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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/10383-0.txt b/10383-0.txt new file mode 100644 index 0000000..e5c6fc4 --- /dev/null +++ b/10383-0.txt @@ -0,0 +1,7152 @@ +*** 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 *** diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..66b60c0 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #10383 (https://www.gutenberg.org/ebooks/10383) diff --git a/old/10383.txt b/old/10383.txt new file mode 100644 index 0000000..89656c3 --- /dev/null +++ b/old/10383.txt @@ -0,0 +1,7579 @@ +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 *** + +***** This file should be named 10383.txt or 10383.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/0/3/8/10383/ + +Produced by Albert R. Mann Library. 2003. Home Economics Archive: +Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. 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