffer, if she persevere in
+nursing; this, however, will again act prejudicially to the child. It
+will be wise, therefore, if pregnancy should occur, and the milk
+disagree with the infant, to resign the duties of a nurse, and to put
+the child upon a suitable artificial diet;--if, however, pregnancy
+should take place before the infant is six month's old, a wet-nurse
+ought to be procured.
+
+
+FROM IRREGULAR NURSING.--This is one of the most frequent sources of
+derangement of the stomach and bowels of the child. The infant that is
+constantly at the breast will always be suffering, more or less, from
+flatulence, griping, looseness of the bowels, and vomiting. This is
+caused by a sufficient interval not being allowed between the meals for
+digestion. The milk, therefore, passes on from the stomach into the
+bowels undigested, and the effects just alluded to follow. Time must
+not only be given for the proper digestion of the milk, but the stomach
+itself must be allowed a season of repose. This evil, then, must be
+avoided most carefully by the mother strictly adhering to those rules
+for nursing which have been already laid down.[FN#34]
+
+
+
+[FN#34]  See page 5.
+
+
+
+FROM TEETHING.--The bowels of the infant at the breast, as well as
+after it is weaned, are generally affected by teething. And it is
+fortunate that this is the case, for it prevents more serious
+affections. Indeed, the diarrhoea that occurs during dentition, except
+it be violent, must not be subdued; if, however, this is the case,
+attention must be paid to it. It will generally be found to be
+accompanied by a swollen gum; the freely lancing of which will
+sometimes alone put a stop to the looseness: further medical aid may,
+however, be necessary.
+
+FROM COLD AND DAMP, ETC.--Of course there are other causes besides
+these already alluded to, giving rise to bowel complaints, during this
+epoch,--causes not cognisable by the mother, however, and not mentioned
+therefore here. It is right, however, that she should be aware that
+these affections are sometimes the result simply of impressions of cold
+or damp, particularly at certain seasons of the year; in the autumn,
+for instance, when, as is well known, bowel complaints are very
+frequent. When thus produced, it is important early to seek medical
+aid, as inflammation is generally the result.
+
+
+
+2. AT THE PERIOD OF WEANING.
+
+
+
+There is great susceptibility to derangements of the stomach and
+bowels of the child at the period when weaning ordinarily takes place,
+so that great care and judgment must be exercised in effecting this
+object. Usually, however, the bowels are deranged during this process
+from one of these causes; from weaning too early, from effecting it too
+suddenly and abruptly, or from over-feeding and the use of improper and
+unsuitable food. There is another cause which also may give rise to
+diarrhoea at this time, independently of weaning, viz. the irritation
+of difficult teething.
+
+
+WEANING TOO EARLY.--The substitution of artificial food for the breast-
+milk of the mother, at a period when the digestive organs of the infant
+are too delicate for this change, is a frequent source of the
+affections now under consideration.
+
+The attempt to wean a delicate child, for instance, when only six
+months old, will inevitably be followed by disorder of the stomach and
+bowels. Unless, therefore, a mother is obliged to resort to this
+measure, from becoming pregnant, or any other unavoidable cause, if she
+consult the welfare of her child, she will not give up nursing at this
+early period. But if she should be no longer competent to suckle, and
+her infant be delicate, a wet-nurse must be obtained; for, the infant's
+bowels becoming disordered, medicine or remedies will avail little
+without healthy breast milk.
+
+The age at which weaning ought to take place must ever depend upon
+circumstances; the ninth month would not be too early for some, the
+twelfth would be for others.[FN#35]
+
+
+
+[FN#35]  See page 51.
+
+
+
+FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once
+of the breast, and substituting artificial food, however proper under
+due regulations such food may be, will invariably cause bowel
+complaints. Certain rules and regulations must be adopted to effect
+weaning safely, the details of which are given elsewhere.[FN#36]
+
+
+
+[FN#36]  See page 52.
+
+
+
+OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These
+causes are more productive of disorder of the stomach and bowels at the
+time of weaning than any yet referred to.
+
+If too large a quantity of food is given at each meal, or the meals
+are too frequently repeated, in both instances the stomach will become
+oppressed, wearied, and deranged; part of the food, perhaps, thrown up
+by vomiting, whilst the remainder, not having undergone the digestive
+process, will pass on into the bowels, irritate its delicate lining
+membrane, and produce flatulence, with griping, purging, and perhaps
+convulsions.
+
+Then, again, improper and unsuitable food will be followed by
+precisely the same effects; and unless a judicious alteration be
+quickly made, remedies will not only have no influence over the
+disease, but the cause being continued, the disease will become most
+seriously aggravated.
+
+It is, therefore, of the first importance to the well-doing of the
+child, that at this period, when the mother is about to substitute an
+artificial food for that of her own breast, she should first ascertain
+what kind of food suits the child best, and then the precise quantity
+which nature demands. Many cases might be cited, where children have
+never had a prescription written for them, simply because, these points
+having been attended to, their diet has been managed with judgment and
+care; whilst, on the other hand, others might be referred to, whose
+life has been hazarded, and all but lost, simply from injudicious
+dietetic management. Over-feeding, and improper articles of food, are
+more frequently productive, in their result, of anxious hours and
+distressing scenes to the parent, and of danger and loss of life to the
+child, than almost any other causes.
+
+
+TEETHING.--The irritation caused by difficult teething may give rise to
+diarrhoea at the period when the infant is weaned, independently
+of the weaning itself. Such disorder of the bowels, if it manifestly
+occur from this cause, is a favourable circumstance, and should not be
+interfered with, unless indeed the attack be severe and aggravated,
+when medical aid becomes necessary. Slight diarrhoea then, during
+weaning, when it is fairly traceable to the cutting of a tooth (the
+heated and inflamed state of the gum will at once point to this as the
+source of the derangement), is of no consequence, but it must not be
+mistaken for disorder arising from other causes. Lancing the gum will
+at once, then, remove the cause, and generally cure the bowel complaint.
+
+
+
+3. TO THE CHILD BROUGHT UP BY HAND.
+
+
+
+Children brought up on an artificial diet are very liable to
+indigestion and bowel complaints; indeed none more so: and it is from
+these affections that so many of these infants perish. When, then, it
+is absolutely necessary from untoward circumstances to have recourse to
+this mode of nourishing the child, the rules and regulations laid down
+in the section on "Artificial Feeding" must be most strictly followed
+out, if the parent would hope to avoid disease and rear her
+child.[FN#37] And if these affections should at any time unfortunately
+manifest themselves, the mother ought carefully and diligently to
+examine whether the plan of feeding pursued is in every particular
+correct, particularly bearing in mind that the two causes most
+frequently productive of disorder in the child are overfeeding and the
+exhibition of unsuitable food--the two grand errors of the nursery.
+These results, however, have already been sufficiently dwelt upon as
+likely to take place at weaning, and they may of course occur to a
+child who is brought up on an artificial diet at any period.
+
+
+
+[FN#37]  See page 34.
+
+
+
+MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.
+
+
+
+As must have been already seen, the maternal treatment chiefly
+consists in the removal of the cause of the disorder; medicine may
+occasionally be exhibited by the mother, but its use in her hands must
+be very limited indeed.
+
+Unfortunately the general resource and only remedy of most mothers in
+affections of the stomach and bowels is an aperient, and a combination
+containing calomel is the one too frequently selected. The primary
+cause of the disorder is undetected, and consequently no measures taken
+for its removal, but purgative powder after purgative powder is given,
+the evil being supposed to rest in the bowels alone, and that such
+means must eventually get rid of it. The mother is not aware all this
+time that the real source of the derangement is probably in the diet
+itself; that there is some error here, and that unless this is
+corrected, the remedies must be worse than useless. The consequence of
+such a plan of proceeding is usually very sad; a confirmed and
+obstinate diarrhoea but too commonly ensues, and the infant is
+sometimes reduced to the last extremity.
+
+The removal of the cause of the disorder, then, in a large number of
+instances of derangement of the stomach and bowels, if effected early,
+will cure the disease, and without further remedy. But it will be
+asked, by what method is this cause to be detected? In this way. In all
+human probability the primary cause of the disorder is connected with
+the diet; this is the case in ninety-nine instances out of a hundred.
+Well, then, is the sick child at the breast? If so, ascertain whether
+the breast-milk is healthy and wholesome, or whether any circumstances
+exist which have rendered it otherwise? If nothing faulty is found
+here, the next question would naturally be, whether the rules and
+regulations laid down for suckling have been strictly adhered to? Or,
+whether the infant is sufficiently old to render it at all probable
+that a tooth may be irritating the gum?
+
+Perhaps the child is being weaned; well, is there any error here? Is
+the change being attempted too early? or too suddenly and abruptly? If
+this is not the case, then, has the child been overfed, or is the food
+given of the proper description?
+
+Is the child being brought up by hand? Then, there is every reason to
+suspect, either that the quality of the food given is not the most
+suitable, or, that the quantity exhibited is too great; in fact, that
+the rules laid down for "artificial feeding" have not been strictly
+acted upon.
+
+By a mode of investigation like this, any defect or error in the
+dietetic management of the infant producing the disorder will be easily
+detected by a careful mother; and its correction alone will, in very
+many instances, be all that is necessary to remove the symptoms.
+
+For example, if flatulence and griping, followed by diarrhoea, occur
+to an infant at the breast; if at the same time it becomes pale, its
+flesh flabby, its disposition fretful, always crying until it is put to
+the breast, the nipple of which it grasps eagerly, sucking eagerly, yet
+never satisfied, for its hunger continues, it is not nourished; if,
+too, the more it sucks, the more the stomach and bowels are deranged,
+the more it vomits and is purged; depend upon it the cause of all the
+evil will be found to be unwholesome milk. No medicine will avail any
+thing here; the cause must be removed; the best medicine, and the only
+remedy, is a breast of healthy milk. And if this is not procured
+early, there will be great danger of a diarrhoea setting in, which may
+probably prove fatal to the child.
+
+Again; if there is simply vomiting of the breast-milk almost
+immediately after the child has been suckled, the milk coming up pure
+and unchanged, and discharged without any apparent effort, and the
+moment after the child is cheerful and happy, this will be found to
+depend upon repletion, and not upon unwholesome milk; in fact, the
+stomach has received too much. This must be prevented in future, not by
+giving medicine, but simply by removing the infant from the nipple
+immediately it ceases to draw strongly, the moment it begins to dally
+with the breast.
+
+Again; if flatulence and griping occur to the child brought up by
+handy this derangement will generally be found to result from
+overfeeding: abstinence and diminution of the quantity of the food will
+generally be all that is necessary here. It will be well, however, for
+the mother in this case, and she may do it with the utmost safety, to
+unload the bowels of their indigestible contents by the exhibition of a
+tea-spoonful of castor oil. A dose or two of this medicine will
+effectually clear them out, without increasing the irritation, or
+weakening the child, whilst it will in most instances altogether remove
+the symptoms. If the flatulence, however, should continue, four or five
+grains of magnesia may be mixed with the last meal at night, and a
+little warm water thrown up into the bowel as an injection the next
+morning.
+
+Diarrhoea occurring in a child brought up by hand, if it be not the
+result of overfeeding, will very frequently be found to arise from
+unsuitable diet, the food given not being of a kind suited to the
+infant's stomach; for what will agree with one child often disagrees
+with another. Alteration of diet will sometimes alone suffice in these
+cases to cure, if this alteration is only made early enough, before any
+considerable irritation of the stomach and bowels has been induced.
+Thin arrow-root made with water (prepared very carefully, or the child
+will refuse it,) should be given for five or six days; the warm bath
+used every night for the same period, a new flannel bandage rolled
+round the body, and the child cautiously protected from a damp
+atmosphere. The arrow-root, upon the cessation of the diarrhoea, may
+have cows' milk added to it, if milk is not found to disagree: when
+this is the case, chicken or weak mutton broth, free from fat, or beef-
+tea, thickened with farinaceous food, with a little salt added, are the
+best substitutes. Should not the diarrhoea yield to the foregoing
+measures, and that readily, medical aid ought to be sought. Diarrhoea
+is very frequent from the time of weaning to the third year of age, and
+certainly in its effects forms so important a disease, that, unless in
+the slight form noticed above, a mother is not justified in attempting
+its relief.
+
+In conclusion, I would observe, that I do not think a mother justified
+in attempting more than what has been laid down here for her guidance.
+It is believed that the few and plain common-sense directions given, if
+followed, will do much to prevent disease, and even to relieve it in
+its milder forms; they will not, however, cure disease itself when
+really established: and again I would repeat, let the mother recollect
+that to prevent disease is her province--to cure it, is the physician's.
+
+
+
+Sect. III.--COSTIVENESS.
+
+
+
+1. IN INFANCY.
+
+
+
+The principle to act upon in the management of the infant's bowels is
+this,--that they should be kept free, and by the mildest and least
+irritating means.
+
+If therefore they become accidentally confined (less than two stools
+in the four-and-twenty hours), and the infant is suckled, the mother
+may ascertain whether an aperient taken by herself will render her milk
+of a sufficiently purgative quality to act upon the bowels of her
+child. This is the mildest mode of all.
+
+If, however, this does not answer, or is not practicable from the
+child being fed artificially, then the mildest aperient medicines must
+be chosen to accomplish this purpose. The kind of medicine to be
+selected, and the doses in which to be adminstered, will be found in
+the section on "Aperient Medicine."[FN#39]
+
+
+
+[FN#39]  See page 97.
+
+
+
+If, however, the bowels of the infant are disposed to be habitually
+confined, it should be ascertained whether this may not be dependent
+upon its diet. The same food that agrees perfectly well with one child
+will frequently cause costiveness in another. An intelligent and
+observing mother will soon discover whether this is the source of the
+mischief, or not. Boiled milk, for instance, will invariably cause
+confined bowels in some children; the same result will follow sago
+boiled in beef tea, with others; whilst, on the other hand, the bowels
+may frequently be brought into regular order, and their confined state
+overcome, by changing the food to Leman's tops and bottoms steeped in
+hot water, and a small quantity of unboiled milk added; or prepared
+barley, mixed in warm water and unboiled milk, will have the same
+effect.
+
+Sometimes children are constitutionally costive, that is, the bowels
+are relieved every third or fourth day, not oftener, and yet perfect
+health is enjoyed. This occasionally will happen in large families, all
+the children, though perfectly healthy and robust, being similarly
+affected. When such is found by a mother to be really the habit of her
+child, it would be very unwise, because injurious to its health, to
+attempt by purgatives to obtain more frequent relief. At the same time
+it will be prudent and necessary for her to watch that the regular time
+is not exceeded. This condition seldom occurs to the very young infant.
+
+
+
+2. IN CHILDHOOD.
+
+
+
+Children of sound health, who are judiciously fed, and have sufficient
+exercise, very seldom need aperient medicine. Errors in diet, a want of
+proper attention to the state of the skin, insufficiency of air and
+exercise, in fine, a neglect of those general principles which have
+been laid down for the management of health, and upon the observance of
+which the due and healthy performance of every function of the body
+depends, are the sources of bowel derangements, and particularly, at
+this age, of costiveness.
+
+I feel assured, however, that some children are more troubled with
+costiveness than others, from the simple but important circumstance of
+their not being early taught the habit of relieving the bowels daily,
+and at a certain hour. There is a natural tendency to this periodical
+relief of the system, and it exists at the earliest age. And if the
+mother only cause this habit to be fairly established in infancy, she
+will do much towards promoting regularity of her child's bowels
+throughout life. The recollection of this fact, and the mother's acting
+upon it, is of the greatest importance to the future health and comfort
+of her children.
+
+If the bowels are accidentally confined at this age, castor oil is
+certainly the best aperient that can be given: it acts mildly but
+efficiently, clearing out the bowels without irritating them. The dose
+must be regulated by the age, as also by the effect that aperients
+generally have upon the individual. Great care must in future be taken
+to avoid the cause or accidental circumstance which produced the
+irregularity.
+
+When the bowels are habitually costive, much care and judgment is
+necessary for their relief and future management. Fortunately this
+condition is very rare in youth. The activity and exposure to the air,
+usual at this period of life, render purgatives unnecessary, unless,
+indeed (as just mentioned), some error in diet, or some unusual
+circumstance, render them accidentally confined. Should, however, the
+foregoing state exist, medicine alone will avail little; there are
+certain general measures which must also be acted up to, and most
+strictly, if the end is to be accomplished. They consist, principally,
+in an observance of great regularity with respect to the time of taking
+food, its quality, quantity, and due mastication; regular and
+sufficient exercise, horse exercise being particularly serviceable; the
+shower-bath, or daily ablution; early rising (the indulgence in the
+habit of lying in bed always predisposing to constipation); and,
+lastly, the patient habituating himself to evacuate the bowels at a
+certain hour of the day. After breakfast appears to be the time when
+the bowels are more disposed to act than at any other part of the day;
+this is the time, then, that should be chosen.
+
+All these points must be sedulously observed, and upon the principles
+laid down in the various chapters upon these subjects, if habitual
+costiveness is expected to be overcome.
+
+
+
+SECT. IV.--WORMS.
+
+
+
+NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF
+MISCHIEF.--Almost all diseases have been, at one time or other,
+attributed to the generation of worms in the intestines. And at the
+present day it is not at all an uncommon occurrence for medical men to
+be called in to prescribe for children, to whom the strongest purgative
+quack medicines have been previously exhibited by parents, for the
+removal of symptoms which, upon investigation, are found in no way
+connected with or produced by worms. The results of such errors are
+always, more or less, mischievous, and sometimes of so serious a nature
+as to lay the foundation of disease which ultimately proves fatal. This
+observation, moreover, it behoves a mother carefully to regard, since
+the symptoms, popularly supposed to indicate the existence of worms,
+are so deceptive, (and none more so than that which is usually so much
+depended upon--the picking of the nose,) that it may be positively
+asserted to be impossible for an unprofessional person to form a
+correct and sound opinion in any of these cases.
+
+It was at one time imagined, and the idea is still popularly current,
+that worms were the occasion of a troublesome and lingering species of
+fever, which was therefore designated worm-fever. This notion is now
+entirely exploded; for if worms be present under such circumstances, it
+is a mere accidental complication; the fever referred to being
+generally of a remitting character, and neither caused by or causing
+the generation of worms. The symptoms of this fever, however, have led
+and continue to lead very many astray. This is not surprising, since
+they so closely resemble those which characterise the presence of
+worms, that an unprofessional person is almost sure to be misled by
+them. Amongst other symptoms, there is the picking of the nose and
+lips, offensive breath, occasional vomiting, deranged bowels, pain in
+the head and belly, with a tumid and swollen condition of the latter, a
+short dry cough, wasting of the flesh, etc.; symptoms continually
+attendant upon the disorder now under consideration. These cases have
+hitherto been perpetually looked upon by mothers as worm-cases, and
+after having been treated by them as such, by the use of the popular
+worm-powders of the day, have, as perpetually, presented themselves to
+the physician greatly and grievously aggravated by such injudicious
+treatment. It is folly, at any time, for an unprofessional person to
+prescribe for a case where worms are actually known to exist: surely
+where there is any doubt upon the latter point it must be greater folly
+still.
+
+The infant at the breast is seldom, if ever, the subject of this
+disorder, whilst an artificial diet, or bringing up by hand,
+predisposes to it. Worms most frequently occur, however, during
+childhood; much more so at this epoch than in adult age. They do not
+invariably occasion indisposition, for they are now and then passed
+without pain or distress by children who are in the enjoyment of
+perfect health, and in whom previously there was not the slightest
+suspicion of their existence. The idea, formerly so prevalent, of their
+being attended with danger, is without foundation; for unless the case
+be mismanaged, they rarely give rise to serious consequences.
+
+
+HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not
+very easy to explain; at the same time it is very certain that some
+known circumstances favour their production.
+
+If the general health of a child be enfeebled, particularly if the
+child be strumous, such a condition will favour the generation of these
+animals. The protracted use of unwholesome and innutritious articles of
+food, or a deficient supply of salt (the most necessary stimulant to
+the digestive organs), or other condiments, predisposes to worms. This
+observation is strikingly illustrated by an occurrence which formerly
+took place in Holland, where an ancient law existed forbidding salt in
+the bread of certain criminals; they were in consequence horribly
+infested with worms, and quickly died. Sugar, too, whilst a necessary
+condiment for the food of children, if given in the form of sweetmeats,
+and their indulgence, long persisted in, may so enfeeble the organs of
+digestion as to cause worms. And, lastly, (though many other causes
+might be referred to) the injudicious means occasionally employed to
+effect the removal of these animals, by the debility produced in the
+intestinal canal, favours not only their re-appearance but their
+increase.
+
+These, then, are so many causes which may occasion worms in the child,
+and of course the best and most effectual method to prevent their
+production is their avoidance. A mother, therefore, should at all times
+be careful in the regulation of the diet and general management of her
+child's habits and health, even if no stronger obligations existed than
+the dread of this disorder; and she must be more than ordinarily
+vigilant on this head, when the slightest disposition to such disorder
+is manifested. Again; she must not forget that the symptoms so commonly
+ascribed as characteristic of worms are much more frequently caused by
+other diseases; that at no time, therefore, is she justified in giving
+worm powders, or strong doses of medicine for such symptoms; for if
+they do exist, their use is always attended with risk, and if they do
+not, the debility which they occasion in the stomach and bowels may
+itself become the source of their production.
+
+
+
+Sect. V. SCARLET FEVER.
+
+
+
+There are several varieties of this disease; it will be more
+perspicuous, however, for our purpose to speak of it under the two
+following forms:--
+
+
+Mild scarlet fever;
+
+Scarlet fever, with sore throat.
+
+
+
+MILD SCARLET FEVER.--In this form of the disease there is only the rash
+with fever.
+
+
+SYMPTOMS.--The anticipating symptoms are those of fever: they precede
+the eruption. The degree of fever, however, is variable; for the
+symptoms are sometimes so moderate as scarcely to attract attention,
+slight and irregular shivering, nausea, perhaps vomiting, thirst, and
+heat of skin; whilst, at others, there is considerable constitutional
+disturbance, indicated by pungent heat of skin, flushing of the face,
+suffusion of the eyes, pain in the head, great anxiety and
+restlessness, and occasionally slight delirium.
+
+These symptoms are followed on the second day (in the majority of
+instances) by the rash. This first appears in numerous specks or minute
+patches of a vivid red colour on the face, neck, and chest. In about
+four-and-twenty hours it becomes gradually diffused over the whole
+trunk. On the following day (the third) it extends to the upper and
+lower extremities, so that at this period the whole surface of the body
+is of a bright red colour, hot and dry. The efflorescence, too, is not
+always confined to the skin, but occasionally tinges the inside of the
+lips, cheeks, palate, throat, nostrils, and even the internal surface
+of the eyelids. Sometimes the efflorescence is continuous and
+universal; but more generally on the trunk of the body there are
+intervals of a natural hue between the patches, with papulous dots
+scattered over them, the colour being most deep on the loins and
+neighbouring parts, at the flexure of the joints, and upon those parts
+of the body which are subjected to pressure. It is also generally most
+vivid in the evening, gradually becoming paler towards morning.
+
+The eruption is at its height on the fourth day;--it begins to decline
+on the fifth, when the interstices widen, and the florid hue fades;--on
+the sixth, the rash is very indistinct; and on the eighth day it is
+wholly gone.
+
+The various symptoms with which the eruption is accompanied, gradually
+disappear with the efflorescence; but the tongue still remains morbidly
+red and clean. The peeling off of the cuticle (the outer layer of the
+skin), which begins about the end of the fifth day on the parts on
+which the eruption first appeared, proceeds; so that about the eighth
+or ninth, portions of the cuticle are thrown off, the thickest and
+largest being those detached from the skin of the hands and feet.
+
+
+
+SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the
+fever and rash are accompanied with inflammation of the throat.
+
+
+SYMPTOMS.--The symptoms are more severe than in the mild form of this
+disease, and, in the majority of instances, the inflammation of the
+throat appears with the eruption, and goes through its progress of
+increase and decline with the cutaneous eruption. Sometimes, however,
+it precedes the fever; whilst at others it does not appear until the
+rash is at its height.
+
+It is generally in the course of the second day that the child
+complains of considerable stiffness in the muscles of the neck,
+extending to the lower jaw, and under the ears;--of a roughness of the
+throat, and difficulty in swallowing;--and some degree of hoarseness
+will be noticed: all so many indications that the throat is affected.
+Very shortly, an increased secretion of the mucus of these parts
+occurs, and, collecting about the tonsils, aggravates the child's
+sufferings, from the frequent and ineffectual efforts made to expel it.
+If the inflammatory action be more severe, exudations of lymph will
+also be poured out, and intermingling with the mucus, greatly augment
+the difficulty of swallowing. At this time the lining membrane of the
+mouth, as also the tongue, assume a florid red colour; the red points
+of the latter becoming much elongated.
+
+The febrile symptoms are severe from the first; amongst others, there
+will be headach, sometimes accompanied by slight delirium, nausea,
+intense heat of skin, languor, and considerable inquietude and anxiety:
+and as the inflammation approaches its height, the fever increases, the
+pulse rises, the breathing becomes oppressed, the skin becomes more
+pungently hot and dry, and the thirst urgent. All these symptoms being
+increased towards evening, when the febrile restlessness is often
+succeeded by delirium.
+
+The rash is seldom perceptible before the third day, and then comes
+out in irregular patches on various parts of the body, particularly
+about the elbows and wrists; thus differing as to the time and mode of
+its appearance, from the mild form of the disease. It frequently
+recedes, or entirely vanishes, the day after it first comes out, and
+then reappears partially, and at uncertain times. This generally
+protracts the duration of the disorder, without, however, producing any
+perceptible change in the other symptoms. On the fifth or sixth day of
+the disease, the fever and inflammation of the throat begin to abate;
+at the same time the rash declines, and the peeling off of the cuticle
+soon follows.
+
+This is the ordinary course of scarlet fever with sore throat; but in
+many cases the symptoms run still higher, and the disease is alarmingly
+dangerous from its commencement. In some instances, there is an acrid
+discharge from the nostrils or ears, often accompanied with deafness;
+as also enlargements of the glands in the neck, followed by the
+formation of abscesses in their immediate neighbourhood. It is
+unnecessary, however, to follow out the symptoms of scarlet fever more
+fully; as all that has been attempted here, has been so to sketch out
+the more prominent symptoms of this disease, that the directions upon
+the parental management may be readily comprehended: they will be very
+brief, but a strict attention thereto will be found all-important to
+the well-doing and comfort of the child.
+
+
+CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be
+seldom difficult to distinguish this disease from other acute eruptive
+disorders. The one to which it bears the greatest resemblance is the
+measles; but from this it is readily distinguished by the absence of
+the cough, the inflamed and watery eye, running at the nose and
+sneezing, which are the predominant symptoms in the early stage of the
+measles; but which do not usually attend on scarlet fever--at least, in
+any high degree. In measles, also, there is an absence of that
+restlessness, anxiety, and depression of spirits, by which scarlet
+fever is peculiarly distinguished.--The rash, too, in measles, does not
+appear till two or three days later than that of scarlet fever. It also
+differs in its characters. In scarlet fever, the eruption consists of
+innumerable minute dots or points, diffused in patches with uneven
+edges of various sizes and forms; and gives to those portions of the
+skin on which it appears, a diffused bright red colour. In measles, the
+rash comes out in irregular semi-lunar or crescentic shaped patches,
+distinctly elevated; the spots being of a deeper red in the centre
+than in the circumference, and leaving intervening spaces in which the
+skin retains its natural pale colour.
+
+
+MATERNAL MANAGEMENT.--The chief points to which the parent's attention
+must be directed, irrespective of a strict attention to the more
+immediate medical treatment directed by the physician, are the
+following:--
+
+
+VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must
+be kept in bed from the first accession of the fever. He must not be
+loaded, however, as was formerly the practice, with a quantity of
+bed-clothes, in order to encourage the fever and increase the quantity
+of eruption. A moderate quantity of clothing is all that is required,
+adapted to the heat of skin and feelings of the patient.
+
+The bed-room must be kept cool and well ventilated. This is of
+importance in the mildest cases; but in the more severe forms of this
+disease, in which the throat is much affected, the constant and free
+admission of pure air will have a most decided and marked good effect
+upon the symptoms. The air should be renewed, therefore, from time to
+time. The linen, both of the bed and the patient, should also be
+frequently changed daily,--if practicable.
+
+However mild the symptoms of this disease may be at the commencement,
+the child must always be carefully and vigilantly watched by the
+parent, as inflammation of some internal organ may suddenly arise
+(which is generally indicated by symptoms sufficiently obvious), and
+thus change an apparently mild form of this disease into one of an
+alarming character.
+
+
+COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole
+surface of the body should be sponged with cold water, or with vinegar
+and water. The heat is by this means rapidly abstracted, and the child
+refreshed; and this may again and again be resorted to, as the heat
+again returns. By this application alone, "the pulse has been
+diminished in frequency, the thirst has abated, the tongue has become
+moist, a general free per spiration has broken forth, the skin has
+become soft and cool, and the eyes have brightened; and these
+indications of relief have been speedily followed by a calm and
+refreshing sleep. In all these respects, the condition of the patient
+presented a complete contrast to that which preceded the cold washing;
+and his languor was exchanged for a considerable share of vigour. The
+morbid heat, it is true, when thus removed, is liable to return, and
+with it the distressing symptoms; but a repetition of the remedy is
+followed by the same beneficial effects as at first."[FN#40]
+
+
+
+[FN#40]  Bateman's Practical Synopsis of Cutaneous Diseases.
+
+
+
+GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected,
+gargles are sometimes ordered; but the pain and inconvenience which
+their employment gives rise to, frequently precludes their use: and
+children seldom understand how to employ them, even if the state of the
+throat permitted it. Under these circumstances, the inhalation of the
+steam of hot water, or hot vinegar and water, may be substituted, and
+with decided benefit. Mudge's inhaler is a good contrivance to effect
+this.
+
+When the throat is found by the mother to be early affected, an
+immediate application to the medical adviser is especially important.
+For, if he be called upon to treat this form of scarlet fever at its
+very commencement, by judicious treatment, the duration and violence of
+the disease may be both shortened and greatly mitigated.
+
+
+REGIMEN.--Cooling drinks, as plain water, toast and water, barley water
+flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may
+all be resorted to in their turn. The child may also be allowed
+oranges, grapes, or lemons sweetened with sugar, particularly when the
+mouth is foul and dry; but care must be taken that neither the pulp nor
+the stones are swallowed. These will both refresh and feed the patient
+as much as is necessary until the decline of the disease. The parent
+must strictly forbid the attendants in the sick chamber giving, at this
+period, any heating or stimulating fluid, as also animal food; and this
+injunction must be strictly regarded, even in the mildest form of the
+disease.
+
+When the child is convalescent, mild nourishment will be required,
+such as arrow-root, tapioca, chicken or mutton broth, beef tea,
+jellies, and roasted apples; and by and by a mutton chop. Wine is
+seldom necessary, except under circumstances of unusual debility after
+a protracted illness, when its moderate use tends much to assist the
+convalescence; but, if given unadvisedly, there will be great hazard of
+exciting internal inflammatory disease.
+
+Relapses are sometimes caused by the child getting about too soon, and
+by indulgence of the appetite, particularly for food: a proper degree
+of restraint, therefore, must be placed upon the child by the parent,
+who cannot too strictly carry out the directions of the medical
+attendant upon the diet and regimen during this period.
+
+Great attention must still be paid to the state of the bowels, and,
+indeed, to all the secretions and excretions.
+
+
+PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote
+the more easy separation of the cuticle from the surface of the body, a
+warm or tepid bath may be usefully employed at the close of the
+disease. It will, moreover, greatly contribute to the comfort of the
+child, and induce a more healthy condition of the skin. Occasionally
+the cuticle of the whole hand and fingers will peel off unbroken, when
+it will resemble precisely a glove in shape.
+
+As is the case in all fevers, more or less, so particularly after
+scarlet fever, there is a great tendency to the falling off of the
+hair. It will be always well, therefore, to shave the head at this
+time, and exhibit daily a tepid shower bath, as early as the strength
+of the child will permit.
+
+
+CAUTIONS, ETC.--The contagious character of this disease requires the
+separation of the invalid from the rest of the family; and, when it is
+practicable, the children should be removed to a distance. This measure
+is imperatively called for, when the form of the disease is very severe
+in its character.
+
+Great caution must also be exercised, after the convalescence of the
+patient, that the other children are not brought into too early contact
+with him: for infection may be thus produced, though several weeks may
+have elapsed from the period of the peeling off of the skin.
+
+The period at which the disease shows itself after the exposure of an
+individual to sources of contagion, is exceedingly various. One child
+will be seized within a few hours; another, not for some days; and now
+and then (though rarely), five or six weeks have intervened between the
+period of exposure and the manifestation of the disease.
+
+When this disease is rife in a family, it will frequently affect the
+individuals composing it very differently. Some escape altogether;--
+others have the mild form of the complaint;--others the severe;--and,
+again, the attendant in the sick room may be attacked with the sore
+throat and fever only, both of which may subside without any appearance
+of a rash.
+
+In conclusion, this disease is a complaint of infancy and childhood,
+rather than of adult age; generally affects the same individual but
+once during his life; and, though examples of a second attack have
+occurred, such a circumstance is extremely rare.
+
+
+
+Sect. VI.--MEASLES.
+
+
+
+Measles consists of a fever, in which the mucous lining of the air-
+passages is principally affected, and which, after about three days'
+duration, results in an eruption of a red rash over the surface.
+
+It depends upon a specific contagion;--occurs most frequently during
+childhood and adolescence, though no age is exempt from it;--and affects
+the system but once; a peculiarity to which an exception is very rare,
+proved by the few instances of the kind which have been recorded.
+
+The period at which the disease manifests itself after infection is
+various,--generally about the ninth day; it has, however, been delayed
+until the sixteenth.
+
+
+DESCRIPTION OF THE DISEASE.--The child infected will be observed not to
+be as well as usual, less active, and out of spirits; his appetite
+will fail, and his sleep be restless and disturbed. It will soon be
+evident that he has apparently taken a cold in his head, and that this
+is accompanied by fever. His voice will be hoarse; there will be
+frequent cough, headach, sneezing, running from the nose and eyes,--the
+eyelids being somewhat swollen, and the eyes inflamed;--the skin will be
+hot and dry, and he will complain of occasional chilliness. In the
+course of the next two or three days, these symptoms will increase in
+severity, and perhaps be accompanied by oppression at the chest and
+hurried breathing, and towards evening by slight delirium.
+
+On the fourth day, the rash will appear, but the symptoms will be
+little, if at all, mitigated; indeed, they will sometimes increase in
+severity. The eruption will first be perceived about the head and face,
+in the form of small red spots, at first distinct from each other, but
+soon coalescing, and forming patches of an irregular crescent-like or
+semilunar figure, of a dull red colour, and slightly elevated (giving a
+sensation of hardness to the finger), while portions of the skin
+intervening between them will retain their natural appearance. At this
+time the eruption will also be found on the inside of the mouth and
+throat, and the hoarseness will consequently increase.
+
+On the fifth day, the rash usually covers the whole surface of the
+body, with the exception of the legs and feet; and is now very vivid on
+the face, which is not unfrequently so much swelled, especially the
+eyelids, that the eyes are quite closed up, as in small-pox. On the
+sixth day, it is fully out on the extremities, and is beginning to fade
+on the face. On the eighth, it is fading from all parts; on the ninth,
+it is hardly perceptible; and has entirely disappeared on the tenth day
+from the commencement of the fever, or the sixth from its own first
+appearance. As the fading proceeds, the spots drop off in the form of
+little branny scales, which are sometimes, from their minuteness,
+scarcely perceptible. They leave a slight discolouration on the skin,
+with considerable itching.
+
+Such is the ordinary course of this disease; occasionally, however,
+deviations are met with.
+
+
+CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under
+the description given of Scarlet Fever, are noticed several signs by
+which that disease may be distinguished from measles: to these may be
+added the absence of cough, of water flowing from the eyes, and of
+redness and swelling of the eyelids as in measles. Again, in measles,
+the eruption is more pointed, of a crimson instead of a scarlet hue,
+and does not appear until two days later than in scarlet fever.
+
+In small-pox, the fever abates as soon as the eruption makes its
+appearance. In scarlet fever, this is by no means the case; and as
+little so in measles: the vomiting, indeed, subsides; but the cough,
+fever, and headach grow more violent; and the difficulty of breathing,
+weakness of the eyes, and, indeed, all the catarrhal symptoms, remain
+without any abatement till the eruption has all but completed its
+course.
+
+
+MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a
+mild, and by no means dangerous, disease: it is sometimes, however,
+accompanied or immediately followed by symptoms of a very serious
+character, and which, it is to be feared, in many instances, owe their
+origin to the carelessness of the attendants in the sick chamber. A
+mother's superintendence, therefore, is much required at this time to
+insure a careful attention to the medical directions, as also to those
+general points of management upon which the well-doing of her child
+much depend, of which the following are the most important:--
+
+
+VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from
+the onset of the attack. He must have so much clothing only as will
+secure his comfort, avoiding equally too much heat or exposure to cold.
+To these points the parent's attention must be particularly directed.
+It is the practice with some nurses, in the belief that a breath of
+cool air is most pernicious, to keep the child constantly enveloped in
+a smothering heap of bed-clothes, with curtains closely drawn, and the
+room well heated by fire, by which means the fever and all its
+concomitant dangers are greatly augmented. It is equally a popular
+error (and yet by many it is still held and acted upon) to suppose that
+because in small-pox exposure to cold is useful, that therefore it
+must be of equal advantage in measles. It cannot be too generally known
+that the nature of the fevers accompanying the two diseases are widely
+different, and that the adoption of this error is productive of the
+most serious consequences; for it would most likely produce in measles
+inflammation of the lungs, which, in truth, is commonly the result of
+carelessness upon this point.
+
+The bed-room should be large and airy; free from currents of cold, but
+well ventilated, and not hot. The room, also, must be darkened, on
+account of the tenderness of the eyes; all noise excluded, and mental
+excitement or irritation carefully avoided.
+
+
+REGIMEN.--Little or no food must be allowed, and whatever is taken must
+be of the simplest kind, and in a liquid form. Mild mucilaginous
+drinks, and warm, may be given liberally; as barley-water, or thin
+gruel, etc.
+
+
+SPONGING, ETC.--The face, chest, arms, and hands should be sponged
+occasionally with vinegar and warm water (one fourth and three
+fourths). This will be productive of great comfort to the little
+patient; it removes the heat, dryness, and itching of the skin, which
+are often very distressing; and is especially useful at night in
+relieving wakefulness. If the cough be troublesome, it will be useful
+for the child to breathe the steam of warm water; not through an
+inhaler, but over a large basin, with the head covered with flannel
+large enough to hang over its edges. By this means the tender and
+inflamed eyes will at the same time derive advantage from the soothing
+effect of the vapour.
+
+
+CAUTIONS.--Whenever the measles is known to be prevalent in a
+neighbourhood, and a child manifests symptoms of cold in the head and
+fever, it should at once be a reason for carefulness on the part of the
+parent. The diet should be light, cooling, and scanty; and the child
+should be carefully kept in doors.
+
+It has been before remarked, that in its ordinary course measles is a
+disease unaccompanied with danger, but that the mildest form may be
+speedily converted into the most dangerous. That is to say, a sudden
+change may lake place in the symptoms, arising out of circumstances
+which could not have been foreseen, and therefore unavoidable; or may
+be produced by improper management on the part of the nurse, such as
+the giving of stimulants, by too much heat, or by exposure to cold. Now
+it is for the parent early to notice any change which may occur from
+the first source, and by her watchfulness to guard against the
+possibility of its arising from either of the second.
+
+In reference to the first, if the child should complain at any period
+of the disease of severe headach, with piercing pain through the
+temples, and if this is accompanied by wandering of mind, great
+increase of suffusion of the eyes, as also intolerance of light, the
+immediate attention of the medical man is demanded. So, if towards the
+dose of the eruption, that is, from the seventh to the ninth day, the
+breathing should again become hurried (this symptom is very generally
+present during the height of the eruption, and is not necessarily
+connected with disease of the lungs), with pain and oppression felt at
+the chest, the cough becoming hacking and incessant, etc. (all symptoms
+cognizable by the mother, and indicative of inflammation of the
+lungs), no time must be lost in seeking medical aid.
+
+With regard to the last cause (improper management), it may be well,
+in reference to it, to observe, that it sometimes happens that the rash
+comes out imperfectly, or, having appeared properly, suddenly
+retrocedes and disappears; and that under such circumstances the nurse
+will almost certainly, if not well watched, give the child "a good
+dose of sulphur in diluted spirit, or a glass of punch containing
+saffron," which are considered specifics for bringing out the eruption.
+Nothing can be more injurious than such remedies, for generally the
+disappearance of the rash will be dependent upon the existence of some
+internal inflammation, or of too high a fever; for the removal of
+which the medical man ought to be instantly applied to. Sometimes,
+however, it may be fairly traced to a careless exposure to cold: under
+such circumstances the child should be instantly, and without
+hesitation, put into the warm bath.
+
+Measles are frequently followed by cough, and deranged bowels; and
+there is always great susceptibility about the child for some time. On
+this account he should be carefully screened from a cold or damp
+atmosphere; the diet should be carefully regulated; and flannel worn
+next to the skin. If the cough should continue, it must not be
+neglected on the supposition that it will wear off; for it demands the
+skilful and careful attention of the medical man.
+
+In conclusion, it may be remarked that very frequently during infancy
+and childhood, and particularly during the period of teething,
+eruptions very similar in appearance to this disease occur; unless,
+however, they are accompanied by the specific fever, and run the
+regular course, they may at once be decided upon as not being the
+measles.
+
+
+
+Sect. VII.--SMALL-POX.
+
+
+
+This disease, the most dreaded of all eruptive fevers, is not so
+commonly met with in the present day as formerly; thanks to that
+Providence which led to the discovery of Jenner. But although its
+occurrence is not so frequent, it still does occasionally present
+itself; when it will assume either a mild or severe form. If it attack
+a child that has not previously been vaccinated, it is called natural
+small-pox; and the chances are that the disorder will be severe in
+character;--if, on the other hand, it occur in the vaccinated, the
+disease will generally be much modified in its symptoms; the attack
+will be mild, and without danger.
+
+
+NATURAL SMALL-POX.--The infection of small-pox having been received
+into the system of a child that has not been vaccinated, fourteen days
+(on an average) will transpire before the commencement of the febrile
+symptoms, or eruptive fever. A distinct rigor or shivering fit then
+takes place, accompanied by pain in the back or in the stomach, with
+sickness, giddiness, or headach; as also great drowsiness. And if an
+infant be the subject of the disease, a convulsive fit will sometimes
+take place, or several in succession.
+
+At the end of eight-and-forty hours from the occurrence of the rigor
+(in the majority of cases), the eruption comes out; and shows itself
+first on the face and neck in minute flea-bite spots. In the course of
+the next four-and-twenty hours in some cases, and in others not until
+the expiration of two or three days, it completely covers the body; not
+being confined exclusively to the skin, but frequently extending to the
+mouth and throat, and even to the external membrane of the eye.
+
+In the course of two or three days from their first appearance the
+little pimples, increasing in size, will be found to contain a thin
+transparent fluid, to pit or become depressed in their centre, and the
+skin in the spaces between them will be found red. On the seventh or
+eighth day from the commencement of the fever, the fluid contained in
+the pimples will be no longer transparent, but opaque; and they will
+consequently appear white, or of a light straw colour. Each pimple or
+pock will be no longer depressed in its centre, but will become raised
+and pointed, being more fully distended by the increased quantity of
+fluid within; and the skin around each pock will now be of a bright
+crimson. The head, face, hands, and wherever else the eruption shows
+itself, gradually swell; and the eyelids are often so much distended as
+to close the eyes and produce temporary blindness. There will always at
+this time be some degree of fever present, and its amount will vary
+with the circumstances of each individual ease. The skin too will be
+very tender, so much so sometimes as greatly to harass and distress the
+child.
+
+On the eleventh day the swelling and inflam of the skin of the body
+and face subside; the pimples upon these parts dry up and form scabs,
+which fall off about the fourteenth or fifteenth day. Those on the
+hands, as they come out later, commonly continue a short time longer.
+The eruption leaves behind, in some cases, the peculiar marks of the
+disease; and in others merely discoloured spots, which disappear in the
+progress of a short time.
+
+The natural small-pox is sometimes much more severe in its character
+than the foregoing, and what is called confluent small-pox is said to
+exist. This form will be marked by great constitutional disturbance,
+and the eruption coming out earlier than in the milder form; instead of
+being distinct, that is, each pimple standing distinct and separate
+one from the other, they will coalesce, and appear flat and doughy, not
+prominent: they will more particularly run into each other on the face,
+where they will form one continuous bag, which soon becoming a sore,
+will discharge copiously.
+
+
+SMALL-POX IN THE VACCINATED.--When small-pox occurs to those that have
+been formerly vaccinated, the disease, in almost every instance, is
+much altered or modified in its character. Indeed in children, in whom
+of course vaccination has been but comparatively lately performed,
+small-pox when it occurs will, in the majority of cases, be so mild
+that the real nature of the disease will be with difficulty determined:
+so mild, that again and again has a parent been heard to exclaim,
+"Surely these few scattered pimples cannot be the small-pox!" If,
+however, as the pimples progress, they are narrowly watched, and are
+seen to become depressed in their centre; if there has been the
+precursory rigor, etc.; and if the source of the disorder can be traced
+to some case of undoubted small-pox, the child in fact having been
+exposed to contagion, no doubt ought to exist in reference to the
+nature of such a case, however slight may be the character of the
+disease.
+
+The usual progress, however, of small-pox modified by vaccination is
+as follows. The first stage is the same usually as in the natural form
+of the disease. As soon, however, as the eruption appears, the
+modifying power of the vaccination becomes apparent. The eruption will
+be found to be generally both less in quantity and more limited in its
+extent; or if even it should come out profusely, and cover a large
+extent of the surface of the body, still the controuling power of the
+vaccination will immediately show itself after its appearance,--first,
+in the complete subsidence of all the febrile symptoms which will now
+take place; and, secondly, in reference to the eruption, part of which
+will die away at once, and the remainder will by the fifth day be
+filled with the opaque yellowish fluid, then dry up, becoming hard and
+horny, and falling off will leave a mottled red appearance of the skin,
+and now and then slight pitting.
+
+Such is the usual progress of the disease: subsequent to vaccination,
+it is a mild and tractable disorder. It is right, however, to mention
+that small-pox has occurred even to the vaccinated in almost as severe
+a form as the confluent natural small-pox, and running its regular
+course unaltered or unmodified. Such instances, however, are extremely
+rare, and form the exceptions to the general rule; for "no reasonable
+doubt can be entertained, from the abundance of facts now before the
+world, that such modification is the law of the animal economy, and
+that the regular or natural progress is the exception."
+
+
+MATERNAL MANAGEMENT.--The grand principle in the treatment of small-pox
+is to moderate and keep under the fever; and however the plans adopted
+by different medical men may vary in particular points to accomplish
+this purpose, they uniformly make this principle their chief aim and
+object. To carry out this intention, however, the medical adviser is
+greatly dependent upon the aid and assistance of a judicious parent,
+and without this it is impossible to hope for a successful issue to
+the case. A clear knowledge, therefore, of those points of general
+management in which in fact a great part of the above principle
+consists (few and simple as these directions are), it must be
+all-important for the mother to be acquainted with: for the rest,
+she must and ought to look to the medical man.
+
+In the more rare and severe form of this disease, viz. the confluent
+small-pox, although in some instances it runs the same course as the
+milder form, the distinct or natural small-pox, still, usually, the
+constitutional symptoms are much more aggravated, and the medical and
+general treatment required will so much depend upon the character of
+the individual case, that we do not think it well to notice it here.
+
+
+BED AND BED-ROOM.--It will not be necessary at first for the child to
+be confined to his bed, but generally about the third or fourth day he
+will gladly resort to it; and if he does not, it will be prudent to
+keep him there. He must not, however, be loaded with bed-clothes, but
+lightly covered; and the bed and body linen should be changed daily, if
+possible.
+
+The bed-room should be capacious and well ventilated; fresh air
+frequently admitted; and if the season of the year permit, and there is
+no dampness of atmosphere, a window should be constantly open during
+the day: it is also desirable to keep the chamber darkened in all
+cases, as there is always a tendency to inflammation of the eyes.
+
+If these directions are not regarded, and a great heat of the
+apartment is permitted, with abundance of bed-clothes heaped upon the
+child, the hot bath is used, and hot and stimulating regimen given
+(upon the old and erroneous notion of bringing out the eruption), the
+mildest case will inevitably be converted into one of the most severe
+and dangerous. Facts have abundantly shown that such measures
+invariably prove the most effectual means of exasperating the disease,
+and endangering life.
+
+
+REGIMEN.--This must be most sparing. Cold water may be given whenever
+the child asks for it. Lemonade should form the common drink during the
+fever; and gruel, barley-water, and roasted apples are all else that is
+required during this period, and not until the disease is going off
+must any change be made in the diet.
+
+The above period having arrived, mildly nutritious food should be
+given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or
+sago; to be followed in a few days by the wing of a chicken or a mutton
+chop; remembering always, that solid animal food must at first be given
+cautiously and sparingly. Wine or stimulants must be positively
+forbidden; unless, indeed, ordered by the medical man, for
+circumstances may arise which render them advisable.
+
+The state of the bowels must be carefully attended to at this time.
+
+
+THE ERUPTION.--In the natural and mild form of this disorder the
+pustules generally break from the sixth to the eighth day; dry scabs
+succeed; and in about nine or ten days the parts heal perfectly,
+requiring no treatment. In the more aggravated cases, however, in which
+the pustules are very numerous, running one into the other, and,
+bursting, discharge greatly, the whole surface of the body should be
+frequently and liberally dusted over with dried flour, or, what is
+better, starch powder. The sores in this instance are always tedious in
+healing, and followed by the well-known pits or marks: these arise from
+a loss of substance in the true skin, and occur more particularly on
+the face, from the great vascularity of this part causing the pustules
+to be more numerous here than elsewhere. It is a popular error to
+suppose that by wearing masks of fine linen or cambric illined with
+particular ointments, these scars or pits may be prevented: it is
+impossible to prevent them; and any local application, except a little
+cold cream or oil of almonds applied to the scabs when they harden,
+will prove more injurious than useful. The child's hands, however,
+should always be muffled to prevent its scratching or breaking the
+sores, for otherwise he will not be kept from thus attempting to allay
+the excessive itching which they occasion.
+
+The hair should be closely cut at an early period of the disease, and
+so kept throughout its continuance. This will contribute very much to
+the comfort of the child, by preventing the hair becoming matted
+together with the discharge from the pustules when they break, which
+gives rise to great pain and irritation. In the confluent and worst
+forms of this disease, this measure it is particularly necessary to
+attend to, as also to the application of cold lotions to the head when
+hot and dry (with other remedial means), as there is always a tendency
+in these cases to the formation of abscesses, the healing of which is
+troublesome and attended with difficulty.
+
+
+CAUTIONS, ETC.--It has already been stated that a free ventilation of
+the bed-room is necessary to the well-doing of the patient. This
+measure, however, must not be confined to the chamber of the sick, but
+acted upon through the whole house.
+
+In conjunction with ventilation, fumigations by means of aromatic
+substances kept slowly burning should be resorted to. A solution of the
+chloride of lime too, a most powerful disinfectant, should be used to
+purify the different apartments. This is best accomplished by steeping
+in the solution pieces of linen, and hanging them about the rooms, as
+also frequently and freely sprinkling the walls themselves; and as soon
+as the invalid is removed, the chamber should be white-washed, the
+various articles of furniture well scoured with soap and water, and the
+room be well and freely ventilated prior to its being again occupied.
+
+The clothes of the patient and the bed linen should be frequently
+removed, and when taken away immediately immersed in boiling water, and
+whilst hung up in the open air sprinkled occasionally with a weak
+solution of the chloride of lime. If these directions are not observed,
+and the clothes are closely wrapped up, they will retain and give out
+the disease to others at a great distance of time.
+
+Again: as the contagious property of smallpox hangs about the child as
+long as any scabs remain (which indeed may be said to retain the poison
+in its concentrated form), a parent must be most careful that the
+invalid is not too early brought in contact with the healthy members of
+the family.
+
+An observance of these precautions is imperatively demanded; they not
+only protect the healthy, but aid the infected.
+
+
+
+Sect. VIII.--HOOPING-COUGH.
+
+
+
+My chief inducement to notice the above disorder arises out of the
+well-known fact, that there is no complaint of childhood more
+frequently subjected to quackery and mismanagement than is this.
+Indeed, there are few maladies against which a greater array and
+variety of means have been recommended, than against hooping-cough.
+
+I suppose from the circumstance of the simple and mild form of the
+complaint being so tractable (provided it remain such) that the
+simplest and mildest measures effect its cure, parents are tempted to
+undertake its management in the more severe and complicated forms; and
+the result is but too often the establishment of disease dangerous to
+life, and sometimes fatal to it.
+
+But although most imprudent for a parent to assume the office of the
+physician, her aid is essentially necessary in carrying out the
+measures prescribed. By her watchfulness and care the duration of the
+disease may not only be abridged, but, what is of much greater
+importance, a more serious and aggravated form of disease prevented;
+for although hooping-cough in itself is not a dangerous disorder, still
+the most simple and slight case, if neglected or mismanaged, may
+quickly be converted into one both complicated and dangerous.
+
+
+DESCRIPTION OF THE DISEASE.--Hooping-cough commences with the symptoms
+of a common cold, which is more or less frequent. These symptoms
+continue from five days to fifteen; at the end of which time the cough
+changes its character, and assumes the convulsive form, which
+distinguishes the disorder. It occurs in paroxysms, varying with the
+severity of the disease from five to six in the twenty-four hours to
+one every ten or fifteen minutes; being generally more severe and
+frequent during the night than in the day.
+
+During a paroxysm the expirations are made with such violence, and
+repeated in such quick succession, that the child cannot breathe, and
+seems in danger of suffocation. The face and neck become swollen and
+purple from suffusion; and the eyes prominent, injected, arid full of
+tears. The little one, with a forewarning of the attack, which it
+dreads, falls on his knees, or clings closely to any thing near him.
+The paroxysm terminates with one or two long inspirations, attended
+with that peculiar noise, or "whoop," from which the disease has
+derived its designation.
+
+Sometimes the fit of coughing is interrupted for a minute or two, so
+that a little rest is obtained; and is then succeeded by another fit
+of coughing and another hoop, until after a succession of these actions
+the paroxysm terminates by vomiting, or a discharge of mucus from the
+lungs, or both.
+
+The disease having continued at its height for two or three weeks, it
+begins naturally to decline; the paroxysms become less frequent and
+violent; the expectoration increases; the cough loses its
+characteristic hoop, and gradually wears away altogether; until at
+length, in two or three months from the first onset of the disease, the
+child is restored to perfect health. Sometimes, however, particularly
+in the autumn, and at other seasons on the occurrence of easterly
+winds, the paroxysms of cough will return,--it will assume its
+spasmodic character, and be accompanied with the "whoop," after a
+month, or even two or three months, of perfect and apparent recovery.
+Errors in diet will sometimes alone have a similar effect.
+
+It is a disease which usually occurs during childhood, rarely affects
+the same individual twice, and is seldom seen in the very young infant.
+
+In reference to the probable result of the disease, when it occurs in
+its mild and simple form in a healthy child, the termination is usually
+favourable; but it may at first assume this form, and afterwards become
+complicated, and consequently more or less dangerous, owing to
+injudicious management, or to various influences over which the mother
+has no control.
+
+It generally appears as an epidemic, and at those seasons when
+catarrhal complaints are most prevalent, and affects many or several at
+the same time. Isolated cases, however, frequently occur, which seem to
+prove the disease to be infectious. Some persons deny that it is so.
+Mothers and nurses, however, who have not had the disease, will often
+contract it from the child under such circumstances, and thus it will
+be quickly propagated through the family. The nursing mother will
+occasionally take it from the infant at her breast. The child who has
+caught it from others whilst at school, and brought home in
+consequence, will communicate it readily to his brothers and sisters,
+although the disease did not exist previously in the family or
+neighbourhood, and was brought from a distant part of the country. All
+these instances are surely proofs of its infectious character, and
+point out the necessity of caution whenever hooping-cough may present
+itself in a family, and the necessity which exists for an early removal
+of the unaffected children from the sphere of its contagious influence.
+The infectious property diminishes as the disease declines.
+
+
+MATERNAL MANAGEMENT.--In the mild and simple form of this disease the
+medical treatment is one rather of prevention than cure, and the
+maternal management consists in assisting, by watchfulness and care,
+the fulfilment of this design.
+
+In these slighter cases little more is required of the mother during
+the Jirst stage of the disorder (that is, before the cough becomes
+spasmodic) than attention to diet, regimen, and the excretions. The
+diet should be farinaceous, with milk, or as may be otherwise directed.
+The child must be confined to a mild equable temperature; in fact, to
+his apartment. It is a popular error to suppose that at this time
+change of air is beneficial to the disease: at a later period it
+certainly is so, but now injurious, and attended with great risk.
+Should the weather be cold, the little patient must be warmly clad, and
+flannel worn next the skin; this latter precaution should always be
+taken in the winter, spring, and autumn. Purgatives and other medicines
+will be required, and ordered by the medical attendant; the chief
+attention, however, of the parent must be directed to any change she
+may observe in the symptoms, breathing, etc.; she must be all on the
+alert to notice the first signs of local inflammation. Of this,
+however, we shall speak presently.
+
+During the early part of the second stage, that is, when the cough
+becomes spasmodic, assuming its peculiar sound, the same diet and
+regimen must be continued, and the same watchfulness observed, lest
+any inflammatory symptoms manifest themselves.
+
+Under the foregoing treatment the disease generally runs its course
+without any untoward event, and the child recovers perfectly.
+Sometimes, however, although the patient is quite well, and the disease
+on the decline, the cough still continues. In these cases, and at this
+time, it is that change of air often proves so very serviceable. The
+sea-side is preferable, if the season of the year permit; and salt-
+water bathing, commencing with the warm or tepid bath, and passing
+gradually to the cold-bath (if no complication forbid it), will also
+prove certainly and rapidly remedial.
+
+Crying, mental irritation, or opposition, frequently bring on a fit;
+and even the sight of another in a paroxysm will induce it in those
+affected by the disease. Running or other active exercise will
+generally cause the fits to be more severe. Young children, too, must
+be carefully watched at night, and be raised up by the nurse as soon as
+the fit is threatened. These hints the mother should bear in mind.
+
+So much for the simple form of the disease, and that in which it most
+frequently and commonly presents itself to our notice: a mild disease;
+and, if carefully managed and watched over, certainly not a dangerous
+one.
+
+Of what, then, is a parent to be afraid, or against what is she to
+guard? Lest other disease insidiously come on, and advance to an
+irremediable degree, masked by the cough, without attracting her
+attention. This is the great source of danger in hooping-cough. The
+physician, in a case of simple hooping-cough, is not in daily
+attendance upon his patient, and therefore not present to notice the
+commencement or first symptoms of those diseases which so frequently
+occur at this time, and the successful treatment of which will mainly
+depend upon their early detection, and the decision with which they are
+treated. When you hear of a child or several children in a family dying
+of hooping-cough, it is not this disease which proves fatal; but death
+is caused by some disease of lungs or brain, which has been super-added
+to the hooping-cough. The progress of hooping-cough, then, must be
+closely attended to by the parent, even in the most favourable cases.
+
+The most frequent complication with hooping-cough is inflammation of
+the air-tubes of the lungs. This is extremely frequent during spring
+and winter, especially in the months of February, March, and April,
+owing to the prevalence of easterly winds at this season. It is not my
+intention to detail the symptoms of this affection, only to point out
+those which will enable a parent to recognise its approach. A parent
+then may take warning, and fear the approach of mischief, when she
+observes the fits of coughing become more frequent and more distressing
+to the child, and the breathing hurried in the intervals of the
+paroxysm; when any exertion or speaking causes increased difficulty of
+breathing or panting; when the expectoration becomes less abundant, and
+difficult to get up; when there is no longer, or at all events less
+frequent, vomiting after the cough, and more or less febrile symptoms
+present.
+
+If the lungs themselves are attacked by inflammation, most of the
+symptoms already pointed out will occur; the cough will be frequent,
+in short paroxysms; the vomiting will not take place; the breathing
+will be very quick and hurried; and as the disease advances the hoop
+will cease.
+
+If hooping-cough attack a child whilst teething, or from six months to
+two or three years of age, it is very common for the brain to suffer,
+and convulsions and water on the head to occur, particularly if the
+latter disease prevails in the family. Whenever the paroxysm of cough
+is increased in violence, the characteristic hoop disappearing, and the
+face becomes very livid; the hands clenched, and the thumbs drawn into
+the palms; the head hot, and marked fits of drowsiness and languor; and
+the child, during sleep, screaming out, or grinding its teeth,--
+something wrong about the head ought to be anticipated. Of the
+treatment we have here nothing to say, except that the gums must be
+carefully examined, and scarified if they require it, and the
+temperature of the head reduced by cold sponging, or the application of
+a bag of ice when necessary. The chief duty, however, of the parent is
+to be alive to these symptoms, and early to detect the incipient
+mischief, that by a prompt application of efficient means the accession
+of so formidable a malady may be prevented.
+
+To specific remedies for this disease it is scarcely necessary to
+allude, after what has been advanced, except by way of warning. In the
+simple form of the complaint such medicines are superfluous, or rather
+some of them, from their violent properties, most dangerous; in the
+complicated forms of the disease they are inadmissible.
+
+The indiscriminate use of purgatives, also, a parent should avoid.
+Bowel affections are not an infrequent attendant upon hooping-cough,
+and always aggravate the primary disorder.
+
+Of external applications all that need be said is this, that if they
+are not violently stimulating they do no harm; if, however, they
+contain tartar emetic, in addition to their doing no good to the
+disease, they cause unnecessary suffering to the patient, and are
+sometimes productive of dangerous and even fatal sores.
+
+
+
+Sect. IX.--CROUP.
+
+
+
+This disease is one of the most formidable of childhood; sudden
+(generally) in its attacks, most active in its progress, and if not
+met by a prompt and decided treatment, fatal in its termination. Hence
+the paramount importance of parents being acquainted with the signs
+which indicate its approach, that medical aid may be secured at the
+very onset of the disease. Upon this early application of suitable
+remedies every thing depends.
+
+
+SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either
+preceded for two or three days by the symptoms of a common cold,
+accompanied with hoarseness and a rough cough; or it may attack with
+the most alarming suddenness, during the night for instance, although
+the child had been merry and well the previous evening.
+
+Hoarseness, however, is the premonitory and important symptom of
+croup; for although it is not every hoarseness that is followed by
+this formidable malady, still this symptom rarely attends a common cold
+in young children, and therefore always deserves when present the
+serious attention of the mother, particularly if accompanied by a rough
+cough.
+
+The symptoms or signs of the approach of this disease have been ably
+and graphically depicted by the late Dr. Cheyne,
+
+"In the approach of an attack of croup, which almost always takes
+place in the evening, probably of a day during which the child has been
+exposed to the weather, and often after catarrhal symptoms have existed
+for several days, he may be observed to be excited; in variable
+spirits; more ready than usual to laugh or to cry; a little flushed;
+occasionally coughing, the sound of the cough being rough, like that
+which attends the catarrhal stage of the measles. More generally,
+however, the patient has been for some time in bed and asleep before
+the nature of the disease with which he is threatened is apparent;
+then, perhaps without awaking, he gives a very unusual cough, well
+known to any one who has witnessed an attack of the croup: it rings as
+if the child had coughed through a brazen trumpet; it is truly a tussis
+clangosa; it penetrates the walls and floors of the apartment, and
+startles the experienced mother--'Oh, I am afraid our child is taking
+the croup!' She runs to the nursery, finds her child sleeping softly,
+and hopes she may be mistaken. But remaining to tend him, before long
+the ringing cough, a single cough, is repeated again and again. The
+patient is roused, and then a new symptom is remarked: the sound of his
+voice is changed; puling, and as if the throat were swelled, it
+corresponds with the cough; the cough is succeeded by a sonorous
+inspiration, not unlike the kink in hooping-cough--a crowing noise, not
+so shrill, but similar to the sound emitted by a chicken in the pip
+(which in some parts of Scotland is called the roup, hence probably the
+word croup); the breathing, hitherto inaudible and natural, now becomes
+audible, and a little slower than common, as if the breath were forced
+through a narrow tube; and this is more remarkable as the disease
+advances," etc. etc.
+
+It is unnecessary for me to add to the foregoing picture.
+
+
+MATERNAL MANAGEMENT.--Having early obtained medical assistance attend
+with the strictest obedience to the directions given. And in this
+disease, more than any other, it is particularly important that the
+mother should give her personal superintendence; for the activity of
+the progress of the disease leaves no time to retrieve errors or atone
+for neglect. The practitioner may be prompt and decided in the measures
+he prescribes, but they will avail little, unless they are as promptly
+and decidedly acted upon.
+
+The parent will have her reward; for, if timely aid has been afforded,
+and adequate means used, the event will be almost invariably favourable.
+
+ITS PREVENTION.--Croup, when it has once attacked a child, is very
+liable to recur at any period before the thirteenth or fourteenth year
+of age. It may even do so several times, and after intervals of various
+duration. It is very desirable, therefore, that a parent should be
+acquainted with the means of prevention.
+
+They consist simply in the following measures:--The careful protection
+of the child from cold or damp weather, particularly the north-east
+winds of spring following heavy rains. Croup is most prevalent in those
+seasons which are cold and moist, or when the alternations of
+temperature are sudden and remarkable. If the residence of the child is
+favourable to the production of croup, (for instance, near a large body
+of water, or in low damp spots,) he should, if possible, be removed to
+a healthier situation. Sponging or the shower-bath, with cold water and
+bay-salt, with considerable friction in drying the body, should be
+commenced in summer, and employed every morning upon the child's rising
+from bed. The clothing should be warm in the winter and spring, the
+neck always covered, and flannel worn next the skin throughout the
+year; but hot rooms, and much clothing when in bed, must be avoided.
+The diet must be light and nourishing; no beer or stimulant given; and
+the state of the bowels must be carefully watched.
+
+The above precautions are of course particularly necessary to enforce
+immediately after a recovery from an attack, for there is a great
+tendency to relapse. If the attack takes place during the winter or
+spring months, the invalid must be kept, until milder weather, in the
+house, and in a room of an equable and moderately warm temperature. If
+in the summer, change of air, as soon as it can be safely effected,
+will be found very useful.
+
+
+
+Sect. X.--WATER IN THE HEAD.
+
+
+
+Water in the head is a formidable disease, and not unfrequent in its
+occurrence. It is often destructive to life, and the instances are
+numerous in which it has appeared again and again in the same family,
+carrying off one child after another, as they have successively arrived
+at the same age.
+
+But notwithstanding its frequency and fearful character, a mother may
+do much to overcome a constitutional predisposition to this disease,
+and thus prevent its appearance; as also she may assist greatly in
+promoting its cure, when it does occur. Hence it is most important that
+a mother should be acquainted with the measures of prevention; and
+also, when it does manifest itself, that clear and accurate information
+should be possessed, upon what may be said to constitute the maternal
+management of the disorder.
+
+
+ITS PREVENTION.--Whenever there is found to exist in a family a
+predisposition to this malady, one or more children having suffered
+from it, a mother must make up her mind, and in the strictest sense of
+the word, to be the guardian of the health of any child she may
+subsequently give birth to. And not only during the period of infancy,
+but during that of childhood also, must she continue the same careful
+and vigilant superintendence.
+
+The infant must be brought up on the breast, and if the mother is not
+of a decidedly healthy and robust constitution, she must obtain a
+wet-nurse possessing such qualifications. The breast-milk, and nothing
+beside, must form the nutriment of the child for at least nine months;
+and if the infant is delicate or strumous, it will be prudent to
+continue it even six months longer. When the period arrives for the
+substitution of artificial food, it must be carefully selected; it must
+be appropriate to the advancing age of the child; nutritious and
+unirritating. Good air and daily exercise, and the bath or sponging,
+are of much importance; in short, all those general measures which have
+a tendency to promote and maintain the tone and general health of the
+system, and thus induce a vigorous and healthy constitution, and to
+which reference has been so fully made in the first chapter of this
+work, must be strictly regarded and followed out by the parent.
+
+The condition of the digestive organs must be the mother's especial
+care. Costiveness must be guarded against; and if at any time the
+secretions from the bowels indicate the presence of derangement, the
+medical attendant must be applied to, that appropriate remedies may
+without delay be exhibited. Their disordered condition is frequently
+productive of head-disease. Again and again have I clearly traced the
+origin of the complaint, of which I am now writing, as more
+immediately resulting from disorder of the digestive apparatus. To a
+child thus predisposed to water in the head, the healthy state of these
+organs is not only of first consequence, but any deviation from health
+to be dreaded, to be immediately attended to, and guarded against in
+future; and, as there is a great liability to these attacks at the time
+of weaning, the above remarks especially apply to that period, when due
+attention must be particularly paid to the plan of diet adopted.
+
+During teething the mother must be especially watchful, for it is at
+this time that the disease so commonly appears; the irritation produced
+by this process being a frequent exciting cause. Every thing,
+therefore, that will tend to allay excitement of the system, must be
+strictly enforced, as well as all causes avoided, which would produce
+derangement of the stomach and bowels. The head should be kept cool.
+For this purpose it must be sponged night and morning throughout the
+whole period of teething; a horse-hair pillow used in the cot; and
+nothing but a light straw hat should be worn, except in winter, The
+diet should be moderate, and carefully regulated after leaving the
+breast, and the child should be as much as possible in the open air.
+The mouth must be occasionally examined, and if the gums become hot or
+distended, they must be scarified or lanced, as may be advised. If the
+parent finds at any time an unusual heat about the head, the medical
+man must be at once consulted; or if there is watchfulness or
+indisposition to sleep at the proper periods, or frequent startings in
+the sleep, irritability of temper, and much crying, danger should be
+apprehended, and prompt and judicious means employed.
+
+Eruptions about the head, or sores behind the ears, discharging more
+or less, will sometimes make their appearance just before the cutting
+of a tooth, and disappear after it is cut; or it will sometimes happen
+that, if not interfered with, they will continue throughout the whole
+period of dentition. Great caution should always be exercised in
+reference to these eruptions in all children; and when there is a
+predisposition to water in the head, it is dangerous to interfere with
+them at all, except they run to such an extent as to become very
+troublesome. The sudden healing of these cutaneous affections has again
+and again been followed by head-disease. They are unsightly in the
+eyes of a parent, but it must be recollected that they render the
+situation of such children much more safe; and when teething is
+completed they will generally disappear spontaneously; or, if they
+should not, they will readily do so by proper medical treatment. I have
+no doubt that many a child's life has been saved by the appearance and
+continuance of these eruptions; and so sensible are medical men of the
+benefit derived from them, that in individuals in whom they do not
+appear, and in whose family there exists a predisposition to the
+disease now under our consideration, an issue or seton, in the arm or
+neck, has sometimes been made, and had a remarkable influence in
+warding off this affection. Dr. Cheyne refers to the circumstance of
+ten children in one family having died of this disease; the eleventh,
+for whom this measure was employed, having been preserved.
+
+Stimulants, throughout the whole period of infancy and childhood, and
+of every description, must be prohibited. Children nursed by drunken
+parents, and who have indulged in the use of spirituous liquors during
+suckling, are never healthy; are the frequent subjects of convulsions,
+and many of them die eventually of water in the head. The practice of
+administering spirits to the child itself; a habit unfortunately not
+very uncommon among the lower classes; produces a similar result.
+Narcotics may operate in a like manner: they derange the whole system
+when persevered in, particularly affecting the brain; promote disease;
+and sometimes give rise to the one in question. This remark should be
+borne in mind by the mother, as Godfrey's Cordial and other
+preparations of opium are too often kept in the nursery, and secretly
+given by unprincipled nurses to quiet a restless and sick child.
+
+All causes of mental excitement should be carefully avoided, and
+particularly the too early or excessive exercise of the intellectual
+faculties. If the child be endowed with a precocious intellect, the
+parent must restrain rather than encourage its exercise. Nothing is
+more likely to light up this disease in a constitution predisposed to
+it, than a premature exertion of the brain itself.
+
+
+MATERNAL MANAGEMENT OF THE DISEASE.--The early detection of this
+disease is of great importance. The chances that the medical treatment
+will terminate successfully much depend upon the early and prompt
+application of remedial means. The reason why these cases have so often
+terminated fatally has arisen from the physician being consulted when
+irremediable mischief had already taken place. It would be difficult,
+however, to point out the signs of its approach in all its forms (for
+this disease does not always commence in the same way, sometimes with
+fever, etc.), still it most frequently occurs preceded by certain
+striking and well-marked symptoms; and whenever the following are
+noticed by the parent apprehensive of mischief, she should at once send
+for her medical adviser:--watchfulness, or starting from sleep with a
+cry of alarm; prolonged screaming without any obvious cause; moaning
+and drowsiness; rolling the head from side to side on the nurse's
+arm, or thrusting it back against the pillow; knitting the brows and
+aversion from light, with heat of head, and constant carrying the
+little hand up to it; half closing the eyelids, and frequent vomiting.
+
+The chief and principal point in the maternal management (for it
+includes every other) is promptly and faithfully to administer the
+remedies prescribed by the medical attendant. A vigilant maternal
+superintendence is more necessary in this than almost any other
+disease; and it is highly desirable, therefore, that the mother should
+have a day and night nurse--individuals upon whom she can depend. A
+careful notice of symptoms and changes in the patient, in the intervals
+of the medical man's visits, and a true and faithful report to him upon
+his return, are of essential importance. A sleepy nurse will neglect
+the application of the most important remedies, and necessarily give an
+unfaithful report of symptoms; hours the most valuable to the child's
+well-doing are thus lost, and the chances of saving its life worse than
+problematical.
+
+The temperature of the room should be kept rather cool than warm, and
+the bed-clothes only sufficient to preserve the natural heat of the
+body. Strong light must be excluded. Great quiet should be observed.
+Freedom from all excitement of the senses, and irritation of the
+temper, should be carefully avoided: this is particularly necessary
+where the child is naturally of a quick and sensitive disposition.
+
+All the excretions must be put aside for the inspection of the
+physician, but not kept in the sick chamber, which must be well aired,
+and perfectly free from closeness. The regimen must be only such as is
+ordered, and any departure therefrom will be attended with mischievous
+consequences. During the early periods of the disease, all that is
+required are cooling diluents, given frequently, and in small
+quantities at a time; and upon approaching convalescence great
+carefulness must be paid to the amount of nourishment allowed, lest the
+disease be rekindled: strict compliance, therefore, to medical
+directions must be given.
+
+A very useful and indeed powerful remedy prescribed in this disease,
+is sometimes rendered utterly useless from a want of a persevering and
+also proper mode of applying it, viz. cold applications to the head.
+It is to be effected either by means of cloths kept constantly wet with
+cold water, or evaporating lotions; or by means of a bladder containing
+pounded ice mixed with water. If the two former are employed they
+require frequent renewal, or they become dry, hot, and more injurious
+than useful; and whichever is used, it must be kept in constant contact
+with the forehead, temples, and upper part of the head. Here is another
+error; they are seldom used large enough, and only partially cover
+these parts. With the further view of keeping the head cool, and
+preventing the accumulation of heat, a flat horse-hair pillow should be
+employed, and the head and shoulders somewhat raised.
+
+Perseverance in the measures prescribed, even when the case appears
+beyond all hope, must ever be the rule of conduct. Recovery, even in
+the most advanced periods of the disease, in cases apparently
+desperate, occasionally takes place. There is great reason to fear that
+many a child has been lost from a want of proper energy and
+perseverance on the part of the attendants in the sick room. They fancy
+the case is hopeless, and, to use their own expression, "they will not
+torment the child with medicine or remedies any longer."
+
+"Whilst there is life, there is hope," is a sentiment which may with
+great truth be applied to all the diseases of infancy and childhood.
+Striking, indeed, are the recoveries which occasionally present
+themselves to the notice of medical men; and those individuals may with
+great justice be charged with unpardonable neglect who do not persevere
+in the employment of the remedies prescribed, even up to the last hours
+of the child's existence.
+
+
+
+
+
+INDEX.
+
+
+
+Ablution, or sponging, 125.
+
+Abstinence, its good effect, in flatulence and griping in the infant,
+50. 226.
+
+Accidents and diseases which may occur to the infant at birth or soon
+after, 187.
+
+Acids, injurious to the teeth, 159.
+
+Air and exercise, in infancy, 83.
+--, in childhood, 89.
+--, its importance to the mother whilst a nurse, 33.
+
+Animal food, in childhood, 55.
+--, its injurious effects upon the young and delicate child, 58.
+
+Aperient liniment, 107.
+--, medicine, 97.
+--, poultice, 104.
+
+Artificial feeding; the causes rendering it necessary, 34.
+
+Artificial food; the proper kind for the child before the sixth
+month, 35.
+--; the mode of administering it, 39.
+--; the quantity to be given at each meal, 42.
+--; the frequency of giving it, 43.
+--; the posture of the child when fed, 43.
+--; the proper kind for the child after the sixth month, to the
+completion of first dentition, 44.
+--; the kind most suitable under the different complaints to which
+infants are liable, 48.
+
+
+Bath, the cold-water, plunge-bath, 118.
+--, the shower, 123.
+--, the warm, 128.
+--, rules for the use of the warm bath, 131.
+
+Bathing, sea, 120.
+--, and cleanliness, during infancy, 72.
+--, during childhood, 75.
+
+Bleeding, from leech-bites, how controlled, 113.
+--, from the navel string, 201.
+--, navel, 203.
+
+Blisters, mode of application, 114.
+
+Bottle, nursing, 40.
+
+Bowels, disorder of, in the infant, 208.
+
+Breasts of the infant, swelling of, 195.
+
+Breathing, how affected by disease, 175.
+
+
+Calomel, danger in its use, 167.
+--, injurious to the teeth, 160.
+
+Carminative, Dalby's, 111.
+
+Carriage, "a good carriage;" how best obtained, 95.
+--; the sad results of the mode frequently adopted, 91.
+
+Castor oil, 99.
+
+Choice of a wet-nurse, rules for, 28.
+
+Cleanliness and bathing, 72.
+
+Clothing, in infancy, 78.
+--, in childhood, 81.
+
+Clysters, what kind best for children, 105.
+--, mode of application, 106.
+
+Cold, infants very susceptible of, 78.
+
+Convulsions, 112, 167.
+
+Cork-nipple teat, 41.
+
+Costiveness, in infancy, 50. 229.
+--, in childhood, 231.
+
+Cough, as a sign of disease, 175.
+
+Countenance, in health, 165.
+
+Countenance, in disease, 165.
+
+Croup, 176. 286.
+
+
+Dalby's Carminative, 111.
+
+Damp, induces disease in the infant, 85.
+
+Dentition, easy, 136.
+--, difficult, 139.
+
+Diarrhoea, in the infant, 50. 227.
+
+Dietetics of infancy, 2.
+--, of childhood, 54.
+--, general directions upon, and of animal food, 55.
+--, sugar, 60.
+--, salt, 61.
+--, fruits, 62.
+--, water, 63.
+--, wine, beer, spirits, 63.
+
+Diet, under the different complaints to which infants are liable, 48.
+--, and regimen of a wet-nurse, 31.
+
+Digestion, in the infant; time requisite for its performance, 42.
+
+Discharge, from the eyes of the infant, 196.
+
+Disease, the importance of its early detection, and hints upon, 162.
+
+Dress, in infancy, 78.
+--, in childhood, 81.
+
+
+Enema. See Clysters.
+
+Eruptions on the skin in infancy; how best prevented, 74.
+--, about the head, and sores behind the ears, 295.
+--, during teething, 147.
+
+Exercise and air, in infancy, 85.
+--, in childhood, 89.
+--, horse-exercise; its importance to delicate children, 89.
+
+Eyes, of the infant, discharge from, after birth, 196.
+
+
+Fever, scarlet, 239.
+
+Flannel clothing, 80.
+
+Flatulence and griping in the infant, 50. 208. 226.
+
+Food, for infants. See Artificial Feeding.
+--, for children. See Dietetics of Childhood.
+--, and regimen, for nurses, 31.
+
+Fruits, 62.
+
+
+Gestures, of the infant, in health and disease, 169.
+
+Godfrey's cordial, 111.
+
+Grief, its effects upon the mother's milk, 34.
+
+Gums, of the infant in difficult dentition, the importance of their
+being lanced, 140.
+
+
+Hare-lip, how the infant may be nourished with this defect, 199.
+
+Head, of the infant, swellings upon, when born, 193.
+
+Hereditary transmission of scrofula and consumption; the best antidote
+to, 20.
+
+Hooping-cough, 275.
+
+Horse-exercise, its importance to delicate children, 89.
+
+Hunter's, Dr., experiments on the effects of wine upon children, 64.
+
+
+Jaundice, in the infant after birth, 204.
+
+
+Ice, how to be applied to the head, 127.
+
+Indigestion, in the infant, 208.
+
+Infant, food for. See Artificial Feeding.
+--; when still-born, how to be managed, 187.
+--; of injuries received during its birth, 193.
+--; retention of its urine after its birth, 194.
+--; swelling of the breasts after birth, 195.
+--; discharge from the eyes, 196.
+--; hare-lip, 199.
+--; bleeding from the navel string, 201.
+--; ulceration, or imperfect healing of the navel, 202.
+
+Infant; bleeding from the navel, 203.
+--, jaundice in, 204.
+--, tongue-tied, 205.
+--, moles and marks on the skin, 206.
+
+Inflation of the lungs of the infant, the mode, 190.
+
+
+Lavement, the proper kind for infants and children, 105.
+
+Leech-bites; the mode of controlling the bleeding of, 113
+
+Liniment, aperient, 107.
+
+Looseness, 208.
+
+Lungs of the infant, inflation of, 190.
+
+
+Magnesia, 102.
+
+Manna, 101.
+
+Maternal nursing, 3.
+--, management of the diseases of children, 184.
+
+Measles, 258.
+--, how distinguished from scarlet fever and small-pox, 255.
+
+Medicine, aperient, 97.
+
+Mercury, 107.
+
+Milk, the mother's; how to be preserved healthy during suckling, 3.
+--; deficiency of, 11.
+--; drying up of, 54.
+--, cow's; for infant's food, 35.
+--, ass's; for infant's food, 37.
+--, all kinds of, sometimes disagrees with the infant, 39.
+
+Mind, anxiety of; effects upon the parent's milk, 24.
+
+Moles and marks on the skin, 206.
+
+Mothers, their duty in relation to suckling, 3.
+--; those who ought never to suckle their children, 20. 24. 26.
+
+Motions of the infant; what the appearance of, and how frequent, in
+health, 99. 172.
+--; their deranged condition, a sign of disease, 173.
+
+
+Napkins, the infant's, 74.
+
+Navel, bleeding from, 203.
+--, ulceration or imperfect healing of, 202.
+
+Navel-string, bleeding from, 201.
+
+Naevi, or moles, 206.
+
+Nurses, wet, rules for the choice of, 28.
+--, diet and management of, 31.
+
+Nursery medicines, 97.
+
+Nursing, maternal, 3.
+--; the plan to be adopted for the first six months, 7.
+--; the plan to be followed after the sixth month to the time of
+weaning, 9.
+--; the injurious effects to the mother of undue and protracted
+suckling, 15.
+--; the injurious effects of undue and protracted suckling to the
+infant, 18.
+
+
+Opiates, 110. 297.
+--, in teething, dangerous, 145.
+
+
+Passion, its effect upon the breast-milk, 33.
+
+Porter, of its use, by the mother during suckling, 1
+--, when mischievous, 4.
+
+Poultice, bread-and-water, how made, 116.
+--, mustard, how made and applied, 115.
+
+Purgative medicine, 97.
+
+
+Retention of urine in the infant, 194.
+
+Rhubarb, 103.
+
+Rules for nursing, 3.
+--, for the use of the warm bath, 181.
+
+
+Salt, as a condiment, 61.
+
+Scarlet fever, 239.
+--, how distinguished from measles, 245.
+
+Scrofulous constitution, 180.
+
+Sea-bathing, 120.
+
+Seasons (the), their influence in producing particular forms of
+disorder, 178.
+
+Shower-bath, 123.
+
+Signs of health in the infant, what, 168.
+--, of disease in the infant, what, 169.
+
+Skin of the infant, importance of its perfect cleanliness, 72.
+--, friction and sponging of, beneficial, 73.
+
+Sleep, during infancy, 66.
+--, childhood, 69.
+--, how affected when the child is ill, 171.
+
+Small-pox, 262.
+
+Spirituous liquors, their pernicious effects to children, 63. 296.
+
+Sponging, 125.
+
+Spoon-feeding, 39.
+
+Still-born, 187.
+
+Stomach and bowels, their derangement, a fruitful source of disease,
+208.
+--, disorders of, in the infant at the breast, 210.
+--, disorders of, at the period of weaning, 217.
+--, disorders of, in the infant brought up by hand, 221.
+--, their treatment, 222.
+
+Stools of the infant, what the appearance of, and how frequent, in
+health, 99. 172.
+--, their deranged condition, a sign of disease, 173.
+
+Suckling, plan of, 3.
+--, by a wet-nurse, 27.
+
+Sugar, 60.
+
+Swelling of the breasts in the infant, 195.
+
+
+Teat of the cow--the artificial--the cork, 41.
+
+Teeth, of the permanent or adult teeth, 148.
+--, the manner in which they appear, 148.
+--, their value and importance, 152.
+--, their management and preservation, 154.
+
+Teething, easy; management of the child, 136.
+--, difficult; hints upon, 139.
+
+Tight-lacing, evils of, 92.
+
+Tongue-tied, 205.
+
+
+Ulceration or imperfect healing of the navel, 201.
+
+Urine, retention of it in the infant after birth, 194.
+
+
+Ventilation of the sleeping-rooms of children, 84.
+--, its importance in sickness, 246.
+
+
+Walking, the best mode of teaching a child, 87.
+
+Warm bath, 128.
+--, rules for the use of, 131.
+--, directions for the use of, when the infant is stillborn, 192.
+
+Water, as a beverage for children, 63.
+--, in the head, 291.
+
+Weaning, the time when to take place, 51.
+--, the mode of effecting it, 52.
+--; drying up the mother's milk, 53.
+
+Wet-nurse suckling, 27.
+--, rules for the choice of, 28.
+--, diet and management of, 31.
+
+Wine, its pernicious effects in childhood, 63.
+
+Worms, 234.
+
+
+
+
+
+THE END.
+
+
+
+
+
+
+Also by Dr. Bull,
+
+
+
+
+HINTS TO MOTHERS
+
+FOR THE
+
+MANAGEMENT OF THEIR HEALTH.
+
+
+Second Edit, greatly enlarged, foolscap 8vo.
+7s. cloth lettered.
+
+
+
+Opinions of the Press.
+
+
+"A very valuable compendium for all who expect to become mothers.--In
+the short preface prefixed to this little work, Dr. Bull judiciously
+remarks, that feelings of delicacy often prevent many young married
+females from making to their medical attendant, a full disclosure of
+the circumstances connected with their state, and which render medical
+assistance necessary. The object of the work is to meet this
+difficulty, by furnishing a species of information for which married
+women are often very unwilling to ask, although they readily search for
+it in books. The matter of Dr. Bull's treatise is arranged completely
+in a popular form--in one that is best calculated to be understood by
+the fair readers to whom it is addressed; and contains a variety of
+useful information, so clearly conveyed as to render it a very valuable
+compendium for all women who expect to become mothers."--Lancet.
+
+
+"A valuable monitor to the fair sex. It contains so much useful
+advice for every woman likely to become a mother, that married men
+would do well to provide it for their partners."--Spectator.
+
+
+"This little volume is the benevolent contribution of good sense and
+professional skill, to the well-being of those who have the strongest
+claims on our sympathy. Unfortunately a vast mass of erroneous notions
+exists in the class to whom it is addressed; to which, and to the
+concealment prompted by delicacy, until the time for medical aid is
+gone by, we are indebted for very much of the danger and suffering
+incident to the periods they are destined to pass through. Dr. Bull, in
+the true spirit of a physician and a gentleman, has by his perspicuous
+statements removed the first, and by his judicious and simple
+directions, anticipated the last of these fruitful sources of evil.
+There is no mother that will not be heartily thankful that this book
+ever fell into her hands; and no husband who should not present it to
+his wife. We cannot urge its value too strongly on all whom it
+concerns."--Eclectic Review.
+
+
+"We recommend it to our readers; and they will confer a benefit on
+their new-married patients by recommending it to them."--British and
+Foreign Medical Review.
+
+
+"Dr. Bull has performed a very kind and important office in the
+publication before us."--Patriot.
+
+
+"We never read any popular treatise, or directions rather, that bear
+more strongly the stamp of scientific and expert mental knowledge. The
+mere reading of our Author's book will do more good in the way of
+encouraging the fearful, and banishing nervous anxiety, than a whole
+conclave of the wisest and most sanguine matrons that society can
+anywhere bring together."--Monthly Review.
+
+
+"This little manual will prove useful exactly in proportion to the
+extent of its circulation."--Medical Gazette.
+
+
+
+
+
+End of the Project Gutenberg EBook of The Maternal Management of Children,
+in Health and Disease., by Thomas Bull, M.D.
+
+*** END OF THE PROJECT GUTENBERG EBOOK 10383 ***
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+
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+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #10383 (https://www.gutenberg.org/ebooks/10383)
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+The Project Gutenberg EBook of The Maternal Management of Children, in
+Health and Disease., by Thomas Bull, M.D.
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Maternal Management of Children, in Health and Disease.
+
+Author: Thomas Bull, M.D.
+
+Release Date: December 4, 2003 [EBook #10383]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK THE MATERNAL MANAGEMENT OF ***
+
+
+
+
+Produced by Albert R. Mann Library. 2003. Home Economics Archive:
+Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. Mann
+Library, Cornell University. http://hearth.library.cornell.edu (Version
+January 2003).
+
+
+
+
+
+THE
+
+MATERNAL MANAGEMENT
+
+OF
+
+CHILDREN,
+
+IN HEALTH AND DISEASE.
+
+
+
+
+By Thomas Bull, M.D.
+
+
+
+
+Physician Accoucheur To The Finsbury Midwifery
+
+Institution, And Lecturer On Midwifery,
+
+And On The Diseases Of Women
+
+And Children;
+
+
+
+Author Of "Hints To Mothers On The
+
+Management Of Their Health."
+
+
+
+
+1840.
+
+
+
+
+PREFACE.
+
+
+
+This little book has been written for the young and inexperienced
+mother. It is intended to furnish her with that information which the
+experience and observation of some years convince the author, young
+mothers, almost without any exception, do not possess; and yet, from
+ignorance of which, the constitution of many an infant has received
+irretrievable injury, and life itself but too frequently fallen a
+sacrifice.
+
+In the first chapters, devoted to the general management of the child
+in health, the author has endeavoured to teach the young mother, that
+the prevention of disease is her province, not its cure; that to this
+object all her best efforts must be directed; and, moreover, that to
+tamper with medicine, when disease has actually commenced, is to hazard
+the life of her offspring.
+
+In the fourth chapter it has been attempted to point out, how the
+first symptoms of disease may be early detected by the parent. The
+subject has been felt to be a difficult one, and to give particular
+directions quite out of the question; but it is hoped that the
+suggestions thrown out will, in some measure, answer the purpose
+intended. On the advantage of an early and prompt application of
+remedies in the diseases of childhood, generally so active in their
+progress and severe in their character, it is unnecessary to offer any
+observation.
+
+The latter part of the work, consisting of the maternal management of
+disease, the author regards as a subject of high and serious moment.
+Small as is the attention which has been hitherto paid to it, yet, in
+the diseases of infancy and childhood, how invaluable is a careful and
+judicious maternal superintendence to give effect to the measures
+prescribed by the physician.
+
+The author has endeavoured to arrange the contents of the work in a
+manner which shall be most easily understood and readily available; and
+he now publishes it with the desire to supply, in some degree, a
+deficiency in this important department of knowledge.
+
+
+
+Finsbury Place, June, 1840.
+
+
+
+
+
+CONTENTS.
+
+
+
+Chapter I.
+
+
+ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
+
+
+
+Sect. - Page
+
+
+
+I. On the Dietetics of Infancy - 2
+
+1. Maternal Nursing - 3
+
+Plan of Suckling - 3
+
+Deficiency of Milk - 11
+
+The injurious Effects to Mother and Infant of undue and protracted
+Suckling - 15
+
+Mothers who ought never to suckle - 20
+
+
+2. Wet-nurse Suckling - 27
+
+Choice of a Wet-nurse - 28
+
+Diet and Regimen of a Wet-nurse - 31
+
+
+3. Artificial Feeding, (bringing up by hand) - 34
+
+The Kind of artificial Food before the sixth Month - 35
+
+The Kind of artificial Food after the sixth Month to the completion of
+first Dentition - 44
+
+The Kind of artificial Food most suitable under the different
+Complaints to which Infants are liable - 48
+
+
+
+II. Weaning - 51
+
+The Time when - 51
+
+The Mode - 52
+
+The drying up of the Mother's Milk - 54
+
+
+
+III. On the Dietetics of Childhood - 54
+
+General Directions, and of animal Food - 55
+
+Sugar - 60
+
+Salt - 61
+
+Fruits - 62
+
+Water - 63
+
+Wine, Beer, and Spirits - 63
+
+
+
+IV. Sleep - 66
+
+During Infancy - 66
+
+During Childhood - 69
+
+
+
+V. Bathing and Cleanliness - 72
+
+During Infancy - 72
+
+During Childhood - 75
+
+
+
+VI. Clothing - 78
+
+During Infancy - 78
+
+During Childhood - 81
+
+
+
+VII. Air and Exercise - 83
+
+In Infancy - 83
+
+In Childhood - 89
+
+
+
+
+Chap. II.
+
+
+ON THE USE AND ABUSE OF CERTAIN REMEDIES.
+
+
+I. Aperient Medicine - 97
+
+Castor Oil - 99
+
+Manna - 101
+
+Magnesia and Rhubarb - 102
+
+The Lavement - 105
+
+The Aperient Liniment - 107
+
+
+
+II. Calomel - 107
+
+
+
+III. Opiates - 110
+
+
+
+IV. Leeching - 113
+
+
+
+V. Blisters and Poultices - 114
+
+
+
+VI. Baths - 117
+
+
+The Cold-water Plunge Bath - 118
+
+Sea Bathing - 120
+
+The Shower Bath - 123
+
+Ablution, or Sponging - 125
+
+The Warm Bath - 188
+
+
+
+
+Chap. III.
+
+
+ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.
+
+
+I. On Teething. - 134
+
+The Manner in which the temporary or milk Teeth appear - 134
+
+The Management of the Infant when Teething is without difficulty - 136
+
+The Management of the Infant in difficult Teething - 139
+
+
+
+II. Hints on the permanent or adult Teeth - 148
+
+The Manner in which they appear - 248
+
+Their Value and Importance - 152
+
+Their Management and Preservation - 154
+
+
+
+
+Chap. IV.
+
+
+HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.
+
+
+I. Signs of Health - 163
+
+
+II. Signs of Disease - 164
+
+Of the Countenance - 165
+
+Of the Gestures - 169
+
+Of the Sleep - 171
+
+Of the Stools - 172
+
+Of the Breathing and Cough - 175
+
+
+
+III. Other Circumstances which will assist in the early Detection of
+Disease - 178
+
+The Influence of the Seasons in producing particular Forms of Disorder
+- 178
+
+The Influence of an hereditary Predisposition to certain Diseases - 179
+
+
+
+
+Chap. V.
+
+
+ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
+
+
+I. Accidents and Diseases which may occur to the Infant at Birth, or
+soon after - 187
+
+
+1. Still-born - 187
+
+2. Injuries received during Birth - 193
+
+3. Retention of Urine - 194
+
+4. Swelling of the Breasts - 195
+
+5. Inflammation of the Eyes - 196
+
+6. Hare-lip - 199
+
+7. Bleeding from the Navel-string - 201
+
+8. Ulceration or imperfect Healing of the Navel - 20l
+
+9. Bleeding from the Navel - 203
+
+10. Jaundice - 204
+
+11. Tongue-tied - 205
+
+12. Moles and Marks on the Skin, etc. - 206
+
+
+
+II. Disorders of the Stomach and Bowels; viz., Indigestion -
+Flatulence - Vomiting - Griping and Looseness - 208
+
+
+1. In the Infant at the Breast - 21O
+
+2. At the period of Weaning - 217
+
+3. In the child brought up by Hand - 221
+
+
+Maternal Treatment - 222
+
+
+
+III. Costiveness - 229
+
+In Infancy - 229
+
+In Childhood - 231
+
+
+
+IV. Worms - 234
+
+Not so frequent as popularly supposed; an error productive of mischief
+- 234
+
+How produced and how best prevented - 237
+
+
+
+V. Scarlet Fever - 239
+
+Mild Form - 239
+
+With Sore Throat - 242
+
+Scarlet Fever compared with Measles - 245
+
+Maternal Management - 246
+
+
+
+VI. Measles - 253
+
+Description - 253
+
+Compared with Scarlet Fever and Small Pox - 255
+
+Maternal Management - 256
+
+
+
+VII. Small-Pox - 262
+
+Natural Small-Pox - 263
+
+Small-Pox in the Vaccinated - 266
+
+Maternal Management - 268
+
+VIII. Hooping Cough - 275
+
+Description - 276
+
+Maternal Management - 279
+
+
+
+IX. Croup - 286
+
+Signs of its Approach - 286
+
+Maternal Management - 289
+
+Its prevention - 289
+
+
+
+X. Water in the Head - 291
+
+Its Prevention - 292
+
+Maternal Management - 298
+
+
+
+
+
+THE MATERNAL MANAGEMENT OF CHILDREN.
+
+
+
+Chapter I.
+
+
+
+ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
+
+
+
+The line of demarcation made between infancy and childhood, both by
+ancient and modern writers, has always been arbitrary. I would draw the
+line between the two, at a period of time which appears to me to be the
+most natural, the most simple, and least likely to lead the reader into
+the danger of misapplying any part of the practical directions of this,
+or any future chapter of the work. We will consider, then, that--
+
+Infancy, commencing with birth, extends to about the end of the second
+year, when the first dentition is completed.
+
+Childhood extends from about the second, to the seventh or eighth
+year, when the second dentition is commenced.
+
+
+
+Sect. I. DIETETICS OF INFANCY.
+
+
+
+In the early months of infancy the organs of digestion are unsuited to
+any other food than that derived from the breast of the mother. So
+little capable are they, indeed, to digest any other, even of the
+blandest and most digestible kind, that probably not more than one
+infant in six or seven ever arrives at the more advanced periods of
+life when deprived of the kind of nourishment nature intended for this
+epoch.
+
+It is not every parent, however, who is able to become a nurse; and
+with many this office would not only be highly injurious to their own
+health, but materially so to that of their offspring. This may arise
+from various causes, hereafter to be noticed, but whenever they exist a
+wet-nurse is demanded.
+
+Again, the latter resource is not always attainable, so that the
+hazardous experiment of an artificial diet, or bringing up by hand, as
+it is then termed, is obliged to be resorted to.
+
+Thus, infantile dietetics naturally divides itself into Maternal
+Nursing, Wet-Nurse Suckling, And Artificial Feeding.
+
+
+
+1. MATERNAL NURSING.
+
+PLAN OF SUCKLING.
+
+
+
+From the first moment the infant is applied to the breast, it must be
+nursed upon a certain plan. This is necessary to the well-doing of the
+child, and will contribute essentially to preserve the health of the
+parent, who will thus be rendered a good nurse, and her duty at the
+same time will become a pleasure.
+
+This implies, however, a careful attention on the part of the mother
+to her own health; for that of her child is essentially dependent upon
+it. Healthy, nourishing, and digestible milk can be procured only from
+a healthy parent; and it is against common sense to expect that, if a
+mother impairs her health and digestion by improper diet, neglect
+of exercise, and impure air, she can, nevertheless, provide as
+wholesome and uncontaminated a fluid for her child, as if she were
+diligently attentive to these important points. Every instance of
+indisposition in the nurse is liable to affect the infant.
+
+And this leads me to observe, that it is a common mistake to suppose
+that, because a woman is nursing, she ought therefore to live very
+fully, and to add an allowance of wine, porter, or other fermented
+liquor, to her usual diet. The only result of this plan is, to cause an
+unnatural degree of fulness in the system, which places the nurse on
+the brink of disease, and which of itself frequently puts a stop to the
+secretion of the milk, instead of increasing it. The right plan of
+proceeding is plain enough; only let attention be paid to the ordinary
+laws of health, and the mother, if she have a sound constitution, will
+make a better nurse than by any foolish deviation founded on ignorance
+and caprice.
+
+The following case proves the correctness of this statement:--
+
+A young married lady, confined with her first child, left the lying-in-
+room at the expiration of the third week, a good nurse, and in perfect
+health. She had had some slight trouble with her nipples, but this was
+soon overcome.
+
+The porter system was now commenced, and from a pint to a pint and a
+half of this beverage was taken in the four and twenty hours. This was
+resorted to, not because there was any deficiency in the supply of
+milk, for it was ample, and the infant thriving upon it; but because,
+having become a nurse, she was told that it was usual and necessary,
+and that without it her milk and strength would ere long fail.
+
+After this plan had been followed for a few days, the mother became
+drowsy and disposed to sleep in the daytime; and headach, thirst, a hot
+skin, in fact, fever supervened; the milk diminished in quantity, and,
+for the first time, the stomach and bowels of the infant became
+disordered. The porter was ordered to be left off; remedial measures
+were prescribed; and all symptoms, both in parent and child, were after
+a while removed, and health restored.
+
+Having been accustomed, prior to becoming a mother, to take a glass or
+two of wine, and occasionally a tumbler of table beer, she was advised
+to follow precisely her former dietetic plan, but with the addition of
+half a pint of barley-milk morning and night. Both parent and child
+continued in excellent health during the remaining period of suckling,
+and the latter did not taste artificial food until the ninth month, the
+parent's milk being all-sufficient for its wants.
+
+No one can doubt that the porter was in this case the source of the
+mischief. The patient had gone into the lying-in-room in full health,
+had had a good time, and came out from her chamber (comparatively) as
+strong as she entered it. Her constitution had not been previously worn
+down by repeated child-bearing and nursing, she had an ample supply of
+milk, and was fully capable, therefore, of performing the duties which
+now devolved upon her, without resorting to any unusual stimulant or
+support. Her previous habits were totally at variance with the plan
+which was adopted; her system became too full, disease was produced,
+and the result experienced was nothing more than what might be expected.
+
+The plan to be followed for the first six months.-Until the breast-
+milk is fully established, which may not be until the second or third
+day subsequent to delivery (almost invariably so in a first
+confinement), the infant must be fed upon a little thin gruel, or upon
+one third water and two thirds milk, sweetened with loaf sugar.
+
+After this time it must obtain its nourishment from the breast alone,
+and for a week or ten days the appetite of the infant must be the
+mother's guide, as to the frequency in offering the breast. The stomach
+at birth is feeble, and as yet unaccustomed to food; its wants,
+therefore, are easily satisfied, but they are frequently renewed. An
+interval, however, sufficient for digesting the little swallowed, is
+obtained before the appetite again revives, and a fresh supply is
+demanded.
+
+At the expiration of a week or so it is essentially necessary, and
+with some children this may be done with safety from the first day of
+suckling, to nurse the infant at regular intervals of three or four
+hours, day and night. This allows sufficient time for each meal to be
+digested, and tends to keep the bowels of the child in order. Such
+regularity, moreover, will do much to obviate fretfulness, and that
+constant cry, which seems as if it could be allayed only by constantly
+putting the child to the breast. A young mother very frequently runs
+into a serious error in this particular, considering every expression
+of uneasiness as an indication of appetite, and whenever the infant
+cries offering it the breast, although ten minutes may not have elapsed
+since its last meal. This is an injurious and even dangerous practice,
+for, by overloading the stomach, the food remains undigested, the
+child's bowels are always out of order, it soon becomes restless and
+feverish, and is, perhaps, eventually lost; when, by simply attending
+to the above rules of nursing, the infant might have become healthy and
+vigorous.
+
+For the same reason, the infant that sleeps with its parent must not
+be allowed to have the nipple remaining in its mouth all night. If
+nursed as suggested, it will be found to awaken, as the hour for its
+meal approaches, with great regularity. In reference to night-nursing,
+I would suggest suckling the babe as late as ten o'clock p. m., and not
+putting it to the breast again until five o'clock the next morning.
+Many mothers have adopted this hint, with great advantage to their own
+health, and without the slightest detriment to that of the child. With
+the latter it soon becomes a habit; to induce it, however, it must be
+taught early.
+
+The foregoing plan, and without variation, must be pursued to the
+sixth month.
+
+
+AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a
+large supply of good and nourishing milk, and her child is healthy and
+evidently flourishing upon it, no change in its diet ought to be made.
+If otherwise, however, (and this will but too frequently be the case,
+even before the sixth month[FN#1],) the child may be fed twice in the
+course of the day, and that kind of food chosen which, after a little
+trial, is found to agree best.
+
+
+
+[FN#1]  See Deficiency of Milk, p. 11.
+
+
+
+Leman's tops and bottoms, steeped in hot water, with the addition of a
+little fresh milk, and sweetened or not with loaf sugar, is one of the
+best description.
+
+If the stomach reject this, farinaceous food boiled in water, and
+mixed with a small quantity of milk, may be employed. Or weak mutton or
+veal broth, or beef tea, clear and free from fat, and mixed with an
+equal quantity of farinaceous food.
+
+If this artificial diet is used before the sixth month, it must be
+given through the sucking-bottle; after this period with a spoon: in
+either case it must be previously passed through a sieve.
+
+When the large or grinding teeth have appeared, the same food is still
+to be continued, but need not any longer be expressed through the sieve.
+
+Such is the plan of nursing to be followed by the mother until she
+wean her infant altogether from the breast. The period when this ought
+to take place, as also the manner of accomplishing it, are detailed
+in the section on "Weaning."[FN#2]
+
+
+
+[FN#2]  See page 51.
+
+
+
+The diet from weaning to the termination of infancy is pointed out
+under "Artificial Feeding."[FN#3]
+
+
+
+[FN#3]  See page 34.
+
+
+
+DEFICIENCY OF MILK.
+
+
+
+If this deficiency exist from the earliest weeks after delivery, and
+it is not quickly remedied by the means presently to be pointed out, a
+wet-nurse must be obtained. It will be of no avail partially to nurse,
+and partially to feed the infant at this period and under such
+circumstances, for if it is not soon lost, it will only live for a few
+months, or a year at most, and be an object of the greatest anxiety and
+grief to its parent. This condition arises from the unwholesomeness of
+the mother's milk, united with the artificial food; for when the milk
+is deficient from the first, and continues so notwithstanding the means
+used for its increase, it is invariably unhealthy in its quality.
+
+This deficiency, however, may exist, and even at a very early period
+after delivery, and yet be removed. This, however, is not to be
+accomplished by the means too frequently resorted to; for it is the
+custom with many, two or three weeks after their confinement, if the
+supply of nourishment for the infant is scanty, to partake largely of
+malt liquor for its increase. Sooner or later this will be found
+injurious to the constitution of the mother: but how, then, is this
+deficiency to be obviated? Let the nurse keep but in good health, and
+this point gained, the milk, both as to quantity and quality, will be
+as ample, nutritious, and good, as can be produced by the individual.
+
+I would recommend a plain, generous, and nutritious diet; not one
+description of food exclusively, but, as is natural, a wholesome,
+mixed, animal, and vegetable diet, with or without wine or malt liquor,
+according to former habit; and, occasionally, where malt liquor has
+never been previously taken, a pint of good sound ale may be taken
+daily with advantage, if it agree with the stomach. Regular exercise in
+the open air is of the greatest importance, as it has an extraordinary
+influence in promoting the secretion of healthy milk. Early after
+leaving the lying-in room, carriage exercise, where it can be
+obtained, is to be preferred, to be exchanged, in a week or so, for
+horse exercise, or the daily walk. The tepid, or cold salt-water shower
+bath, should be used every morning; but if it cannot be borne, sponging
+the body withsalt-water must be substituted.
+
+By adopting with perseverance the foregoing plan, a breast of milk
+will be obtained as ample in quantity, and good in quality, as the
+constitution of the parent can produce, as the following case proves:
+
+On the 17th September, 1839, I attended a lady twenty-four years of
+age, a delicate, but healthy woman, in her first confinement. The
+labour was good. Every thing went on well for the first week, except
+that, although the breasts became enlarged, and promised a good supply
+of nourishment for the infant, at its close there was merely a little
+oozing from the nipple. During the next fortnight a slight, but very
+gradual increase in quantity took place, so that a dessert spoonful
+only was obtained about the middle of this period, and perhaps double
+this quantity at its expiration. In the mean time the child was
+necessarily fed upon an artificial diet, and as a consequence its
+bowels became deranged, and a severe diarrhoea followed. A wet-nurse
+was advised for the child as the only means of saving its life, and
+change of air for the mother as the most likely expedient (in
+connection with the general treatment pointed out above) for obtaining
+a good breast of milk. Accordingly, on the 5th October, the patient,
+taking with her the infant and a wet-nurse, went a few miles from town.
+
+For three or four days it was a question whether the little one would
+live, for so greatly had it been reduced by the looseness of the bowels
+that it had not strength to grasp the nipple of its nurse; the milk,
+therefore, was obliged to be drawn, and the child fed with it from a
+spoon. After the lapse of a few days, however, it could obtain the
+breast-milk for itself; and, to make short of the case, on the 25th of
+the same month, the mother and child returned home, the former having a
+very fair proportion of healthy milk in her bosom, and the child
+perfectly recovered and evidently thriving fast upon it.
+
+Where, however, there has been an early deficiency in the supply of
+nourishment, it will most frequently happen that, before the sixth or
+seventh month, the infant's demands will be greater than the mother can
+meet. The deficiency must be made up by artificial food, which must be
+of a kind generally employed before the sixth month, and given through
+the bottle. If, however, this plan of dieting should disagree, the
+child must, even at this period, have a wet-nurse.
+
+Women who marry comparatively late in life, and bear children,
+generally have a deficiency of milk after the second or third month:
+artificial feeding must in part be here resorted to.
+
+
+
+THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED
+SUCKLING.
+
+
+
+UPON THE MOTHER.--The period of suckling is generally one of the most
+healthy of a woman's life. But there are exceptions to this as a
+general rule; and nursing, instead of being accompanied by health, may
+be the cause of its being materially, and even fatally, impaired. This
+may arise out of one of two causes, either, a parent continuing to
+suckle too long; or, from the original powers or strength not being
+equal to the continued drain on the system.
+
+Examples of the first class I am meeting with daily. I refer to poor
+married women, who, having nursed their infants eighteen months, two
+years, or even longer than this, from the belief that by so doing they
+will prevent pregnancy, call to consult me with an exhausted frame and
+disordered general health, arising solely from protracted nursing,
+pursued from the above mistaken notion.
+
+I most frequently meet with examples of the second class in the
+delicate woman, who, having had two or three children in quick
+succession, her health has given way, so that she has all the symptoms
+arising from undue suckling, when perhaps the infant at her breast is
+not more than two or three months old.
+
+Since the health of the mother, then, will suffer materially from this
+circumstance, she ought not to be ignorant of the fact; so that, when
+the first symptoms manifest themselves, she may be able to recognise
+their insidious approach; and tracing them to their real cause, obtain
+medical advice before her health be seriously impaired.
+
+
+SYMPTOMS.--The earliest symptom is a dragging sensation in the back
+when the child is in the act of sucking, and an exhausted feeling of
+sinking and emptiness at the pit of the stomach afterwards. This is
+soon followed by loss of appetite, costive bowels, and pain on the left
+side; then, the head will be more or less affected, sometimes with much
+throbbing, singing in the ears, and always some degree of giddiness,
+with great depression of spirits.
+
+Soon the chest becomes affected, and the breathing is short,
+accompanied by a dry cough and palpitation of the heart upon the
+slightest exertion. As the disease advances, the countenance becomes
+very pale, and the flesh wastes, and profuse night perspirations, great
+debility, swelling of the ankles, and nervousness ensue. It is
+unnecessary, however, to enter into a more full detail of symptoms.
+
+
+TREATMENT.--All that it will be useful to say in reference to
+treatment, is this; that, although much may be done in the first
+instance by medicine, change of air, cold and sea bathing, yet the
+quickest and most effectual remedy is to wean the child, and thus
+remove the cause.
+
+
+THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful
+reason why the child should be weaned, or rather, have a young and
+healthy wet-nurse, if practicable. The effects upon the infant, suckled
+under such circumstances, will be most serious. Born in perfect health,
+it will now begin to fall off in its appearance, for the mother's milk
+will be no longer competent to afford it due nourishment; it will be
+inadequate in quantity and quality. Its countenance, therefore, will
+become pale; its look sickly and aged; the flesh soft and flabby; the
+limbs emaciated; the belly, in some cases, large, in others, shrunk;
+and the evacuations fetid and unnatural; and in a very few weeks, the
+blooming healthy child will be changed into the pale, sickly, peevish,
+wasted creature, whose life appears hardly desirable.
+
+The only measure that can save the life, and recover an infant from
+this state, is that which would previously have prevented it a healthy
+wet-nurse.
+
+If the effects upon the infant should not be so aggravated as those
+just described, and it subsequently live and thrive, there will be a
+tendency in such a constitution to scrofula and consumption, to
+manifest itself at some future period of life, undoubtedly acquired
+from the parent, and dependent upon the impaired state of her health at
+the time of its suckling. A wet-nurse early resorted to, will prevent
+this.
+
+It will be naturally asked, for how long a period a mother ought to
+perform the office of a nurse? No specific time can be mentioned, and
+the only way in which the question can be met is this: no woman, with
+advantage to her own health, can suckle her infant beyond twelve or
+eighteen months; and at various periods between the third and twelfth
+month, many women will be obliged partially or entirely to resign the
+office.[FN#4]
+
+
+
+[FN#4]  See "Weaning," p. 51.
+
+
+
+The monthly periods generally reappear from the twelfth to the
+fourteenth month from delivery; and when established, as the milk is
+found invariably to diminish in quantity, and also to deteriorate in
+quality, and the child is but imperfectly nourished, it is positively
+necessary in such instances at once to wean it.
+
+
+
+OF MOTHERS WHO OUGHT NEVER TO SUCKLE.
+
+
+
+There are some females who ought never to undertake the office of
+suckling, both on account of their own health, and also that of their
+offspring.
+
+
+THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the
+infant born of such a parent there will be a constitutional
+predisposition to the same disease; and, if it is nourished from her
+system, this hereditary predisposition will be confirmed.
+
+"No fact in medicine is better established than that which proves the
+hereditary transmission from parents to children of a constitutional
+liability to pulmonary disease, and especially to consumption; yet no
+condition is less attended to in forming matrimonial engagements. The
+children of scrofulous and consumptive parents are generally
+precocious, and their minds being early matured, they engage early in
+the business of life, and often enter the married state before their
+bodily frame has had time to consolidate. For a few years every thing
+seems to go on prosperously, and a numerous family gathers around them.
+All at once, however, even while youth remains, their physical powers
+begin to give way, and they drop prematurely into the grave, exhausted
+by consumption, and leaving children behind them, destined, in all
+probability, either to be cut off as they approach maturity, or to run
+through the same delusive but fatal career as that of the parents from
+whom they derived their existence."[FN#5] There is scarcely an
+individual who reads these facts, to whom memory will not furnish some
+sad and mournful example of their truth; though they perhaps may have
+hitherto been in ignorance of the exciting cause.
+
+
+
+[FN#5]  Combe's Principles of Physiology applied to the Preservation of
+Health, etc.
+
+
+
+It is, however, with the mother as a nurse that I have now to do, and
+I would earnestly advise every one of a consumptive or strumous habit
+(and if there is any doubt upon this point, the opinion of a medical
+adviser will at once decide it) never to suckle her offspring; her
+constitution renders her unfit for the task. And, however painful it
+may be to her mind at every confinement to debar herself this
+delightful duty, she must recollect that it will be far better for her
+own health, and infinitely more so for that of the child, that she
+should not even attempt it; that her own health would be injured, and
+her infant's, sooner or later, destroyed by it.
+
+The infant of a consumptive parent, however, must not be brought up by
+hand. It must have a young, healthy, and vigorous wet-nurse; and in
+selecting a woman for this important duty very great care must be
+observed.[FN#6] The child should be nursed until it is twelve or fifteen
+months old. In some cases it will be right to continue it until the
+first set of teeth have appeared, when it will be desirable that a
+fresh wet-nurse should be obtained for the last six months.[FN#7] If
+the child is partially fed during the latter months (from
+necessity or any other cause), the food should be of the lightest
+quality, and constitute but a small proportion of its nutriment.
+
+
+
+[FN#6]  See "Choice of a Wet-nurse," p. 28.
+
+[FN#7]  One that has been confined about six weeks or two months.
+
+
+
+But not only must the nourishment of such a child be regarded, but the
+air it breathes, and the exercise that is given to it; as also, the
+careful removal of all functional derangements as they occur, by a
+timely application to the medical attendant, and maintaining,
+especially, a healthy condition of the digestive organs. All these
+points must be strictly followed out, if any good is to be effected.
+
+By a rigid attention to these measures the mother adopts the surest
+antidote, indirectly, to overcome the constitutional predisposition to
+that disease, the seeds of which, if not inherited from the parent,
+are but too frequently developed in the infant during the period of
+nursing; and, at the same time, she takes the best means to engender a
+sound and healthy constitution in her child. This, surely, is worth any
+sacrifice.
+
+If the infant derives the disposition to a strumous constitution
+entirely from the father, and the mother's health be unexceptionable,
+then I would strongly advise her to suckle her own child.
+
+
+THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There
+are other women who ought never to become nurses. The mother of a
+highly nervous temperament, who is alarmed at any accidental change she
+may happen to notice in her infant's countenance, who is excited and
+agitated by the ordinary occurrences of the day; such a parent will do
+her offspring more harm than good by attempting to suckle it. Her milk
+will be totally unfit for its nourishment: at one time it will be
+deficient in quantity, at another, so depraved in its quality, that
+serious disturbance to the infant's health, will ensue. The young and
+inexperienced mother, who is a parent for the first time, and
+altogether ignorant of the duties of her office, and at the same time
+most anxious to fulfil them faithfully, is but too frequently an
+instance in point; although at a future period she will generally make
+a good nurse. The following is an illustration:--
+
+In December, 1838, I attended a young married lady in her first
+confinement, and in excellent health. She gave birth to a fine, plump,
+healthy boy. Every thing went on well for three weeks, the mother
+having an abundant supply of milk, and the infant evidently thriving
+upon it. About this time, however, the child had frequent fits of
+crying; the bowels became obstinately costive;--the motions being
+lumpy, of a mixed colour, quite dry, and passed with great pain. It
+became rapidly thin, and after a while its flesh so wasted, and became
+so flabby, that it might be said literally to hang on the bones. The
+fits of crying now increased in frequency and violence, coming on every
+time after the little one left the breast, when it would commence
+screaming violently, beat the air with its hands and feet, and nothing
+that was done could appease it. Having lasted for half an hour or more,
+it would fall asleep quite exhausted; the fit recurring again, when
+again it had been to the breast.
+
+It was very evident that the infant's hunger was not satisfied, as it
+was also but too evident its body was not nourished by the parent's
+milk, which, although abundant in quantity (the breast being large and
+full of milk), was at this time seriously deteriorated in its nutritive
+quality. This was caused, I believe, from great anxiety of mind. Her
+nurse became suddenly deranged, and the whole responsibility and care
+of the child thus devolved upon the mother, of the duties connected
+with which she was entirely ignorant.
+
+A wet-nurse was obtained. In a very few hours after this change was
+effected, the screaming ceased, the child had quiet and refreshing
+sleep, and in twelve hours a healthy motion was passed. The child
+gained flesh almost as quickly as it had previously lost it, and is now
+as fine and healthy an infant as it promised to be when born.
+
+Whenever there has existed previously any nervous or mental affection
+in the parent, wet-nurse suckling is always advisable; this, with
+judicious management of childhood, will do much to counteract the
+hereditary predisposition.
+
+
+THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE
+OUGHT NOT.--The mother who cannot make up her mind exclusively to
+devote herself to the duties of a nurse, and give up all engagements
+that would interfere with her health, and so with the formation of
+healthy milk, and with the regular and stated periods of nursing her
+infant, ought never to suckle. It is unnecessary to say why; but I
+think it right, for the child's sake, to add, that if it does not
+sicken, pine, and die, disease will be generated in its constitution,
+to manifest itself at some future period.
+
+The child, then, under all the foregoing circumstances, must be
+provided with its support from another source, and a wet-nurse is the
+best.
+
+
+
+2. WET-NURSE SUCKLING.
+
+
+
+Ill health and many other circumstances may prevent a parent from
+suckling her child, and render a wet-nurse necessary. Now, although she
+will do wisely to leave the choice of one to her medical attendant,
+still, as some difficulty may attend this, and as most certainly the
+mother herself ought to be acquainted with the principal points to
+which his attention is directed in the selection of a good nurse, it
+will be well to point out in what they consist.
+
+
+
+CHOICE OF A WET-NURSE.
+
+
+
+The first thing to which a medical man looks, is the general health of
+the woman; next, the condition of her breast, the quality of her milk
+its age and her own; whether she is ever unwell while nursing; and,
+last of all, the condition and health of the child.
+
+
+IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the
+marks of a sound constitution, and ought to be free from all suspicion
+of a strumous character; her tongue clean, and digestion good; her
+teeth and gums sound and perfect; her skin free from eruption, and her
+breath sweet.
+
+
+WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and
+well formed; its size not dependent upon a large quantity of fat, which
+will generally take away from its firmness, giving it a flabby
+appearance, but upon its glandular structure, which conveys to the
+touch a knotted, irregular, and hard feel; and the nipple must be
+perfect, of moderate size, but well developed.
+
+
+WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish-
+white colour; sweet to the taste; and when allowed to stand, should
+throw up a considerable quantity of cream.
+
+
+WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely
+expired, the wet-nurse to be hired ought certainly not to have reached
+her second month. At this time, the nearer the birth of the child, and
+the delivery of its foster-parent, the better: the reason for which
+is, that during the first few weeks the milk is thinner and more watery
+than it afterwards becomes. If, consequently, a new-born infant be
+provided with a nurse, who has been delivered three or four months, the
+natural relation between its stomach and the quality of the milk is
+destroyed, and the infant suffers from the oppression of food too heavy
+for its digestive power.
+
+On the other hand, if you are seeking a wet-nurse for an infant of
+four or five months old, it would be very prejudicial to transfer the
+child to a woman recently delivered; the milk would be too watery for
+its support, and its health in consequence would give way.
+
+
+THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from
+twenty-one to thirty admits of no question. And the woman who has had
+one or two children before is always to be preferred, as she will be
+likely to have more milk, and may also be supposed to have acquired
+some experience in the management of infants.
+
+
+INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her
+at once. You will have no difficulty in ascertaining this point; for
+this class of persons have an idea that their milk is renewed, as they
+term it, by this circumstance, monthly; and, therefore, that it is a
+recommendation, rendering their milk fitter for younger children than
+it would otherwise have been. It produces, however, quite a contrary
+effect; it much impairs the milk, which will be found to disagree with
+the child, rendering it at first fretful,--after a time being vomited
+up, and productive of frequent watery dark green motions.
+
+
+Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the
+sprightly appearance of health, to bear the marks of being well
+nourished, its flesh firm, its skin clean and free from eruptions. It
+should be examined in this respect, particularly about the head, neck,
+and gums.
+
+If a medical man finds that both mother and child answer to the above
+description, he has no hesitation in recommending the former as likely
+to prove a good wet-nurse.
+
+
+
+DIET AND REGIMEN OF A WET-NURSE.
+
+
+
+The regimen of a wet-nurse should not differ much from that to which
+she has been accustomed; and any change which it may be necessary to
+make in it should be gradual. It is erroneous to suppose that women
+when nursing require to be much more highly fed than at other times: a
+good nurse does not need this, and a bad one will not be the better for
+it. The quantity which many nurses eat and drink, and the indolent life
+which they too often lead, have the effect of deranging their digestive
+organs, and frequently induce a state of febrile excitement, which
+always diminishes, and even sometimes altogether disperses, the milk.
+
+It will be necessary then to guard against the nurse overloading her
+stomach with a mass of indigestible food and drink. She should live as
+much as possible in the manner to which she has been accustomed; she
+should have a wholesome, mixed, animal and vegetable diet, and a
+moderate and somewhat extra quantity of malt liquor, provided it agree
+with her system.
+
+A very prevailing notion exists that porter tends to produce a great
+flow of milk, and in consequence the wet-nurse is allowed as much as
+she likes; a large quantity is in this way taken, and after a short
+time so much febrile action excited in the system, that instead of
+increasing the flow of milk, it diminishes it greatly. Some parents,
+however, aware of this fact, will go into an opposite extreme, and
+refuse the nurse even that which is necessary. Either excess is of
+course wrong. It is difficult in general terms to say what ought to be
+considered a proper daily allowance, but some is in general necessary;
+and whenever a woman has been used to drink malt-liquor, she will
+rarely make a good wet-nurse if she is denied a reasonable quantity of
+that beverage. Good sound ale sometimes agrees better than porter. It
+may be well here to remark, that in London, I frequently meet with
+severe cases of diarrhoea in infants at the breast, fairly traceable to
+bad porter, which vitiating the quality of the milk, no medical
+treatment cures the disease, until this beverage is left off or
+changed, when it at once disappears.
+
+The nurse should take exercise daily in the open air. Nothing tends
+more directly to maintain a good supply of healthy milk, than air and
+exercise; and the best wet-nurse would soon lose her milk, if
+constantly kept within doors. Sponging the whole body also with cold
+water with bay-salt in it every morning, should be insisted upon, if
+possible: it preserves cleanliness, and greatly invigorates the health.
+United with this, the nurse should rise early, and also be regularly
+employed during the day in some little portion of duty in the family, an
+attendance upon the wants of the child not being alone sufficient.
+
+An amiable disposition and good temper are very desirable. A violent
+fit of passion may exert so peculiar an influence in changing the
+natural properties of the milk, that a child has been known to be
+attacked with a fit of convulsions after being suckled by a nurse while
+labouring under the effects of a fit of anger. The depressing passions
+frequently drive the milk away altogether. It is hence of no small
+moment, that a wet-nurse be of a quiet and even temper, and not
+disposed to mental disturbance.
+
+
+
+3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.
+
+
+
+Extreme delicacy of constitution, diseased condition of the frame,
+defective secretion of milk, and other causes, may forbid the mother
+suckling her child; and unless she can perform this office with safety
+to herself, and benefit to her infant, she ought not to attempt it. In
+this case a young and healthy wet-nurse is the best substitute; but
+even this resource is not always attainable. Under these circumstances,
+the child must be brought up on an artificial diet "by hand,"--as it is
+popularly called.
+
+To accomplish this with success requires the most careful attention on
+the part of the parent, and at all times is attended with risk to the
+life of the child; for although some children, thus reared, live and
+have sound health, these are exceptions to the general rule, artificial
+feeding being in most instances unsuccessful.
+
+
+
+THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.
+
+
+
+It should be as like the breast-milk as possible. This is obtained by
+a mixture of cow's milk, water, and sugar, in the following
+proportions:--
+
+
+Fresh cow's milk, two thirds;
+Boiling water, or thin barley water, one third;
+Loaf sugar, a sufficient quantity to sweeten.
+
+
+This is the best diet that can be used for the first six months, after
+which some farinaceous food may be combined.
+
+In early infancy, mothers are too much in the habit of giving thick
+gruel, panada, biscuit-powder, and such matters, thinking that a diet
+of a lighter kind will not nourish. This is a mistake; for these
+preparations are much too solid; they overload the stomach, and cause
+indigestion, flatulence, and griping. These create a necessity for
+purgative medicines and carminatives, which again weaken digestion,
+and, by unnatural irritation, perpetuate the evils which render them
+necessary. Thus many infants are kept in a continual round of
+repletion, indigestion, and purging, with the administration of
+cordials and narcotics, who, if their diet were in quantity and quality
+suited to their digestive powers, would need no aid from physic or
+physicians.
+
+In preparing this diet, it is highly important to obtain pure milk,
+not previously skimmed, or mixed with water; and in warm weather just
+taken from the cow. It should not be mixed with the water or sugar
+until wanted, and not more made than will be taken by the child at the
+time, for it must be prepared fresh at every meal. It is best not to
+heat the milk over the fire, but let the water be in a boiling state
+when mixed with it, and thus given to the infant tepid or lukewarm.
+
+As the infant advances in age, the proportion of milk may be gradually
+increased; this is necessary after the second month, when three parts
+of milk to one of water may be allowed. But there must be no change in
+the kind of diet if the health of the child is good, and its appearance
+perceptibly improving. Nothing is more absurd than the notion, that in
+early life children require a variety of food; only one kind of food is
+prepared by nature, and it is impossible to transgress this law without
+marked injury.
+
+If cow's milk disagree with an infant--and this is sometimes
+unfortunately the case, even from its birth ass's milk,--diluted with
+one third its quantity of water, may be given as a substitute. I am now
+attending a lady in her fourth confinement, who is unable, from defect
+in her nipples, to suckle her children. The first child had a healthy
+wet-nurse, and has grown a fine healthy lad. The second, a girl, was
+unfortunate in her nurse, she being of a strumous and unhealthy
+constitution, although to a casual observer bearing the appearance of
+health. The child lived only three months, and the nurse died of a
+rapid consumption shortly after. This discouraged the mother from
+adopting wet-nurse suckling for the third child (a great error); and an
+artificial diet of cow's milk was resorted to. The third day from
+commencing this plan, flatulence, griping, purging, and vomiting came
+on, one symptom quickly following the other; the child wasted, and on
+the sixth day had several convulsive fits. The diet was immediately
+changed for ass's milk, and in less than twelve hours the sickness and
+purging ceased; the flatulence was relieved; the motions, from being
+green, watery, and passed with great violence and pain, became of a
+healthy consistence and colour, and the screaming ceased. The symptoms
+did not return, the child thrived, very soon consuming regularly one
+quart of the ass's milk daily, and is now a fine healthy girl two years
+old. A fortnight since the parent was confined with a fourth child.
+Cow's milk was given to it for two or three days (from the difficulty
+of obtaining that of the ass), the same train of symptoms, precisely,
+came on with which the third child had been affected, which again gave
+way upon following up the same plan of diet--the substitution of the
+ass's milk for that of the cow. The evident conclusion from this is,
+that the breast-milk of a healthy woman is incomparably the most
+suitable diet for the infant; but that, if she be not of a healthy
+constitution, it may be destructive to the child; and that where this
+cannot be obtained, and cow's milk is found to disagree, ass's milk may
+sometimes be resorted to with the happiest results.[FN#8]
+
+
+
+[FN#8]  An infant will generally consume a quart, or a little more, of
+ass's milk in the four and twenty hours; and as this quantity is
+nearly as much as the animal will give, it is best to purchase an ass
+for the express purpose. The foal must be separated from the mother,
+and the forage of the latter carefully attended to, or the milk will
+disagree with the child.
+
+
+
+Sometimes the mother's breast, and every description of milk, is
+rejected by the child; in which case recourse must be had to veal or
+weak mutton broth, or beef tea, clear and free from fat, mixed with a
+very small quantity of farinaceous food, carefully passed through a
+sieve before it is poured into the sucking-bottle.
+
+
+THE MODE OF ADMINISTERING IT.--There are two ways--by the spoon, and by
+the nursing-bottle. The first ought never to be employed at this
+period, inasmuch as the power of digestion in infants is very weak,
+and their food is designed by nature to be taken very slowly into the
+stomach, being procured from the breast by the act of sucking, in which
+act a great quantity of saliva is secreted, and being poured into the
+mouth, mixes with the milk, and is swallowed with it. This process of
+nature, then, should be emulated as far as possible; and food (for this
+purpose) should be imbibed by suction from a nursing-bottle: it is thus
+obtained slowly, and the suction employed secures the mixture of a due
+quantity of saliva, which has a highly important influence on digestion.
+
+Too much care cannot be taken to keep the bottle perfectly sweet. For
+this purpose there should always be two in the nursery, to be used
+alternately; and, if any food remain after a meal, it must be emptied
+out. The bottle must always be scalded out after use. The flat glass
+nursing-bottle itself is too well known to need description; it may be
+well, however, to say a word about the teat that covers its narrow
+neck, and through which the infant sucks the food. If the artificial
+or prepared cow's teat is made use of, it should be so attached to the
+bottle that its extremity does not extend beyond its apex more than
+half or three quarters of an inch; for if it projects more than this,
+the child will get the sides of the teat so firmly pressed together
+between its gums, that there will be no channel for the milk to flow
+through. This remark applies equally to the teat made of soft wash-
+leather, which many ladies prefer to that of the cow, and it is a good
+substitute; but then a fresh piece of leather must be made use of
+daily, otherwise the food will be tainted, and the child's bowels
+deranged. It is also necessary that both of these, when used, should
+have a small conical piece of sponge inclosed.
+
+The most cleanly and convenient apparatus is a cork nipple, upon the
+plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork,
+being of a particularly fine texture, is supple and elastic, yielding
+to the infant's lips while sucking, and is much more durable than the
+teats ordinarily used.
+
+
+
+[FN#9]  Sold by Weiss et Son, 62. Strand,
+
+
+
+Whatever kind of bottle or teat is used, however, it must never be
+forgotten that cleanliness is absolutely essential to the success of
+this plan of rearing children.
+
+
+THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.--This must be regulated
+by the age of the child, and its digestive power. A little experience
+will soon enable a careful and observing mother to determine this
+point.--As the child grows older the quantity of course must be
+increased.
+
+The chief error in rearing the young is overfeeding; and a most
+serious one it is; but which may be easily avoided by the parent
+pursuing a systematic plan with regard to the hours of feeding, and
+then only yielding to the indications of appetite, and administering
+the food slowly, in small quantities at a time. This is the only way
+effectually to prevent indigestion, and bowel complaints, and the
+irritable condition of the nervous system, so common in infancy, and
+secure to the infant healthy nutrition, and consequent strength of
+constitution. As has been well observed, "Nature never intended the
+infant's stomach to be converted into a receptacle for laxatives,
+carminatives, antacids, stimulants, and astringents; and when these
+become necessary, we may rest assured that there is something faulty in
+our management, however perfect it may seem to ourselves."
+
+
+THE FREQUENCY OF GIVING FOOD.--This must be determined, as a general
+rule, by allowing such an interval between each meal as will insure the
+digestion of the previous quantity; and this may be fixed at about
+every three or four hours. If this rule be departed from, and the child
+receives a fresh supply of food every hour or so, time will not be
+given for the digestion of the previous quantity, and as a consequence
+of this process being interrupted, the food passing on into the bowel
+undigested, will there ferment and become sour, will inevitably produce
+cholic and purging, and in no way contribute to the nourishment of the
+child.
+
+
+THE POSTURE OF THE CHILD WHEN FED.--It is important to attend to this.
+It must not receive its meals lying; the head should be raised on the
+nurse's arm, the most natural position, and one in which there will be
+no danger of the food going the wrong way, as it is called. After each
+meal the little one should be put into its cot, or repose on its
+mother's knee, for at least half an hour. This is essential for the
+process of digestion, as exercise is important at other times for the
+promotion of health.
+
+
+
+THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION
+OF FIRST DENTITION.
+
+
+
+As soon as the child has got any teeth,--and about this period one or
+two will make their appearance,--solid farinaceous matter boiled in
+water, beaten through a sieve, and mixed with a small quantity of milk,
+may be employed. Or tops and bottoms, steeped in hot water, with the
+addition of fresh milk and loaf sugar to sweeten. And the child may
+now, for the first time, be fed with a spoon.
+
+When one or two of the large grinding teeth have appeared, the same
+food may be continued, but need not be passed through a sieve. Beef tea
+and chicken broth may occasionally be added; and, as an introduction to
+the use of a more completely animal diet, a portion, now and then, of a
+soft boiled egg; by and by a small bread pudding, made with one egg in
+it, may be taken as the dinner meal.
+
+Nothing is more common than for parents during this period to give
+their children animal food. This is a great error. "To feed an infant
+with animal food before it has teeth proper for masticating it, shows a
+total disregard to the plain indications of nature, in withholding such
+teeth till the system requires their assistance to masticate solid
+food. And the method of grating and pounding meat, as a substitute for
+chewing, may be well suited to the toothless octogenarian, whose
+stomach is capable of digesting it; but the stomach of a young child is
+not adapted to the digestion of such food, and will be disordered by
+it."[FN#10]
+
+
+
+[FN#10]  Sir James Clarke on Consumption.
+
+
+
+"If the principles already laid down be true, it cannot reasonably be
+maintained that a child's mouth without teeth, and that of an adult,
+furnished with the teeth of carnivorous and graminivorous animals, are
+designed by the Creator for the same sort of food. If the mastication
+of solid food, whether animal or vegetable, and a due admixture of
+saliva, be necessary for digestion, then solid food cannot be proper,
+when there is no power of mastication. If it is swallowed in large
+masses it cannot be masticated at all, and will have but a small chance
+of being digested; and in an undigested state it will prove injurious
+to the stomach and to the other organs concerned in digestion, by
+forming unnatural compounds. The practice of giving solid food to a
+toothless child, is not less absurd, than to expect corn to be ground
+where there is no apparatus for grinding it. That which would be
+considered as an evidence of idiotism or insanity in the last instance,
+is defended and practised in the former. If, on the other hand, to
+obviate this evil, the solid matter, whether animal or vegetable, be
+previously broken into small masses, the infant will instantly swallow
+it, but it will be unmixed with saliva. Yet in every day's observation
+it will be seen, that children are so fed in their most tender age; and
+it is not wonderful that present evils are by this means produced, and
+the foundation laid for future disease."[FN#11]
+
+
+
+[FN#11]  Dr. John Clarke's Commentaries.
+
+
+
+The diet pointed out, then, is to be continued until the second year.
+Great care, however, is necessary in its management; for this period of
+infancy is ushered in by the process of teething, which is commonly
+connected with more or less of disorder of the system. Any error,
+therefore, in diet or regimen is now to be most carefully avoided. 'Tis
+true that the infant, who is of a sound and healthy constitution, in
+whom, therefore, the powers of life are energetic, and who up to this
+time has been nursed upon the breast of its parent, and now commences
+an artificial diet for the first time, disorder is scarcely
+perceptible, unless from the operation of very efficient causes. Not
+so, however, with the child who from the first hour of its birth has
+been nourished upon artificial food. Teething under such circumstances
+is always attended with more or less of disturbance of the frame, and
+disease of the most dangerous character but too frequently ensues. It
+is at this age, too, that all infectious and eruptive fevers are most
+prevalent; worms often begin to form, and diarrhoea, thrush, rickets,
+cutaneous eruptions, etc. manifest themselves, and the foundation of
+strumous disease is originated or developed. A judicious management of
+diet will prevent some of these complaints, and mitigate the violence
+of others when they occur.
+
+
+
+THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT
+COMPLAINTS TO WHICH INFANTS ARE LIABLE.
+
+
+
+Artificial food, from mismanagement and other causes, will now and
+then disagree with the infant. The stomach and bowels are thus
+deranged, and medicine is resorted to, and again and again the same
+thing occurs.
+
+This is wrong, and but too frequently productive of serious and
+lasting mischief. Alteration of diet, rather than the exhibition of
+medicine, should, under these circumstances, be relied on for remedying
+the evil. Calomel, and such like remedies, "the little powders of the
+nursery," ought not to be given on every trivial occasion. More
+mischief has been effected, and more positive disease produced, by the
+indiscriminate use of the above powerful drug, either alone or in
+combination with other drastic purgatives, than would be credited.
+Purgative medicines ought at all times to be exhibited with caution to
+an infant, for so delicate and susceptible is the structure of its
+alimentary canal, that disease is but too frequently caused by that
+which was resorted to in the first instance as a remedy. The bowels
+should always be kept free; but then it must be by the mildest and
+least irritating means.
+
+It is a very desirable thing, then, to correct the disordered
+conditions of the digestive organs of an infant, if possible, without
+medicine; and much may be done by changing the nature, and sometimes
+by simply diminishing the quantity, of food.
+
+A diarrhoea, or looseness of the bowels, may frequently be checked by
+giving, as the diet, sago thoroughly boiled in very weak beef-tea, with
+the addition of a little milk. The same purpose is frequently to be
+answered by two thirds of arrow-root with one third of milk, or simply
+thin arrow-root made with water only; or, if these fail, baked flour,
+mixed with boiled milk.
+
+Costiveness of the bowels may frequently be removed by changing the
+food to tops and bottoms steeped in hot water, and a small quantity of
+milk added, or prepared barley,--mixed in warm water and unboiled milk.
+
+Flatulence and griping generally arise from an undue quantity of food,
+which passing undigested into the bowels, they are thus irritated and
+disturbed. This may be cured by abstinence alone. The same state of
+things may be caused by the food not being prepared fresh at every
+meal, or even from the nursing-bottle or vessel in which the food is
+given not having been perfectly clean. In this case weak chicken-broth,
+or beef-tea freed from fat, and thickened with soft boiled rice or
+arrow-root, may be given.
+
+
+
+Sect. II. WEANING.
+
+
+
+THE TIME WHEN TO TAKE PLACE.--The time when weaning is to take place
+must ever depend upon a variety of circumstances, which will regulate
+this matter, independently of any general rule that might be laid down.
+The mother's health may, in one case, oblige her to resort to weaning
+before the sixth month, and, in another instance, the delicacy of the
+infant's health, to delay it beyond the twelfth. Nevertheless, as a
+general rule, both child and parent being in good health, weaning ought
+never to take place earlier than the ninth (the most usual date), and
+never delayed beyond the twelfth month.
+
+I should say further, that if child and parent are both in vigorous
+health, if the infant has cut several of its teeth, and been already
+accustomed to be partially fed, weaning ought to be gradually
+accomplished at the ninth month. On the other hand, that if the child
+is feeble in constitution, the teeth late in appearing, and the mother
+is healthy, and has a sufficient supply of good milk, especially if it
+be the autumnal season, it will be far better to prolong the nursing
+for a few months. In such a case, the fact of the on-appearance of the
+teeth indicates an unfitness of the system for any other than the
+natural food from the maternal breast.
+
+And again, if the infant is born of a consumptive parent, and a
+healthy and vigorous wet-nurse has been provided, weaning should most
+certainly be deferred beyond the usual time, carefully watching,
+however, that neither nurse nor child suffer from its continuance.
+
+
+THE MODE.--It should be effected gradually. From the sixth month most
+children are fed twice or oftener in the four-and-twenty hours; the
+infant is in fact, therefore, from this time in the progress of
+weaning; that is to say, its natural diet is partly changed for an
+artificial one, so that when the time for complete weaning arrives, it
+will be easily accomplished, without suffering to the mother, or much
+denial to the child.
+
+It is, however, of the greatest importance to regulate the quantity
+and quality of the food at this time. If too much food is given (and
+this is the great danger) the stomach will be overloaded, the digestive
+powers destroyed, and if the child is not carried off suddenly by
+convulsions, its bowels will become obstinately disordered; it will
+fall away from not being nourished, and perhaps eventually become a
+sacrifice to the overanxious desire of the parent and its friends to
+promote its welfare.
+
+The kind of food proper for this period, and the mode of administering
+it, is detailed in the previous section, on "Artificial Feeding."[FN#12]
+
+
+
+[FN#12]  The kind of food after the sixth month to the completion of
+first dentition, p. 44.
+
+
+
+Much exercise in the open air (whenever there is no dampness of
+atmosphere) is highly necessary and beneficial at this time; it tends
+to invigorate the system, and strengthens the digestive organs, and
+thus enables the latter to bear without injury the alteration in diet.
+
+
+THE DRYING UP OF THE MOTHER'S MILK.--This will generally be attended
+with no difficulty. When the weaning is effected gradually, the milk
+will usually go away of itself without any measures being resorted to.
+If, however, the breasts should continue loaded, or indeed painfully
+distended, a gentle aperient should be taken every morning, so that the
+bowels are kept slightly relaxed; the diet must be diminished in
+quantity, and solid nourishment only taken. The breast, if painfully
+distended, must be occasionally drawn, but only just sufficiently to
+relieve the distention. In either case they must be rubbed for five or
+ten minutes, every four or five hours, with the following liniment,
+previously warmed:--
+
+Compound soap liniment, one ounce and a half;
+Laudanum, three drachms.
+
+
+
+Sect. III. DIETETICS OF CHILDHOOD.
+
+
+
+Childhood, as has been before intimated, extends from about the second
+to the seventh or eighth year, when the second dentition is commenced.
+
+No precise rules of diet can be laid down for this period, as this
+requires to be adapted in every case to the particular constitution
+concerned. There are, however, certain general principles which must be
+acted upon, and which can be easily modified by a judicious and
+observant parent, as circumstances and constitution may require.
+
+
+GENERAL DIRECTIONS, AND OF ANIMAL FOOD.--The diet of the latter months
+of infancy is still to be continued, but with the important addition of
+animal food, which the child has now got teeth to masticate. This must
+be given in small quantity; it should be of the lightest quality, only
+allowed on alternate days, and even then its effects must be carefully
+watched, as all changes in the regimen of children should be gradual.
+
+A child at this age, then, should have its meals at intervals of about
+four hours:--thus its breakfast between seven and eight o'clock, to
+consist of tops and bottoms, steeped in hot water, a little milk added,
+and the whole sweetened with sugar; or bread may be softened in hot
+water, the latter drained off, and fresh milk and sugar added to the
+bread. Its dinner about twelve o'clock, to consist, every other day, of
+a small quantity of animal food (chicken, fresh mutton, or beef, being
+the only meats allowed) with a little bread and water; on the alternate
+days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow-
+root pudding, containing one egg; or farinaceous food, with beef-tea.
+Its afternoon mealy about four o'clock, the same diet as formed the
+breakfast. At seven, a little arrow-root, made with a very small
+proportion of milk, or a biscuit, or crust of bread, after which the
+child should be put to bed.
+
+The child must be taught to take its food slowly, retain it in it's
+mouth long, and swallow it tardily. Nothing must be given in the
+intervals of the meals. The stomach requires a period of repose after
+the labour of digestion; and if the child is entertained by its nurse,
+and its mind occupied, there will be no difficulty in following out
+this important direction.
+
+As the child grows older, the quantity at each meal should be
+increased; the tops and bottoms changed for bread and pure milk, boiled
+or not; meat may be taken daily, except circumstances forbid it; and a
+small quantity of vegetable also.
+
+If a child, then, be of a sound constitution, with healthy bowels, a
+cool skin, and clean tongue, the diet may be liberal, and provided it
+is sufficiently advanced in age, animal food may be taken daily. Too
+low a diet would stint the growth of such a child, and induce a state
+of body deficient in vigour, and unfit for maintaining full health:
+scrofula and other diseases would be induced. At the same time let the
+mother guard against pampering, for this would lead to evils no less
+formidable, though of a different character. And as long as the general
+health of this child is unimpaired, the body and mind active, and no
+evidence present to mark excess of nutriment, this diet may be
+continued. But if languor at any time ensue, fever become manifested,
+the skin hotter than natural, the tongue white and furred, and the
+bowels irregular, then, though these symptoms should bebonly in slight
+degree, and unattended with any specific derangement amounting to what
+is considered disease, not only should the parent lower the diet, and
+for a time withdraw the animal part, but the medical adviser should be
+consulted, that measures may be taken to correct the state of repletion
+which has been suffered to arise. For some time after its removal, care
+should also be taken to keep the diet under that, which occasioned the
+constitutional disturbance.
+
+But if the child be of a delicate and weakly constitution (and this is
+unfortunately the more common case), it will not bear so generous a
+diet as the foregoing. During the three or four earliest years, it
+should be restricted chiefly to a mild farinaceous diet, with a small
+allowance only of meat on alternate days. The constant endeavour of the
+parent now should be, to seek to increase the digestive power and
+bodily vigour of her child by frequent exercise in the open air, and by
+attention to those general points of management detailed in the after-
+part of this chapter. This accomplished, a greater proportion of animal
+food may be given, and, in fact, will become necessary for the growth
+of the system, while at the same time there will be a corresponding
+power for its assimilation and digestion.
+
+A great error in the dietetic management of such children is but too
+frequently committed by parents. They suppose that because their child
+is weakly and delicate, that the more animal food it takes the more it
+will be strengthened, and they therefore give animal food too early,
+and in too great quantity. It only adds to its debility. The system, as
+a consequence, becomes excited, nutrition is impeded, and disease
+produced, ultimately manifesting itself in scrofula, disease in the
+abdomen, head, or chest. The first seeds of consumption are but too
+frequently originated in this way. A child so indulged will eat
+heartily enough, but he remains thin notwithstanding. After a time he
+will have frequent fever, will appear heated and flushed towards
+evening, when he will drink greedily, and more than is usual in
+children of the same age; there will be deranged condition of the
+bowels, and headach,--the child will soon become peevish, irritable, and
+impatient; it will entirely lose the good humour so natural to
+childhood, and that there is something wrong will be evident enough,
+the parent, however, little suspecting the real cause and occasion of
+all the evil. In such a child, too, it will be found that the ordinary
+diseases of infancy, scarlet fever, measles, small pox, etc., will be
+attended with an unusual degree of constitutional disturbance; that it
+will not bear such active treatment as other children, or so quickly
+rally from the illness.
+
+"Strength is to be obtained not from the kind of food which contains
+most nourishment in itself, but from that which is best adapted to the
+condition of the digestive organs at the time when it is taken."
+
+
+SUGAR.--This is a necessary condiment for the food of children, and it
+is nutritious, and does not injure the teeth, as is generally imagined.
+"During the sugar season," observes Dr. Dunglison, "the negroes of
+the West India islands drink copiously of the juice of the cane, yet
+their teeth are not injured; on the contrary, they have been praised by
+writers for their beauty and soundness; and the rounded form of the
+body, whilst they can indulge in the juice, sufficiently testifies to
+the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats,
+on the other hand, are most indigestible, and seriously injurious.
+
+
+
+[FN#13]  Elements of Hygiem. Philadephia, 1835.
+
+
+
+SALT.--This is necessary for the health of a child; it acts as a
+stimulant to the digestive organs, and if not allowed in sufficient
+quantity with the food, worms will result.[FN#14] It may, therefore, be
+added in small quantity, and with advantage, even to the farinaceous
+food of infants. Salted meats, however, should never be permitted to
+the child; for by the process of salting the fibre of the meat is so
+changed, that it is less nutritive, as well as less digestible.
+
+
+
+[FN#14]  Lord Sommerville, in his Address to the Board of Agriculture,
+gave an interesting account of the effects of a punishment which
+formerly existed in Holland. "The ancient laws of the country ordained
+men to be kept on bread alone, un-mixed with salt, as the severest
+punishment that could be inflicted upon them in their moist climate.
+The effect was horrible: these wretched criminals are said to have been
+devoured by worms engendered in their own stomachs."
+
+"The wholesomeness and digestibility of our bread are undoubtedly
+much promoted by the addition of the salt which it so universally
+receives. A pound of salt is generally added to each bushel of flour.
+Hence it may be presumed, that every adult consumes two ounces of salt
+per week, or six pounds and a half per annum, in bread alone."
+
+Dr. Paris on Diet.
+
+
+
+FRUITS.--These, and of all kinds whether fresh or dried, a delicate
+child is better without; except the orange, which when perfectly ripe
+may be allowed to any child, but the white or inner skin should be
+scrupulously rejected, as it is most indigestible.
+
+A healthy child may be permitted to partake of most fresh fruits. Of
+the stone-fruits, the ripe peach, the apricot, and nectarine, are the
+most wholesome; but cherries, from the stones being but too frequently
+swallowed, had better not be allowed. Apples and pears, when ripe and
+well masticated, are not unwholesome; and the apple when baked affords
+a pleasant repast, and where there is a costive habit, it is useful as
+a laxative. The small-seeded fruits, however, are by far the most
+wholesome. Of these, the ripe strawberry and raspberry deserve the
+first rank. The grape is also cooling and antiseptic, but the husks and
+seeds should be rejected. The gooseberry is less wholesome on account
+of the indigestibility of the skin, which is too frequently swallowed.
+
+Dried fruits a child should never be permitted to eat.
+
+
+WATER.--This should be the only beverage throughout childhood. Toast-
+and-water, if the child prefer it, which is rendered slightly more
+nutritive than the more simple fluid. The water employed in its
+preparation, however, must be at a boiling temperature, and it ought to
+be drunk as soon as it has sufficiently cooled; for by being kept, it
+acquires a mawkish and unpleasant flavour.
+
+
+WINE, BEER, etc.--The practice of giving wine, or, indeed, any
+stimulant, to a healthy child, is highly reprehensible; it ought never
+to be given but medicinally.
+
+The circulation in infancy and childhood is not only more rapid than
+in the adult, but easily excited to greater vehemence of action; the
+nervous system, too, is so susceptible, that the slightest causes of
+irritation produce strong and powerful impressions: the result in
+either case is diseased action in the frame, productive of fever,
+convulsions, etc.; wine, accordingly, is detrimental to children.
+
+An experiment made by Dr. Hunter upon two of his children illustrates,
+in a striking manner, the pernicious effects of even a small portion of
+intoxicating liquors in persons of this tender age. To one of the
+children he gave, every day after dinner, a full glass of sherry: the
+child was five years of age, and unaccustomed to the use of wine. To
+the other child, of nearly the same age, and equally unused to wine, he
+gave an orange. In the course of a week, a very marked difference was
+perceptible in the pulse, urine, and evacuations from the bowels of the
+two children. The pulse of the first was raised, the urine high
+coloured, and the evacuations destitute of their usual quantity of
+bile. In the other child, no change whatever was produced. He then
+reversed the experiment, giving to the first the orange, and to the
+second the wine, and the results corresponded: the child who had the
+orange continued well, and the system of the other got straightway
+into disorder, as in the first experiment.[FN#15]
+
+
+
+[FN#15]  Marcellin relates an instance of seven children in a family
+whose bowels became infested with worms, from the use of stimulants.
+They were cured by substituting water for the pernicious beverage.
+
+
+
+In this town, spirits, particularly gin, are given to infants and
+children to a frightful extent. I have seen an old Irish woman give
+diluted spirits to the infant just born. A short time since one of
+those dram-drinking children, about eight years of age, was brought
+into one of our hospitals. The attendants, from its emaciated
+appearance, considered the child was dying from mere starvation; which
+was true enough in a certain sense. Food was accordingly offered and
+pressed upon it, but the boy would not even put it to his lips. The
+next day it was discovered that the mother brought the child very
+nearly a pint of gin, every drop of which before night he had consumed.
+
+It is easy to discover when children have been fed upon spirits: they
+are always emaciated; have a lean, yellow, haggard look: the eyes
+sunk, the lips pale, and the teeth discoloured, the cadaverous aspect
+of the countenance being most fearful. They are continually suffering
+from bowel complaints and convulsive disorders; which, under these
+circumstances, terminate invariably in an early death.
+
+
+
+Sect. IV. SLEEP.
+
+
+
+DURING INFANCY.--For three or four weeks after birth the infant sleeps
+more or less, day and night, only waking to satisfy the demands of
+hunger; at the expiration of this time, however, each interval of
+wakefulness grows longer, so that it sleeps less frequently, but for
+longer periods at a time.
+
+This disposition to repose in the early weeks of the infant's life
+must not be interfered with; but this period having expired, great care
+is necessary to induce regularity in its hours of sleep, otherwise too
+much will be taken in the day-time, and restless and disturbed nights
+will follow. The child should be brought into the habit of sleeping in
+the middle of the day, before its dinner, and for about two hours,
+more or less. If put to rest at a later period of the day, it will
+invariably cause a bad night.
+
+At first the infant should sleep with its parent. The low temperature
+of its body, and its small power of generating heat, render this
+necessary. If it should happen, however, that the child has disturbed
+and restless nights, it must immediately be removed to the bed and care
+of another female, to be brought to its mother at an early hour in the
+morning, for the purpose of being nursed. This is necessary for the
+preservation of the mother's health, which through sleepless nights
+would of course be soon deranged, and the infant would also suffer from
+the influence which such deranged health would have upon the milk.
+
+When a month or six weeks has elapsed, the child, if healthy, may
+sleep alone in a cradle or cot, care being taken that it has a
+sufficiency of clothing, that the room in which it is placed is
+sufficiently warm, viz. 60 degrees, and the position of the cot itself
+is not such as to be exposed to currents of cold air. It is essentially
+necessary to attend to these points, since the faculty of producing
+heat, and consequently the power of maintaining the temperature, is
+less during sleep than at any other time, and therefore exposure to
+cold is especially injurious. It is but too frequently the case that
+inflammation of some internal organ will occur under such
+circumstances, without the true source of the disease ever being
+suspected. Here, however, a frequent error must be guarded against,--
+that of covering up the infant in its cot with too much clothing
+throwing over its face the muslin handkerchief--and, last of all,
+drawing the drapery of the bed closely together. The object is to keep
+the infant sufficiently warm with pure air; it therefore ought to have
+free access to its mouth, and the atmosphere of the whole room should
+be kept sufficiently warm to allow the child to breathe it freely: in
+winter, therefore, there must always be a fire in the nursery.
+
+The child up to two years old, at least, should sleep upon a feather
+bed, for the reasons referred to above. The pillow, however, after the
+sixth month, should be made of horsehair; for at this time teething
+commences, and it is highly important that the head should be kept cool.
+
+
+DURING CHILDHOOD.--Up to the third or fourth year the child should be
+permitted to sleep for an hour or so before its dinner. After this time
+it may gradually be discontinued; but it must be recollected, that
+during the whole period of childhood more sleep is required than in
+adult age. The child, therefore, should be put to rest every evening
+between seven and eight; and if it be in health it will sleep soundly
+until the following morning. No definite rule, however, can be laid
+down in reference to the number of hours of sleep to be allowed; for
+one will require more or less than another.[FN#16] Regularity as to
+the time of going to rest is the chief point to attend to; permit
+nothing to interfere with it, and then only let the child sleep without
+disturbance, until it awakes of its own accord on the following
+morning, and it will have had sufficient rest.
+
+
+
+[FN#16]  The amount of sleep necessary to preserve health varies
+according to the state of the body, and the habits of the individual.
+As already observed, infants pass much the greater portion of their
+time in sleep. Children sleep twelve or fourteen hours. The schoolboy
+generally ten. In youth, a third part of the twenty-four hours is spent
+in sleep. Whilst, in advanced age, many do not spend more than four,
+five, or six hours in sleep.
+
+
+
+It is a cruel thing for a mother to sacrifice her child's health that
+she may indulge her own vanity, and yet how often is this done in
+reference to sleep. An evening party is to assemble, and the little
+child is kept up for hours beyond its stated time for retiring to rest,
+that it may be exhibited, fondled, and admired. Its usual portion of
+sleep is thus abridged, and, from the previous excitement, what little
+he does obtain, is broken and unrefreshing, and he rises on the morrow
+wearied and exhausted.
+
+Once awake, it should not be permitted to lie longer in bed, but
+should be encouraged to arise immediately. This is the way to bring
+about the habit of early rising, which prevents many serious evils to
+which parents are not sufficiently alive, promotes both mental and
+corporeal health, and of all habits is said to be the most conducive to
+longevity.
+
+A child should never be suddenly aroused from sleep; it excites the
+brain, quickens the action of the heart, and, if often repeated,
+serious consequences would result. The change of sleeping to waking
+should always be gradual.
+
+The bed on which the child now sleeps should be a mattress: at this
+age a feather bed is always injurious to children; for the body,
+sinking deep into the bed, is completely buried in feathers, and the
+unnatural degree of warmth thus produced relaxes and weakens the
+system, particularly the skin, and renders the child unusually
+susceptible to the impressions of cold. Then, instead of the bed being
+made up in the morning as soon as vacated, and while still saturated
+with the nocturnal exhalations from the body, the bed-clothes should be
+thrown over the backs of chairs, the mattress shaken well up, and the
+window thrown open for several hours, so that the apartment shall be
+thoroughly ventilated. It is also indispensably requisite not to allow
+the child to sleep with persons in bad health, or who are far advanced
+in life; if possible, it should sleep alone.
+
+
+
+Sect. V. BATHING AND CLEANLINESS.
+
+
+
+
+DURING INFANCY.--Too much attention cannot be paid to cleanliness; it
+is essential to the infant's health. The principal points to which
+especial attention must be paid by the parent for this purpose are the
+following:--
+
+
+TEMPERATURE OF THE WATER.--At first the infant should be washed daily
+with warm water; and a bath every night, for the purpose of thoroughly
+cleaning the body, is highly necessary. To bathe a delicate infant of a
+few days or even weeks old in cold water with a view "to harden" the
+constitution (as it is called), is the most effectual way to undermine
+its health and entail future disease. By degrees, however, the water
+with which it is sponged in the morning should be made tepid, the
+evening bath being continued warm enough to be grateful to the feelings.
+
+A few months having passed by, the temperature of the water may be
+gradually lowered until cold is employed, with which it may be either
+sponged or even plunged into it, every morning during summer. If
+plunged into cold water, however, it must be kept in but a minute; for
+at this period, especially, the impression of cold continued for any
+considerable time depresses the vital energies, and prevents that
+healthy glow on the surface which usually follows the momentary and
+brief action of cold, and upon which its usefulness depends. With some
+children, indeed, there is such extreme delicacy and deficient reaction
+as to render the cold bath hazardous; no warm glow over the surface
+takes place when its use inevitably does harm: its effects, therefore,
+must be carefully watched.
+
+
+DRYING THE SKIN.--The surface of the skin should always be carefully
+and thoroughly rubbed dry with flannel,--indeed, more than dry, for the
+skin should be warmed and stimulated by the assiduous gentle friction
+made use of. For this process of washing and drying must not be done
+languidly, but briskly and expeditiously; and will then be found to be
+one of the most effectual means of strengthening the infant. It is
+especially necessary carefully to dry the arm-pits, groins, and nates;
+and if the child is very fat, it will be well to dust over these parts
+with hair-powder or starch: this prevents excoriations and sores, which
+are frequently very troublesome. Soap is only required to those parts
+of the body which are exposed to the reception of dirt.
+
+
+NAPKINS.--The frequency of the discharges from the bowels and bladder
+requires a frequent change of napkins. A nurse cannot be too careful of
+this duty from the first, so that she may be enabled to discover the
+periods when those discharges are about to take place, that she may not
+only anticipate them, but teach the child, at a very early age, to give
+intelligent warning of its necessities. Thus a habit of regularity with
+regard to those functions will be established, which will continue
+through life, and tend greatly to the promotion of health. As the child
+grows older, the system of cleanliness must in no particular be
+relaxed, and it will be found the best preservative against those
+eruptive disorders which are so frequent and troublesome during the
+period of infancy.
+
+
+DURING CHILDHOOD.--When this period arrives, or shortly after, bathing
+is but too frequently left off; the hands and face of the child are
+kept clean, and with this the nurse is satisfied; the daily ablution of
+the whole body, however, is still necessary, not only for the
+preservation of cleanliness, but because it promotes in a high degree
+the health of the child.
+
+
+PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.--A child of a
+vigorous constitution and robust health, as he rises from his bed
+refreshed and active by his night's repose, should be put into the
+shower-bath, or, if this excites and alarms him too much, must be
+sponged from head to foot with salt water. If the weather be very cold,
+the water may be made slightly tepid, but if his constitution will bear
+it, the water should be cold throughout the year. Then the body should
+be speedily dried, and hastily but well rubbed with a somewhat coarse
+towel, and the clothes put on without any unnecessary delay. This
+should be done every morning of the child's life.
+
+If such a child is at the sea-side, advantage should be taken of this
+circumstance, and seabathing should be substituted. The best time is
+two or three hours after breakfast; but he must not be fatigued
+beforehand, for if so, the cold bath cannot be used without danger.
+Care must be taken that he does not remain in too long, as the animal
+heat will be lowered below the proper degree, which would be most
+injurious. In boys of a feeble constitution, great mischief is often
+produced in this way. It is a matter also of great consequence in
+bathing children that they should not be terrified by the immersion,
+and every precaution should be taken to prevent this. The healthy and
+robust boy, too, should early be taught to swim, whenever this is
+practicable, for it is attended with the most beneficial effects; it is
+a most invigorating exercise, and the cold bath thus becomes doubly
+serviceable.
+
+
+PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.--If a child is of a
+delicate and strumous constitution, the cold bath during the summer
+is one of the best tonics that can be employed; and if living on the
+coast, sea-bathing will be found of singular benefit. The effects,
+however, of sea-bathing upon such a constitution must be particularly
+watched, for unless it is succeeded by a glow,--a feeling of increased
+strength,--and a keen appetite, it will do no good, and ought at once
+to be abandoned for the warm or tepid bath. The opinion that warm baths
+generally relax and weaken, is erroneous; for in this case, as in all
+cases when properly employed, they would give tone and vigour to the
+whole system; in fact, the tepid bath is to this child what the cold
+bath is to the more robust.
+
+In conclusion: if the bath in any shape cannot from circumstances be
+obtained, then cold saltwater sponging must be used daily, and all the
+year round, so long as the proper reaction or glow follows its use; but
+when this is not the case, and this will generally occur, if the child
+is delicate and the weather cold, tepid vinegar and water, or tepid
+salt water, must be substituted.
+
+
+
+Sect. VI. CLOTHING.
+
+
+
+IN INFANCY.--Infants are very susceptible of the impressions of cold; a
+proper regard, therefore, to a suitable clothing of the body, is
+imperative to their enjoyment of health. Unfortunately, an opinion is
+prevalent in society, that the tender child has naturally a great power
+of generating heat and resisting cold; and from this popular error has
+arisen the most fatal results. This opinion has been much strengthened
+by the insidious manner in which cold operates on the frame, the
+injurious effects not being always manifest during or immediately after
+its application, so that but too frequently the fatal result is traced
+to a wrong source, or the infant sinks under the action of an unknown
+cause.
+
+The power of generating heat in warm-blooded animals is at its minimum
+at birth, and increases successively to adult age; young animals,
+instead of being warmer than adults, are generally a degree or two
+colder, and part with their heat more readily; facts which cannot be
+too generally known. They show how absurd must be the folly of that
+system of "hardening" the constitution (to which reference has been
+before made), which induces the parent to plunge the tender and
+delicate child into the cold bath at all seasons of the year, and
+freely expose it to the cold, cutting currents of an easterly wind,
+with the lightest clothing.
+
+The principles which ought to guide a parent in clothing her infant
+are as follows:--
+
+The material and quantity of the clothes should be such as to preserve
+a sufficient proportion of warmth to the body, regulated therefore by
+the season of the year, and the delicacy or strength of the infant's
+constitution. In effecting this, however, the parent must guard against
+the too common practice of enveloping the child in innumerable folds of
+warm clothing, and keeping it constantly confined to very hot and close
+rooms; thus running into the opposite extreme to that to which I have
+just alluded: for nothing tends so much to enfeeble the constitution,
+to induce disease, and render the skin highly susceptible to the
+impression of cold; and thus to produce those very ailments which it
+is the chief intention to guard against.
+
+In their make they should be so arranged as to put no restrictions to
+the free movements of all parts of the child's body; and so loose and
+easy as to permit the insensible perspiration to have a free exit,
+instead of being confined to and absorbed by the clothes, and held in
+contact with the skin, till it gives rise to irritation.
+
+In their quality they should be such as not to irritate the delicate
+skin of the child. In infancy, therefore, flannel is rather too rough,
+but is desirable as the child grows older, as it gives a gentle
+stimulus to the skin, and maintains health.
+
+In its construction the dress should be so simple as to admit of being
+quickly put on, since dressing is irksome to the infant, causing it to
+cry, and exciting as much mental irritation as it is capable of
+feeling. Pins should be wholly dispensed with, their use being
+hazardous through the carelessness of nurses, and even through the
+ordinary movements of the infant itself.
+
+The clothing must be changed daily.--It is eminently conducive to good
+health that a complete change of dress should be made every day. If
+this is not done, washing will, in a great measure, fail in its object,
+especially in insuring freedom from skin diseases.
+
+
+IN CHILDHOOD.--The clothing of the child should possess the same
+properties as that of infancy. It should afford due warmth, be of such
+materials as do not irritate the skin, and so made as to occasion no
+unnatural constriction.
+
+In reference to due warmth, it may be well again to repeat, that too
+little clothing (that state of semi-nudity which the vanity of some
+parents encourage) is frequently productive of the most sudden attacks
+of active disease; and that children who are thus exposed with naked
+breasts and thin clothing in a climate so variable as ours are the
+frequent subjects of croup, and other dangerous affections of the air-
+passages and lungs. On the other hand, it must not be forgotten, that
+too warm clothing is a source of disease,--sometimes even of the same
+diseases which originate in exposure to cold,--and often renders the
+frame more susceptible of the impressions of cold, especially of cold
+air taken into the lungs. Regulate the clothing, then, according to the
+season; resume the winter dress early; lay it aside late; for it is in
+spring and autumn that the vicissitudes in our climate are greatest,
+and congestive and inflammatory complaints most common.
+
+With regard to material (as was before observed), the skin will at
+this age bear flannel next to it; and it is now not only proper, but
+necessary. It may be put off with advantage during the night, and
+cotton maybe substituted during the summer, the flannel being resumed
+early in the autumn. If from very great delicacy of constitution it
+proves too irritating to the skin, fine fleecy hosiery will in general
+be easily endured, and will greatly conduce to the preservation of
+health.
+
+It is highly important that the clothes of the boy should be so made
+that no restraints shall be put on the movements of the body or limbs,
+nor injurious pressure made on his waist or chest. All his muscles
+ought to have full liberty to act, as their free exercise promotes both
+their growth and activity, and thus insures the regularity and
+efficiency of the several functions to which these muscles are
+subservient.
+
+The same remarks apply with equal force to the dress of the girl; and
+happily, during childhood, at least, no distinction is made in this
+matter between the sexes. Not so, however, when the girl is about to
+emerge from this period of life; a system of dress is then adopted
+which has the most pernicious effects upon her health, and the
+development of the body, the employment of tight stays, which impede
+the free and full action of the respiratory organs, being only one of
+the many restrictions and injurious practices from which in latter
+years they are thus doomed to suffer so severely.
+
+
+
+Sect. VII. AIR AND EXERCISE.
+
+
+
+IN INFANCY.--The respiration of a pure air is at all times, and under
+all circumstances, indispensable to the health of the infant. The
+nursery therefore should be large, well ventilated, in an elevated part
+of the house, and so situated as to admit a free supply both of air
+and light. For the same reasons, the room in which the infant sleeps
+should be large, and the air frequently renewed; for nothing is so
+prejudicial to its health as sleeping in an impure and heated
+atmosphere. The practice, therefore, of drawing thick curtains closely
+round the bed is highly pernicious; they only answer a useful purpose
+when they defend the infant from any draught of cold air.
+
+The proper time for taking the infant into the open air must, of
+course, be determined by the season of the year, and the state of the
+weather. "A delicate infant born late in the autumn will not generally
+derive advantage from being carried into the open air, in this climate,
+till the succeeding spring; and if the rooms in which he is kept are
+large, often changed, and well ventilated, he will not suffer from the
+confinement, while he will, most probably, escape catarrhal affections,
+which are so often the consequence of the injudicious exposure of
+infants to a cold and humid atmosphere."[FN#17] If, however, the child
+is strong and healthy, no opportunity should be lost of taking it into
+the open air at stated periods, experience daily proving that it has
+the most invigorating and vivifying influence upon the system. Regard,
+however, must always be had to the state of the weather; and to a damp
+condition of the atmosphere the infant should never be exposed, as it
+is one of the most powerful exciting causes of consumptive disease. The
+nurse-maid, too, should not be allowed to loiter and linger about, thus
+exposing the infant unnecessarily, and for an undue length of time;
+this is generally the source of all the evils which accrue from taking
+the babe into the open air.
+
+
+
+[FN#17]  Sir James Clark on Consumption.
+
+
+
+Exercise, also, like air, is essentially important to the health of
+the infant. Its first exercise, of course, will be in the nurse's arms.
+After a month or two, when it begins to sleep less during the day, it
+will delight to roll and kick about on the sofa: it will thus use its
+limbs freely; and this, with carrying out into the open air, is all
+the exercise it requires at this period. By and by, however, the child
+will make its first attempts to walk. Now it is important that none of
+the many plans which have been devised to teach a child to walk, should
+be adopted--the go-cart, leading-strings, etc.; their tendency is
+mischievous; and flatness of the chest, confined lungs, distorted
+spine, and deformed legs, are so many evils which often originate in
+such practices. This is explained by the fact of the bones in infancy
+being comparatively soft and pliable, and if prematurely subjected by
+these contrivances to carry the weight of the body, they yield just
+like an elastic stick bending under a weight, and as a natural
+consequence become curved and distorted.
+
+It is highly necessary that the young and experienced mother should
+recollect this fact, for the early efforts of the little one to walk
+are naturally viewed by her with so much delight, that she will be apt
+to encourage and prolong its attempts, without any thought of the
+mischief which they may occasion; thus many a parent has had to mourn
+over the deformity which she has herself created.
+
+It may be as well here to remark, that if such distortion is timely
+noticed, it is capable of correction, even after evident curvature has
+taken place. It is to be remedied by using those means that shall
+invigorate the frame, and promote the child's general health (a daily
+plunge into the cold bath, or sponging with cold salt water, will be
+found signally efficacious), and by avoiding the original cause of the
+distortion--never allowing the child to get upon his feet. The only way
+to accomplish the latter intention, is to put both the legs into a
+large stocking; this will effectually answer this purpose, while, at
+the same time, it does not prevent the free and full exercise of the
+muscles of the legs. After some months pursuing this plan, the limbs
+will be found no longer deformed, the bones to have acquired firmness
+and the muscles strength; and the child may be permitted to get upon
+his feet again without any hazard of perpetuating or renewing the evil.
+
+The best mode of teaching a child to walk, is to let it teach itself,
+and this it will do readily enough. It will first crawl about: this
+exercises every muscle in the body, does not fatigue the child, throws
+no weight upon the bones, but imparts vigour and strength, and is thus
+highly useful. After a while, having the power, it will wish to do
+more: it will endeavour to lift itself upon its feet by the aid of a
+chair, and though it fail again and again in its attempts, it will
+still persevere until it accomplish it. By this it learns, first, to
+raise itself from the floor; and secondly, to stand, but not without
+keeping hold of the object on which it has seized. Next it will balance
+itself without holding, and will proudly and laughingly show that it
+can stand alone. Fearful, however, as yet of moving its limbs without
+support, it will seize a chair or anything else near it, when it will
+dare to advance as far as the limits of its support will permit. This
+little adventure will be repeated day after day with increased
+exultation; when, after numerous trials, he will feel confident of his
+power to balance himself, and he will run alone. Now time is required
+for this gradual self-teaching, during which the muscles and bones
+become strengthened; and when at last called upon to sustain the weight
+of the body, are fully capable of doing so.
+
+
+IN CHILDHOOD.--When the child has acquired sufficient strength to take
+active exercise, he can scarcely be too much in the open air; the more
+he is habituated to this, the more capable will he be of bearing the
+vicissitudes of the climate. Children, too, should always be allowed to
+amuse themselves at pleasure, for they will generally take that kind
+and degree of exercise which is best calculated to promote the growth
+and development of the body. In the unrestrained indulgence of their
+youthful sports, every muscle of the body comes in for its share of
+active exercise; and free growth, vigour, and health are the result.
+
+If, however, a child is delicate and strumous, and too feeble to take
+sufficient exercise on foot,--and to such a constitution the respiration
+of a pure air and exercise are indispensable for the improvement of
+health, and without them all other efforts will fail,--riding on a
+donkey or pony forms the best substitute. This kind of exercise will
+always be found of infinite service to delicate children; it amuses the
+mind, and exercises the muscles of the whole body, and yet in so
+gentle a manner as to induce little fatigue.
+
+The exercises of horseback, however, are most particularly useful
+where there is a tendency in the constitution to pulmonary consumption,
+either from hereditary or accidental causes. It is here beneficial, as
+well through its influence on the general health, as more directly on
+the lungs themselves. There can be no doubt that the lungs, like the
+muscles of the body, acquire power and health of function by exercise.
+Now during a ride this is obtained, and without much fatigue to the
+body. The free and equable expansion of the lungs by full inspiration,
+necessarily takes place; this maintains their healthy structure, by
+keeping all the air-passages open and pervious; it prevents congestion
+in the pulmonary circulation, and at the same time provides more
+completely for the necessary chemical action on the blood, by changing,
+at each act of respiration, a sufficient proportion of the whole air
+contained in the lungs,--all objects of great importance, and all
+capable of being promoted, more or less, by the means in question.
+
+And be it remembered that these remarks apply with equal force to the
+girl as to the boy. She should be allowed, and even encouraged, to take
+the same active exercise. Fortunately, this course is followed during
+childhood; not so, unfortunately (in the majority of cases, at least),
+after this period. Young females are then subjected to those unnatural
+restraints, both in exercise and dress, which fashion and vanity
+impose, to be followed by effects which, though not immediately
+obvious, are capable of laying the foundation of evils that cannot
+afterwards be remedied.
+
+A good carriage is the point aimed at (and to which I particularly
+refer), and the means adopted for its cultivation fail, after all, in
+their end, just in proportion to their rigid employment. For this
+purpose the head is kept erect, and the shoulders drawn back, and they
+are to be kept in this position not for an hour or so, but continually.
+To preserve, however, this unnatural and constrained position, requires
+considerable muscular powers, such as no girl can exercise without
+long, painful, and injurious training; nor even by this, unless other
+measures be resorted to in aid of her direct endeavours. For instead of
+the muscles obtaining increased power and strength by these efforts (to
+enforce a good carriage), they are enfeebled, and soon become more and
+more incapable of performing what is required of them. This fact soon
+becomes perceptible; weakness is noticed; but instead of correcting
+this by the only rational mode, that of invigorating the weakened
+muscles, mechanical aid is called in to support them, and laced
+waistcoats are resorted to. These undoubtedly give support--nay, they
+may be so used as almost wholly to supersede the muscular efforts, with
+the advantage of not tiring, however long or continuously employed.
+Improvement of carriage is manifested, the child is sensible of relief
+from a painful exertion, the mother is pleased with the success of her
+management, and this success appears to superficial observation fully
+to confirm the judgment which superintends it. Yet what are the
+consequences to which her measures tend, and which such measures are
+daily and hourly producing? The muscles of the back and chest,
+restrained in their natural and healthful exercise by the waistcoat
+called in to aid them, and more signally, in after-life, by the tightly-
+laced stays or corsets, become attenuated, and still further enfeebled,
+until at length they are wholly dependent on the mechanical aid, being
+quite incapable of dispensing with it for any continuance.
+
+By and by a taper waist becomes an object of ambition, and the stays
+are laced more closely than ever. This is still done gradually, and, at
+first, imperceptibly to the parties. The effect, however, though slow,
+is sure; and the powers of endurance thus exercised come in time to
+bear, almost unconsciously, what, if suddenly or quickly attempted, no
+heroism could possibly sustain. This increased pressure impedes the
+motion of the ribs. For perfect respiration these motions should be
+free and unrestrained, and perfect respiration is necessary to those
+changes in the blood which fit it for nutrition, and the other purposes
+of the animal frame. In proportion as respiration is impeded, is the
+blood imperfectly vitalised, and in the same ratio are the nutrient and
+other functions dependent on the blood inadequately performed. Here,
+then, is one source of debility, which affects the whole frame,
+reducing every part below the standard of healthful vigour. Quickened
+respiration soon ensues, the heart becomes excited, the pulse
+accelerated, and palpitation is in time superadded.
+
+There are still further evils produced by tight lacing. For the
+pressure being chiefly made on the lower part of the chest, the stomach
+and liver are necessarily compressed, to the great disturbance of their
+functions; and being pressed downwards too, these trespass on that
+space which the other abdominal viscera require, superinducing still
+further derangements. Thus almost every function of the body becomes
+more or less impeded.
+
+And again, the girl not being able always to have her body cased in
+the tight-laced stays, some relaxation must take place. Under it the
+muscles of the back, deprived of their accustomed support, and
+incapable of themselves to sustain the incumbent weight, yield, and the
+column of the spine bends, at first anteriorly, causing round shoulders
+and an arched back; but eventually inclines to one or other side,
+giving rise to the well-known and too frequently occurring state of
+lateral curvature. This last change most frequently commences in the
+sitting posture, such females being, through general debility, much
+disposed to sedentary habits. Such, though but very slightly sketched,
+are a few of the evils attending this baneful practice.
+
+But how, then, is a good carriage to be obtained; which is not only
+pleasing to the eye, but is, when natural, absolutely conducive itself
+to health? To insure a good carriage, the only rational way is to give
+the necessary power, especially to the muscles chiefly concerned; and
+this is to be done, not by wearying those muscles by continual and
+unrelieved exertion, but by invigorating the frame generally, and more
+especially by strengthening the particular muscles through varied
+exercise alternated with due repose. Attention to general health,
+suitable diet, regular bowels, moderate but regular exercise, not of
+particular muscles only, but of the whole frame, cold-bathing or
+sponging, and other such measures, will maintain a good carriage, by
+giving that power which the more direct means so generally practised
+serve but to exhaust.[FN#18]
+
+
+
+[FN#18]  The above remarks on "good carriage" are almost wholly taken
+from a valuable article of Dr. Barlow's, in the "Cyclopaedia of
+Practical Medicine."
+
+
+
+Chap. II.
+
+
+
+ON THE USE AND ABUSE OF CERTAIN REMEDIES.
+
+
+Sect. I.--APERIENT MEDICINE.
+
+
+
+One of the greatest errors of the nursery is the too frequent and
+indiscriminate exhibition by the mother or nurse of purgative medicine
+to the infant. Various are the forms in which it is given; perhaps the
+little powders obtained from the chemist is the most frequent, as it is
+certainly the most injurious, form, their chief ingredient being
+calomel.
+
+The choice of the aperient, or the dose, or the exact condition of the
+health of the infant, or whether it is an aperient at all that is
+required, are points entirely overlooked: a little medicine is thought
+necessary, because the child appears unwell, and a purgative, or a
+little white powder, is forthwith given. The great art of
+medicine is the proper application of the proper medicine, in the
+proper dose, at the proper time; points never considered in the
+nursery. For example, I have known a large dose of magnesia given by a
+nurse to an infant, that had been suffering from a diarrhoea of some
+days' standing, and very quickly cause death. Now, magnesia is one of
+the most useful and harmless medicines that can be given to an infant
+when indicated; when prescribed in a dose suited to its age, and when
+the proper time is fixed upon for its exhibition; in the foregoing
+case, however, every thing forbad its use, but none of these points
+were considered.
+
+Aperient medicine, too, is sometimes unwittingly repeated to remove
+those symptoms which it has itself produced. Some incidental pain and
+uneasiness, some slightly greenish appearance of the motions, leads the
+mother to believe that more purging is necessary, when, in fact, both
+circumstances have probably been induced by the irritation caused by
+the purgatives already too freely administered. How frequently is this
+the case, during the first week or ten days of the infant's life, when
+the nurse doses the child with tea-spoonful after tea-spoonful of
+castor oil, for the relief of pain, which her repeated doses of
+medicine have alone created.
+
+The bowels of an infant in health should be relieved two, three, or
+four times in the twenty-four hours. The stools should be of the
+consistence of thin mustard, and of a lightish yellow colour, having
+little smell, free from lumps or white curdy matter, and passed without
+pain, or any considerable quantity of wind. And a parent is only
+justified in giving aperient medicine, when any deviation from these
+conditions exists; and only then, when what may be called healthy
+costiveness is present, viz. either the stools less frequent than they
+ought to be, or lumpy and partially solid. Then, the only purgative
+medicines that can be given with safely to an infant, without medical
+sanction, are, castor oil, manna, rhubarb, and magnesia; the
+application of the lavement, and the aperient liniment.
+
+
+
+CASTOR OIL
+
+
+This is one of the mildest aperients, prompt in its action, and
+effective in clearing out the contents of the bowels; it is a
+medicine, therefore, particularly applicable to infants.
+
+During teething there is generally much torpor of the bowels; here,
+then, castor oil is a very appropriate and useful artificial means of
+increasing the frequency of the alvine discharges.
+
+Then, again, no purgative can be so much relied on for overcoming
+habitual costiveness as castor oil; it may for this purpose be given
+daily for some weeks, gradually reducing the dose until only a few
+drops be taken; after which the bowels generally continue to act
+without further artificial assistance. Even its occasional
+administration leaves the bowels in a relaxed state; a great advantage
+over other purgatives, which generally cause, after their action is
+passed off, a confined state.
+
+The proper dose will depend upon the age, and the known effect of
+aperient medicine upon the childsome requiring more, others less:
+
+Under one year, one small tea-spoonful.
+
+Under three years, two ditto.
+
+Under six years, three ditto.
+
+Under ten years and upwards, a table spoonful. The quantity being more
+or less according to the facility with which the bowels are purged.
+
+It may be given in various ways; poured upon a little mint water, or
+blended with a little moist sugar;--or, if the stomach is unusually
+delicate, the oil may be made into an emulsion with some aromatic
+water, by the intervention of the yolk of an egg and a little syrup of
+roses or sugar combined with it. The following proportions make an
+elegant and not at all a disagreeable mixture, of which a desert-
+spoonful (or more, according to the age,) may be repeated every hour
+until it operate:
+
+Castor oil, six drachms;
+The yolk of an egg;
+Mix well together, and add
+Dill water, two ounces,
+Syrup of roses, two drachms.
+
+
+
+MANNA.
+
+
+This also may be given with impunity to the youngest infant; it is
+sweet to the taste, and mild in its operation. It should be exhibited
+in doses of one to two drachms in a little warm milk; or if it cause
+flatulence in this form, in some aromatic water, a desert spoonful of
+carraway-seed or dill water. For children above two years, it must
+always be given with some other aperient: thus, it may be combined with
+castor oil by the medium of mucilage or the yolk of an egg; in fact, it
+might be substituted for the syrup of roses in the previous
+prescription for castor oil.
+
+
+
+MAGNESIA AND RHUBARB.
+
+
+Magnesia, besides being a laxative, allays irritability of the
+stomach; it is consequently useful during dentition, at which period
+there is both much irritability and a prevailing acescency of the
+stomach. The dose is from five grains to ten for an infant, increasing
+the quantity to fifteen grains or twenty to children of nine or ten
+years of age. When taken alone the best vehicle is hot milk, which
+greatly quickens its aperient operation. And whenever the bowels are
+distended with wind, the pure magnesia is preferable to the carbonate.
+
+It is well to mention here, that when the infant throws up the nurse's
+milk it is generally curdled; a fact which leads the inexperienced
+mother to infer that the child is suffering from acidity; and to
+counteract the supposed evil magnesia is given again and again. This is
+a useless and pernicious practice, for curdling or coagulation of the
+milk always takes place in the stomach, and is produced by the gastric
+juice, and is so far from being a morbid process, that milk cannot be
+properly digested without it.
+
+Rhubarb, it should always be recollected, has an astringent as well as
+purgative property, according to the extent of the dose in which it is
+administered; the former of which never opposes or interferes with the
+energy of the latter, since it only takes effect when the substance is
+administered in small doses, or, if given in larger ones, not until it
+has ceased to operate as a cathartic. This latter circumstance renders
+it particularly eligible in cases of diarrhoea, as it evacuates the
+offending matter before it operates as an astringent upon the bowels.
+
+As a purgative it operates mildly, and may be given to the youngest
+infant; if from two to twelve months old, from three to six grains; for
+children above that age, the dose may range from ten grains to twenty.
+Its operation, however, is much quickened by the addition of magnesia;
+both of which are more effective when thus united than when given
+separately. The following form, in a costive and flatulent state of the
+bowels, will be found useful[FN#19]; a tea-spoonful or more may be given
+every three or four hours until the desired effect is obtained:--
+
+
+Powdered rhubarb, half a drachm;
+
+Magnesia, two scruples;
+
+Compound spirits of ammonia, twenty drops;
+
+Dill water, two ounces;
+
+Simple syrup, two drachms.
+
+
+
+[FN#19]  This may be made up and kept in the nursery for a long time
+without spoiling.
+
+
+
+Rhubarb, mixed with flour and warm water, may be made into a poultice,
+and applied to the abdomen of a child that obstinately refuses to
+swallow medicine, and it will be found to produce the same effect as if
+the medicine had been taken into the stomach; it will purge briskly.
+
+
+
+THE LAVEMENT.
+
+
+This is an excellent nursery remedy when the bowels are obstinately
+costive. It may then be employed as a substitute for medicine, a
+protracted and frequent use of which (even of the mildest aperients) is
+apt to injure the digestive functions, and to give rise to some degree
+of intestinal irritation. Lavements, however, like aperient medicine,
+must not be resorted to for a long time together; for whilst the latter
+irritate, the former most certainly tend, after a long continued use,
+to debilitate the bowels, and thus render them less than ever disposed
+to act for themselves. They are an excellent occasional remedy.
+
+The simplest form of an aperient enema, is warm water; but barley-
+water, or thin gruel, or even milk and water, are to be preferred at
+all times, as they are of a more bland and less irritating nature. If
+it be desirable to increase the strength of the injection, castor oil
+may be added. The proportions of fluid which are necessary for the
+different stages of life, under ordinary circumstances, maybe stated
+as follows:--An infant at its birth requires about one fluid ounce; a
+child between the age of one and five years, from three to four fluid
+ounces; and a youth of ten or fifteen, from six to eight fluid ounces.
+
+The mode of administering an injection to an infant deserves
+particular attention, as injury might be caused by its being performed
+in a careless or unskilful manner. A gum elastic pipe should be always
+used instead of the hard ivory tube. Having smeared this over with
+lard, and placed the infant on its left side, with its knees bent up in
+the lap of the nurse, it is to be passed a couple of inches into the
+bowel, in a direction not parallel to the axis of the body, but rather
+inclined to the left. The latter circumstance should never be
+neglected, for if not attended to, there will be difficulty in
+administering the injection. The fluid must then be propelled very
+gradually, or it will be instantly rejected; on the whole being thrown
+up (the pipe carefully and slowly withdrawn), the child must be kept
+quietly reposing on its nurse's lap, and in the same posture for some
+little time.
+
+
+
+THE APERIENT LINIMENT.
+
+
+A liniment to be rubbed on the stomach is another resource in cases of
+habitual costiveness, and will frequently be attended with great
+success when repeated purgatives have been resisted.
+
+Olive or castor oil may be used for this purpose; they must be warmed
+and rubbed over the abdomen night and morning, for five or ten minutes.
+Perhaps the best form of liniment that can be made use of is the
+following:--
+
+Compound soap liniment, one ounce;
+Compound tincture of aloes, half an ounce.
+
+
+
+Sect. II.--CALOMEL.
+
+
+
+Calomel is one of the most useful medicines we possess; but though
+powerful for good, it is by no means powerless for mischief, and pages
+might be written upon the evil effects which have resulted from its
+indiscriminate use in the nursery; medical men are daily and hourly
+witnessing this fact. It is particularly eligible in the diseases of
+children; but then it is quite impossible for unprofessional persons to
+judge when it may be appropriately exhibited. And it cannot be too
+generally known, that the effect of this medicine upon the evacuations
+is always to make them appear unnatural. From ignorance of this fact,
+calomel is often repeated again and again to relieve that very
+condition which it has itself produced, causing, but too frequently, a
+degree of irritation in the delicate lining membrane of the bowel,
+which it may be very difficult for a medical man to remove, and perhaps
+a source of misery to the child as long as it lives.
+
+Its frequent exhibition has also another evil attending it, for "the
+immoderate use of mercury in early infancy produces more, perhaps, than
+any other similar cause, that universal tendency to decay, which, in
+many instances, destroys almost every tooth at an early age."[FN#20]
+
+
+
+[FN#20]  Bell on the Teeth.
+
+
+
+In the diseases of childhood it is often administered by the mother or
+nurse with a degree of careless excess which ultimately, if not
+immediately, produces severe and irremediable injury. I have met with
+such cases; but Mr. Bell details a remarkable instance in point: "A
+child, about three years of age, was brought to me, having a most
+extensive ulceration in the gum of the lower jaw, by which the alveolar
+process (that portion of the jaw which forms the sockets of the teeth)
+was partially denuded. The account given by the mother was, that the
+child had some time previously been the subject of measles, for which a
+chemist, whom she consulted, gave her white powders, one of which was
+ordered to be taken every four hours. It appears by the result, that
+this must have been calomel; for, after taking it for two or three
+days, profuse salivation was produced, with swollen tongue, inflamed
+gums, etc., followed by ulceration of the gum, lips, and cheek. On
+examining the denuded alveolar process, I found that a considerable
+necrosis (death of the bone) had taken place, including the whole
+anterior arch of the jaw from the first double tooth on the left side
+to the eye-tooth on the right. By degrees the dead portion of bone was
+raised, and became loose, when I found that the mischief was not
+confined to the alveolar process, but comprised the whole substance of
+the bone within the space just mentioned," etc. Surely the knowledge of
+such a case as this would induce every prudent mother to exclude
+calomel from her list of domestic nursery medicines.
+
+
+
+Sect. III.--OPIATES.
+
+
+
+This class of medicine is often kept in the nursery, in the forms of
+laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's
+cordial.
+
+The object with which they are generally given is to allay pain by
+producing sleep; they are, therefore, remedies of great convenience to
+the nurse; and I am sorry to be obliged to add, that, so exhibited,
+they are but too often fatal to the little patient.
+
+The fact is, that in the hands of the physician, there is no medicine
+the administration of which requires greater caution and judgment than
+opiates, both from the susceptibility of infants to their narcotic
+influence, and their varying capability of bearing it; the danger,
+therefore, with which their use is fraught in the hands of a nurse
+should for ever exclude them from the list of domestic nursery
+medicines.
+
+Dalby's carminative and Godfrey's cordial are, perhaps, more
+frequently used than any other forms; and some striking cases,
+illustrative of the fatal results of exhibiting them indiscriminately,
+and without medical sanction, are on record.[FN#21] The late Dr.
+Clark, in his "Commentaries," mentions a case which he saw, where
+"forty drops of Dolly's carminative destroyed an infant." Dr. Merriman
+gives the following in a note in Underwood, "On the Diseases of
+Children:"--
+
+
+
+[FN#21]  Two or three fatal cases, and upon which coroners' inquests
+were held, have occurred within the last two years.
+
+
+
+"A woman, living near Fitzroy Square, thinking her child not quite
+well, gave it a dose of Godfrey's cordial, which she purchased at a
+chemist's in the neighbourhood. In a very short time after taking it
+the child fell into convulsions, and soon died. In less than a month
+the child of another woman in the same house was found to be ill with
+disordered bowels. The first woman, not at all suspecting that the
+Godfrey's cordial had produced the convulsions in her infant, persuaded
+her friend to give the same medicine to her child. A dose from the same
+bottle was given, and this child was likewise attacked almost
+immediately with convulsions, and also died."
+
+Convulsions and epilepsy, without such fatal results as the foregoing,
+are not uncommon as the effect of a single dose of an opiate given
+unadvisedly; and by their continued and habitual use (and the form of
+syrup of poppies is but too often administered by an indiscreet and
+lazy nurse, unknown by the parent), a low, irritative, febrile state is
+produced, gradually followed by loss of flesh, the countenance becoming
+pallid, sallow, and sunken, the eyes red and swollen, and the
+expression stupid and heavy, and the powers of the constitution at last
+becoming completely undermined. Such an object is to be seen daily
+among the poorer classes,--the miniature of a sickly aged person: death
+soon follows here.
+
+
+
+Sect. IV.--LEECHING.
+
+
+
+Difficulty sometimes arises in putting a stop to the bleeding from
+leech-bites; a matter of considerable importance in the case of a
+delicate infant. The following measures may be resorted to for this
+purpose:--
+
+1. Expose the surface of the part to the external air, so that a
+coagulum of blood may form at the orifice: this simple mode will
+frequently arrest it.
+
+2. If this fail, make compression upon the part: this is one of the
+most effectual means of restraining haemorrhage. It is to be effected
+by taking a piece of lint folded three or four thicknesses, and the
+size of the finger-nail, to be steadily pressed upon the open orifice
+with the point of the finger until the blood has ceased to flow. The
+pledget of lint, however, must not be removed for some hours
+afterwards, or the bleeding will break out afresh.
+
+3. If the compression fails in stopping the bleeding, or from the
+situation of the leech-bites it cannot be adopted, because there is no
+firm point of resistance upon which to make pressure, the part may be
+dusted with starch or gum arabic powder, or, if this is of no avail,
+the wound may be touched with lunar caustic.
+
+If none of these measures are successful, the assistance of the
+medical attendant must be obtained; and if firm pressure be made upon
+the part, no serious loss of blood can ensue before his arrival.
+
+Leeches should never be resorted to by a parent for any of the
+diseases of infancy, without medical direction.
+
+
+
+Sect. V.--BLISTERS AND POULTICES.
+
+
+
+A blister should never be applied for any infantile disease, except
+when ordered by a medical man, as its injudicious use might greatly
+aggravate the complaint.
+
+There are also one or two precautions in reference to the mode of the
+application of a blister, which it is always right for a parent to
+attend to. From the great irritability of the skin, it should never be
+allowed to remain on longer than from two to four hours. At the
+expiration of this time, the surface will usually become red and
+inflamed; and, if the blister is removed, and the part dressed with
+fresh spermaceti ointment spread on lint, or with a soft bread and
+water poultice, a full blister will soon be raised: the little patient
+is thus saved much suffering, and a very troublesome sore prevented. A
+piece of tissue or silver paper, interposed between the blister and the
+skin, will answer the same purpose; the blister will act well, and the
+evils before alluded to will be prevented.
+
+After a blister has been two or three hours applied, its edge should
+be carefully raised, to ascertain the effect produced; and if the
+surface be much inflamed, more particularly if little points of
+vesication (watery bladders) are present, it should be removed, and the
+above directions attended to.
+
+Mustard poultices are invaluable in some of the diseases of infancy
+and childhood, and therefore frequently ordered.
+
+A mustard poultice is made by mixing two thirds of mustard flour and
+one third of wheaten flour with warm water or vinegar, in sufficient
+quantity to render the powder of the consistence of paste. It is then
+spread on linen from the size of a half-crown to that of the palm of
+the hand, according to the effect intended, and placed on the skin. How
+long it is to be kept on will depend upon the individual sensibility of
+the skin of the child; but, in general, from fifteen to twenty minutes
+will be found amply sufficient. The application, however, must at all
+times be carefully watched; for if it remain on too long, ulceration,
+and death of the part, might ensue; therefore, directly the skin is
+found tolerably red, the poultice should be removed. After its removal,
+the part may be exposed, or, if very painful, smeared over with fresh
+cream or common cerate.
+
+A bread and water poultice, although one of the commonest applications
+in use, is rarely well made or properly applied. It thus becomes
+injurious rather than useful; adding to the inflammation or irritation
+of the part, instead of soothing and allaying it. Nothing, however, is
+more simple than the mode of its preparation.
+
+Cut slices of stale bread of sufficient quantity, scald out a bason,
+put the bread into it, pour upon it boiling water, cover it over, and
+let it stand for ten minutes; next strain the water oft, gently squeeze
+the saturated bread in a thin cloth, so that the poultice shall not be
+too moist, and then spread it upon a cloth so that it shall be in
+thickness half an inch, and of a size large enough to cover the whole
+of the inflamed part, and a little more. Apply it just warm enough to
+be borne, and cover it well with oiled silk. A poultice thus made, will
+act as a local tepid bath to the inflamed part; and the oiled silk
+preventing evaporation, it will be found, when taken off, as moist as
+the first moment that it was put on.
+
+
+
+Sect. VI.--BATHS.
+
+
+
+Baths are much resorted to during infancy and childhood, both in
+health and in disease. In the former state, they constitute an
+important measure of hygeiene (this has been briefly alluded to under
+the section "Bathing"), and in the latter, a valuable remedial agent.
+Their indiscriminate use, however, might be followed by serious
+consequences; it is therefore important to point out a few rules for
+their judicious employment.
+
+
+
+THE COLD WATER PLUNGE BATH.
+
+
+
+It consists of water in its natural degree of heat; its temperature
+varying, according to the season of the year or other circumstances,
+from 30 degrees to 60 degrees.
+
+The phenomena produced upon a strong and healthy boy plunging into
+this bath will be as follows:--He will first experience a sensation of
+cold, followed by slight shuddering, and, if the immersion has been
+sudden, a peculiar impression in the nervous system, called a shock.
+Almost immediately after the shock, the feeling of cold will vanish,
+and give place to a sensation of warmth, speedily diffusing itself over
+the whole frame. If the boy leaves the bath at this time, or, at all
+events, before the warmth of the body goes off, and quickly dresses
+himself, a renewal of the reaction which had followed the shock of
+immersion will be experienced; he will be in a most delightful glow,--
+there will be a general feeling of enjoyment, accompanied by a sensible
+increase of animal power, and invigoration of the whole system. But, on
+the other hand, if the boy greatly prolong his stay in the water, no
+reaction will ensue, and he will become chilly, which will gradually
+increase to a strong and general shivering;--his feet and legs will
+become benumbed, and the whole body will soon be languid, exhausted,
+and powerless. The same result will happen to the young and delicate
+infant, if plunged into this bath; the same sensations will be
+produced; except that here the shock is scarcely followed by any
+reaction, and therefore from the first moment of the immersion, the
+shivering and consequent train of sensations occur. This arises from
+the infant at birth having less power of producing heat than when
+further advanced in age.
+
+From the foregoing remarks, then, it will be seen, that, in early
+infancy, the cold bath is inadmissible, and water of a higher
+temperature than that which feels cool to the hand of the nurse should
+always be used at this age. But that, as the child grows older,--if of
+a healthy and vigorous constitution,--the cold bath is unquestionably
+most desirable; and, if used in a proper manner, will be found to act
+as a most powerful tonic to the system. The summer is of course the
+only period of the year when the cold plunging bath can be resorted to
+for the child.
+
+
+
+SEA BATHING.
+
+
+
+When sea bathing can be obtained, it is even more conducive to the
+health of the child than the fresh water plunge bath; for the sea water
+is more tonic, stimulant, and bracing, than fresh. The period of the
+year best adapted for sea bathing is the summer and autumn. The best
+time of the day for bathing is two or three hours after breakfast;
+except in very hot weather, when an earlier hour must be chosen.
+Exercise is always useful previously to the bath; but it must be
+gentle, so as not to induce fatigue or much perspiration, Then the bath
+must be entered suddenly, with a plunge, inasmuch as an instantaneous
+immersion produces a greater reaction than a gradual immersion.[FN#22]
+The length of time of remaining in will depend upon circumstances. One
+dip only is enough at the first bath. Subsequently the time of
+remaining in the water may be prolonged, but this must be increased
+gradually; the positive necessity of leaving the bath while there still
+remains sufficient power of reaction being always kept in mind.
+Exercise in the water, particularly that of swimming, is highly useful.
+The body should be speedily and well dried, immediately upon coming
+out; a rough jack towel is an excellent means of accomplishing this
+purpose, while at the same time it insures considerable friction of the
+surface of the skin. If the boy is in sound health, he may bathe daily.
+
+
+
+[FN#22]  It is a matter of importance in bathing children, that they
+should not be terrified by the immersion, and every precaution should
+be taken to prevent this.
+
+
+
+As a remedy, sea bathing is highly serviceable. Its employment,
+however, requires much caution, and great mischief is sometimes
+committed by its indiscriminate use.
+
+The child of a strumous habit may be greatly benefited by sea bathing,
+united with a few years' residence on the coast. Indeed, by carefully
+following up a course of sea bathing, a suitable diet, and a judicious
+mode of living, the very temperament of the individual may be all but
+changed, and a power and activity imparted to the system, productive
+eventually of comparatively strong and robust health. A parent will do
+wisely, therefore, to send a child of such a habit to a school on the
+coast. Great caution, however, must be observed when bathing is
+commenced, lest the shock be too powerful for the energies of the
+system, and be not followed by the necessary degree of reaction. It
+will be prudent to begin with the tepid bath (85 degrees to 92
+degrees), and gradually reduce the temperature until the open sea can
+be resorted to without fear. The measures already mentioned for
+promoting reaction--exercise previous to immersion; the immersion at
+first only momentary, and followed by strong friction--must be
+diligently regarded in such a case.
+
+In the child of a delicate and feeble habit, much out of health, whose
+general debility is dependent on some organic disease, sea bathing is
+not only improper, but dangerous. Instead of being strengthened, such a
+child will be rendered more weak and debilitated. On the other hand,
+when the child is of a weak and relaxed habit, but free from organic
+disease, the cold bath will be highly useful, provided sufficient power
+of reaction exist in the system. In this case the skin and flesh of the
+child is relaxed and flabby; there is a great tendency to warm
+perspirations in bed, capricious appetite, confined or relaxed bowels,
+indisposition to exertion, and weariness from the slightest effort.
+
+
+
+THE SHOWER BATH.
+
+
+
+The effects of the shower bath are, on the whole, similar to those of
+the plunge bath of the same degree of temperature, except that the
+immediate shock of the shower bath is in general felt to be greater
+than that from simple immersion. This, however, may be met by putting
+warm water into the bottom of the bath in sufficient quantity to cover
+the ankles of the individual taking the bath, which tends at once to
+lessen the shock, and to increase the reaction.
+
+The apprehension and alarm experienced by young children in entering
+this kind of bath is easily overcome, by using at first a modification
+of it, lately brought into use. It consists of a tin vessel in the form
+of a large bottle, pierced at the bottom like a colander, and
+terminating in the upper part in a narrow tube, with an open mouth.
+When put into water it becomes filled, which is retained by closing the
+mouth of the tube with the finger; on removing which the water flows
+gradually out of the sieve-like bottom in a gentle shower. This may be
+used to the youngest child. At first the quantity of water employed
+should be small, and its temperature warm; as, however, the child grows
+older and accustomed to the bath, the former may be increased, and the
+latter lowered. Its tonic effect may be augmented by the addition
+ofbay salt, and by much active rubbing.
+
+As the child gets older the common form of shower bath may be used,
+and throughout the year, if he enjoy robust health; during the winter
+season, however, the water should be made tepid. This bath should be
+taken immediately upon rising from bed.
+
+
+
+ABLUTION, OR SPONGING.
+
+
+
+By ablution is meant the process of applying water to the surface of
+the body by means of a sponge or towel. It is one of the best
+substitutes for the cold bath; and if done quickly and thoroughly,
+produces a glow and invigoration of frame almost equal to the former.
+It is also the surest preventive against catching cold.
+
+Every child in health ought to be obliged, every morning of its life
+(when other means of bathing cannot be obtained), upon rising, and
+while the body still retains all the warmth of the bed, to sponge the
+whole body. If too young to do it for himself, it must be done for him.
+Salt or vinegar should be added to the water; and if the boy be robust,
+cold water may be used throughout the year; if not, in the winter
+season it must be made tepid.
+
+As a remedy, cold water sponging, and the application of ice and iced
+water, are often ordered under certain states of disease by the medical
+attendant, and frequently followed by delightful results. But it is
+necessary that they should be properly applied to do good.
+
+Cold water sponging is a convenient and grateful method of moderating
+febrile heat of the surface, provided undoubted powers of reaction be
+present in the system. It is frequently ordered, therefore, to be
+employed in eruptive fevers, as measles, scarlet fever, smallpox, and
+other fevers; and also in some local inflammations, particularly of the
+brain. Vinegar may be added to the water under these circumstances
+with advantage. It should at first be used tepid or cool, but
+afterwards cold. As a general rule, the more dry and parched the heat
+of the surface, the more urgent the necessity for the application of
+the cold, and the more frequently and fearlessly ought it to be
+renewed,--every hour or half-hour not being too often. Should the child
+fall asleep during the process, and begin to perspire, it must be
+intermitted, but resumed again on a recurrence of the parching heat.
+
+Ice and iced water are most frequently employed in affections of the
+brain. The former is most conveniently applied in a well-cleaned pig's
+bladder, which should be half filled with broken fragments of the ice.
+The bladder prevents moisture about the clothes, and, from its smooth
+and pliant nature, readily accommodates itself to every part of the
+child's head. If iced water is used, care must be taken that the cloths
+are sufficiently large to cover the whole of the head, and they should
+be doubled to prevent their getting rapidly warm. Indeed, in applying
+cold locally, as in inflammation of the brain, one rule it is of the
+utmost importance to observe, viz. that the application of the cold
+shall be continuous; therefore a second set of cold cloths or bags of
+ice should be applied before the former has become warm. This plan,
+especially pursued during the night, along with judicious internal
+treatment, will save many children from perishing under the most
+insidious and fatal disease of childhood--water on the brain.
+
+If neither water of a sufficiently low temperature, nor ice, can be
+procured, then recourse may be had to refrigerating mixtures, of which
+the following is a good form:--
+
+Common water, five pints;
+Vinegar, two pints;
+Nitre, eight ounces;
+Sal ammoniac, four ounces.
+
+
+
+THE WARM BATH.
+
+
+
+The warm bath judiciously prescribed is one of the most valuable
+remedial agents we possess; but although powerful for good, when
+misapplied, it is equally powerful for mischief. For instance, in
+active inflammatory affections, before the loss of blood, the use of
+the warm bath would greatly aggravate the disease; and yet, for an
+infant with active inflammation of the respiratory organs, it is
+continually resorted to. Again, nothing is more common than for a
+child, when attacked with convulsions, to be put immediately in the
+warm bath; and, generally speaking, it is extremely beneficial in this
+class of diseases; but it is sometimes no less prejudicial, when
+applied without due examination of the peculiarities of individual
+cases. For, in plethoric and gross children, the local abstraction of
+blood from the head, and the complete unloading of the alimentary
+canal, are often necessary to render such a measure beneficial, or even
+free from danger. In convulsions, however, and particularly when
+arising from teething, a parent may, without hesitation, at any time
+immerse the feet of the infant in water as warm as can be borne, at the
+same time that cloths wet with cold water are applied to the head and
+temples.
+
+As a preventive, where there is a tendency to disease, the warm bath
+may be employed without scruple, and will be found most serviceable.
+Its value in this point of view is very great, and it is to be
+regretted that it is not sufficiently appreciated and used. For
+example, a severe cold has been taken, and inflammation of the air-
+tubes is threatened: only put the child into a warm bath, and, with the
+common domestic remedies, a very serious attack may be warded off.
+Again, in the commencement of a diarrhoea, a warm bath, and
+discontinuing the cause of the attack, will alone suffice to cure; and,
+more-over, in the protracted diarrhoea attendant upon teething, where,
+after various remedies have been tried in vain, the child has lost
+flesh and strength to an apparently hopeless degree, Recovery has been
+brought about by the simple use of the warm bath.
+
+In the treatment of scrofulous children, warm and tepid bathing is of
+great value. In such cases, a course of warm sea bathing, with active
+friction over the whole surface after each bath, will at once relieve
+that abdominal fulness which is generally present, improve the
+functions of the skin, and give tone and vigour to the whole system.
+Towards the termination of such a course of baths, their temperature
+must be gradually reduced till they become tepid (85 degrees to 92
+degrees).
+
+The opinion that warm baths generally relax is erroneous: they are, no
+doubt, debilitating when used by persons of a weak and relaxed
+constitution, or when continued too long; but, on the contrary, they
+invariably give tone when employed in the cases to which they are
+properly applicable.
+
+A partial warm bath, such as the foot-bath, is of much service in
+warding off many complaints. If a child get the feet wet, plunging them
+into warm water will often prevent any ill consequences; and even when
+the first chill and slight shiverings which usher in colds, fevers, and
+other inflammatory complaints, have been complained of, the disease may
+be cut short by the use of a foot-bath, continued till free
+perspiration occurs.
+
+
+
+RULES FOR THE USE OF THE WARM BATH.
+
+
+
+TEMPERATURE OF THE WATER.--When the warm bath is used as a measure of
+hygeiene, as a general rule, any degree of temperature may be chosen
+between 92 degrees and 98 degrees, which appears to be most agreeable
+to the child; but on no account must 98 degrees be exceeded. When
+ordered as a remedial measure, the temperature will of course be fixed
+by the medical attendant.
+
+The same degree of temperature must be kept up during the whole period
+of immersion. For this purpose the thermometer must be kept in the
+bath, and additions of warm water made as the temperature is found to
+decrease. These additions of warm water, however, must be regulated by
+the indications of the thermometer, and not by the feelings of the
+child.
+
+
+PERIOD OF REMAINING IN THE BATH.--This must depend upon circumstances.
+As a measure of hygeiene, it must be varied according to the age of the
+child. For the first four or five weeks, the infant should not be kept
+in beyond three or four minutes; and the duration must afterwards be
+gradually prolonged as the child advances in age, until it extends to a
+quarter of an hour, a period which may be allowed after it has attained
+the age of four years.
+
+When the bath is employed as a remedial agent, the time of immersion
+must be prolonged; this will be determined by the medical adviser.
+Speaking generally, a quarter of an hour may be said to be the shortest
+period, an hour the longest, and half an hour the medium.
+
+When in the bath, care must be taken that the child's body is immersed
+up to the shoulders or neck, otherwise that part of the body which is
+out of the bath (the shoulders, arms, and chest), being exposed to the
+cooler temperature of the air, will be chilled.
+
+When the infant or child is taken out of the bath, the general
+surface, especially the feet, must be carefully rubbed dry with towels
+previously warmed; and when one of the objects of the bath is to excite
+much perspiration, the child should be immediately wrapped in flannel
+and put to bed. When, however, the object is not to excite
+perspiration, the child may be dressed in his ordinary clothing, but
+should not be allowed to expose himself to the open air for at least an
+hour.
+
+
+TIME OF USING THE BATH.--When resorted to for sudden illness, the bath
+must of course be employed at any time needed. When used for any
+complaint of long standing, or a measure of hygeiene, as a general
+rule, it should be taken between breakfast and dinner, about two hours
+after the former, or an hour and a half before the latter. This implies
+that the infant should never be put into the bath after having been
+freely nourished at the breast. Neither should it ever be used when the
+child is in a state of free perspiration from exercise, or on awaking
+from sleep.
+
+
+
+Chap. III.
+
+OF TEETHING, AND HINTS ON THE PERMANENT OR ADULT TEETH.
+
+
+
+The infant at birth has no teeth visible: the mouth is toothless. It
+possesses, however, hidden in the jaw, the rudiments of two sets. The
+first of these which makes its appearance, are called the Temporary or
+Milk Teeth; the second, the Permanent or Adult Teeth, and these come up
+as the former fall out, and so gradually replace them.
+
+
+
+Sect. I.--ON TEETHING.
+
+
+
+THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set
+of teeth, or milk-teeth as they are called, are twenty in number; they
+usually appear in pairs, and those of the lower jaw generally precede
+the corresponding ones of the upper. The first of the milk-teeth is
+generally cut about the sixth or seventh month, and the last of the set
+at various periods from the twentieth to the thirtieth months. Thus the
+whole period occupied by the first dentition may be estimated at from a
+year and a half to two years. The process varies, however, in different
+individuals, both as to its whole duration, and as to the periods and
+order in which the teeth make their appearance. It is unnecessary,
+however, to add more upon this point.
+
+Their developement is a natural process. It is too frequently,
+however, rendered a painful and difficult one, by errors in the
+management of the regimen and health of the infant, previously to the
+coming of the teeth, and during the process itself.
+
+Thus, chiefly in consequence of injudicious management, it is made the
+most critical period of childhood. Not that I believe the extent of
+mortality fairly traceable to it, is by any means so great as has been
+stated; for it is rated as high as one sixth of all the children who
+undergo it. Still, no one doubts that first dentition is frequently a
+period of great danger to the infant. It therefore becomes a very
+important question to an anxious and affectionate mother, how the
+dangers and difficulties of teething can in any degree be diminished,
+or, if possible, altogether prevented. A few hints upon this subject,
+then, may be useful. I shall consider, first, the management of the
+infant, when teething is accomplished without difficulty;--and,
+secondly, the management of the infant when it is attended with
+difficulty.
+
+
+
+MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.
+
+
+
+In the child of a healthy constitution, which has been properly, that
+is, naturally, fed, upon the milk of its mother alone, the symptoms
+attending teething will be of the mildest kind, and the management of
+the infant most simple and easy.
+
+
+SYMPTOMS.--The symptoms of natural dentition (which this may be fairly
+called) are, an increased flow of saliva, with swelling and heat of the
+gums, and occasionally flushing of the cheeks. The child frequently
+thrusts its fingers, or any thing within its grasp, into its mouth. Its
+thirst is increased, and it takes the breast more frequently, though,
+from the tender state of the gums, for shorter periods than usual. It
+is fretful and restless; and sudden fits of crying and occasional
+starting from sleep, with a slight tendency to vomiting, and even
+looseness of the bowels, are not uncommon. Many of these symptoms often
+precede the appearance of the tooth by several weeks, and indicate that
+what is called "breeding the teeth" is going on. In such cases, the
+symptoms disappear in a few days, to recur again when the tooth
+approaches the surface of the gum.
+
+
+TREATMENT.--The management of the infant in this case is very simple,
+and seldom calls for the interference of the medical attendant. The
+child ought to be much in the open air, and well exercised: the bowels
+should be kept freely open with castor oil; and be always gently
+relaxed at this time. Cold sponging employed daily, and the surface of
+the body rubbed dry with as rough a flannel as the delicate skin of the
+child will bear; friction being very useful. The breast should be given
+often, but not for long at a time; the thirst will thus be allayed, the
+gums kept moist and relaxed, and their irritation soothed, without the
+stomach being overloaded. The mother must also carefully attend, at
+this time, to her own health and diet, and avoid all stimulant food or
+drinks.
+
+From the moment dentition begins, pressure on the gums will be found
+to be agreeable to the child, by numbing the sensibility and dulling
+the pain. For this purpose coral is usually employed, or a piece of
+orris-root, or scraped liquorice root; a flat ivory ring, however, is
+far safer and better, for there is no danger of its being thrust into
+the eyes or nose. Gentle friction of the gums, also, by the finger of
+the nurse, is pleasing to the infant; and, as it seems to have some
+effect in allaying irritation, may be frequently resorted to. In
+France, and in this country also, it is very much the practice to dip
+the liquorice-root, and other substances, into honey, or powdered
+sugar-candy; and in Germany, a small bag, containing a mixture of sugar
+and spices, is given to the infant to suck, whenever it is fretful and
+uneasy during teething. The constant use, however, of sweet and
+stimulating ingredients must do injury to the stomach, and renders
+their employment very objectionable.
+
+
+
+THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.
+
+
+
+In the child which has been partly or altogether brought up by hand,
+or who is of a feeble and delicate constitution, or imbued with any
+hereditary taint, the process of dentition will be attended with more
+or less difficulty, and not unfrequendy with danger.
+
+
+SYMPTOMS.--The symptoms of difficult dentition are of a much more
+aggravated description than those which attend the former case; and it
+is right that a mother should, to a certain extent, be acquainted
+with their character, that she may early request that medical aid,
+which, if judiciously applied, will mitigate, and generally quickly
+remove them.
+
+Difficult dentition will be attended with painful inflammation and
+swelling of the gum, which is hotter, of a deeper red, than natural,
+and intolerant of the slightest pressure. There is often great
+determination of blood to the head, which a mother may recognise by the
+cheeks being red, hot, and swollen; the eyes red, irritable, and
+watery; and the saliva running from the mouth profusely. The fever is
+great, and the thirst extreme. The child is at one time restless and
+irritable, and at another heavy and oppressed: the sleep will be
+broken, and the infant frequently awake suddenly and in alarm from its
+short slumbers. Such are the chief symptoms of difficult teething, and
+which will be present to a greater or less degree.
+
+
+TREATMENT.--As most of the above symptoms are induced by the painful
+tension of the gum, it would seem that the most rational mode of
+attempting their relief is by freely lancing the swollen part. Great
+prejudices, however, still exist in the minds of some parents against
+this operation. They think it gives great pain, and, if the tooth is
+not very near, makes its coming through the gum subsequently the more
+difficult.
+
+With regard to the first objection, the lancet is carried through the
+gum so quickly, that this is hardly possible; and the fact that the
+infant will often smile in your face after it is done, although
+previously crying from pain, is sufficient evidence that it is not a
+very painful operation. In reference to the second, that the scar which
+ensues, opposes, by its hardness, the subsequent progress of the tooth,
+it is quite groundless; for cicatrices, like all other new-formed
+parts, are much more easily absorbed than the original structure.
+
+Of the practical utility and perfect safety of this operation we have
+ample proof in its daily performance with impunity, and in the instant
+relief which it often affords to all the symptoms.
+
+Mere scarifying the gums is sometimes all that is required, and will
+afford great relief. This operation, therefore, should not be opposed
+by the mother. She, at the same time, should be acquainted with its
+precise object, lest the speedy return of the symptoms, and the non-
+appearance of the expected tooth, might tend to bring the operation of
+lancing the gums into disrepute.
+
+The parental management of the infant, then, and by which much of the
+pain and difficulty of teething may be removed or alleviated, consists
+in attending to the following directions:--
+
+
+FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of
+the mother's duty to pay especial attention; and, by so doing, she will
+save her child much suffering. The condition of the mouth should be
+carefully inspected from time to time; and should a swollen gum be
+discovered, it should immediately be attended to, not waiting till
+constitutional symptoms appear before she employs proper aid for her
+child. For this purpose the mother should make herself familiar with
+the appearances of the gum under distention and inflammation; a matter
+of no difficulty, accompanied, as this condition usually is, by a
+profuse secretion of saliva, heat of mouth, and at a time when the age
+of the child justifies the supposition that it is about to cut its
+first tooth, or, if it have some teeth, that others are about to appear.
+
+
+SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it
+should always have its quantity of nourishment diminished. If it is
+being fed, as well as nursed at the breast, at the time, the former
+should be immediately withheld: if it is being fed alone, the only
+kind of food that should be allowed is milk and water. These cases are
+much aggravated by the not uncommon habit of parents giving the infant
+food whenever it cries from the irritation attending upon the process;
+and thus a slightly difficult dentition is converted into serious
+disease.
+
+
+THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched,
+that they may not become confined; it being necessary that they should
+be gently relaxed at this time. If a slight diarrhoea is present, it
+must not be checked; if it pass beyond this, however, medicine must be
+had recourse to, and great benefit will also arise from putting the
+child into a warm hip-bath, and warmly clothing the body, but keeping
+the head cool.
+
+
+FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold
+water night and morning, and no other covering than that which nature
+has provided should be put upon it when within doors or asleep; and on
+no occasion should warm felt or velvet hats be worn during mild or warm
+weather, straw or white hats being much lighter and cooler. The child
+should be much in the open air.
+
+The sponging of the infant's body daily, either with cold or tepid
+water, must depend upon the season of the year and constitution of the
+child, as well as upon other circumstances. Sponging the head with cold
+water night and morning is almost invariably atttended with great
+benefit, and may be resorted to in every case without fear; and now and
+then the use of the warm hip-bath, for several days together, will be
+ordered by the physician, which, by acting upon the skin, diminishes
+the determination of blood to the head, and thus forms an important
+source of relief.
+
+
+FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not
+unfrequently excited by difficult teething, and then give great alarm
+to the parent, relief will be afforded by immersing the hips, legs,
+and feet of the infant in water as warm as can be borne, and at the
+same time applying over the head and temples a piece of flannel wet
+with cold water. I have also often cut the fit short by sprinkling cold
+water in the child's face while in the bath. The gums should always be
+looked to, and if they appear swollen, and painful, at once lanced. I
+have known the most formidable convulsions to cease immediately after
+this operation.
+
+
+SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses
+to administer narcotics to quiet infants while teething. It is not only
+objectionable, but, from the uncertain effects of sedatives upon
+infants, a very dangerous practice, and they ought never to be given,
+except at the suggestion of a medical man. It is far better, if the
+child is restless at night, to have it frequently taken out of its cot,
+and carried about in an airy room; for the cool air, and change of
+posture, will do much to allay the feverishness and restlessness of the
+child.
+
+
+From these few hints, it must have been seen how much the sufferings
+from teething may be mitigated by judicious management. That, if the
+parent is able to support her infant upon the breast alone, teething
+will be found comparatively an easy process, and unattended with
+danger; the mother thus reaping a delightful reward for all the
+anxieties and privations nursing necessarily involves. That the child
+brought up partially, or entirely, by hand will always pass through
+dentition with more or less of pain and difficulty; but that even here,
+if the diet has been properly regulated, much less suffering and
+inconvenience will arise than when less attention has been paid to it.
+And, lastly, that, when teething is difficult, how highly important it
+is to call in proper aid at an early period, and to carry out fully the
+directions of the medical attendant, allowing no foolish prejudices to
+interfere with his prescriptions and management.
+
+If I stood in need of any argument to impress upon the mind of a
+parent the importance of attending to the last injunction, I would
+simply state, that its neglect is but too frequently the cause of
+disease of the brain, terminating in death, or a state of idiotcy far
+worse than death, of which I know more than one living instance.
+
+It may be as well to add, that eruptions about the ears, head, face,
+and various parts of the body, very frequently appear during the
+process of the first teething.[FN#23] If they are slight, they should
+be left alone, being rather useful than otherwise; if they are
+troublesome, they must receive that kind of attention from the parent
+which will be pointed out under the chapter on diseases. The same
+remark applies to enlargements of the glands of the neck, which
+frequently appear at this time.
+
+
+
+[FN#23]  In some infants a rash always precedes the cutting a tooth.
+Sometimes it appears in the form of hard elevated pimples as large as
+peas; in other instances in the form of red patches, of the size of a
+shilling, upon the arms, shoulders, and back of the neck. They are
+always harmless, require no particular attention, and prevent, I doubt
+not, more serious complaints.
+
+
+
+SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.
+
+
+
+Parents are not sufficiently alive to the importance of attending to
+the condition of the mouth of their children at the period of changing
+the first for the second set of teeth; they do not seem to be aware
+how much the comfort, appearance, and future health of the child
+depends upon it. Nor do they subsequently impress upon the minds of
+their children how necessary, on their part, is the observance of
+certain rules for the preservation of the teeth, and how distressing
+are the effects which result from their neglect. It is proposed, here,
+to say a few words for the information and guidance of the parent upon
+this subject.
+
+
+
+THE MANNER IN WHICH THEY APPEAR.
+
+
+
+The change of the temporary for the permanent or adult teeth
+commences, in the majority of instances, at about seven years of age;
+occasionally it occurs as early as five, and as late as eight years and
+a half. The necessity which exists for this change, and the mode by
+which it is effected, are striking and beautiful; it is, however, not
+our object to enter fully upon its consideration here.
+
+It has already been observed, that the infant is born with the
+rudiments of two sets of teeth in the jaw, although neither make their
+appearance till long after birth. The time when, and the manner in
+which the first set appear has been pointed out. Now although these
+admirably answer the purposes for which they were given up to the
+seventh year, after this period they fail to do so: they are not
+sufficiently numerous,--in their structure they are not strong or
+durable,--nor is their power of mastication sufficiently great.
+
+They are not sufficiently large or numerous. If the mouth of a child
+at this age is examined, it will be seen, that a considerable interval
+has taken place between the teeth in consequence of the growth and
+expansion of the face; hence a larger set has become necessary to fill
+the arch. But it may be asked, do not the teeth grow with the growth of
+the body? and if not, why is it so? They do not, and for this reason:
+the important office which these organs are destined to perform requires
+that they should be composed of a substance too dense and of too low
+an organization to allow of any subsequent growth and enlargement. Thus
+the size of the teeth is determined and acquired before they make their
+appearance through the gums. This being the case, it will be readily
+seen, that the teeth which would be of appropriate size in the mouth of
+the infant, would be quite inadequate to the enlarged dimensions of the
+adult; hence the necessity of a second set, exceeding in number, and
+size the teeth of the first.
+
+That a necessity also exists at this age, that the weak and delicate
+teeth of childhood should be exchanged for a set stronger and more
+durable in their structure, more robust and more powerful, will be
+sufficiently apparent, if we only recollect the great change which has
+gradually been taking place in the nature of the food of the two epochs
+of childhood and adult age.
+
+The second set, or permanent teeth, then, lying under the milk-teeth
+and hidden in the jaw, undergo in this situation their full
+developement, before they appear above the gum. This occurrence
+commences about seven years of age, at which period the first set
+begin to fall out from their roots becoming absorbed, and no longer
+retaining their hold of the jaw; to be entirely replaced in the course
+of a few years by the permanent set, which thus succeeds them. The
+first teeth of this set which make their appearance are the large
+double teeth, which emerge from the gum immediately behind the last of
+the temporary set. Next the two front teeth of the lower jaw fall out,
+and are succeeded by two others of similar character and form, but of
+larger size; then the two corresponding teeth of the upper row are cast
+off, and their place supplied; shortly after the teeth immediately
+adjoining these; then the double teeth of the first set are exchanged
+for their smaller successors of the second. The eye-teeth after a time
+begin to make their appearance; and then more double teeth; making in
+all twenty-eight teeth, and occupying in their developement from the
+seventh to the fourteenth year of age. They are not, however, yet
+complete; for between the latter date and the twenty-first year four
+more teeth appear, called the wisdom teeth, making the adult set or
+permanent teeth to amount in all to thirty-two teeth. It should be
+observed, that whilst this is the most usual course in which this set
+appear, the line of succession is sometimes different.
+
+
+
+THEIR VALUE AND IMPORTANCE.
+
+
+
+It would seem almost unnecessary to say a word upon so self-evident a
+truth, and yet perhaps the full extent of this statement is not
+generally appreciated. It has not, perhaps, occurred to the minds of
+all, that upon the right position and arrangement of the teeth the
+beauty and expression of the countenance much depends. But so it is;
+for however regular and perfect the general features, if the teeth are
+irregular or deficient, an unpleasing expression, proportionate to the
+extent of the displacement, is inevitably produced. Now every mother
+should be alive to this fact, that she may early apply to the dentist
+to have any error of the above nature rectified, before it is too late.
+
+On their complete and entire state also depends the perfection of
+utterance and articulation. The child, for instance, makes no attempt
+at articulation until it has acquired several teeth; this faculty
+becomes also exceedingly imperfect during the process of changing them;
+from this time it continues to improve, until again it is permanently
+impaired in old age, when they are finally lost. And so again, if a
+child lose merely a single tooth from the front of its mouth, lisping
+will result; or if a supernumerary or irregular tooth be present, the
+articulation will be abrupt and imperfect:--the former plainly showing
+the importance of the entireness of the series, and the latter, the
+necessity of regularity in their arrangement and position.
+
+The teeth, however, are chiefly important in relation to the part they
+sustain in connection with digestion, viz. the mastication of the food.
+By this act the food, after being received into the mouth, is mixed
+with the saliva and broken down, till it becomes of an uniform pulpy
+consistence, fit for being easily swallowed, and acted upon by the
+gastric juice on its arrival in the stomach. That due mastication of
+the food is essential to healthy digestion, which will be promoted or
+retarded in exact proportion as it approaches or falls short of this
+point, is a fact so generally known as scarcely to need comment.
+Suffice it to add, that, if food be introduced into the stomach
+unmasticated, the gastric juice will only act upon its surface; and
+after a number of hours it will be either rejected by vomiting, or pass
+on into the intestine, to give rise to cholic, bowel complaints, or
+flatulence, and very frequently in children to a serious attack of
+convulsions.
+
+
+
+THEIR MANAGEMENT AND PRESERVATION.
+
+
+
+IRREGULARITY OF ARRANGEMENT AND POSITION.--Every parent ought to have
+the mouth of her child inspected occasionally, during the advance of
+the permanent teeth, that any irregularity in their position or
+arrangement may be prevented. And it is equally her duty to see to it,
+that she choose a competent person to do this, since great mistakes are
+not unfrequently made in this matter, and which themselves become the
+source of evils far more serious than those they are intended to
+obviate. "I have known," says Mr. Bell, "no less than eight or even ten
+firm teeth forcibly removed from the jaws of a child at once, when
+there was not the slightest reason to apprehend any evil result from
+their being left alone." Here there was a most cruel, because
+unnecessary, infliction of pain, as well as great hazard incurred of
+seriously injuring the permanent teeth by interfering with the
+secretion of their enamel. And besides all this there is another and
+yet greater evil, for, if the temporary teeth be removed, before the
+permanent ones are so advanced as to be ready to occupy their
+situation, the arch of the jaw will assuredly contract, and when,
+subsequently, the permanent teeth are fully formed, there will not be
+room for them to range in their proper situation. Thus the operation
+which was intended to prevent irregularity becomes the cause of its
+occurrence, and that in its very worst form, producing a want of
+accordance between the size of the teeth and that of the jaw.
+
+The eye-teeth generally occasion most anxiety to a parent, from the
+prominent position in which they present themselves; but in the
+majority of cases nothing but time is required to reduce them to their
+proper station. But, whatever may be the peculiarities of each
+individual case, the dentist will decide what may be required; only, I
+would again repeat, do not neglect the occasional inspection of the
+mouth at this age, if you regard the future comfort and appearance of
+your child.
+
+
+THEIR PRESERVATION.--The preservation of the teeth requires attention to
+several points; the first and principal of which is, to enforce the
+habit in the child of thoroughly cleaning the teeth by means of water
+and a brush night and morning, and rinsing out the mouth after each
+meal. The brush should not be very hard, as it will not only be more
+difficult to clean the interstices between the teeth, the
+part in which the tartar[FN#24] is most likely to be deposited, but by
+its friction, will occasion the gradual absorption of the gum and the
+exposure of the neck of the teeth. The hair of the brush should be firm
+and elastic, and not too closely set.
+
+
+
+[FN#24]  A sort of calcareous substance, which becomes deposited at
+the roots of the teeth, from a want of proper attention to
+cleanliness; and, if allowed to remain, will destroy first their
+beauty, and then the organ itself.
+
+
+
+TARTAR.--If there is a tendency to the formation of tartar, then it will
+be necessary to have recourse to some tooth-powder. Tooth-powders,
+however, must be chosen with care, as many of them are composed of
+substances highly injurious to the teeth. "Many of the tooth-powders
+which are offered for sale, with the promise of rendering the teeth
+beautifully white, perform, for a time, all that is promised, at the
+expense of permanent and irremediable injury to the teeth; for they
+often contain a quantity of tartaric or other acid, which effects a
+gradual decomposition of the enamel."[FN#25] Prepared chalk is one of
+the simplest and best tooth-powders.
+
+
+
+[FN#25]  Bell on the Teeth.
+
+
+
+The following form, also, may be used with advantage:--
+
+Prepared chalk, three ounces;
+Orris root, powdered, half an ounce;
+Powdered myrrh, half an ounce;
+Cuttle fish, powdered, one ounce;
+Essential oil of cinnamon, four drops.--Mix.
+
+The best preservative, then, against the formation of tartar, is to
+see that the child cleans his teeth thoroughly night and morning with
+the brush, powder, and water, and also (if possible) that he rinses out
+the mouth after each meal.
+
+If the gums should be tender, irritable, and bleed (as is frequently
+the case when an individual gets out of health, or the tartar
+accumulates) the mouth may be washed night and morning with a tumbler of
+tepid water, containing from ten to twenty drops of the tincture of
+myrrh, and the same quantity of spirits of camphor; or the following
+form may be used:--
+
+Alum, one drachm and a half;
+Tincture of myrrh, two drachms;
+Camphor mixture, five ounces and a half.--Mix.
+
+
+ACIDS.--The use of acids to the teeth cannot be too strongly deprecated:
+they decompose their substance, and lead to their rapid decay. Hence
+the whiteness produced by acid tooth-powders and washes is not less
+deceitful than ruinous in its consequences. As has been just observed,
+they perform all that their vendors promise, causing the teeth, for a
+little while, to become very white and beautiful in their appearance,
+but, at the same time, injuring them irremediably: the enamel becomes
+gradually decomposed, the bone of the tooth exposed, and its death is
+the inevitable consequence.
+
+It is therefore of great importance when acid medicines are ordered
+for children that they should be taken through a glass tube, to prevent
+their coming in contact with the teeth. From a want of this precaution,
+I know a lady (and there are many such instances) who once had as sound
+and fine a set of teeth as any one could boast of, but from this cause
+has had nearly the whole of the upper row destroyed. She was in
+delicate health: it was judged requisite that she should take for a
+considerable time (with other medicines) sulphuric acid; but the glass
+tube was not thought of, and the consequences followed which have been
+described.
+
+
+CALOMEL.--This medicine, as it is frequently given, alone, or in the
+little white powders, in infancy and childhood, by mothers and nurses,
+is productive of serious and indeed irremediable injury to the teeth.
+"The immoderate use of mercury in early infancy produces, more perhaps
+than any other similar cause, that universal tendency to decay, which,
+in many instances, destroys almost every tooth at an early age. It is
+certainly not unimportant to bear this fact in mind, in the
+administration of this sovereign remedy, this panacea, as many appear
+to consider it, in infantile diseases."[FN#26]
+
+
+
+[FN#26]  Bell on the Teeth.
+
+
+
+HEAT AND COLD.--The teeth are exceedingly apt to suffer from sudden
+variations of temperature. Fluids, therefore, should never be taken
+into the mouth so hot or so cold as to produce the slightest pain; and,
+for the same reason, the water with which the mouth is cleansed should
+in winter be always warm or tepid. When ices are taken, the precaution
+of placing them in the centre of the mouth, so as to prevent contact
+with the teeth, should be carefully observed.
+
+There are many other causes which might be mentioned as tending to
+induce decay of the teeth, but their consideration here is purposely
+avoided.
+
+It is hoped that enough has been said to draw the parent's attention
+to the subject of the teeth, to prevent their neglect, and yet at the
+same time to induce a cautious management.
+
+
+
+CHAP. IV.
+
+
+HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER.
+
+
+
+Life is soon extinguished in infancy. At this epoch any disease is
+formidable, and must be met most promptly. It is either sudden and
+active in its assaults, or comes with slow and insidious approach. The
+first signs of its coming on are not always visible to an unpractised
+eye: it may have made dangerous advances before the mother's mind is
+awakened to its presence; and medical aid may be solicited when
+remedies and advice are no longer of any avail.
+
+It is therefore highly important that a mother should possess such
+information as will enable her to detect disease at its first
+appearance, and thus insure for her child timely medical assistance.
+This knowledge it will not be difficult for her to obtain. She has only
+to bear in mind what are the indications which constitute health, and
+she will at once see that all deviations from it must denote the
+presence of disorder, if not of actual disease. With these changes she
+must to a certain extent make herself acquainted.
+
+
+
+Sect. I.--SIGNS OF HEALTH.
+
+
+
+The signs of health are to be found, first, in the healthy performance
+of the various functions of the body; the regular demands made for its
+supply, neither in excess or deficiency; and a similar regularity in
+its excretions both in quantity and appearance.
+
+If the figure of the healthy infant is observed, something may be
+learnt from this. There will be perceived such an universal roundness
+in all parts of the child's body, that there is no such thing as an
+angle to be found in the whole figure; whether the limbs are bent or
+straight, every line forms a portion of a circle. The limbs will feel
+firm and solid, and unless they are bent, the joints cannot be
+discovered.
+
+The tongue, even in health, is always white, but it will be free from
+sores,--the skin cool,--the eye bright,--the complexion clear,--the head
+cool,--and the abdomen not projecting too far,--the breathing regular,
+and without effort.
+
+When awake, the infant will be cheerful and sprightly, and, loving to
+be played with, will often break out into its merry, happy, laugh;
+whilst, on the other hand, when asleep, it will appear calm, every
+feature composed, its countenance displaying an expression of
+happiness, and frequently, perhaps, lit up with a smile.
+
+
+
+Sect. II. SIGNS OF DISEASE.
+
+
+
+Just in proportion as the above appearances are present and entire,
+health may be said to exist; and just in proportion to their partial or
+total absence disease will have usurped its place.
+
+We will, however, for the sake of clearness examine the signs of
+disease as they are manifested separately by the countenance,--the
+gestures,--in sleep,--in the stools,--and by the breathing and cough.
+
+
+
+OF THE COUNTENANCE.
+
+
+
+In health the countenance of a thild is expressive of serenity in mind
+and body; but if the child be unwell, this expression will be changed,
+and in a manner which, to a certain extent, will indicate what part of
+the system is at fault.
+
+The brows will be contracted, if there is pain, and its seat is in the
+head. This is frequently the very first outward sign of any thing being
+wrong, and will occur at the very onset of disease; if therefore
+remarked at an early period, and proper remedies used, its notice may
+prevent one of the most fearful of infantile complaints--"Water in the
+Head."
+
+If this sign is passed by unheeded, and the above disease be
+threatened, soon the eyes will become fixed and staring,--the head hot,
+and moved uneasily from side to side upon the pillow, or lie heavily
+upon the nurse's arm,--the child will start in its sleep, grinding its
+teeth, and awake alarmed and screaming,--its face will be flushed,
+particularly the cheeks (as if rouged),--its hands hot,--but feet cold,
+its bowels obstinately costive, or its motions scanty, dark-coloured,
+and foul.
+
+If the lips are drawn apart, so as to show the teeth or gums, the seat
+of the pain is in the belly. This sign, however, will only be present
+during the actual existence of suffering; if, therefore, there be any
+doubt whether it exist, press upon the stomach, and watch the eifect on
+the expression of the countenance.
+
+If the pain arise simply from irritation of the bowels excited from
+indigestion, it will be temporary, and the sign will go and come just
+as the spasm may occur, and slight remedial measures will give relief.
+
+If, however, the disease be more serious, and inflammation ensue, this
+sign will be more constantly present, and soon the countenance will
+become pale, or sallow and sunken,--the child will dread motion, and
+lie upon its back with the knees bent up to the belly,--the tongue will
+be loaded,--and in breathing, while the chest will be seen to heave
+with more than usual effort, the muscles of the belly will remain
+perfectly quiescent.
+
+If the nostrils are drawn upwards and in quick motion, pain exists in
+the chest. This sign, however, will generally be the accompaniment of
+inflammation of the chest, in which case the countenance will be
+discoloured,--the eyes more or less staring, and the breathing will be
+difficult and hurried; and if the child's mode of respiring be watched,
+the chest will be observed to be unmoved, while the belly quickly
+heaves with every inspiration.
+
+Convulsions are generally preceded by some changes in the countenance.
+The upper lip will be drawn up, and is occasionally bluish or livid.
+Then there may be slight squinting, or a singular rotation of the eye
+upon its own axis; alternate flushing or paleness of the face; and
+sudden animation followed by languor.
+
+These signs will sometimes manifest themselves many hours, nay days,
+before the attack occurs; may be looked upon as premonitory; and if
+timely noticed, and suitable medical aid resorted to, the occurrence of
+a fit may be altogether prevented.
+
+The state of the eyes should always be attended to. In health they are
+clear and bright, but in disease they become dull, and give a heavy
+appearance to the countenance; though after long continued irritation
+they will assume a degree of quickness which is very remarkable, and a
+sort of pearly brightness which is better known from observation than
+it can be from description.
+
+The direction of the eyes, too, should be regarded, for from this we
+may learn something. When the infant is first brought to the light,
+both eyes are scarcely ever directed to the same object: this occurs
+without any tendency to disease, and merely proves, that regarding one
+object with both eyes is only an acquired habit. But when the child has
+come to that age when the eyes are by habit directed to the same
+object, and afterwards it loses that power, this circumstance alone may
+be looked upon as a frequent prelude to disease affecting the head.
+
+
+
+OF THE GESTURES.
+
+
+
+The gestures of a healthy child are all easy and natural; but in
+sickness those deviations occur, which alone will often denote the
+nature of the disease.
+
+Suppose an infant to have acquired the power to support itself, to
+hold its head erect; let sickness come, its head will droop
+immediately, and this power will be lost, only to be regained with the
+return of health; and during the interval every posture and movement
+will be that of languor.
+
+The little one that has just taught itself to run alone from chair to
+chair, having two or three teeth pressing upon and irritating the gums,
+will for a time be completely taken off its feet, and perhaps lie
+languidly in its cot, or on its nurse's arm.
+
+The legs being drawn up to the belly, and accompanied by crying, are
+proofs of disorder and pain in the bowels. Press upon this part, and
+your pressure will increase the pain. Look to the secretions from the
+bowels themselves, and by their unhealthy character your suspicions, in
+reference to the seat of the disorder, are at once confirmed.
+
+The hands of a child in health are rarely carried above its mouth; but
+let there be any thing wrong about the head and pain present, and the
+little one's hands will be constantly raised to the head and face.
+
+Sudden starting when awake, as also during sleep, though it occur from
+trifling causes, should never be disregarded. It is frequently
+connected with approaching disorder of the brain. It may forebode a
+convulsive fit, and such suspicion is confirmed, if you find the thumb
+of the child drawn in and firmly pressed upon the palm, with the
+fingers so compressed upon it, that the hand cannot be forced open
+without difficulty. The same condition will exist in the toes, but not
+to so great a degree; there may also be a puffy state of the back of the
+hands and feet, and both foot and wrist bent downwards.
+
+There are other and milder signs threatening convulsions and connected
+with gesture, which should be regarded:--the head being drawn rigidly
+backwards,--an arm fixed firmly to the side, or near to it,--as also one
+of the legs drawn stifly upwards. These signs, as also those enumerated
+above, are confirmed beyond all doubt, if there be present certain
+alterations in the usual habits of the child:--if the sleep is
+disturbed,--if there be frequent fits of crying,--great peevishness of
+temper,--the countenance alternately flushed and pale,--sudden animation
+followed by as sudden a fit of languor,--catchings of the breath
+followed by a long and deep inspiration,--all so many premonitory
+symptoms of an approaching attack.
+
+
+
+OF THE SLEEP.
+
+
+
+The sleep of the infant in health is quiet, composed, and refreshing.
+In very early infancy, when not at the breast, it is for the most
+part asleep in its cot; and although as the months advance it sleeps
+less, yet when the hour for repose arrives, the child is no sooner laid
+down to rest, than it drops off into a quiet, peaceful slumber.
+
+Not so, if ill. Frequently it will be unwilling to be put into its cot
+at all, and the nurse will be obliged to take the infant in her arms;
+it will then sleep but for a short time, and in a restless and
+disturbed manner.
+
+If it suffer pain, however slight, the countenance will indicate it;
+and, as when awake, so now, if there is any thing wrong about the head,
+the contraction of the eye-brow and grinding of the teeth will appear;
+if any thing wrong about the belly, the lips will be drawn apart,
+showing the teeth or gums,--and in both instances there will be great
+restlessness and frequent startings.
+
+
+
+OF THE STOOLS.
+
+
+
+In the new-born infant the motions are dark coloured, very much like
+pitch both in consistence and appearance. The first milk, however,
+secreted in the mother's breast, acts as an aperient upon the infant's
+bowels, and thus in about four-and-twenty hours it is cleansed away; or
+if it should not, a tea-spoonful of castor oil accomplishes this
+purpose.
+
+From this time, and through the whole of infancy, the stools will be
+of a lightish yellow colour, the consistence of thin mustard, having
+little smell, smooth in appearance, and therefore free from lumps or
+white curded matter, and passed without pain or any considerable
+quantity of wind. And as long as the child is in health, it will have
+daily two or three, or even four, of these evacuations. But as it grows
+older, they will not be quite so frequent; they will become darker in
+colour, and more solid, though not so much so as in the adult.
+
+Any deviation, then, from the above characters, is of course a sign of
+something wrong; and as a deranged condition of the bowels is
+frequently the first indication we have of coming disease, the nurse
+should daily be directed to watch the evacuations. Their appearance,
+colour, and the manner in which discharged, are the points principally
+to be looked to. If the stools have a very curdy appearance, or are too
+liquid, or green, or dark-coloured, or smell badly, they are unnatural.
+And in reference to the manner in which they are discharged, it should
+be borne in mind, that, in a healthy child, the motion is passed with
+but little wind, and as if squeezed out, but in disease, it will be
+thrown out with considerable force, which is a sign of great
+irritation. The number, too, of stools passed within the four-and-
+twenty hours it is important to note, so that if the child does not
+have its accustomed relief, (and it must not be forgotten that
+children, although in perfect health, differ as to the precise number,)
+a little castor oil may be at once exhibited, and thus mischief be
+prevented.
+
+This, however, is not the place to discuss the question of disordered
+bowels, but simply to point out how this circumstance may be
+known.[FN#27]
+
+
+
+[FN#27]  See section on Disorders of the Stomach and Bowels, p. 208.
+
+
+
+OF THE BREATHING AND COUGH.
+
+
+
+The breathing of a child in health is formed of equal inspirations and
+expirations, and it breathes quietly, regularly, inaudibly, and without
+effort. But let inflammation of the air-tubes or lungs take place, and
+the inspiration will become in a few hours so quickened and hurried,
+and perhaps audible, that the attention has only to be directed to the
+circumstance to be at once perceived.
+
+Now all changes which occur in the breathing from its healthy
+standard, however slight the shades of difference may be, it is most
+important should be noticed early. For many of the complaints in the
+chest, although very formidable in their character, if only seen early
+by the medical man, may be arrested in their progress; but otherwise,
+may be beyond the control of art. A parent, therefore, should make
+herself familiar with the breathing of her child in health, and she
+will readily mark any change which may arise.
+
+Of cough I should not have said any thing in this chapter, as it can
+never fail to be noticed, except that it is highly necessary to throw
+out one caution. Whenever a child has the symptoms of a common cold,
+attended by hoarseness and a rough cough, always look upon it with
+suspicion, and never neglect seeking a medical opinion. Hoarseness does
+not usually attend a common cold in the child, and these symptoms may
+be premonitory of an attack of "croup;" a disease excessively rapid in
+its progress, and which, from the importance of the parts affected,
+carrying on, as they do, a function indispensably necessary to life,
+requires the most prompt and decided treatment.
+
+The following observations of Dr. Cheyne are so strikingly
+illustrative, and so pertinent to my present purpose, that I cannot
+refrain inserting them:--"In the approach of an attack of croup, which
+almost always takes place in the evening, probably of a day during
+which the child has been exposed to the weather, and often after
+catarrhal symptoms have existed for several days, he may be observed to
+be excited, in variable spirits, more ready than usual to laugh than to
+cry, a little flushed, occasionally coughing, the sound of the cough
+being rough, like that which attends the catarrhal stage of the
+measles. More generally, however, the patient has been for some time in
+bed and asleep, before the nature of the disease with which he is
+threatened is apparent; then, perhaps, without waking, he gives a very
+unusual cough, well known to any one who has witnessed an attack of the
+croup; it rings as if the child had coughed through a brazen trumpet;
+it is truly a tussis clangosa; it penetrates the walls and floor of the
+apartment, and startles the experienced mother,--'Oh! I am afraid our
+child is taking the croup!' She runs to the nursery, finds her child
+sleeping softly, and hopes she may be mistaken. But remaining to tend
+him, before long the ringing cough, a single cough, is repeated again
+and again; the patient is roused, and then a new symptom is remarked;
+the sound of his voice is changed; puling, and as if the throat were
+swelled, it corresponds with the cough," etc.
+
+How important that a mother should be acquainted with the above signs
+of one of the most terrific complaints to which childhood is subject;
+for, if she only send for medical assistance during its first stage,
+the treatment will be almost invariably successful; whereas, if this
+"golden opportunity" is lost, this disease will seldom yield to the
+influence of measures, however wisely chosen or perseveringly employed.
+
+
+
+SECT. III.--OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION
+OF DISEASE.
+
+
+
+1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF
+DISORDER.--The recollection of the fact, that at the different seasons
+of
+the year some diseases are more prevalent than at other periods, will
+greatly aid a judicious parent in the early detection of the presence
+of disorder, and its kind, in her child.
+
+Thus, in the early part of the winter, what is called catarrh, viz. an
+increased secretion of mucus from the membranes of the nose, fauces,
+and air-tubes, with fever, and attended with sneezing and cough,
+thirst, lassitude, and want of appetite, is generally prevalent.
+
+As the winter advances, the air-tubes of the lungs, and the lungs
+themselves, are liable to become the seat of disorder; and those signs
+will present themselves, which have been pointed out in the previous
+section as characteristic of such attacks.
+
+In the spring, we have still the same diseases prevalent, and in
+addition, measles, scarlet fever, small-pox, and chicken pox, which
+increase in liability towards the close of this season, and with the
+first weeks of summer.
+
+In the summer, disease is less prevalent than at any other period of
+the year; but towards its middle and close, and through the whole of
+the autumnal months, bowel complaints may be expected, in the forms of
+diarrhoea, cholera, and dysentery.
+
+
+2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.--
+Without entering into this subject at large, still it may be useful to
+remark, that in some families there is a predisposition to some
+diseases, which, occurring in the first child, will, as each succeeding
+child is born, attack at the same age. Amongst other diseases of this
+class are, croup, hooping-cough, and water in the head.
+
+This observation should not only lead a mother to be alive to the
+possibility of the successional occurrence of these diseases in her
+family, and so early note their appearance, and seek medical advice,
+but should at the same time make her most anxious, on the one hand, to
+shield her child from all their exciting causes, and on the other, to
+adopt those measures which may contribute indirectly to overcome the
+constitutional predisposition to them.
+
+
+Of the scrofulous constitution, I will merely mention here, that it is
+of the greatest importance, where a predisposition to this disease
+exists in a family, that a mother should immediately attend to any
+alteration in the gait or contour of her child, and give prompt
+attention also to any complaint made of swelling about a joint,
+although it may be unattended with pain. The importance of this remark
+will be seen by contrasting the result of the following cases which
+occurred in children of the same family.
+
+
+
+Case I.
+
+
+A. B., a female child, having blue eyes, light hair, and a fair
+complexion, in the early part of the year 1838, being then two years of
+age, had an enlargement of the left knee joint. For some weeks previous
+to this time, there had been a degree of heat about the part; but as no
+pain apparently existed, it was not regarded as of any consequence, and
+nothing was done. The child, living in the neighbourhood of London, was
+afterwards placed under medical treatment. Two or three months having
+elapsed, it was brought to town, and shown to me, in consequence of a
+slight tumefaction over the lower part of the spine. This soon
+disappeared under the measures employed, and eventually the disease of
+the knee (evidently scrofulous) was arrested, so that now the case
+promises to be cured; but the joint will for ever be stiff, and the
+limb thus affected shorter than the other.
+
+
+
+Case II.
+
+
+G. B., the brother of the above, a handsome boy, with light hair, fine
+blue eyes,--indeed, very much like his little sister,--in the year
+1836, had enlargements of the glands in his neck, which were relieved
+by the treatment resorted to.
+
+In April, 1839, being then eight years old, he was observed by his
+mother to limp slightly in walking, but complained of little or no
+pain. From the caution, however, which had been given to the parent at
+the time I was consulted about the previous case, to notice at an early
+period any symptom of this nature in her children, the fact was
+immediately attended to. The affection was evidently in the hip; there
+was imperfection in the gait, and pain upon pressing over the joint. A
+blister was applied, perfect rest to the limb enjoined, and steel
+medicines ordered; and in a fortnight the motions of the joint were
+restrained more effectually by the application of strips of soap
+plaster and a bandage. In three months the child was ordered to the sea-
+side, and eventually was able to walk without the slightest limp or
+pain, and may be said to be quite well.
+
+I would not say that in the first case, if the disease had been
+discovered early, and at that time met by judicious medical treatment,
+a stiff knee and shortened limb would have been prevented, although
+this is my belief; but in reference to the latter case, I have no
+hesitation in saying, that without the disease had been early detected
+by the mother, and as promptly attended to by her, the remedial
+measures might have failed,--certainly the result would not have been
+so highly satisfactory as it was.
+
+
+
+Chap. V.
+
+
+ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
+
+
+
+The especial province of the mother is the prevention of disease, not
+its cure. To the establishment and carrying out of this principle,
+every word contained in the preceding pages has directly or indirectly
+tended.
+
+This, however, is not all. When disease attacks the child, the mother
+has then a part to perform, which it is especially important during the
+epochs of infancy and childhood should be done well. I refer to those
+duties which constitute the maternal part of the management of disease.
+
+Medical treatment, for its successful issue, is greatly dependent upon
+a careful, pains-taking, and judicious maternal superintendence. No
+medical treatment can avail at any time, if directions be only
+partially carried out, or be negligently attended to; and will most
+assuredly fail altogether, if counteracted by the erroneous prejudices
+of ignorant attendants. But to the affections of infancy and childhood,
+this remark applies with great force; since, at this period, disease is
+generally so sudden in its assaults, and rapid in its progress, that
+unless the measures prescribed are rigidly and promptly administered,
+their exhibition is soon rendered altogether fruitless.
+
+The amount of suffering, too, may be greatly lessened by the
+thoughtful and discerning attentions of the mother. The wants and
+necessities of the young child must be anticipated; the fretfulness
+produced by disease, soothed by kind and affectionate persuasion; and
+the possibility of the sick and sensitive child being exposed to harsh
+and ungentle conduct, carefully provided against.
+
+Again, not only is a firm and strict compliance with medical
+directions in the administration of remedies, of regimen, and general
+measures, necessary, but an unbiased, faithful, and full report of
+symptoms to the physician, when he visits his little patient, is of
+the first importance. An ignorant servant or nurse, unless great
+caution be exercised by the medical attendant, may, by an unintentional
+but erroneous report of symptoms, produce a very wrong impression upon
+his mind, as to the actual state of the disease. His judgment may, as a
+consequence, be biased in a wrong direction, and the result prove
+seriously injurious to the welldoing of the patient. The medical man
+cannot sit hour after hour watching symptoms; hence the great
+importance of their being faithfully reported. This can alone be done
+by the mother, or some person equally competent.
+
+There are other weighty considerations which might be adduced here,
+proving how much depends upon efficient maternal management in the time
+of sickness; but they will be severally dwelt upon, when the diseases
+with which they are more particularly connected are spoken of.
+
+
+
+Sect. 1.--ACCIDENTS AND DISEASES WHICH MAY OCCUR TO THE INFANT AT
+BIRTH, OR SOON AFTER.
+
+
+STILL-BORN.
+
+
+
+Sometimes the child comes into the world apparently dead, and, unless
+the most active exertions are made by the attendants, is lost. The
+superintendence of the means used devolves upon the medical man; but it
+would be often well if his assistants were already acquainted with the
+measures pursued under these circumstances, for they would be more
+likely to be carried into effect with promptitude and success, than
+they now frequently are. And again, the still-born child is frequently
+in this state from having been born very rapidly, and before the
+medical man can have arrived, it will be more especially useful in
+such a case, that the attendants in the lying-in-room should know how
+to proceed.
+
+The various causes producing this condition it is unnecessary to
+mention.
+
+The condition itself may exist in a greater or less degree: the infant
+may be completely stillborn, with no indication of life, except,
+perhaps, the pulsation of the cord, or a feeble action of the heart;--or
+it may make ineffectual efforts at breathing, or even cry faintly, and
+yet subsequently perish for want of strength to establish perfectly the
+process of respiration. Under all these circumstances, a good deal can
+often be effected by art. In every instance, therefore, in which we
+have not positive evidence of the child being dead, in the existence of
+putrefaction, or of such malformation as is incompatible with life, it
+is our duty to give a fair trial to the means for restoring suspended
+animation; and as long as the slightest attempt at motion of the
+respiratory organs is evinced, or the least pulsation of the heart
+continues, we have good grounds for persevering and hoping for ultimate
+success.
+
+The measures to be employed to restore a still-born child will be a
+little modified by the circumstances present.
+
+
+IF THERE IS NO PULSATION--NO BEATING IN THE CORD, when the child comes
+into the world, it may at once be separated from the mother. This is
+to be effected by first tying the navel-string with common sewing
+thread (three or four times doubled), about two inches from the body of
+the child, and again two inches from the former ligature, and then
+dividing the cord with a pair of scissors between the two. And now the
+means for its restoration are to be made use of, which are detailed
+below, viz. inflation of the lungs, and perhaps the warm bath. If, with
+the above circumstances, the child's face be livid and swollen, some
+drops of blood should previously be allowed to escape before the
+ligature is applied to that part of the navel-string which is now only
+attached to the child.
+
+
+IF THERE IS PULSATION IN THE CORD, BUT RESPIRATION IS NOT FULLY
+ESTABLISHED, it must not be divided; and as long as pulsation
+continues, and the child does not breathe perfectly and regularly, no
+ligature should be applied. The first thing to be done here, is to pass
+the finger, covered with the fold of a handkerchief or soft napkin, to
+the back of the child's mouth, to remove any mucus which might obstruct
+the passage of air into the lungs, and at the same time to tickle
+those parts, and thereby excite respiratory movements. The chest
+should then be rubbed by the hand, and a gentle shock given to the body
+by slapping the back. If these means fail, the chest and soles of the
+feet must next be rubbed with spirits, the nostrils and back of the
+throat irritated with a feather previously dipped in spirits of wine,
+and ammonia or hartshorn may be held to the nose.
+
+
+INFLATION OF THE LUNGS.--These means not having been successful, and
+the pulsation in the cord having ceased, the infant must be separated,
+and inflation of the lungs resorted to. This is to be effected gently
+and cautiously as follows:--
+
+The child, wrapped in flannel, is to be laid on its back upon a table
+placed near the fire. Its head is to be slightly extended, and the
+nostrils held between the fingers and thumb of one hand, whilst with
+the fingers of the other slight pressure is to be made upon the pit of
+the stomach, so as to prevent the air from passing into that organ. The
+lungs of the child are now to be filled with air, by the operator
+applying his own lips--with a fold of silk or muslin intervening, for
+the sake of cleanliness--to those of the child, and then simply blowing
+in its mouth, he is to propel the air from his own chest into that of
+the infant. Previously, however, to his doing this, he should make
+several deep and rapid inspirations, and, finally, a full inspiration,
+in order to obtain greater purity of air in his own lungs.
+
+When the chest of the child has been thus distended, it is to be
+compressed gently with the hand, so as to empty the lungs; and then the
+inflation, with the alternately compressing the chest, must be repeated
+again and again, until either the commencement of natural respiration
+is announced by a sneeze or deep sigh, or until after long-continued,
+steady, persevering, but unavailing, efforts to effect this object
+shall have removed all ground of hope for a successful issue.
+
+Whilst these efforts are being made, some other individual must
+endeavour to maintain or restore the warmth of the infant's body, by
+gently but constantly pressing and rubbing its limbs between his warm
+hands. And after respiration is established, the face must still be
+freely exposed to the air, whilst the warmth of the limbs and body is
+carefully sustained.
+
+It will sometimes happen--and to this circumstance the operator should
+be fully alive--that when the child begins to manifest symptoms of
+returning animation, its tongue will be drawn backwards and upwards
+against the roof of the mouth, filling up the passage to the throat,
+and preventing further inflation of the lungs. This is to be remedied
+by the introduction of the fore-finger to the upper and back part of
+the child's tongue, and gently pressing it downwards and forwards, by
+which the difficulty will be removed, and the air again passes.
+
+
+THE WARM BATH.--More reliance may be placed upon the above measure to
+restore animation, than upon the warm bath. Still this is sometimes
+useful, and therefore must not be neglected. Whilst inflation is going
+on, the bath may be got ready, then resorted to, and if unsuccessful,
+inflation may and ought again to be followed up.[FN#28] If the bath is
+useful at all, it will be so immediately upon putting the infant into
+it; respiration will be excited, followed by a cry; and if this does
+not occur at once, it would be wrong to keep the child longer in the
+bath, as it would be only losing valuable time which ought to be
+devoted to other efforts. The temperature of the bath should be about
+100 degrees; and if, upon plunging the infant into it, it fortunately
+excite the respiratory effort, it should then be taken out, rubbed with
+dry but hot flannels, and, when breathing is fully established, laid in
+a warm bed, or, what is still better, in its mother's bosom; letting
+it, however, have plenty of air.
+
+
+
+[FN#28]  We should not relinquish our endeavours at resuscitation
+under two or three hours, or even longer; and if ultimately
+successful, the state of the infant should be carefully watched for two
+or three days.
+
+
+
+INJURIES RECEIVED DURING BIRTH.
+
+If a labour be long and tedious, the head and body of the child may be
+bruised and disfigured.
+
+The shape of the head is frequently altered by the compression it has
+undergone, so that it may be elongated, and measure from the chin to
+the back of the head as much as six or seven inches. This always
+excites surprise, sometimes apprehension, in the minds of the
+attendants: there is no ground for it. It must be allowed to regain its
+natural shape without interference.
+
+Tumours or swellings upon the head are very common. They arise from
+pressure upon the part during the labour. The only treatment that is
+required, or safe, is, freedom from all pressure, and the application
+of cold lotions composed of brandy or vinegar and water. The swelling
+will gradually subside. It will be right to direct the attention of the
+medical man to this circumstance.
+
+The face may be frightfully disfigured from the above cause,
+exceedingly black, and the features distorted. Nothing is necessary
+here; in a few days the face will recover its proper appearance.
+
+
+
+RETENTION OF URINE.
+
+
+
+Occasionally an infant will not pass any urine for many hours after
+its birth. This most frequently arises from the fact of none being
+secreted. In the last case of this kind that I was called to, three
+days had elapsed since birth, and no urine had been passed; it proved
+that none had been secreted. Sometimes, however, it is the effect of
+another cause, which the use of the warm bath will be found to remove,
+which should always therefore be employed four and twenty hours after
+the birth of the infant, if it has not by that time passed any water.
+
+It now and then happens, but fortunately very rarely, that some
+physical obstruction exists. It is always important, therefore, for the
+nurse to pay attention to the above point; and it is her duty to direct
+the attention of the medical man to the subject, if anything unusual or
+unnatural be present. The same observation applies to the bowel also;
+and if twelve hours pass without any motion, the parts should be
+examined.
+
+
+
+SWELLING OF THE BREASTS.
+
+
+
+At birth, or two or three days subsequently, the breasts of the infant
+will frequently be found swollen, hard, and painful, containing a fluid
+much resembling milk. Nurses generally endeavour to squeeze this out,
+and thus do great mischief; for by this means inflammation is excited
+in the part, and sometimes abscess is the result.
+
+If the breasts are simply slightly enlarged, it is unnecessary to do
+any thing more than rub them occasionally and very gently with warm
+almond oil, and a little time will restore them to their proper size.
+
+If, however, they are inflamed, hot, painful, with a red surface, and
+unusually large, a bread and water poultice must be applied every three
+or four hours, which will generally prevent either the formation of
+matter, or any other unpleasant consequence. In a few days, under this
+treatment, they will usually subside, and be quite well.
+
+
+
+INFLAMMATION OF THE EYES.
+
+
+
+ITS IMPORTANCE.--About the second or third day after the child's birth,
+an inflammation sometimes attacks the eye, which is of considerable
+consequence. The more so, from its commencing in a way not calculated
+to excite the attention, or alarm the fears, of the mother or nurse.
+The child cannot express its sensations, and the swelling of the eye
+conceals the progress of the disease, so that serious mischief is
+frequently done before the medical man sees the patient. In the first
+place, the inflammation is not immediately noticed; and, in the second,
+the measures employed are frequently insufficient to check its
+progress: hence it causes more blindness (I refer to the lower classes
+of society more particularly) than any other inflammatory disorder that
+happens to the eye; and the number of children is very considerable,
+whose sight is partially or completely destroyed by it. The parent or
+nurse is apt to suppose, when this inflammation first appears, that it
+is merely a cold in the eye, which will go off; and the consequences
+which I have just mentioned take place, in many cases, before they are
+aware of the danger, and before the medical man is resorted to for
+assistance.
+
+I only desire, in mentioning this complaint, to inform the attendants
+of the lying-in-room of its great importance, that it may not be
+trifled with, that upon its first approach the physician may be
+informed of it, and that the treatment he directs for its cure may be
+sedulously and rigidly followed.
+
+
+SYMPTOMS.--The inflammation commonly comes on about three days after
+birth, but it may take place at a later period. It may be known by its
+commencing thus:--When the child wakes from sleep, the eyelids will be
+observed to stick together a little; their edges will be redder than
+natural, and especially at the corners; the child experiences pain from
+the access of light, and therefore shuts the eye against it. A little
+white matter will also be observed lying on the inside of the lower
+lid. After a short time, the lids swell, become red on their external
+surface, and a large quantity of matter is secreted, and constantly
+poured from the eye; the quantity of discharge increasing until it
+becomes very great.
+
+But enough has been said to point out the importance of the disease,
+and the signs by which it may be recognised at its first approach.
+
+TREATMENT.--Keeping the eye free from discharge, by the constant
+removal of the matter secreted, is what the medical attendant will
+chiefly insist upon; and without this is done, any treatment he may
+adopt will be useless; with it, there is no doubt of a successful issue
+of the case, provided his attention has only been called to it at a
+sufficiently early period.
+
+
+
+HARE-LIP.
+
+
+
+This is a blemish too well known to require a formal description. The
+questions most interesting to a mother in relation to it, are,--How is
+her child to be nourished, that is born with it? and when ought an
+operation to be performed for its removal?
+
+
+THE MODE OF FEEDING THE INFANT.--If the defect is but trifling, the
+infant will be able to suck, provided the mother's nipple is large, and
+the milk flows freely from it. If this is not the case, the difficulty
+may be obviated by using the cork nipple shield.[FN#29] I have known
+this to answer the purpose admirably, when the mother had previously
+despaired of nursing her infant, the nipple being too small for it to
+grasp.
+
+
+
+[FN#29]  See p. 41.
+
+
+
+If, however, the defect exists in a still greater degree, feeding by
+means of the spoon must be resorted to; the greatest care being
+necessary as to the quantity, quality, and preparation of the
+food.[FN#30]
+
+
+
+[FN#30]  See "Artificial Feeding," p. 34.
+
+
+
+CAUTION IN REFERENCE TO THE OPERATION.--With regard to the operation
+for the removal of this deformity, I would strongly warn parents
+against desiring its too early performance. Various considerations
+contribute to make the distressed parents anxious for this. But very
+seldom indeed--except the deformity be very great, and implicating other
+parts beside the lip--will the operation be required, or ought it to be
+resorted to, before the second year and a half of the infant's life;
+and for this very cogent reasons exist. For instance, convulsions may
+thus be induced, which often terminate fatally.
+
+The most proper age for removing this deformity by operation, is from
+that of two years and a half to four years.
+
+
+
+BLEEDING FROM THE NAVEL-STRING.
+
+
+
+Bleeding from the navel-string will sometime take place hours after it
+has been supposed to be carefully secured. This will arise, either from
+the cord being carelessly tied, or from its being unusually large at
+birth, and in a few hours shrinking so much that the ligature no
+longer sufficiently presses on the vessels. In either case, it is of
+importance that the attendants in the lying-in-room should understand
+how to manage this accident when it occurs, that it may not prove
+injurious or fatal to the child.
+
+
+THE MODE OF ARRESTING THE BLEEDING.--The clothes of the child and the
+flannel roller must be taken off;--the whole cord without delay must be
+unwrapped, and then a second ligature be applied below the original
+one, (viz. nearer to the body of the infant,) taking great care that
+it shall not cut through the cord when drawn very tight, but at the
+same time drawing it sufficiently tight to compress the vessels.
+
+The ligature should be composed of fine linen threads, three or four
+thicknesses, and not of tape or bobbin, or any substance of this
+nature, as it cannot be relied on for this purpose.
+
+
+
+ULCERATION OR IMPERFECT HEALING OF THE NAVEL.
+
+
+
+The cord separates from the navel generally some time between the
+fifth and fifteenth day from delivery, and the part usually heals
+without giving the slightest trouble.
+
+This, however, is not always the case, for sometimes a thin discharge
+will take place, which, if the part be examined, will be found to
+proceed from a small growth about the size, perhaps, of a pea, or even
+less. This must be removed by applying a little powdered alum,--or, if
+this fail, it should be once or twice slightly touched with blue-stone,
+and afterwards dressed with calamine cerate.
+
+At other times, though fortunately very rarely, excoriation of the
+navel and the parts around takes place, which quickly spreads, and
+assumes an angry and threatening character. If, however, the attention
+of the medical man is called to it early, it will always do well: until
+his directions are given, apply a nicely made bread and water poultice.
+
+
+
+BLEEDING FROM THE NAVEL.
+
+
+
+Sometimes, a day or two after the cord separates, or at the time of
+separation, bleeding takes place from the navel: fortunately, this very
+seldom occurs; indeed, it is very rarely met with; and I only mention
+it, to observe that, upon its occurrence, the point of the finger
+should be placed over the part, and pressure steadily applied until
+medical assistance is obtained.
+
+Now and then, in these cases, a growth sprouts up and bleeds. Let this
+be touched with lunar caustic, or any other astringent application, or
+let pressure be employed, still it will bleed,--not freely or in a
+stream, but there will be a constant drain from the part, and the
+infant, as a consequence, will waste, and be brought to death's door.
+Excise it, it will only make matters worse. The treatment in this case
+consists in simply winding a piece of very narrow tape round the
+growth, and then leaving it untouched. The bleeding will soon cease;
+the fungus will sprout over the upper margin of the tape; in a very
+short time it will, as it were, strangle the disease, which
+subsequently falling off, a complete cure is accomplished.
+
+
+
+JAUNDICE.
+
+
+
+It frequently happens, during the first or second week after birth,
+that the skin of the child becomes very yellow, and it has all the
+appearance of having the jaundice. This gives rise to great distress to
+the parent when she perceives it, and she becomes very anxious for the
+medical man's next visit.
+
+Now, ordinarily, it is of no consequence; commonly disappearing
+spontaneously, and requiring no medical treatment. If, however, it
+does not go off in two or three days, a tea-spoonful of castor oil
+should be given once, or oftener, if necessary.
+
+It is, of course, possible for an attack of real jaundice to occur at
+this early period, and a disease of a very serious nature will then
+have to be dealt with; but, except as a consequence of malformation (a
+very infrequent occurrence), it is not likely to arise; and therefore
+jaundice during the first and second week after delivery need not
+create alarm.
+
+
+
+Tongue-tied.
+
+
+
+FROM WHAT IT ARISES.--This arises from the bridle under the tongue being
+so short, or its attachment to the tongue extended so near the tip, as
+to interfere with the motions of the organ in sucking, and, in after
+years, in speaking. It is a rare occurrence, although nothing is more
+common than for medical men to have infants brought to them supposed to
+be labouring under the above defect.
+
+HOW ITS EXISTENCE MAY BE DETERMINED.--The best guide for a parent to
+determine whether it exist or not, is for her to watch whether the
+infant can protrude the tip of the tongue beyond the lips: if so, it
+will be able to suck a good nipple readily, and nothing need or ought
+to be done. No mother will unnecessarily expose her infant to an
+operation, which, unless very carefully performed, is not altogether
+unattended with danger; and, if she suspects any defect of this kind to
+exist, she has only to observe the circumstance mentioned above, to
+satisfy her mind upon the subject.
+
+
+
+MOLES AND MARKS ON THE SKIN, ETC.
+
+
+
+The supposed influence of the imagination of the mother, in the
+production of the above appearances in the texture of the skin of her
+infant, has been fully discussed in the author's work "Hints to
+Mothers, etc." This part of the subject is, however, foreign to the
+present inquiry, which chiefly has reference to the probable effect of
+their presence upon the health of the child.
+
+They may be divided into two classes: the brownish mole, and claret-
+stain; and small but somewhat elevated tumours, either of a dark blue,
+livid colour, or of a bright vermilion hue.
+
+
+MOLES AND STAINS.--They are of no importance, as far as the health of
+the infant is concerned. If situated in the face, however, they
+frequently cause great disfigurement, as the claret-stain, which may be
+seen sometimes to occupy nearly half the face. But they happily do not
+increase in size, remaining stationary through life; and as any
+operation that might be proposed for their removal, would only cause an
+equal, if not greater, deformity, they ought to be left alone.
+
+
+COLOURED SPOTS OR TUMOURS.--These vary in their number, size, and
+situation. The same child is sometimes born with many of them. They may
+be as small as a pea, or as large as a crown piece. They are not only
+found on the skin, but on the lips, in the mouth, etc. etc.
+
+These, also, sometimes remain stationary in their size, having no
+tendency to enlarge, unless, indeed, they are subjected to friction or
+pressure. But as they frequently require surgical aid, in which case,
+the earlier the application of remedial measures, the less severe in
+their kind, and the greater the probability of a speedy and successful
+result,--so is it always important for the mother early to obtain a
+medical opinion, that the measure of interference or non-interference
+may be decided.
+
+
+
+Sect. II. DISORDERS OF THE STOMACH AND BOWELS OF THE INFANT.
+
+
+
+INDIGESTION, FLATULENCE, VOMITING, GRIPING, AND LOOSENESS.
+
+
+
+Disorder of the stomach and bowels is one of the most fruitful sources
+of the diseases of infancy. Only prevent their derangement, and, all
+things being equal, the infant will be healthy and flourish, and need
+not the aid of physic or physicians. Experience daily proves, that a
+large proportion of the children who die in infancy are lost from
+derangement of these organs, as the primary cause.
+
+There are many causes which may give rise to these affections; many of
+them appertain to the mother's system, some to that of the infant. All
+are capable, to a great extent, of being prevented or remedied. It is,
+therefore, most important that a mother should not be ignorant or
+misinformed upon this subject. It is the prevention of these
+affections, however, that will be principally dwelt upon in this
+chapter; for let the mother ever bear in mind, and act upon the
+principle, that the prevention of disease alone belongs to her; the
+cure to the physician.
+
+For the sake of clearness and reference, these disorders will be
+spoken of as they occur:--
+
+To the infant at the breast.
+At the period of weaning.
+And to the infant brought up by hand.
+
+
+
+1. TO THE INFANT AT THE BREAST.
+
+
+
+UNHEALTHY MILK.--The infant's stomach and bowels may become deranged
+from the breast-milk becoming unwholesome.
+
+This may arise from the parent getting out of health, a circumstance
+which will be so manifest to herself, and to those more immediately
+interested in her welfare, that it is only necessary just to allude to
+it here. Suffice it to say, that there are many causes of a general
+kind to which it may owe its origin; but that the most frequent is
+undue lactation, a subject to which reference has already been made,
+and the effects both upon mother and child fully dwelt upon.[FN#31] To
+cure derangement of the bowels from this cause, a wet-nurse is the
+only remedy.
+
+
+
+[FN#31]  See page 15.
+
+
+
+Anxiety of mind in the mother will cause her milk to be unhealthy in
+its character, and deficient in quantity, giving rise to flatulence,
+griping, and sometimes even convulsions in the infant.[FN#32] A fit of
+passion in the nurse will frequently be followed by a fit of bowel
+complain in the child.[FN#33] These causes of course are temporary, and
+when removed the milk becomes a healthy and sufficient for the child as
+before.
+
+
+
+[FN#32]  See page 25.
+
+[FN#33]  See page 33.
+
+
+
+Sudden and great mental disturbance, however, will occasionally drive
+away the milk altogether, and in a few hours. A Mrs. S., aet. 21, a
+fine healthy woman, of a blonde complexion, was confined of a boy in
+October, 1836. She had a good time, and a plentiful supply of milk for
+the child, which she continued to suckle till the following January, a
+period of three months, when her milk suddenly disappeared. This
+circumstance puzzled the medical attendant, for he could not trace it
+to any physical ailment; but the milk never returned, and a wet-nurse
+became necessary. In the following spring the husband of this lady
+failed, an adversity which had been impending since the date when the
+breast-milk disappeared, upon which day the deranged state of the
+husband's affairs was made known to the wife,--a fact which at once
+explained the mysterious disappearance of the milk.
+
+Unwholesome articles of diet will affect the mother's milk, and
+derange the infant's bowels. On the 25th May, 1836, I was called to see
+an infant at the breast with diarrhoea. The remedial measures had but
+little effect so long as the infant was allowed the breast-milk; but
+this being discontinued, and arrow-root made with water only allowed,
+the complaint was quickly put a stop to. Believing that the mother's
+milk was impaired from some accidental cause which might now be passed,
+the infant was again allowed the breast. In less than four-and-twenty
+hours, however, the diarrhoea returned. The mother being a very healthy
+woman, it was suspected that some unwholesome article in her diet might
+be the cause. The regimen was accordingly carefully inquired into, when
+it appeared that porter from a neighbouring publican's had been
+substituted for their own for some little time past. This proved to be
+bad, throwing down, when left to stand a few hours, a considerable
+sediment; it was discontinued; good sound ale taken instead; the
+infant again put to the breast, upon the milk of which it flourished,
+and never had another attack.
+
+In the same way aperient medicine, taken by the mother, will act on
+the child's bowels, through the effect which it produces upon her milk.
+This, however, is not the case with all kinds of purgative medicine,
+nor does the same purgative produce a like effect upon all children. It
+is well, therefore, for a parent to notice what aperient acts thus
+through her system upon that of her child, and what does not, and when
+an aperient becomes necessary for herself, unless she desire that the
+infant's bowels be moved, to avoid the latter; if otherwise, she may
+take the former with good effect.
+
+Again; the return of the monthly periods whilst the mother is a nurse
+always affects the properties of the milk, more or less, deranging the
+stomach and bowels of the infant. It will thus frequently happen, that
+a few days before the mother is going to be unwell, the infant will
+become fretful and uneasy; its stomach will throw up the milk, and its
+motions will be frequent, watery, and greenish. And then, when the
+period is fully over, the milk will cease to purge. It is principally
+in the early months, however, that the infant seems to be affected by
+this circumstance; for it will be generally found that although the
+milk is certainly impaired by it, being less abundant and nutritious,
+still, after the third or fourth month it ceases to affect the infant.
+Is then a mother, because her monthly periods return after her
+delivery, to give up nursing? Certainly not, unless the infant's health
+is seriously affected by it; for she will generally find that, as the
+periods come round, by keeping the infant pretty much from the breast,
+during its continuance, and feeding him upon artificial food, she will
+prevent disorder of the child's health, and be able in the intervals to
+nurse her infant with advantage. It must be added, however, that a wet-
+nurse is to be resorted to rather than any risk incurred of injuring
+the child's health; and that, in every case, partial feeding will be
+necessary at a much earlier period than when a mother is not thus
+affected.
+
+The milk may also be rendered less nutritive, and diminished in
+quantity, by the mother again becoming pregnant. In this case,
+however, the parent's health will chiefly suffer, if she persevere in
+nursing; this, however, will again act prejudicially to the child. It
+will be wise, therefore, if pregnancy should occur, and the milk
+disagree with the infant, to resign the duties of a nurse, and to put
+the child upon a suitable artificial diet;--if, however, pregnancy
+should take place before the infant is six month's old, a wet-nurse
+ought to be procured.
+
+
+FROM IRREGULAR NURSING.--This is one of the most frequent sources of
+derangement of the stomach and bowels of the child. The infant that is
+constantly at the breast will always be suffering, more or less, from
+flatulence, griping, looseness of the bowels, and vomiting. This is
+caused by a sufficient interval not being allowed between the meals for
+digestion. The milk, therefore, passes on from the stomach into the
+bowels undigested, and the effects just alluded to follow. Time must
+not only be given for the proper digestion of the milk, but the stomach
+itself must be allowed a season of repose. This evil, then, must be
+avoided most carefully by the mother strictly adhering to those rules
+for nursing which have been already laid down.[FN#34]
+
+
+
+[FN#34]  See page 5.
+
+
+
+FROM TEETHING.--The bowels of the infant at the breast, as well as
+after it is weaned, are generally affected by teething. And it is
+fortunate that this is the case, for it prevents more serious
+affections. Indeed, the diarrhoea that occurs during dentition, except
+it be violent, must not be subdued; if, however, this is the case,
+attention must be paid to it. It will generally be found to be
+accompanied by a swollen gum; the freely lancing of which will
+sometimes alone put a stop to the looseness: further medical aid may,
+however, be necessary.
+
+FROM COLD AND DAMP, ETC.--Of course there are other causes besides
+these already alluded to, giving rise to bowel complaints, during this
+epoch,--causes not cognisable by the mother, however, and not mentioned
+therefore here. It is right, however, that she should be aware that
+these affections are sometimes the result simply of impressions of cold
+or damp, particularly at certain seasons of the year; in the autumn,
+for instance, when, as is well known, bowel complaints are very
+frequent. When thus produced, it is important early to seek medical
+aid, as inflammation is generally the result.
+
+
+
+2. AT THE PERIOD OF WEANING.
+
+
+
+There is great susceptibility to derangements of the stomach and
+bowels of the child at the period when weaning ordinarily takes place,
+so that great care and judgment must be exercised in effecting this
+object. Usually, however, the bowels are deranged during this process
+from one of these causes; from weaning too early, from effecting it too
+suddenly and abruptly, or from over-feeding and the use of improper and
+unsuitable food. There is another cause which also may give rise to
+diarrhoea at this time, independently of weaning, viz. the irritation
+of difficult teething.
+
+
+WEANING TOO EARLY.--The substitution of artificial food for the breast-
+milk of the mother, at a period when the digestive organs of the infant
+are too delicate for this change, is a frequent source of the
+affections now under consideration.
+
+The attempt to wean a delicate child, for instance, when only six
+months old, will inevitably be followed by disorder of the stomach and
+bowels. Unless, therefore, a mother is obliged to resort to this
+measure, from becoming pregnant, or any other unavoidable cause, if she
+consult the welfare of her child, she will not give up nursing at this
+early period. But if she should be no longer competent to suckle, and
+her infant be delicate, a wet-nurse must be obtained; for, the infant's
+bowels becoming disordered, medicine or remedies will avail little
+without healthy breast milk.
+
+The age at which weaning ought to take place must ever depend upon
+circumstances; the ninth month would not be too early for some, the
+twelfth would be for others.[FN#35]
+
+
+
+[FN#35]  See page 51.
+
+
+
+FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once
+of the breast, and substituting artificial food, however proper under
+due regulations such food may be, will invariably cause bowel
+complaints. Certain rules and regulations must be adopted to effect
+weaning safely, the details of which are given elsewhere.[FN#36]
+
+
+
+[FN#36]  See page 52.
+
+
+
+OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These
+causes are more productive of disorder of the stomach and bowels at the
+time of weaning than any yet referred to.
+
+If too large a quantity of food is given at each meal, or the meals
+are too frequently repeated, in both instances the stomach will become
+oppressed, wearied, and deranged; part of the food, perhaps, thrown up
+by vomiting, whilst the remainder, not having undergone the digestive
+process, will pass on into the bowels, irritate its delicate lining
+membrane, and produce flatulence, with griping, purging, and perhaps
+convulsions.
+
+Then, again, improper and unsuitable food will be followed by
+precisely the same effects; and unless a judicious alteration be
+quickly made, remedies will not only have no influence over the
+disease, but the cause being continued, the disease will become most
+seriously aggravated.
+
+It is, therefore, of the first importance to the well-doing of the
+child, that at this period, when the mother is about to substitute an
+artificial food for that of her own breast, she should first ascertain
+what kind of food suits the child best, and then the precise quantity
+which nature demands. Many cases might be cited, where children have
+never had a prescription written for them, simply because, these points
+having been attended to, their diet has been managed with judgment and
+care; whilst, on the other hand, others might be referred to, whose
+life has been hazarded, and all but lost, simply from injudicious
+dietetic management. Over-feeding, and improper articles of food, are
+more frequently productive, in their result, of anxious hours and
+distressing scenes to the parent, and of danger and loss of life to the
+child, than almost any other causes.
+
+
+TEETHING.--The irritation caused by difficult teething may give rise to
+diarrhoea at the period when the infant is weaned, independently
+of the weaning itself. Such disorder of the bowels, if it manifestly
+occur from this cause, is a favourable circumstance, and should not be
+interfered with, unless indeed the attack be severe and aggravated,
+when medical aid becomes necessary. Slight diarrhoea then, during
+weaning, when it is fairly traceable to the cutting of a tooth (the
+heated and inflamed state of the gum will at once point to this as the
+source of the derangement), is of no consequence, but it must not be
+mistaken for disorder arising from other causes. Lancing the gum will
+at once, then, remove the cause, and generally cure the bowel complaint.
+
+
+
+3. TO THE CHILD BROUGHT UP BY HAND.
+
+
+
+Children brought up on an artificial diet are very liable to
+indigestion and bowel complaints; indeed none more so: and it is from
+these affections that so many of these infants perish. When, then, it
+is absolutely necessary from untoward circumstances to have recourse to
+this mode of nourishing the child, the rules and regulations laid down
+in the section on "Artificial Feeding" must be most strictly followed
+out, if the parent would hope to avoid disease and rear her
+child.[FN#37] And if these affections should at any time unfortunately
+manifest themselves, the mother ought carefully and diligently to
+examine whether the plan of feeding pursued is in every particular
+correct, particularly bearing in mind that the two causes most
+frequently productive of disorder in the child are overfeeding and the
+exhibition of unsuitable food--the two grand errors of the nursery.
+These results, however, have already been sufficiently dwelt upon as
+likely to take place at weaning, and they may of course occur to a
+child who is brought up on an artificial diet at any period.
+
+
+
+[FN#37]  See page 34.
+
+
+
+MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.
+
+
+
+As must have been already seen, the maternal treatment chiefly
+consists in the removal of the cause of the disorder; medicine may
+occasionally be exhibited by the mother, but its use in her hands must
+be very limited indeed.
+
+Unfortunately the general resource and only remedy of most mothers in
+affections of the stomach and bowels is an aperient, and a combination
+containing calomel is the one too frequently selected. The primary
+cause of the disorder is undetected, and consequently no measures taken
+for its removal, but purgative powder after purgative powder is given,
+the evil being supposed to rest in the bowels alone, and that such
+means must eventually get rid of it. The mother is not aware all this
+time that the real source of the derangement is probably in the diet
+itself; that there is some error here, and that unless this is
+corrected, the remedies must be worse than useless. The consequence of
+such a plan of proceeding is usually very sad; a confirmed and
+obstinate diarrhoea but too commonly ensues, and the infant is
+sometimes reduced to the last extremity.
+
+The removal of the cause of the disorder, then, in a large number of
+instances of derangement of the stomach and bowels, if effected early,
+will cure the disease, and without further remedy. But it will be
+asked, by what method is this cause to be detected? In this way. In all
+human probability the primary cause of the disorder is connected with
+the diet; this is the case in ninety-nine instances out of a hundred.
+Well, then, is the sick child at the breast? If so, ascertain whether
+the breast-milk is healthy and wholesome, or whether any circumstances
+exist which have rendered it otherwise? If nothing faulty is found
+here, the next question would naturally be, whether the rules and
+regulations laid down for suckling have been strictly adhered to? Or,
+whether the infant is sufficiently old to render it at all probable
+that a tooth may be irritating the gum?
+
+Perhaps the child is being weaned; well, is there any error here? Is
+the change being attempted too early? or too suddenly and abruptly? If
+this is not the case, then, has the child been overfed, or is the food
+given of the proper description?
+
+Is the child being brought up by hand? Then, there is every reason to
+suspect, either that the quality of the food given is not the most
+suitable, or, that the quantity exhibited is too great; in fact, that
+the rules laid down for "artificial feeding" have not been strictly
+acted upon.
+
+By a mode of investigation like this, any defect or error in the
+dietetic management of the infant producing the disorder will be easily
+detected by a careful mother; and its correction alone will, in very
+many instances, be all that is necessary to remove the symptoms.
+
+For example, if flatulence and griping, followed by diarrhoea, occur
+to an infant at the breast; if at the same time it becomes pale, its
+flesh flabby, its disposition fretful, always crying until it is put to
+the breast, the nipple of which it grasps eagerly, sucking eagerly, yet
+never satisfied, for its hunger continues, it is not nourished; if,
+too, the more it sucks, the more the stomach and bowels are deranged,
+the more it vomits and is purged; depend upon it the cause of all the
+evil will be found to be unwholesome milk. No medicine will avail any
+thing here; the cause must be removed; the best medicine, and the only
+remedy, is a breast of healthy milk. And if this is not procured
+early, there will be great danger of a diarrhoea setting in, which may
+probably prove fatal to the child.
+
+Again; if there is simply vomiting of the breast-milk almost
+immediately after the child has been suckled, the milk coming up pure
+and unchanged, and discharged without any apparent effort, and the
+moment after the child is cheerful and happy, this will be found to
+depend upon repletion, and not upon unwholesome milk; in fact, the
+stomach has received too much. This must be prevented in future, not by
+giving medicine, but simply by removing the infant from the nipple
+immediately it ceases to draw strongly, the moment it begins to dally
+with the breast.
+
+Again; if flatulence and griping occur to the child brought up by
+handy this derangement will generally be found to result from
+overfeeding: abstinence and diminution of the quantity of the food will
+generally be all that is necessary here. It will be well, however, for
+the mother in this case, and she may do it with the utmost safety, to
+unload the bowels of their indigestible contents by the exhibition of a
+tea-spoonful of castor oil. A dose or two of this medicine will
+effectually clear them out, without increasing the irritation, or
+weakening the child, whilst it will in most instances altogether remove
+the symptoms. If the flatulence, however, should continue, four or five
+grains of magnesia may be mixed with the last meal at night, and a
+little warm water thrown up into the bowel as an injection the next
+morning.
+
+Diarrhoea occurring in a child brought up by hand, if it be not the
+result of overfeeding, will very frequently be found to arise from
+unsuitable diet, the food given not being of a kind suited to the
+infant's stomach; for what will agree with one child often disagrees
+with another. Alteration of diet will sometimes alone suffice in these
+cases to cure, if this alteration is only made early enough, before any
+considerable irritation of the stomach and bowels has been induced.
+Thin arrow-root made with water (prepared very carefully, or the child
+will refuse it,) should be given for five or six days; the warm bath
+used every night for the same period, a new flannel bandage rolled
+round the body, and the child cautiously protected from a damp
+atmosphere. The arrow-root, upon the cessation of the diarrhoea, may
+have cows' milk added to it, if milk is not found to disagree: when
+this is the case, chicken or weak mutton broth, free from fat, or beef-
+tea, thickened with farinaceous food, with a little salt added, are the
+best substitutes. Should not the diarrhoea yield to the foregoing
+measures, and that readily, medical aid ought to be sought. Diarrhoea
+is very frequent from the time of weaning to the third year of age, and
+certainly in its effects forms so important a disease, that, unless in
+the slight form noticed above, a mother is not justified in attempting
+its relief.
+
+In conclusion, I would observe, that I do not think a mother justified
+in attempting more than what has been laid down here for her guidance.
+It is believed that the few and plain common-sense directions given, if
+followed, will do much to prevent disease, and even to relieve it in
+its milder forms; they will not, however, cure disease itself when
+really established: and again I would repeat, let the mother recollect
+that to prevent disease is her province--to cure it, is the physician's.
+
+
+
+Sect. III.--COSTIVENESS.
+
+
+
+1. IN INFANCY.
+
+
+
+The principle to act upon in the management of the infant's bowels is
+this,--that they should be kept free, and by the mildest and least
+irritating means.
+
+If therefore they become accidentally confined (less than two stools
+in the four-and-twenty hours), and the infant is suckled, the mother
+may ascertain whether an aperient taken by herself will render her milk
+of a sufficiently purgative quality to act upon the bowels of her
+child. This is the mildest mode of all.
+
+If, however, this does not answer, or is not practicable from the
+child being fed artificially, then the mildest aperient medicines must
+be chosen to accomplish this purpose. The kind of medicine to be
+selected, and the doses in which to be adminstered, will be found in
+the section on "Aperient Medicine."[FN#39]
+
+
+
+[FN#39]  See page 97.
+
+
+
+If, however, the bowels of the infant are disposed to be habitually
+confined, it should be ascertained whether this may not be dependent
+upon its diet. The same food that agrees perfectly well with one child
+will frequently cause costiveness in another. An intelligent and
+observing mother will soon discover whether this is the source of the
+mischief, or not. Boiled milk, for instance, will invariably cause
+confined bowels in some children; the same result will follow sago
+boiled in beef tea, with others; whilst, on the other hand, the bowels
+may frequently be brought into regular order, and their confined state
+overcome, by changing the food to Leman's tops and bottoms steeped in
+hot water, and a small quantity of unboiled milk added; or prepared
+barley, mixed in warm water and unboiled milk, will have the same
+effect.
+
+Sometimes children are constitutionally costive, that is, the bowels
+are relieved every third or fourth day, not oftener, and yet perfect
+health is enjoyed. This occasionally will happen in large families, all
+the children, though perfectly healthy and robust, being similarly
+affected. When such is found by a mother to be really the habit of her
+child, it would be very unwise, because injurious to its health, to
+attempt by purgatives to obtain more frequent relief. At the same time
+it will be prudent and necessary for her to watch that the regular time
+is not exceeded. This condition seldom occurs to the very young infant.
+
+
+
+2. IN CHILDHOOD.
+
+
+
+Children of sound health, who are judiciously fed, and have sufficient
+exercise, very seldom need aperient medicine. Errors in diet, a want of
+proper attention to the state of the skin, insufficiency of air and
+exercise, in fine, a neglect of those general principles which have
+been laid down for the management of health, and upon the observance of
+which the due and healthy performance of every function of the body
+depends, are the sources of bowel derangements, and particularly, at
+this age, of costiveness.
+
+I feel assured, however, that some children are more troubled with
+costiveness than others, from the simple but important circumstance of
+their not being early taught the habit of relieving the bowels daily,
+and at a certain hour. There is a natural tendency to this periodical
+relief of the system, and it exists at the earliest age. And if the
+mother only cause this habit to be fairly established in infancy, she
+will do much towards promoting regularity of her child's bowels
+throughout life. The recollection of this fact, and the mother's acting
+upon it, is of the greatest importance to the future health and comfort
+of her children.
+
+If the bowels are accidentally confined at this age, castor oil is
+certainly the best aperient that can be given: it acts mildly but
+efficiently, clearing out the bowels without irritating them. The dose
+must be regulated by the age, as also by the effect that aperients
+generally have upon the individual. Great care must in future be taken
+to avoid the cause or accidental circumstance which produced the
+irregularity.
+
+When the bowels are habitually costive, much care and judgment is
+necessary for their relief and future management. Fortunately this
+condition is very rare in youth. The activity and exposure to the air,
+usual at this period of life, render purgatives unnecessary, unless,
+indeed (as just mentioned), some error in diet, or some unusual
+circumstance, render them accidentally confined. Should, however, the
+foregoing state exist, medicine alone will avail little; there are
+certain general measures which must also be acted up to, and most
+strictly, if the end is to be accomplished. They consist, principally,
+in an observance of great regularity with respect to the time of taking
+food, its quality, quantity, and due mastication; regular and
+sufficient exercise, horse exercise being particularly serviceable; the
+shower-bath, or daily ablution; early rising (the indulgence in the
+habit of lying in bed always predisposing to constipation); and,
+lastly, the patient habituating himself to evacuate the bowels at a
+certain hour of the day. After breakfast appears to be the time when
+the bowels are more disposed to act than at any other part of the day;
+this is the time, then, that should be chosen.
+
+All these points must be sedulously observed, and upon the principles
+laid down in the various chapters upon these subjects, if habitual
+costiveness is expected to be overcome.
+
+
+
+SECT. IV.--WORMS.
+
+
+
+NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF
+MISCHIEF.--Almost all diseases have been, at one time or other,
+attributed to the generation of worms in the intestines. And at the
+present day it is not at all an uncommon occurrence for medical men to
+be called in to prescribe for children, to whom the strongest purgative
+quack medicines have been previously exhibited by parents, for the
+removal of symptoms which, upon investigation, are found in no way
+connected with or produced by worms. The results of such errors are
+always, more or less, mischievous, and sometimes of so serious a nature
+as to lay the foundation of disease which ultimately proves fatal. This
+observation, moreover, it behoves a mother carefully to regard, since
+the symptoms, popularly supposed to indicate the existence of worms,
+are so deceptive, (and none more so than that which is usually so much
+depended upon--the picking of the nose,) that it may be positively
+asserted to be impossible for an unprofessional person to form a
+correct and sound opinion in any of these cases.
+
+It was at one time imagined, and the idea is still popularly current,
+that worms were the occasion of a troublesome and lingering species of
+fever, which was therefore designated worm-fever. This notion is now
+entirely exploded; for if worms be present under such circumstances, it
+is a mere accidental complication; the fever referred to being
+generally of a remitting character, and neither caused by or causing
+the generation of worms. The symptoms of this fever, however, have led
+and continue to lead very many astray. This is not surprising, since
+they so closely resemble those which characterise the presence of
+worms, that an unprofessional person is almost sure to be misled by
+them. Amongst other symptoms, there is the picking of the nose and
+lips, offensive breath, occasional vomiting, deranged bowels, pain in
+the head and belly, with a tumid and swollen condition of the latter, a
+short dry cough, wasting of the flesh, etc.; symptoms continually
+attendant upon the disorder now under consideration. These cases have
+hitherto been perpetually looked upon by mothers as worm-cases, and
+after having been treated by them as such, by the use of the popular
+worm-powders of the day, have, as perpetually, presented themselves to
+the physician greatly and grievously aggravated by such injudicious
+treatment. It is folly, at any time, for an unprofessional person to
+prescribe for a case where worms are actually known to exist: surely
+where there is any doubt upon the latter point it must be greater folly
+still.
+
+The infant at the breast is seldom, if ever, the subject of this
+disorder, whilst an artificial diet, or bringing up by hand,
+predisposes to it. Worms most frequently occur, however, during
+childhood; much more so at this epoch than in adult age. They do not
+invariably occasion indisposition, for they are now and then passed
+without pain or distress by children who are in the enjoyment of
+perfect health, and in whom previously there was not the slightest
+suspicion of their existence. The idea, formerly so prevalent, of their
+being attended with danger, is without foundation; for unless the case
+be mismanaged, they rarely give rise to serious consequences.
+
+
+HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not
+very easy to explain; at the same time it is very certain that some
+known circumstances favour their production.
+
+If the general health of a child be enfeebled, particularly if the
+child be strumous, such a condition will favour the generation of these
+animals. The protracted use of unwholesome and innutritious articles of
+food, or a deficient supply of salt (the most necessary stimulant to
+the digestive organs), or other condiments, predisposes to worms. This
+observation is strikingly illustrated by an occurrence which formerly
+took place in Holland, where an ancient law existed forbidding salt in
+the bread of certain criminals; they were in consequence horribly
+infested with worms, and quickly died. Sugar, too, whilst a necessary
+condiment for the food of children, if given in the form of sweetmeats,
+and their indulgence, long persisted in, may so enfeeble the organs of
+digestion as to cause worms. And, lastly, (though many other causes
+might be referred to) the injudicious means occasionally employed to
+effect the removal of these animals, by the debility produced in the
+intestinal canal, favours not only their re-appearance but their
+increase.
+
+These, then, are so many causes which may occasion worms in the child,
+and of course the best and most effectual method to prevent their
+production is their avoidance. A mother, therefore, should at all times
+be careful in the regulation of the diet and general management of her
+child's habits and health, even if no stronger obligations existed than
+the dread of this disorder; and she must be more than ordinarily
+vigilant on this head, when the slightest disposition to such disorder
+is manifested. Again; she must not forget that the symptoms so commonly
+ascribed as characteristic of worms are much more frequently caused by
+other diseases; that at no time, therefore, is she justified in giving
+worm powders, or strong doses of medicine for such symptoms; for if
+they do exist, their use is always attended with risk, and if they do
+not, the debility which they occasion in the stomach and bowels may
+itself become the source of their production.
+
+
+
+Sect. V. SCARLET FEVER.
+
+
+
+There are several varieties of this disease; it will be more
+perspicuous, however, for our purpose to speak of it under the two
+following forms:--
+
+
+Mild scarlet fever;
+
+Scarlet fever, with sore throat.
+
+
+
+MILD SCARLET FEVER.--In this form of the disease there is only the rash
+with fever.
+
+
+SYMPTOMS.--The anticipating symptoms are those of fever: they precede
+the eruption. The degree of fever, however, is variable; for the
+symptoms are sometimes so moderate as scarcely to attract attention,
+slight and irregular shivering, nausea, perhaps vomiting, thirst, and
+heat of skin; whilst, at others, there is considerable constitutional
+disturbance, indicated by pungent heat of skin, flushing of the face,
+suffusion of the eyes, pain in the head, great anxiety and
+restlessness, and occasionally slight delirium.
+
+These symptoms are followed on the second day (in the majority of
+instances) by the rash. This first appears in numerous specks or minute
+patches of a vivid red colour on the face, neck, and chest. In about
+four-and-twenty hours it becomes gradually diffused over the whole
+trunk. On the following day (the third) it extends to the upper and
+lower extremities, so that at this period the whole surface of the body
+is of a bright red colour, hot and dry. The efflorescence, too, is not
+always confined to the skin, but occasionally tinges the inside of the
+lips, cheeks, palate, throat, nostrils, and even the internal surface
+of the eyelids. Sometimes the efflorescence is continuous and
+universal; but more generally on the trunk of the body there are
+intervals of a natural hue between the patches, with papulous dots
+scattered over them, the colour being most deep on the loins and
+neighbouring parts, at the flexure of the joints, and upon those parts
+of the body which are subjected to pressure. It is also generally most
+vivid in the evening, gradually becoming paler towards morning.
+
+The eruption is at its height on the fourth day;--it begins to decline
+on the fifth, when the interstices widen, and the florid hue fades;--on
+the sixth, the rash is very indistinct; and on the eighth day it is
+wholly gone.
+
+The various symptoms with which the eruption is accompanied, gradually
+disappear with the efflorescence; but the tongue still remains morbidly
+red and clean. The peeling off of the cuticle (the outer layer of the
+skin), which begins about the end of the fifth day on the parts on
+which the eruption first appeared, proceeds; so that about the eighth
+or ninth, portions of the cuticle are thrown off, the thickest and
+largest being those detached from the skin of the hands and feet.
+
+
+
+SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the
+fever and rash are accompanied with inflammation of the throat.
+
+
+SYMPTOMS.--The symptoms are more severe than in the mild form of this
+disease, and, in the majority of instances, the inflammation of the
+throat appears with the eruption, and goes through its progress of
+increase and decline with the cutaneous eruption. Sometimes, however,
+it precedes the fever; whilst at others it does not appear until the
+rash is at its height.
+
+It is generally in the course of the second day that the child
+complains of considerable stiffness in the muscles of the neck,
+extending to the lower jaw, and under the ears;--of a roughness of the
+throat, and difficulty in swallowing;--and some degree of hoarseness
+will be noticed: all so many indications that the throat is affected.
+Very shortly, an increased secretion of the mucus of these parts
+occurs, and, collecting about the tonsils, aggravates the child's
+sufferings, from the frequent and ineffectual efforts made to expel it.
+If the inflammatory action be more severe, exudations of lymph will
+also be poured out, and intermingling with the mucus, greatly augment
+the difficulty of swallowing. At this time the lining membrane of the
+mouth, as also the tongue, assume a florid red colour; the red points
+of the latter becoming much elongated.
+
+The febrile symptoms are severe from the first; amongst others, there
+will be headach, sometimes accompanied by slight delirium, nausea,
+intense heat of skin, languor, and considerable inquietude and anxiety:
+and as the inflammation approaches its height, the fever increases, the
+pulse rises, the breathing becomes oppressed, the skin becomes more
+pungently hot and dry, and the thirst urgent. All these symptoms being
+increased towards evening, when the febrile restlessness is often
+succeeded by delirium.
+
+The rash is seldom perceptible before the third day, and then comes
+out in irregular patches on various parts of the body, particularly
+about the elbows and wrists; thus differing as to the time and mode of
+its appearance, from the mild form of the disease. It frequently
+recedes, or entirely vanishes, the day after it first comes out, and
+then reappears partially, and at uncertain times. This generally
+protracts the duration of the disorder, without, however, producing any
+perceptible change in the other symptoms. On the fifth or sixth day of
+the disease, the fever and inflammation of the throat begin to abate;
+at the same time the rash declines, and the peeling off of the cuticle
+soon follows.
+
+This is the ordinary course of scarlet fever with sore throat; but in
+many cases the symptoms run still higher, and the disease is alarmingly
+dangerous from its commencement. In some instances, there is an acrid
+discharge from the nostrils or ears, often accompanied with deafness;
+as also enlargements of the glands in the neck, followed by the
+formation of abscesses in their immediate neighbourhood. It is
+unnecessary, however, to follow out the symptoms of scarlet fever more
+fully; as all that has been attempted here, has been so to sketch out
+the more prominent symptoms of this disease, that the directions upon
+the parental management may be readily comprehended: they will be very
+brief, but a strict attention thereto will be found all-important to
+the well-doing and comfort of the child.
+
+
+CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be
+seldom difficult to distinguish this disease from other acute eruptive
+disorders. The one to which it bears the greatest resemblance is the
+measles; but from this it is readily distinguished by the absence of
+the cough, the inflamed and watery eye, running at the nose and
+sneezing, which are the predominant symptoms in the early stage of the
+measles; but which do not usually attend on scarlet fever--at least, in
+any high degree. In measles, also, there is an absence of that
+restlessness, anxiety, and depression of spirits, by which scarlet
+fever is peculiarly distinguished.--The rash, too, in measles, does not
+appear till two or three days later than that of scarlet fever. It also
+differs in its characters. In scarlet fever, the eruption consists of
+innumerable minute dots or points, diffused in patches with uneven
+edges of various sizes and forms; and gives to those portions of the
+skin on which it appears, a diffused bright red colour. In measles, the
+rash comes out in irregular semi-lunar or crescentic shaped patches,
+distinctly elevated; the spots being of a deeper red in the centre
+than in the circumference, and leaving intervening spaces in which the
+skin retains its natural pale colour.
+
+
+MATERNAL MANAGEMENT.--The chief points to which the parent's attention
+must be directed, irrespective of a strict attention to the more
+immediate medical treatment directed by the physician, are the
+following:--
+
+
+VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must
+be kept in bed from the first accession of the fever. He must not be
+loaded, however, as was formerly the practice, with a quantity of
+bed-clothes, in order to encourage the fever and increase the quantity
+of eruption. A moderate quantity of clothing is all that is required,
+adapted to the heat of skin and feelings of the patient.
+
+The bed-room must be kept cool and well ventilated. This is of
+importance in the mildest cases; but in the more severe forms of this
+disease, in which the throat is much affected, the constant and free
+admission of pure air will have a most decided and marked good effect
+upon the symptoms. The air should be renewed, therefore, from time to
+time. The linen, both of the bed and the patient, should also be
+frequently changed daily,--if practicable.
+
+However mild the symptoms of this disease may be at the commencement,
+the child must always be carefully and vigilantly watched by the
+parent, as inflammation of some internal organ may suddenly arise
+(which is generally indicated by symptoms sufficiently obvious), and
+thus change an apparently mild form of this disease into one of an
+alarming character.
+
+
+COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole
+surface of the body should be sponged with cold water, or with vinegar
+and water. The heat is by this means rapidly abstracted, and the child
+refreshed; and this may again and again be resorted to, as the heat
+again returns. By this application alone, "the pulse has been
+diminished in frequency, the thirst has abated, the tongue has become
+moist, a general free per spiration has broken forth, the skin has
+become soft and cool, and the eyes have brightened; and these
+indications of relief have been speedily followed by a calm and
+refreshing sleep. In all these respects, the condition of the patient
+presented a complete contrast to that which preceded the cold washing;
+and his languor was exchanged for a considerable share of vigour. The
+morbid heat, it is true, when thus removed, is liable to return, and
+with it the distressing symptoms; but a repetition of the remedy is
+followed by the same beneficial effects as at first."[FN#40]
+
+
+
+[FN#40]  Bateman's Practical Synopsis of Cutaneous Diseases.
+
+
+
+GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected,
+gargles are sometimes ordered; but the pain and inconvenience which
+their employment gives rise to, frequently precludes their use: and
+children seldom understand how to employ them, even if the state of the
+throat permitted it. Under these circumstances, the inhalation of the
+steam of hot water, or hot vinegar and water, may be substituted, and
+with decided benefit. Mudge's inhaler is a good contrivance to effect
+this.
+
+When the throat is found by the mother to be early affected, an
+immediate application to the medical adviser is especially important.
+For, if he be called upon to treat this form of scarlet fever at its
+very commencement, by judicious treatment, the duration and violence of
+the disease may be both shortened and greatly mitigated.
+
+
+REGIMEN.--Cooling drinks, as plain water, toast and water, barley water
+flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may
+all be resorted to in their turn. The child may also be allowed
+oranges, grapes, or lemons sweetened with sugar, particularly when the
+mouth is foul and dry; but care must be taken that neither the pulp nor
+the stones are swallowed. These will both refresh and feed the patient
+as much as is necessary until the decline of the disease. The parent
+must strictly forbid the attendants in the sick chamber giving, at this
+period, any heating or stimulating fluid, as also animal food; and this
+injunction must be strictly regarded, even in the mildest form of the
+disease.
+
+When the child is convalescent, mild nourishment will be required,
+such as arrow-root, tapioca, chicken or mutton broth, beef tea,
+jellies, and roasted apples; and by and by a mutton chop. Wine is
+seldom necessary, except under circumstances of unusual debility after
+a protracted illness, when its moderate use tends much to assist the
+convalescence; but, if given unadvisedly, there will be great hazard of
+exciting internal inflammatory disease.
+
+Relapses are sometimes caused by the child getting about too soon, and
+by indulgence of the appetite, particularly for food: a proper degree
+of restraint, therefore, must be placed upon the child by the parent,
+who cannot too strictly carry out the directions of the medical
+attendant upon the diet and regimen during this period.
+
+Great attention must still be paid to the state of the bowels, and,
+indeed, to all the secretions and excretions.
+
+
+PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote
+the more easy separation of the cuticle from the surface of the body, a
+warm or tepid bath may be usefully employed at the close of the
+disease. It will, moreover, greatly contribute to the comfort of the
+child, and induce a more healthy condition of the skin. Occasionally
+the cuticle of the whole hand and fingers will peel off unbroken, when
+it will resemble precisely a glove in shape.
+
+As is the case in all fevers, more or less, so particularly after
+scarlet fever, there is a great tendency to the falling off of the
+hair. It will be always well, therefore, to shave the head at this
+time, and exhibit daily a tepid shower bath, as early as the strength
+of the child will permit.
+
+
+CAUTIONS, ETC.--The contagious character of this disease requires the
+separation of the invalid from the rest of the family; and, when it is
+practicable, the children should be removed to a distance. This measure
+is imperatively called for, when the form of the disease is very severe
+in its character.
+
+Great caution must also be exercised, after the convalescence of the
+patient, that the other children are not brought into too early contact
+with him: for infection may be thus produced, though several weeks may
+have elapsed from the period of the peeling off of the skin.
+
+The period at which the disease shows itself after the exposure of an
+individual to sources of contagion, is exceedingly various. One child
+will be seized within a few hours; another, not for some days; and now
+and then (though rarely), five or six weeks have intervened between the
+period of exposure and the manifestation of the disease.
+
+When this disease is rife in a family, it will frequently affect the
+individuals composing it very differently. Some escape altogether;--
+others have the mild form of the complaint;--others the severe;--and,
+again, the attendant in the sick room may be attacked with the sore
+throat and fever only, both of which may subside without any appearance
+of a rash.
+
+In conclusion, this disease is a complaint of infancy and childhood,
+rather than of adult age; generally affects the same individual but
+once during his life; and, though examples of a second attack have
+occurred, such a circumstance is extremely rare.
+
+
+
+Sect. VI.--MEASLES.
+
+
+
+Measles consists of a fever, in which the mucous lining of the air-
+passages is principally affected, and which, after about three days'
+duration, results in an eruption of a red rash over the surface.
+
+It depends upon a specific contagion;--occurs most frequently during
+childhood and adolescence, though no age is exempt from it;--and affects
+the system but once; a peculiarity to which an exception is very rare,
+proved by the few instances of the kind which have been recorded.
+
+The period at which the disease manifests itself after infection is
+various,--generally about the ninth day; it has, however, been delayed
+until the sixteenth.
+
+
+DESCRIPTION OF THE DISEASE.--The child infected will be observed not to
+be as well as usual, less active, and out of spirits; his appetite
+will fail, and his sleep be restless and disturbed. It will soon be
+evident that he has apparently taken a cold in his head, and that this
+is accompanied by fever. His voice will be hoarse; there will be
+frequent cough, headach, sneezing, running from the nose and eyes,--the
+eyelids being somewhat swollen, and the eyes inflamed;--the skin will be
+hot and dry, and he will complain of occasional chilliness. In the
+course of the next two or three days, these symptoms will increase in
+severity, and perhaps be accompanied by oppression at the chest and
+hurried breathing, and towards evening by slight delirium.
+
+On the fourth day, the rash will appear, but the symptoms will be
+little, if at all, mitigated; indeed, they will sometimes increase in
+severity. The eruption will first be perceived about the head and face,
+in the form of small red spots, at first distinct from each other, but
+soon coalescing, and forming patches of an irregular crescent-like or
+semilunar figure, of a dull red colour, and slightly elevated (giving a
+sensation of hardness to the finger), while portions of the skin
+intervening between them will retain their natural appearance. At this
+time the eruption will also be found on the inside of the mouth and
+throat, and the hoarseness will consequently increase.
+
+On the fifth day, the rash usually covers the whole surface of the
+body, with the exception of the legs and feet; and is now very vivid on
+the face, which is not unfrequently so much swelled, especially the
+eyelids, that the eyes are quite closed up, as in small-pox. On the
+sixth day, it is fully out on the extremities, and is beginning to fade
+on the face. On the eighth, it is fading from all parts; on the ninth,
+it is hardly perceptible; and has entirely disappeared on the tenth day
+from the commencement of the fever, or the sixth from its own first
+appearance. As the fading proceeds, the spots drop off in the form of
+little branny scales, which are sometimes, from their minuteness,
+scarcely perceptible. They leave a slight discolouration on the skin,
+with considerable itching.
+
+Such is the ordinary course of this disease; occasionally, however,
+deviations are met with.
+
+
+CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under
+the description given of Scarlet Fever, are noticed several signs by
+which that disease may be distinguished from measles: to these may be
+added the absence of cough, of water flowing from the eyes, and of
+redness and swelling of the eyelids as in measles. Again, in measles,
+the eruption is more pointed, of a crimson instead of a scarlet hue,
+and does not appear until two days later than in scarlet fever.
+
+In small-pox, the fever abates as soon as the eruption makes its
+appearance. In scarlet fever, this is by no means the case; and as
+little so in measles: the vomiting, indeed, subsides; but the cough,
+fever, and headach grow more violent; and the difficulty of breathing,
+weakness of the eyes, and, indeed, all the catarrhal symptoms, remain
+without any abatement till the eruption has all but completed its
+course.
+
+
+MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a
+mild, and by no means dangerous, disease: it is sometimes, however,
+accompanied or immediately followed by symptoms of a very serious
+character, and which, it is to be feared, in many instances, owe their
+origin to the carelessness of the attendants in the sick chamber. A
+mother's superintendence, therefore, is much required at this time to
+insure a careful attention to the medical directions, as also to those
+general points of management upon which the well-doing of her child
+much depend, of which the following are the most important:--
+
+
+VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from
+the onset of the attack. He must have so much clothing only as will
+secure his comfort, avoiding equally too much heat or exposure to cold.
+To these points the parent's attention must be particularly directed.
+It is the practice with some nurses, in the belief that a breath of
+cool air is most pernicious, to keep the child constantly enveloped in
+a smothering heap of bed-clothes, with curtains closely drawn, and the
+room well heated by fire, by which means the fever and all its
+concomitant dangers are greatly augmented. It is equally a popular
+error (and yet by many it is still held and acted upon) to suppose that
+because in small-pox exposure to cold is useful, that therefore it
+must be of equal advantage in measles. It cannot be too generally known
+that the nature of the fevers accompanying the two diseases are widely
+different, and that the adoption of this error is productive of the
+most serious consequences; for it would most likely produce in measles
+inflammation of the lungs, which, in truth, is commonly the result of
+carelessness upon this point.
+
+The bed-room should be large and airy; free from currents of cold, but
+well ventilated, and not hot. The room, also, must be darkened, on
+account of the tenderness of the eyes; all noise excluded, and mental
+excitement or irritation carefully avoided.
+
+
+REGIMEN.--Little or no food must be allowed, and whatever is taken must
+be of the simplest kind, and in a liquid form. Mild mucilaginous
+drinks, and warm, may be given liberally; as barley-water, or thin
+gruel, etc.
+
+
+SPONGING, ETC.--The face, chest, arms, and hands should be sponged
+occasionally with vinegar and warm water (one fourth and three
+fourths). This will be productive of great comfort to the little
+patient; it removes the heat, dryness, and itching of the skin, which
+are often very distressing; and is especially useful at night in
+relieving wakefulness. If the cough be troublesome, it will be useful
+for the child to breathe the steam of warm water; not through an
+inhaler, but over a large basin, with the head covered with flannel
+large enough to hang over its edges. By this means the tender and
+inflamed eyes will at the same time derive advantage from the soothing
+effect of the vapour.
+
+
+CAUTIONS.--Whenever the measles is known to be prevalent in a
+neighbourhood, and a child manifests symptoms of cold in the head and
+fever, it should at once be a reason for carefulness on the part of the
+parent. The diet should be light, cooling, and scanty; and the child
+should be carefully kept in doors.
+
+It has been before remarked, that in its ordinary course measles is a
+disease unaccompanied with danger, but that the mildest form may be
+speedily converted into the most dangerous. That is to say, a sudden
+change may lake place in the symptoms, arising out of circumstances
+which could not have been foreseen, and therefore unavoidable; or may
+be produced by improper management on the part of the nurse, such as
+the giving of stimulants, by too much heat, or by exposure to cold. Now
+it is for the parent early to notice any change which may occur from
+the first source, and by her watchfulness to guard against the
+possibility of its arising from either of the second.
+
+In reference to the first, if the child should complain at any period
+of the disease of severe headach, with piercing pain through the
+temples, and if this is accompanied by wandering of mind, great
+increase of suffusion of the eyes, as also intolerance of light, the
+immediate attention of the medical man is demanded. So, if towards the
+dose of the eruption, that is, from the seventh to the ninth day, the
+breathing should again become hurried (this symptom is very generally
+present during the height of the eruption, and is not necessarily
+connected with disease of the lungs), with pain and oppression felt at
+the chest, the cough becoming hacking and incessant, etc. (all symptoms
+cognizable by the mother, and indicative of inflammation of the
+lungs), no time must be lost in seeking medical aid.
+
+With regard to the last cause (improper management), it may be well,
+in reference to it, to observe, that it sometimes happens that the rash
+comes out imperfectly, or, having appeared properly, suddenly
+retrocedes and disappears; and that under such circumstances the nurse
+will almost certainly, if not well watched, give the child "a good
+dose of sulphur in diluted spirit, or a glass of punch containing
+saffron," which are considered specifics for bringing out the eruption.
+Nothing can be more injurious than such remedies, for generally the
+disappearance of the rash will be dependent upon the existence of some
+internal inflammation, or of too high a fever; for the removal of
+which the medical man ought to be instantly applied to. Sometimes,
+however, it may be fairly traced to a careless exposure to cold: under
+such circumstances the child should be instantly, and without
+hesitation, put into the warm bath.
+
+Measles are frequently followed by cough, and deranged bowels; and
+there is always great susceptibility about the child for some time. On
+this account he should be carefully screened from a cold or damp
+atmosphere; the diet should be carefully regulated; and flannel worn
+next to the skin. If the cough should continue, it must not be
+neglected on the supposition that it will wear off; for it demands the
+skilful and careful attention of the medical man.
+
+In conclusion, it may be remarked that very frequently during infancy
+and childhood, and particularly during the period of teething,
+eruptions very similar in appearance to this disease occur; unless,
+however, they are accompanied by the specific fever, and run the
+regular course, they may at once be decided upon as not being the
+measles.
+
+
+
+Sect. VII.--SMALL-POX.
+
+
+
+This disease, the most dreaded of all eruptive fevers, is not so
+commonly met with in the present day as formerly; thanks to that
+Providence which led to the discovery of Jenner. But although its
+occurrence is not so frequent, it still does occasionally present
+itself; when it will assume either a mild or severe form. If it attack
+a child that has not previously been vaccinated, it is called natural
+small-pox; and the chances are that the disorder will be severe in
+character;--if, on the other hand, it occur in the vaccinated, the
+disease will generally be much modified in its symptoms; the attack
+will be mild, and without danger.
+
+
+NATURAL SMALL-POX.--The infection of small-pox having been received
+into the system of a child that has not been vaccinated, fourteen days
+(on an average) will transpire before the commencement of the febrile
+symptoms, or eruptive fever. A distinct rigor or shivering fit then
+takes place, accompanied by pain in the back or in the stomach, with
+sickness, giddiness, or headach; as also great drowsiness. And if an
+infant be the subject of the disease, a convulsive fit will sometimes
+take place, or several in succession.
+
+At the end of eight-and-forty hours from the occurrence of the rigor
+(in the majority of cases), the eruption comes out; and shows itself
+first on the face and neck in minute flea-bite spots. In the course of
+the next four-and-twenty hours in some cases, and in others not until
+the expiration of two or three days, it completely covers the body; not
+being confined exclusively to the skin, but frequently extending to the
+mouth and throat, and even to the external membrane of the eye.
+
+In the course of two or three days from their first appearance the
+little pimples, increasing in size, will be found to contain a thin
+transparent fluid, to pit or become depressed in their centre, and the
+skin in the spaces between them will be found red. On the seventh or
+eighth day from the commencement of the fever, the fluid contained in
+the pimples will be no longer transparent, but opaque; and they will
+consequently appear white, or of a light straw colour. Each pimple or
+pock will be no longer depressed in its centre, but will become raised
+and pointed, being more fully distended by the increased quantity of
+fluid within; and the skin around each pock will now be of a bright
+crimson. The head, face, hands, and wherever else the eruption shows
+itself, gradually swell; and the eyelids are often so much distended as
+to close the eyes and produce temporary blindness. There will always at
+this time be some degree of fever present, and its amount will vary
+with the circumstances of each individual ease. The skin too will be
+very tender, so much so sometimes as greatly to harass and distress the
+child.
+
+On the eleventh day the swelling and inflam of the skin of the body
+and face subside; the pimples upon these parts dry up and form scabs,
+which fall off about the fourteenth or fifteenth day. Those on the
+hands, as they come out later, commonly continue a short time longer.
+The eruption leaves behind, in some cases, the peculiar marks of the
+disease; and in others merely discoloured spots, which disappear in the
+progress of a short time.
+
+The natural small-pox is sometimes much more severe in its character
+than the foregoing, and what is called confluent small-pox is said to
+exist. This form will be marked by great constitutional disturbance,
+and the eruption coming out earlier than in the milder form; instead of
+being distinct, that is, each pimple standing distinct and separate
+one from the other, they will coalesce, and appear flat and doughy, not
+prominent: they will more particularly run into each other on the face,
+where they will form one continuous bag, which soon becoming a sore,
+will discharge copiously.
+
+
+SMALL-POX IN THE VACCINATED.--When small-pox occurs to those that have
+been formerly vaccinated, the disease, in almost every instance, is
+much altered or modified in its character. Indeed in children, in whom
+of course vaccination has been but comparatively lately performed,
+small-pox when it occurs will, in the majority of cases, be so mild
+that the real nature of the disease will be with difficulty determined:
+so mild, that again and again has a parent been heard to exclaim,
+"Surely these few scattered pimples cannot be the small-pox!" If,
+however, as the pimples progress, they are narrowly watched, and are
+seen to become depressed in their centre; if there has been the
+precursory rigor, etc.; and if the source of the disorder can be traced
+to some case of undoubted small-pox, the child in fact having been
+exposed to contagion, no doubt ought to exist in reference to the
+nature of such a case, however slight may be the character of the
+disease.
+
+The usual progress, however, of small-pox modified by vaccination is
+as follows. The first stage is the same usually as in the natural form
+of the disease. As soon, however, as the eruption appears, the
+modifying power of the vaccination becomes apparent. The eruption will
+be found to be generally both less in quantity and more limited in its
+extent; or if even it should come out profusely, and cover a large
+extent of the surface of the body, still the controuling power of the
+vaccination will immediately show itself after its appearance,--first,
+in the complete subsidence of all the febrile symptoms which will now
+take place; and, secondly, in reference to the eruption, part of which
+will die away at once, and the remainder will by the fifth day be
+filled with the opaque yellowish fluid, then dry up, becoming hard and
+horny, and falling off will leave a mottled red appearance of the skin,
+and now and then slight pitting.
+
+Such is the usual progress of the disease: subsequent to vaccination,
+it is a mild and tractable disorder. It is right, however, to mention
+that small-pox has occurred even to the vaccinated in almost as severe
+a form as the confluent natural small-pox, and running its regular
+course unaltered or unmodified. Such instances, however, are extremely
+rare, and form the exceptions to the general rule; for "no reasonable
+doubt can be entertained, from the abundance of facts now before the
+world, that such modification is the law of the animal economy, and
+that the regular or natural progress is the exception."
+
+
+MATERNAL MANAGEMENT.--The grand principle in the treatment of small-pox
+is to moderate and keep under the fever; and however the plans adopted
+by different medical men may vary in particular points to accomplish
+this purpose, they uniformly make this principle their chief aim and
+object. To carry out this intention, however, the medical adviser is
+greatly dependent upon the aid and assistance of a judicious parent,
+and without this it is impossible to hope for a successful issue to
+the case. A clear knowledge, therefore, of those points of general
+management in which in fact a great part of the above principle
+consists (few and simple as these directions are), it must be
+all-important for the mother to be acquainted with: for the rest,
+she must and ought to look to the medical man.
+
+In the more rare and severe form of this disease, viz. the confluent
+small-pox, although in some instances it runs the same course as the
+milder form, the distinct or natural small-pox, still, usually, the
+constitutional symptoms are much more aggravated, and the medical and
+general treatment required will so much depend upon the character of
+the individual case, that we do not think it well to notice it here.
+
+
+BED AND BED-ROOM.--It will not be necessary at first for the child to
+be confined to his bed, but generally about the third or fourth day he
+will gladly resort to it; and if he does not, it will be prudent to
+keep him there. He must not, however, be loaded with bed-clothes, but
+lightly covered; and the bed and body linen should be changed daily, if
+possible.
+
+The bed-room should be capacious and well ventilated; fresh air
+frequently admitted; and if the season of the year permit, and there is
+no dampness of atmosphere, a window should be constantly open during
+the day: it is also desirable to keep the chamber darkened in all
+cases, as there is always a tendency to inflammation of the eyes.
+
+If these directions are not regarded, and a great heat of the
+apartment is permitted, with abundance of bed-clothes heaped upon the
+child, the hot bath is used, and hot and stimulating regimen given
+(upon the old and erroneous notion of bringing out the eruption), the
+mildest case will inevitably be converted into one of the most severe
+and dangerous. Facts have abundantly shown that such measures
+invariably prove the most effectual means of exasperating the disease,
+and endangering life.
+
+
+REGIMEN.--This must be most sparing. Cold water may be given whenever
+the child asks for it. Lemonade should form the common drink during the
+fever; and gruel, barley-water, and roasted apples are all else that is
+required during this period, and not until the disease is going off
+must any change be made in the diet.
+
+The above period having arrived, mildly nutritious food should be
+given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or
+sago; to be followed in a few days by the wing of a chicken or a mutton
+chop; remembering always, that solid animal food must at first be given
+cautiously and sparingly. Wine or stimulants must be positively
+forbidden; unless, indeed, ordered by the medical man, for
+circumstances may arise which render them advisable.
+
+The state of the bowels must be carefully attended to at this time.
+
+
+THE ERUPTION.--In the natural and mild form of this disorder the
+pustules generally break from the sixth to the eighth day; dry scabs
+succeed; and in about nine or ten days the parts heal perfectly,
+requiring no treatment. In the more aggravated cases, however, in which
+the pustules are very numerous, running one into the other, and,
+bursting, discharge greatly, the whole surface of the body should be
+frequently and liberally dusted over with dried flour, or, what is
+better, starch powder. The sores in this instance are always tedious in
+healing, and followed by the well-known pits or marks: these arise from
+a loss of substance in the true skin, and occur more particularly on
+the face, from the great vascularity of this part causing the pustules
+to be more numerous here than elsewhere. It is a popular error to
+suppose that by wearing masks of fine linen or cambric illined with
+particular ointments, these scars or pits may be prevented: it is
+impossible to prevent them; and any local application, except a little
+cold cream or oil of almonds applied to the scabs when they harden,
+will prove more injurious than useful. The child's hands, however,
+should always be muffled to prevent its scratching or breaking the
+sores, for otherwise he will not be kept from thus attempting to allay
+the excessive itching which they occasion.
+
+The hair should be closely cut at an early period of the disease, and
+so kept throughout its continuance. This will contribute very much to
+the comfort of the child, by preventing the hair becoming matted
+together with the discharge from the pustules when they break, which
+gives rise to great pain and irritation. In the confluent and worst
+forms of this disease, this measure it is particularly necessary to
+attend to, as also to the application of cold lotions to the head when
+hot and dry (with other remedial means), as there is always a tendency
+in these cases to the formation of abscesses, the healing of which is
+troublesome and attended with difficulty.
+
+
+CAUTIONS, ETC.--It has already been stated that a free ventilation of
+the bed-room is necessary to the well-doing of the patient. This
+measure, however, must not be confined to the chamber of the sick, but
+acted upon through the whole house.
+
+In conjunction with ventilation, fumigations by means of aromatic
+substances kept slowly burning should be resorted to. A solution of the
+chloride of lime too, a most powerful disinfectant, should be used to
+purify the different apartments. This is best accomplished by steeping
+in the solution pieces of linen, and hanging them about the rooms, as
+also frequently and freely sprinkling the walls themselves; and as soon
+as the invalid is removed, the chamber should be white-washed, the
+various articles of furniture well scoured with soap and water, and the
+room be well and freely ventilated prior to its being again occupied.
+
+The clothes of the patient and the bed linen should be frequently
+removed, and when taken away immediately immersed in boiling water, and
+whilst hung up in the open air sprinkled occasionally with a weak
+solution of the chloride of lime. If these directions are not observed,
+and the clothes are closely wrapped up, they will retain and give out
+the disease to others at a great distance of time.
+
+Again: as the contagious property of smallpox hangs about the child as
+long as any scabs remain (which indeed may be said to retain the poison
+in its concentrated form), a parent must be most careful that the
+invalid is not too early brought in contact with the healthy members of
+the family.
+
+An observance of these precautions is imperatively demanded; they not
+only protect the healthy, but aid the infected.
+
+
+
+Sect. VIII.--HOOPING-COUGH.
+
+
+
+My chief inducement to notice the above disorder arises out of the
+well-known fact, that there is no complaint of childhood more
+frequently subjected to quackery and mismanagement than is this.
+Indeed, there are few maladies against which a greater array and
+variety of means have been recommended, than against hooping-cough.
+
+I suppose from the circumstance of the simple and mild form of the
+complaint being so tractable (provided it remain such) that the
+simplest and mildest measures effect its cure, parents are tempted to
+undertake its management in the more severe and complicated forms; and
+the result is but too often the establishment of disease dangerous to
+life, and sometimes fatal to it.
+
+But although most imprudent for a parent to assume the office of the
+physician, her aid is essentially necessary in carrying out the
+measures prescribed. By her watchfulness and care the duration of the
+disease may not only be abridged, but, what is of much greater
+importance, a more serious and aggravated form of disease prevented;
+for although hooping-cough in itself is not a dangerous disorder, still
+the most simple and slight case, if neglected or mismanaged, may
+quickly be converted into one both complicated and dangerous.
+
+
+DESCRIPTION OF THE DISEASE.--Hooping-cough commences with the symptoms
+of a common cold, which is more or less frequent. These symptoms
+continue from five days to fifteen; at the end of which time the cough
+changes its character, and assumes the convulsive form, which
+distinguishes the disorder. It occurs in paroxysms, varying with the
+severity of the disease from five to six in the twenty-four hours to
+one every ten or fifteen minutes; being generally more severe and
+frequent during the night than in the day.
+
+During a paroxysm the expirations are made with such violence, and
+repeated in such quick succession, that the child cannot breathe, and
+seems in danger of suffocation. The face and neck become swollen and
+purple from suffusion; and the eyes prominent, injected, arid full of
+tears. The little one, with a forewarning of the attack, which it
+dreads, falls on his knees, or clings closely to any thing near him.
+The paroxysm terminates with one or two long inspirations, attended
+with that peculiar noise, or "whoop," from which the disease has
+derived its designation.
+
+Sometimes the fit of coughing is interrupted for a minute or two, so
+that a little rest is obtained; and is then succeeded by another fit
+of coughing and another hoop, until after a succession of these actions
+the paroxysm terminates by vomiting, or a discharge of mucus from the
+lungs, or both.
+
+The disease having continued at its height for two or three weeks, it
+begins naturally to decline; the paroxysms become less frequent and
+violent; the expectoration increases; the cough loses its
+characteristic hoop, and gradually wears away altogether; until at
+length, in two or three months from the first onset of the disease, the
+child is restored to perfect health. Sometimes, however, particularly
+in the autumn, and at other seasons on the occurrence of easterly
+winds, the paroxysms of cough will return,--it will assume its
+spasmodic character, and be accompanied with the "whoop," after a
+month, or even two or three months, of perfect and apparent recovery.
+Errors in diet will sometimes alone have a similar effect.
+
+It is a disease which usually occurs during childhood, rarely affects
+the same individual twice, and is seldom seen in the very young infant.
+
+In reference to the probable result of the disease, when it occurs in
+its mild and simple form in a healthy child, the termination is usually
+favourable; but it may at first assume this form, and afterwards become
+complicated, and consequently more or less dangerous, owing to
+injudicious management, or to various influences over which the mother
+has no control.
+
+It generally appears as an epidemic, and at those seasons when
+catarrhal complaints are most prevalent, and affects many or several at
+the same time. Isolated cases, however, frequently occur, which seem to
+prove the disease to be infectious. Some persons deny that it is so.
+Mothers and nurses, however, who have not had the disease, will often
+contract it from the child under such circumstances, and thus it will
+be quickly propagated through the family. The nursing mother will
+occasionally take it from the infant at her breast. The child who has
+caught it from others whilst at school, and brought home in
+consequence, will communicate it readily to his brothers and sisters,
+although the disease did not exist previously in the family or
+neighbourhood, and was brought from a distant part of the country. All
+these instances are surely proofs of its infectious character, and
+point out the necessity of caution whenever hooping-cough may present
+itself in a family, and the necessity which exists for an early removal
+of the unaffected children from the sphere of its contagious influence.
+The infectious property diminishes as the disease declines.
+
+
+MATERNAL MANAGEMENT.--In the mild and simple form of this disease the
+medical treatment is one rather of prevention than cure, and the
+maternal management consists in assisting, by watchfulness and care,
+the fulfilment of this design.
+
+In these slighter cases little more is required of the mother during
+the Jirst stage of the disorder (that is, before the cough becomes
+spasmodic) than attention to diet, regimen, and the excretions. The
+diet should be farinaceous, with milk, or as may be otherwise directed.
+The child must be confined to a mild equable temperature; in fact, to
+his apartment. It is a popular error to suppose that at this time
+change of air is beneficial to the disease: at a later period it
+certainly is so, but now injurious, and attended with great risk.
+Should the weather be cold, the little patient must be warmly clad, and
+flannel worn next the skin; this latter precaution should always be
+taken in the winter, spring, and autumn. Purgatives and other medicines
+will be required, and ordered by the medical attendant; the chief
+attention, however, of the parent must be directed to any change she
+may observe in the symptoms, breathing, etc.; she must be all on the
+alert to notice the first signs of local inflammation. Of this,
+however, we shall speak presently.
+
+During the early part of the second stage, that is, when the cough
+becomes spasmodic, assuming its peculiar sound, the same diet and
+regimen must be continued, and the same watchfulness observed, lest
+any inflammatory symptoms manifest themselves.
+
+Under the foregoing treatment the disease generally runs its course
+without any untoward event, and the child recovers perfectly.
+Sometimes, however, although the patient is quite well, and the disease
+on the decline, the cough still continues. In these cases, and at this
+time, it is that change of air often proves so very serviceable. The
+sea-side is preferable, if the season of the year permit; and salt-
+water bathing, commencing with the warm or tepid bath, and passing
+gradually to the cold-bath (if no complication forbid it), will also
+prove certainly and rapidly remedial.
+
+Crying, mental irritation, or opposition, frequently bring on a fit;
+and even the sight of another in a paroxysm will induce it in those
+affected by the disease. Running or other active exercise will
+generally cause the fits to be more severe. Young children, too, must
+be carefully watched at night, and be raised up by the nurse as soon as
+the fit is threatened. These hints the mother should bear in mind.
+
+So much for the simple form of the disease, and that in which it most
+frequently and commonly presents itself to our notice: a mild disease;
+and, if carefully managed and watched over, certainly not a dangerous
+one.
+
+Of what, then, is a parent to be afraid, or against what is she to
+guard? Lest other disease insidiously come on, and advance to an
+irremediable degree, masked by the cough, without attracting her
+attention. This is the great source of danger in hooping-cough. The
+physician, in a case of simple hooping-cough, is not in daily
+attendance upon his patient, and therefore not present to notice the
+commencement or first symptoms of those diseases which so frequently
+occur at this time, and the successful treatment of which will mainly
+depend upon their early detection, and the decision with which they are
+treated. When you hear of a child or several children in a family dying
+of hooping-cough, it is not this disease which proves fatal; but death
+is caused by some disease of lungs or brain, which has been super-added
+to the hooping-cough. The progress of hooping-cough, then, must be
+closely attended to by the parent, even in the most favourable cases.
+
+The most frequent complication with hooping-cough is inflammation of
+the air-tubes of the lungs. This is extremely frequent during spring
+and winter, especially in the months of February, March, and April,
+owing to the prevalence of easterly winds at this season. It is not my
+intention to detail the symptoms of this affection, only to point out
+those which will enable a parent to recognise its approach. A parent
+then may take warning, and fear the approach of mischief, when she
+observes the fits of coughing become more frequent and more distressing
+to the child, and the breathing hurried in the intervals of the
+paroxysm; when any exertion or speaking causes increased difficulty of
+breathing or panting; when the expectoration becomes less abundant, and
+difficult to get up; when there is no longer, or at all events less
+frequent, vomiting after the cough, and more or less febrile symptoms
+present.
+
+If the lungs themselves are attacked by inflammation, most of the
+symptoms already pointed out will occur; the cough will be frequent,
+in short paroxysms; the vomiting will not take place; the breathing
+will be very quick and hurried; and as the disease advances the hoop
+will cease.
+
+If hooping-cough attack a child whilst teething, or from six months to
+two or three years of age, it is very common for the brain to suffer,
+and convulsions and water on the head to occur, particularly if the
+latter disease prevails in the family. Whenever the paroxysm of cough
+is increased in violence, the characteristic hoop disappearing, and the
+face becomes very livid; the hands clenched, and the thumbs drawn into
+the palms; the head hot, and marked fits of drowsiness and languor; and
+the child, during sleep, screaming out, or grinding its teeth,--
+something wrong about the head ought to be anticipated. Of the
+treatment we have here nothing to say, except that the gums must be
+carefully examined, and scarified if they require it, and the
+temperature of the head reduced by cold sponging, or the application of
+a bag of ice when necessary. The chief duty, however, of the parent is
+to be alive to these symptoms, and early to detect the incipient
+mischief, that by a prompt application of efficient means the accession
+of so formidable a malady may be prevented.
+
+To specific remedies for this disease it is scarcely necessary to
+allude, after what has been advanced, except by way of warning. In the
+simple form of the complaint such medicines are superfluous, or rather
+some of them, from their violent properties, most dangerous; in the
+complicated forms of the disease they are inadmissible.
+
+The indiscriminate use of purgatives, also, a parent should avoid.
+Bowel affections are not an infrequent attendant upon hooping-cough,
+and always aggravate the primary disorder.
+
+Of external applications all that need be said is this, that if they
+are not violently stimulating they do no harm; if, however, they
+contain tartar emetic, in addition to their doing no good to the
+disease, they cause unnecessary suffering to the patient, and are
+sometimes productive of dangerous and even fatal sores.
+
+
+
+Sect. IX.--CROUP.
+
+
+
+This disease is one of the most formidable of childhood; sudden
+(generally) in its attacks, most active in its progress, and if not
+met by a prompt and decided treatment, fatal in its termination. Hence
+the paramount importance of parents being acquainted with the signs
+which indicate its approach, that medical aid may be secured at the
+very onset of the disease. Upon this early application of suitable
+remedies every thing depends.
+
+
+SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either
+preceded for two or three days by the symptoms of a common cold,
+accompanied with hoarseness and a rough cough; or it may attack with
+the most alarming suddenness, during the night for instance, although
+the child had been merry and well the previous evening.
+
+Hoarseness, however, is the premonitory and important symptom of
+croup; for although it is not every hoarseness that is followed by
+this formidable malady, still this symptom rarely attends a common cold
+in young children, and therefore always deserves when present the
+serious attention of the mother, particularly if accompanied by a rough
+cough.
+
+The symptoms or signs of the approach of this disease have been ably
+and graphically depicted by the late Dr. Cheyne,
+
+"In the approach of an attack of croup, which almost always takes
+place in the evening, probably of a day during which the child has been
+exposed to the weather, and often after catarrhal symptoms have existed
+for several days, he may be observed to be excited; in variable
+spirits; more ready than usual to laugh or to cry; a little flushed;
+occasionally coughing, the sound of the cough being rough, like that
+which attends the catarrhal stage of the measles. More generally,
+however, the patient has been for some time in bed and asleep before
+the nature of the disease with which he is threatened is apparent;
+then, perhaps without awaking, he gives a very unusual cough, well
+known to any one who has witnessed an attack of the croup: it rings as
+if the child had coughed through a brazen trumpet; it is truly a tussis
+clangosa; it penetrates the walls and floors of the apartment, and
+startles the experienced mother--'Oh, I am afraid our child is taking
+the croup!' She runs to the nursery, finds her child sleeping softly,
+and hopes she may be mistaken. But remaining to tend him, before long
+the ringing cough, a single cough, is repeated again and again. The
+patient is roused, and then a new symptom is remarked: the sound of his
+voice is changed; puling, and as if the throat were swelled, it
+corresponds with the cough; the cough is succeeded by a sonorous
+inspiration, not unlike the kink in hooping-cough--a crowing noise, not
+so shrill, but similar to the sound emitted by a chicken in the pip
+(which in some parts of Scotland is called the roup, hence probably the
+word croup); the breathing, hitherto inaudible and natural, now becomes
+audible, and a little slower than common, as if the breath were forced
+through a narrow tube; and this is more remarkable as the disease
+advances," etc. etc.
+
+It is unnecessary for me to add to the foregoing picture.
+
+
+MATERNAL MANAGEMENT.--Having early obtained medical assistance attend
+with the strictest obedience to the directions given. And in this
+disease, more than any other, it is particularly important that the
+mother should give her personal superintendence; for the activity of
+the progress of the disease leaves no time to retrieve errors or atone
+for neglect. The practitioner may be prompt and decided in the measures
+he prescribes, but they will avail little, unless they are as promptly
+and decidedly acted upon.
+
+The parent will have her reward; for, if timely aid has been afforded,
+and adequate means used, the event will be almost invariably favourable.
+
+ITS PREVENTION.--Croup, when it has once attacked a child, is very
+liable to recur at any period before the thirteenth or fourteenth year
+of age. It may even do so several times, and after intervals of various
+duration. It is very desirable, therefore, that a parent should be
+acquainted with the means of prevention.
+
+They consist simply in the following measures:--The careful protection
+of the child from cold or damp weather, particularly the north-east
+winds of spring following heavy rains. Croup is most prevalent in those
+seasons which are cold and moist, or when the alternations of
+temperature are sudden and remarkable. If the residence of the child is
+favourable to the production of croup, (for instance, near a large body
+of water, or in low damp spots,) he should, if possible, be removed to
+a healthier situation. Sponging or the shower-bath, with cold water and
+bay-salt, with considerable friction in drying the body, should be
+commenced in summer, and employed every morning upon the child's rising
+from bed. The clothing should be warm in the winter and spring, the
+neck always covered, and flannel worn next the skin throughout the
+year; but hot rooms, and much clothing when in bed, must be avoided.
+The diet must be light and nourishing; no beer or stimulant given; and
+the state of the bowels must be carefully watched.
+
+The above precautions are of course particularly necessary to enforce
+immediately after a recovery from an attack, for there is a great
+tendency to relapse. If the attack takes place during the winter or
+spring months, the invalid must be kept, until milder weather, in the
+house, and in a room of an equable and moderately warm temperature. If
+in the summer, change of air, as soon as it can be safely effected,
+will be found very useful.
+
+
+
+Sect. X.--WATER IN THE HEAD.
+
+
+
+Water in the head is a formidable disease, and not unfrequent in its
+occurrence. It is often destructive to life, and the instances are
+numerous in which it has appeared again and again in the same family,
+carrying off one child after another, as they have successively arrived
+at the same age.
+
+But notwithstanding its frequency and fearful character, a mother may
+do much to overcome a constitutional predisposition to this disease,
+and thus prevent its appearance; as also she may assist greatly in
+promoting its cure, when it does occur. Hence it is most important that
+a mother should be acquainted with the measures of prevention; and
+also, when it does manifest itself, that clear and accurate information
+should be possessed, upon what may be said to constitute the maternal
+management of the disorder.
+
+
+ITS PREVENTION.--Whenever there is found to exist in a family a
+predisposition to this malady, one or more children having suffered
+from it, a mother must make up her mind, and in the strictest sense of
+the word, to be the guardian of the health of any child she may
+subsequently give birth to. And not only during the period of infancy,
+but during that of childhood also, must she continue the same careful
+and vigilant superintendence.
+
+The infant must be brought up on the breast, and if the mother is not
+of a decidedly healthy and robust constitution, she must obtain a
+wet-nurse possessing such qualifications. The breast-milk, and nothing
+beside, must form the nutriment of the child for at least nine months;
+and if the infant is delicate or strumous, it will be prudent to
+continue it even six months longer. When the period arrives for the
+substitution of artificial food, it must be carefully selected; it must
+be appropriate to the advancing age of the child; nutritious and
+unirritating. Good air and daily exercise, and the bath or sponging,
+are of much importance; in short, all those general measures which have
+a tendency to promote and maintain the tone and general health of the
+system, and thus induce a vigorous and healthy constitution, and to
+which reference has been so fully made in the first chapter of this
+work, must be strictly regarded and followed out by the parent.
+
+The condition of the digestive organs must be the mother's especial
+care. Costiveness must be guarded against; and if at any time the
+secretions from the bowels indicate the presence of derangement, the
+medical attendant must be applied to, that appropriate remedies may
+without delay be exhibited. Their disordered condition is frequently
+productive of head-disease. Again and again have I clearly traced the
+origin of the complaint, of which I am now writing, as more
+immediately resulting from disorder of the digestive apparatus. To a
+child thus predisposed to water in the head, the healthy state of these
+organs is not only of first consequence, but any deviation from health
+to be dreaded, to be immediately attended to, and guarded against in
+future; and, as there is a great liability to these attacks at the time
+of weaning, the above remarks especially apply to that period, when due
+attention must be particularly paid to the plan of diet adopted.
+
+During teething the mother must be especially watchful, for it is at
+this time that the disease so commonly appears; the irritation produced
+by this process being a frequent exciting cause. Every thing,
+therefore, that will tend to allay excitement of the system, must be
+strictly enforced, as well as all causes avoided, which would produce
+derangement of the stomach and bowels. The head should be kept cool.
+For this purpose it must be sponged night and morning throughout the
+whole period of teething; a horse-hair pillow used in the cot; and
+nothing but a light straw hat should be worn, except in winter, The
+diet should be moderate, and carefully regulated after leaving the
+breast, and the child should be as much as possible in the open air.
+The mouth must be occasionally examined, and if the gums become hot or
+distended, they must be scarified or lanced, as may be advised. If the
+parent finds at any time an unusual heat about the head, the medical
+man must be at once consulted; or if there is watchfulness or
+indisposition to sleep at the proper periods, or frequent startings in
+the sleep, irritability of temper, and much crying, danger should be
+apprehended, and prompt and judicious means employed.
+
+Eruptions about the head, or sores behind the ears, discharging more
+or less, will sometimes make their appearance just before the cutting
+of a tooth, and disappear after it is cut; or it will sometimes happen
+that, if not interfered with, they will continue throughout the whole
+period of dentition. Great caution should always be exercised in
+reference to these eruptions in all children; and when there is a
+predisposition to water in the head, it is dangerous to interfere with
+them at all, except they run to such an extent as to become very
+troublesome. The sudden healing of these cutaneous affections has again
+and again been followed by head-disease. They are unsightly in the
+eyes of a parent, but it must be recollected that they render the
+situation of such children much more safe; and when teething is
+completed they will generally disappear spontaneously; or, if they
+should not, they will readily do so by proper medical treatment. I have
+no doubt that many a child's life has been saved by the appearance and
+continuance of these eruptions; and so sensible are medical men of the
+benefit derived from them, that in individuals in whom they do not
+appear, and in whose family there exists a predisposition to the
+disease now under our consideration, an issue or seton, in the arm or
+neck, has sometimes been made, and had a remarkable influence in
+warding off this affection. Dr. Cheyne refers to the circumstance of
+ten children in one family having died of this disease; the eleventh,
+for whom this measure was employed, having been preserved.
+
+Stimulants, throughout the whole period of infancy and childhood, and
+of every description, must be prohibited. Children nursed by drunken
+parents, and who have indulged in the use of spirituous liquors during
+suckling, are never healthy; are the frequent subjects of convulsions,
+and many of them die eventually of water in the head. The practice of
+administering spirits to the child itself; a habit unfortunately not
+very uncommon among the lower classes; produces a similar result.
+Narcotics may operate in a like manner: they derange the whole system
+when persevered in, particularly affecting the brain; promote disease;
+and sometimes give rise to the one in question. This remark should be
+borne in mind by the mother, as Godfrey's Cordial and other
+preparations of opium are too often kept in the nursery, and secretly
+given by unprincipled nurses to quiet a restless and sick child.
+
+All causes of mental excitement should be carefully avoided, and
+particularly the too early or excessive exercise of the intellectual
+faculties. If the child be endowed with a precocious intellect, the
+parent must restrain rather than encourage its exercise. Nothing is
+more likely to light up this disease in a constitution predisposed to
+it, than a premature exertion of the brain itself.
+
+
+MATERNAL MANAGEMENT OF THE DISEASE.--The early detection of this
+disease is of great importance. The chances that the medical treatment
+will terminate successfully much depend upon the early and prompt
+application of remedial means. The reason why these cases have so often
+terminated fatally has arisen from the physician being consulted when
+irremediable mischief had already taken place. It would be difficult,
+however, to point out the signs of its approach in all its forms (for
+this disease does not always commence in the same way, sometimes with
+fever, etc.), still it most frequently occurs preceded by certain
+striking and well-marked symptoms; and whenever the following are
+noticed by the parent apprehensive of mischief, she should at once send
+for her medical adviser:--watchfulness, or starting from sleep with a
+cry of alarm; prolonged screaming without any obvious cause; moaning
+and drowsiness; rolling the head from side to side on the nurse's
+arm, or thrusting it back against the pillow; knitting the brows and
+aversion from light, with heat of head, and constant carrying the
+little hand up to it; half closing the eyelids, and frequent vomiting.
+
+The chief and principal point in the maternal management (for it
+includes every other) is promptly and faithfully to administer the
+remedies prescribed by the medical attendant. A vigilant maternal
+superintendence is more necessary in this than almost any other
+disease; and it is highly desirable, therefore, that the mother should
+have a day and night nurse--individuals upon whom she can depend. A
+careful notice of symptoms and changes in the patient, in the intervals
+of the medical man's visits, and a true and faithful report to him upon
+his return, are of essential importance. A sleepy nurse will neglect
+the application of the most important remedies, and necessarily give an
+unfaithful report of symptoms; hours the most valuable to the child's
+well-doing are thus lost, and the chances of saving its life worse than
+problematical.
+
+The temperature of the room should be kept rather cool than warm, and
+the bed-clothes only sufficient to preserve the natural heat of the
+body. Strong light must be excluded. Great quiet should be observed.
+Freedom from all excitement of the senses, and irritation of the
+temper, should be carefully avoided: this is particularly necessary
+where the child is naturally of a quick and sensitive disposition.
+
+All the excretions must be put aside for the inspection of the
+physician, but not kept in the sick chamber, which must be well aired,
+and perfectly free from closeness. The regimen must be only such as is
+ordered, and any departure therefrom will be attended with mischievous
+consequences. During the early periods of the disease, all that is
+required are cooling diluents, given frequently, and in small
+quantities at a time; and upon approaching convalescence great
+carefulness must be paid to the amount of nourishment allowed, lest the
+disease be rekindled: strict compliance, therefore, to medical
+directions must be given.
+
+A very useful and indeed powerful remedy prescribed in this disease,
+is sometimes rendered utterly useless from a want of a persevering and
+also proper mode of applying it, viz. cold applications to the head.
+It is to be effected either by means of cloths kept constantly wet with
+cold water, or evaporating lotions; or by means of a bladder containing
+pounded ice mixed with water. If the two former are employed they
+require frequent renewal, or they become dry, hot, and more injurious
+than useful; and whichever is used, it must be kept in constant contact
+with the forehead, temples, and upper part of the head. Here is another
+error; they are seldom used large enough, and only partially cover
+these parts. With the further view of keeping the head cool, and
+preventing the accumulation of heat, a flat horse-hair pillow should be
+employed, and the head and shoulders somewhat raised.
+
+Perseverance in the measures prescribed, even when the case appears
+beyond all hope, must ever be the rule of conduct. Recovery, even in
+the most advanced periods of the disease, in cases apparently
+desperate, occasionally takes place. There is great reason to fear that
+many a child has been lost from a want of proper energy and
+perseverance on the part of the attendants in the sick room. They fancy
+the case is hopeless, and, to use their own expression, "they will not
+torment the child with medicine or remedies any longer."
+
+"Whilst there is life, there is hope," is a sentiment which may with
+great truth be applied to all the diseases of infancy and childhood.
+Striking, indeed, are the recoveries which occasionally present
+themselves to the notice of medical men; and those individuals may with
+great justice be charged with unpardonable neglect who do not persevere
+in the employment of the remedies prescribed, even up to the last hours
+of the child's existence.
+
+
+
+
+
+INDEX.
+
+
+
+Ablution, or sponging, 125.
+
+Abstinence, its good effect, in flatulence and griping in the infant,
+50. 226.
+
+Accidents and diseases which may occur to the infant at birth or soon
+after, 187.
+
+Acids, injurious to the teeth, 159.
+
+Air and exercise, in infancy, 83.
+--, in childhood, 89.
+--, its importance to the mother whilst a nurse, 33.
+
+Animal food, in childhood, 55.
+--, its injurious effects upon the young and delicate child, 58.
+
+Aperient liniment, 107.
+--, medicine, 97.
+--, poultice, 104.
+
+Artificial feeding; the causes rendering it necessary, 34.
+
+Artificial food; the proper kind for the child before the sixth
+month, 35.
+--; the mode of administering it, 39.
+--; the quantity to be given at each meal, 42.
+--; the frequency of giving it, 43.
+--; the posture of the child when fed, 43.
+--; the proper kind for the child after the sixth month, to the
+completion of first dentition, 44.
+--; the kind most suitable under the different complaints to which
+infants are liable, 48.
+
+
+Bath, the cold-water, plunge-bath, 118.
+--, the shower, 123.
+--, the warm, 128.
+--, rules for the use of the warm bath, 131.
+
+Bathing, sea, 120.
+--, and cleanliness, during infancy, 72.
+--, during childhood, 75.
+
+Bleeding, from leech-bites, how controlled, 113.
+--, from the navel string, 201.
+--, navel, 203.
+
+Blisters, mode of application, 114.
+
+Bottle, nursing, 40.
+
+Bowels, disorder of, in the infant, 208.
+
+Breasts of the infant, swelling of, 195.
+
+Breathing, how affected by disease, 175.
+
+
+Calomel, danger in its use, 167.
+--, injurious to the teeth, 160.
+
+Carminative, Dalby's, 111.
+
+Carriage, "a good carriage;" how best obtained, 95.
+--; the sad results of the mode frequently adopted, 91.
+
+Castor oil, 99.
+
+Choice of a wet-nurse, rules for, 28.
+
+Cleanliness and bathing, 72.
+
+Clothing, in infancy, 78.
+--, in childhood, 81.
+
+Clysters, what kind best for children, 105.
+--, mode of application, 106.
+
+Cold, infants very susceptible of, 78.
+
+Convulsions, 112, 167.
+
+Cork-nipple teat, 41.
+
+Costiveness, in infancy, 50. 229.
+--, in childhood, 231.
+
+Cough, as a sign of disease, 175.
+
+Countenance, in health, 165.
+
+Countenance, in disease, 165.
+
+Croup, 176. 286.
+
+
+Dalby's Carminative, 111.
+
+Damp, induces disease in the infant, 85.
+
+Dentition, easy, 136.
+--, difficult, 139.
+
+Diarrhoea, in the infant, 50. 227.
+
+Dietetics of infancy, 2.
+--, of childhood, 54.
+--, general directions upon, and of animal food, 55.
+--, sugar, 60.
+--, salt, 61.
+--, fruits, 62.
+--, water, 63.
+--, wine, beer, spirits, 63.
+
+Diet, under the different complaints to which infants are liable, 48.
+--, and regimen of a wet-nurse, 31.
+
+Digestion, in the infant; time requisite for its performance, 42.
+
+Discharge, from the eyes of the infant, 196.
+
+Disease, the importance of its early detection, and hints upon, 162.
+
+Dress, in infancy, 78.
+--, in childhood, 81.
+
+
+Enema. See Clysters.
+
+Eruptions on the skin in infancy; how best prevented, 74.
+--, about the head, and sores behind the ears, 295.
+--, during teething, 147.
+
+Exercise and air, in infancy, 85.
+--, in childhood, 89.
+--, horse-exercise; its importance to delicate children, 89.
+
+Eyes, of the infant, discharge from, after birth, 196.
+
+
+Fever, scarlet, 239.
+
+Flannel clothing, 80.
+
+Flatulence and griping in the infant, 50. 208. 226.
+
+Food, for infants. See Artificial Feeding.
+--, for children. See Dietetics of Childhood.
+--, and regimen, for nurses, 31.
+
+Fruits, 62.
+
+
+Gestures, of the infant, in health and disease, 169.
+
+Godfrey's cordial, 111.
+
+Grief, its effects upon the mother's milk, 34.
+
+Gums, of the infant in difficult dentition, the importance of their
+being lanced, 140.
+
+
+Hare-lip, how the infant may be nourished with this defect, 199.
+
+Head, of the infant, swellings upon, when born, 193.
+
+Hereditary transmission of scrofula and consumption; the best antidote
+to, 20.
+
+Hooping-cough, 275.
+
+Horse-exercise, its importance to delicate children, 89.
+
+Hunter's, Dr., experiments on the effects of wine upon children, 64.
+
+
+Jaundice, in the infant after birth, 204.
+
+
+Ice, how to be applied to the head, 127.
+
+Indigestion, in the infant, 208.
+
+Infant, food for. See Artificial Feeding.
+--; when still-born, how to be managed, 187.
+--; of injuries received during its birth, 193.
+--; retention of its urine after its birth, 194.
+--; swelling of the breasts after birth, 195.
+--; discharge from the eyes, 196.
+--; hare-lip, 199.
+--; bleeding from the navel string, 201.
+--; ulceration, or imperfect healing of the navel, 202.
+
+Infant; bleeding from the navel, 203.
+--, jaundice in, 204.
+--, tongue-tied, 205.
+--, moles and marks on the skin, 206.
+
+Inflation of the lungs of the infant, the mode, 190.
+
+
+Lavement, the proper kind for infants and children, 105.
+
+Leech-bites; the mode of controlling the bleeding of, 113
+
+Liniment, aperient, 107.
+
+Looseness, 208.
+
+Lungs of the infant, inflation of, 190.
+
+
+Magnesia, 102.
+
+Manna, 101.
+
+Maternal nursing, 3.
+--, management of the diseases of children, 184.
+
+Measles, 258.
+--, how distinguished from scarlet fever and small-pox, 255.
+
+Medicine, aperient, 97.
+
+Mercury, 107.
+
+Milk, the mother's; how to be preserved healthy during suckling, 3.
+--; deficiency of, 11.
+--; drying up of, 54.
+--, cow's; for infant's food, 35.
+--, ass's; for infant's food, 37.
+--, all kinds of, sometimes disagrees with the infant, 39.
+
+Mind, anxiety of; effects upon the parent's milk, 24.
+
+Moles and marks on the skin, 206.
+
+Mothers, their duty in relation to suckling, 3.
+--; those who ought never to suckle their children, 20. 24. 26.
+
+Motions of the infant; what the appearance of, and how frequent, in
+health, 99. 172.
+--; their deranged condition, a sign of disease, 173.
+
+
+Napkins, the infant's, 74.
+
+Navel, bleeding from, 203.
+--, ulceration or imperfect healing of, 202.
+
+Navel-string, bleeding from, 201.
+
+Naevi, or moles, 206.
+
+Nurses, wet, rules for the choice of, 28.
+--, diet and management of, 31.
+
+Nursery medicines, 97.
+
+Nursing, maternal, 3.
+--; the plan to be adopted for the first six months, 7.
+--; the plan to be followed after the sixth month to the time of
+weaning, 9.
+--; the injurious effects to the mother of undue and protracted
+suckling, 15.
+--; the injurious effects of undue and protracted suckling to the
+infant, 18.
+
+
+Opiates, 110. 297.
+--, in teething, dangerous, 145.
+
+
+Passion, its effect upon the breast-milk, 33.
+
+Porter, of its use, by the mother during suckling, 1
+--, when mischievous, 4.
+
+Poultice, bread-and-water, how made, 116.
+--, mustard, how made and applied, 115.
+
+Purgative medicine, 97.
+
+
+Retention of urine in the infant, 194.
+
+Rhubarb, 103.
+
+Rules for nursing, 3.
+--, for the use of the warm bath, 181.
+
+
+Salt, as a condiment, 61.
+
+Scarlet fever, 239.
+--, how distinguished from measles, 245.
+
+Scrofulous constitution, 180.
+
+Sea-bathing, 120.
+
+Seasons (the), their influence in producing particular forms of
+disorder, 178.
+
+Shower-bath, 123.
+
+Signs of health in the infant, what, 168.
+--, of disease in the infant, what, 169.
+
+Skin of the infant, importance of its perfect cleanliness, 72.
+--, friction and sponging of, beneficial, 73.
+
+Sleep, during infancy, 66.
+--, childhood, 69.
+--, how affected when the child is ill, 171.
+
+Small-pox, 262.
+
+Spirituous liquors, their pernicious effects to children, 63. 296.
+
+Sponging, 125.
+
+Spoon-feeding, 39.
+
+Still-born, 187.
+
+Stomach and bowels, their derangement, a fruitful source of disease,
+208.
+--, disorders of, in the infant at the breast, 210.
+--, disorders of, at the period of weaning, 217.
+--, disorders of, in the infant brought up by hand, 221.
+--, their treatment, 222.
+
+Stools of the infant, what the appearance of, and how frequent, in
+health, 99. 172.
+--, their deranged condition, a sign of disease, 173.
+
+Suckling, plan of, 3.
+--, by a wet-nurse, 27.
+
+Sugar, 60.
+
+Swelling of the breasts in the infant, 195.
+
+
+Teat of the cow--the artificial--the cork, 41.
+
+Teeth, of the permanent or adult teeth, 148.
+--, the manner in which they appear, 148.
+--, their value and importance, 152.
+--, their management and preservation, 154.
+
+Teething, easy; management of the child, 136.
+--, difficult; hints upon, 139.
+
+Tight-lacing, evils of, 92.
+
+Tongue-tied, 205.
+
+
+Ulceration or imperfect healing of the navel, 201.
+
+Urine, retention of it in the infant after birth, 194.
+
+
+Ventilation of the sleeping-rooms of children, 84.
+--, its importance in sickness, 246.
+
+
+Walking, the best mode of teaching a child, 87.
+
+Warm bath, 128.
+--, rules for the use of, 131.
+--, directions for the use of, when the infant is stillborn, 192.
+
+Water, as a beverage for children, 63.
+--, in the head, 291.
+
+Weaning, the time when to take place, 51.
+--, the mode of effecting it, 52.
+--; drying up the mother's milk, 53.
+
+Wet-nurse suckling, 27.
+--, rules for the choice of, 28.
+--, diet and management of, 31.
+
+Wine, its pernicious effects in childhood, 63.
+
+Worms, 234.
+
+
+
+
+
+THE END.
+
+
+
+
+
+
+Also by Dr. Bull,
+
+
+
+
+HINTS TO MOTHERS
+
+FOR THE
+
+MANAGEMENT OF THEIR HEALTH.
+
+
+Second Edit, greatly enlarged, foolscap 8vo.
+7s. cloth lettered.
+
+
+
+Opinions of the Press.
+
+
+"A very valuable compendium for all who expect to become mothers.--In
+the short preface prefixed to this little work, Dr. Bull judiciously
+remarks, that feelings of delicacy often prevent many young married
+females from making to their medical attendant, a full disclosure of
+the circumstances connected with their state, and which render medical
+assistance necessary. The object of the work is to meet this
+difficulty, by furnishing a species of information for which married
+women are often very unwilling to ask, although they readily search for
+it in books. The matter of Dr. Bull's treatise is arranged completely
+in a popular form--in one that is best calculated to be understood by
+the fair readers to whom it is addressed; and contains a variety of
+useful information, so clearly conveyed as to render it a very valuable
+compendium for all women who expect to become mothers."--Lancet.
+
+
+"A valuable monitor to the fair sex. It contains so much useful
+advice for every woman likely to become a mother, that married men
+would do well to provide it for their partners."--Spectator.
+
+
+"This little volume is the benevolent contribution of good sense and
+professional skill, to the well-being of those who have the strongest
+claims on our sympathy. Unfortunately a vast mass of erroneous notions
+exists in the class to whom it is addressed; to which, and to the
+concealment prompted by delicacy, until the time for medical aid is
+gone by, we are indebted for very much of the danger and suffering
+incident to the periods they are destined to pass through. Dr. Bull, in
+the true spirit of a physician and a gentleman, has by his perspicuous
+statements removed the first, and by his judicious and simple
+directions, anticipated the last of these fruitful sources of evil.
+There is no mother that will not be heartily thankful that this book
+ever fell into her hands; and no husband who should not present it to
+his wife. We cannot urge its value too strongly on all whom it
+concerns."--Eclectic Review.
+
+
+"We recommend it to our readers; and they will confer a benefit on
+their new-married patients by recommending it to them."--British and
+Foreign Medical Review.
+
+
+"Dr. Bull has performed a very kind and important office in the
+publication before us."--Patriot.
+
+
+"We never read any popular treatise, or directions rather, that bear
+more strongly the stamp of scientific and expert mental knowledge. The
+mere reading of our Author's book will do more good in the way of
+encouraging the fearful, and banishing nervous anxiety, than a whole
+conclave of the wisest and most sanguine matrons that society can
+anywhere bring together."--Monthly Review.
+
+
+"This little manual will prove useful exactly in proportion to the
+extent of its circulation."--Medical Gazette.
+
+
+
+
+
+End of the Project Gutenberg EBook of The Maternal Management of Children,
+in Health and Disease., by Thomas Bull, M.D.
+
+*** END OF THIS PROJECT GUTENBERG EBOOK THE MATERNAL MANAGEMENT OF ***
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