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THE REARING, MANAGEMENT, AND DISEASES OF INFANCY AND CHILDHOOD.
Physiology of Life, as illustrated by Respiration, Circulation, and Digestion.
2445. The infantine management of children, like the
mother's love for her offspring, seems to be born with the child, and to be a
direct intelligence of Nature. It may thus, at first sight, appear as
inconsistent and presumptuous to tell a woman how to rear her infant as to
instruct her in the manner of loving it. Yet, though Nature is unquestionably
the best nurse, Art makes so admirable a foster-mother, that no sensible woman,
in her novitiate of parent, would refuse the admonitions of art, or the
teachings of experience, to consummate her duties of nurse. It is true that, in
a civilized state of society, few young wives reach the epoch that makes them
mothers without some insight, traditional or practical, into the management of
infants: consequently, the cases wherein a woman is left to her own unaided
intelligence, or what, in such a case, may be called instinct, and obliged to
trust to the promptings of nature alone for the well-being of her child, are
very rare indeed. Again, every woman is not gifted with the same physical
ability for the harassing duties of a mother; and though Nature, as a general
rule, has endowed all female creation with the attributes necessary to that most
beautiful and, at the same time, holiest function,--the healthy rearing of their
offspring,--the cases are sufficiently numerous to establish the exception,
where the mother is either physically or socially incapacitated from undertaking
these most pleasing duties herself, and where, consequently, she is compelled to
trust to adventitious aid for those natural benefits which are at once the
mother's pride and delight to render to her child.
2446. In these cases, when obliged to call in the services of hired assistance, she must trust the dearest obligation of her life to one who, from her social sphere, has probably notions of rearing children diametrically opposed to the preconceived ideas of the mother, and at enmity with all her sentiments of right and prejudices of position.
2447. It has justly been said--we think by Hood--that the children of the poor are not brought up, but dragged up. However facetious this remark may seem, there is much truth in it; and that children, reared in the reeking dens of squalor and poverty, live at all, is an apparent anomaly in the course of things, that, at first sight, would seem to set the laws of sanitary provision at defiance, and make it appear a perfect waste of time to insist on pure air and exercise as indispensable necessaries of life, and especially so as regards infantine existence.
2448. We see elaborate care bestowed on a family of children, everything studied that can tend to their personal comfort,--pure air, pure water, regular ablution, a dietary prescribed by art, and every precaution adopted that medical judgment and maternal love can dictate, for the well-being of the parents' hope; and find, in despite of all this care and vigilance, disease and death invading the guarded treasure. We turn to the foetor and darkness that, in some obscure court, attend the robust brood who, coated in dirt, and with mud and refuse for playthings, live and thrive, and grow into manhood, and, in contrast to the pale face and flabby flesh of the aristocratic child, exhibit strength, vigour, and well-developed frames, and our belief in the potency of the life-giving elements of air, light, and cleanliness receives a shock that, at first sight, would appear fatal to the implied benefits of these, in reality, all-sufficient attributes of health and life.
2449. But as we must enter more largely on this subject hereafter, we shall leave its consideration for the present, and return to what we were about to say respecting trusting to others' aid in the rearing of children. Here it is that the young and probably inexperienced mother may find our remarks not only an assistance but a comfort to her, in as far as, knowing the simplest and best system to adopt, she may be able to instruct another, and see that her directions are fully carried out.
2450. The human body, materially considered, is a beautiful piece of mechanism, consisting of many parts, each one being the centre of a system, and performing its own vital function irrespectively of the others, and yet dependent for its vitality upon the harmony and health of the whole. It is, in fact, to a certain extent, like a watch, which, when once wound up and set in motion, will continue its function of recording true time only so long as every wheel, spring, and lever performs its allotted duty, and at its allotted time; or till the limit that man's ingenuity has placed to its existence as a moving automaton has been reached, or, in other words, till it has run down.
2451. What the key is to the mechanical watch, air is to the physical man. Once admit air into the mouth and nostrils, and the lungs expand, the heart beats, the blood rushes to the remotest part of the body, the mouth secretes saliva, to soften and macerate the food; the liver forms its bile, to separate the nutriment from the digested aliment; the kidneys perform their office; the eye elaborates its tears, to facilitate motion and impart that glistening to the orb on which depends so much of its beauty; and a dewy moisture exudes from the skin, protecting the body from the extremes of heat and cold, and sharpening the perception of touch and feeling. At the same instant, and in every part, the arteries, like innumerable bees, are everywhere laying down layers of muscle, bones, teeth, and, in fact, like the coral zoophyte, building up a continent of life and matter; while the veins, equally busy, are carrying away the débris and refuse collected from where the zoophyte arteries are building,--this refuse, in its turn, being conveyed to the liver, there to be converted into bile.
2452. All these--and they are but a few of the vital actions constantly taking place--are the instant result of one gasp of life-giving air. No subject can be fraught with greater interest than watching the first spark of life, as it courses with electric speed "through all the gates and alleys" of the soft, insensate body of the infant. The effect of air on the new-born child is as remarkable in its results as it is wonderful in its consequence; but to understand this more intelligibly, it must first be remembered that life consists of the performance of three vital functions--RESPIRATION, CIRCULATION, and DIGESTION. The lungs digest the air, taking from it its most nutritious element, the oxygen, to give to the impoverished blood that circulates through them. The stomach digests the food, and separates the nutriment--chyle--from the aliment, which it gives to the blood for the development of the frame; and the blood, which is understood by the term circulation, digests in its passage through the lungs the nutriment--chyle--to give it quantity and quality, and the oxygen from the air to give it vitality. Hence it will be seen, that, speaking generally, the three vital functions resolve themselves into one,--DIGESTION; and that the lungs are the primary and the most important of the vital organs; and respiration, the first in fact, as we all know it is the last in deed, of all the functions performed by the living body.
2453. The first effect of air on the infant is a slight
tremor about the lips and angles of the mouth, increasing to twitchings, and
finally to a convulsive contraction of the lips and cheeks, the consequence of
sudden cold to the nerves of the face. This spasmodic action produces a gasp,
causing the air to rush through the mouth and nostrils, and enter the windpipe
and upper portion of the flat and contracted lungs, which, like a sponge partly
immersed in water, immediately expand. This is succeeded by a few faint sobs or
pants, by which larger volumes of air are drawn into the chest, till, after a
few seconds, and when a greater bulk of the lungs has become inflated, the
breast-bone and ribs rise, the chest expands, and, with a sudden start, the
infant gives utterance to a succession of loud, sharp cries, which have the
effect of filling every cell of the entire organ with air and life. To the
anxious mother, the first voice of her child is, doubtless, the sweetest music
she ever heard; and the more loudly it peals, the greater should be her joy, as
it is an indication of health and strength, and not only shows the perfect
expansion of the lungs, but that the process of life has set in with vigour.
Having welcomed in its own existence, like the morning bird, with a shrill note
of gladness, the infant ceases its cry, and, after a few short sobs, usually
subsides into sleep or quietude.
2454. At the same instant that the air rushes into the lungs, the valve, or door between the two sides of the heart-and through which the blood had previously passed-is closed and hermetically sealed, and the blood taking a new course, bounds into the lungs, now expanded with air, and which we have likened to a wetted sponge, to which they bear a not unapt affinity, air being substituted for water. It here receives the oxygen from the atmosphere, and the chyle, or white blood, from the digested food, and becomes, in an instant, arterial blood, a vital principle, from which every solid and fluid of the body is constructed. Besides the lungs, Nature has provided another respiratory organ, a sort of supplemental lung, that, as well as being a covering to the body, inspires air and expires moisture;--this is the cuticle, or skin; and so intimate is the connection between the skin and lungs, that whatever injures the first, is certain to affect the latter.
2455. Hence the difficulty of breathing experienced after scalds or burns on the cuticle, the cough that follows the absorption of cold or damp by the skin, the oppressed and laborious breathing experienced by children in all eruptive diseases, while the rash is coming to the surface, and the hot, dry skin that always attends congestion of the lungs, and fever.
2456. The great practical advantage derivable from this fact is, the knowledge that whatever relieves the one benefits the other. Hence, too, the great utility of hot baths in all affections of the lungs or diseases of the skin; and the reason why exposure to cold or wet is, in nearly all cases, followed by tightness of the chest, sore throat, difficulty of breathing, and cough. These symptoms are the consequence of a larger quantity of blood than is natural remaining in the lungs, and the cough is a mere effort of Nature to throw off the obstruction caused by the presence of too much blood in the organ of respiration. The hot bath, by causing a larger amount of blood to rush suddenly to the skin, has the effect of relieving the lungs of their excess of blood, and by equalizing the circulation, and promoting perspiration from the cuticle, affords immediate and direct benefit, both to the lungs and the system at large.
2457. The organs that either directly or indirectly
contribute to the process of digestion are, the mouth, teeth, tongue, and
gullet, the stomach, small intestines, the pancreas, the salivary glands, and
the liver. Next to respiration, digestion is the chief function in the economy
of life, as, without the nutritious fluid digested from the aliment, there would
be nothing to supply the immense and constantly recurring waste of the system,
caused by the activity with which the arteries at all periods, but especially
during infancy and youth, are building up the frame and developing the body. In
infancy (the period of which our present subject treats), the series of parts
engaged in the process of digestion may be reduced simply to the stomach and
liver, or rather its secretion,--the bile. The stomach is a thick muscular bag,
connected above with the gullet, and, at its lower extremity, with the
commencement of the small intestines. The duty or function of the stomach is to
secrete from the arteries spread over its inner surface, a sharp acid liquid
called the gastric juice; this, with a due mixture of saliva, softens,
dissolves, and gradually digests the food or contents of the stomach, reducing
the whole into a soft pulpy mass, which then passes into the first part of the
small intestines, where it comes in contact with the bile from the gall-bladder,
which immediately separates the digested food into two parts, one is a white
creamy fluid called chyle, and the absolute concentration of all nourishment,
which is taken up by proper vessels, and, as we have before said, carried
directly to the heart, to be made blood of, and vitalized in the lungs, and thus
provide for the wear and tear of the system. It must be here observed that the
stomach can only digest solids, for fluids, being incapable of that process, can
only be absorbed; and without the result of digestion, animal, at least human
life, could not exist. Now, as Nature has ordained that infantine life shall be
supported on liquid aliment, and as, without a digestion the body would perish,
some provision was necessary to meet this difficulty, and that provision was
found in the nature of the liquid itself, or in other words, THE MILK. The
process of making cheese, or fresh curds and whey, is familiar to most persons;
but as it is necessary to the elucidation of our subject, we will briefly repeat
it. The internal membrane, or the lining coat of a calf's stomach, having been
removed from the organ, is hung up, like a bladder, to dry; when required, a
piece is cut off, put in a jug, a little warm water poured upon it, and after a
few hours it is fit for use; the liquid so made being called rennet. A little
of this rennet, poured into a basin of warm milk, at once coagulates the greater
part, and separates from it a quantity of thin liquor, called whey. This is
precisely the action that takes place in the infant's stomach after every supply
from the breast. The cause is the same in both cases, the acid of the gastric
juice in the infant's stomach immediately converting the milk into a soft
cheese. It is gastric juice, adhering to the calf's stomach, and drawn out by
the water, forming rennet, that makes the curds in the basin. The cheesy
substance being a solid, at once undergoes the process of digestion, is
separated into chyle by the bile, and, in a few hours, finds its way to the
infant's heart, to become blood, and commence the architecture of its little
frame. This is the simple process of a baby's digestion:-milk converted into
cheese, cheese into chyle, chyle into blood, and blood into flesh, bone, and
tegument-how simple is the cause, but how sublime and wonderful are the effects!
2458. We have described the most important of the three functions that take place in the infant's body-respiration and digestion; the third, namely, circulation, we hardly think it necessary to enter on, not being called for by the requirements of the nurse and mother; so we shall omit its notice, and proceed from theoretical to more practical considerations. Children of weakly constitutions are just as likely to be born of robust parents, and those who earn their bread by toil, as the offspring of luxury and affluence; and, indeed, it is against the ordinary providence of Nature to suppose the children of the hardworking and necessitous to be hardier and more vigorous than those of parents blessed with ease and competence.
2459. All children come into the world in the same imploring helplessness, with the same general organization and wants, and demanding either from the newly-awakened mother's love, or from the memory of motherly feeling in the nurse, or the common appeals of humanity in those who undertake the earliest duties of an infant, the same assistance and protection, and the same fostering care.
2460. We have already described the phenomena produced
on the new-born child by the contact of air, which, after a succession of
muscular twitchings, becomes endowed with voice, and heralds its advent by a
loud but brief succession of cries. But though this is the general rule, it
sometimes happens (from causes it is unnecessary here to explain) that the
infant does not cry, or give utterance to any audible sounds, or if it does,
they are so faint as scarcely to be distinguished as human accents, plainly
indicating that life, as yet, to the new visitor, is neither a boon nor a
blessing; the infant being, in fact, in a state of suspended or imperfect
vitality,--a state of quasi existence, closely approximating the condition of
2461. As soon as this state of things is discovered, the child should be turned on its right side, and the whole length of the spine, from the head downwards, rubbed with all the fingers of the right hand, sharply and quickly, without intermission, till the quick action has not only evoked heat, but electricity in the part, and till the loud and sharp cries of the child have thoroughly expanded the lungs, and satisfactorily established its life. The operation will seldom require above a minute to effect, and less frequently demands a repetition. If there is brandy at hand, the fingers before rubbing may be dipped into that, or any other spirit.
2462. There-is another condition of what we may call "mute births," where the child only makes short ineffectual gasps, and those at intervals of a minute or two apart, when the lips, eyelids, and fingers become of a deep purple or slate colour, sometimes half the body remaining white, while the other half, which was at first swarthy, deepens to a livid hue. This condition of the infant is owing to the valve between the two sides of the heart remaining open, and allowing the unvitalized venous blood to enter the arteries and get into the circulation.
2463. The object in this case, as in the previous one, is to dilate the lungs as quickly as possible, so that, by the sudden effect of a vigorous inspiration, the valve may be firmly closed, and the impure blood, losing this means of egress, be sent directly to the lungs. The same treatment is therefore necessary as in the previous case, with the addition, if the friction along the spine has failed, of a warm bath at a temperature of about 80°, in which the child is to be plunged up to the neck, first cleansing the mouth and nostrils of the mucus that might interfere with the free passage of air.
2464. While in the bath, the friction along the spine is to be continued, and if the lungs still remain unexpended, while one person retains the child in an inclined position in the water, another should insert the pipe of a small pair of bellows into one nostril, and while the month is closed and the other nostril compressed on the pipe with the hand of the assistant, the lungs are to be slowly inflated by steady puffs of air from the bellows, the hand being removed from the mouth and nose after each inflation, and placed on the pit of the stomach, and by a steady pressure expelling it out again by the mouth. This process is to be continued, steadily inflating and expelling the air from the lungs, till, with a sort of tremulous leap, Nature takes up the process, and the infant begins to gasp, and finally to cry, at first low and faint, but with every gulp of air increasing in length and strength of volume, when it is to be removed from the water, and instantly wrapped (all but the face and mouth) in a flannel. Sometimes, however, all these means will fail in effecting an utterance from the child, which will lie, with livid lips and a flaccid body, every few minutes opening its mouth with a short gasping pant, and then subsiding into a state of pulseless inaction, lingering probably some hours, till the spasmodic pantings growing further apart, it ceases to exist.
2465. The time that this state of negative vitality will linger in the frame of an infant is remarkable; and even when all the previous operations, though long-continued, have proved ineffectual, the child will often rally from the simplest of means--the application of dry heat. When removed from the bath, place three or four hot bricks or tiles on the hearth, and lay the child, loosely folded in a flannel, on its back along them, taking care that there is but one fold of flannel between the spine and heated bricks or tiles. When neither of these articles can be procured, put a few clear pieces of red cinder in a warming-pan, and extend the child in the same manner along the closed lid. As the heat gradually diffuses itself over the spinal marrow, the child that was dying, or seemingly dead, will frequently give a sudden and energetic cry, succeeded in another minute by a long and vigorous peal, making up, in volume and force, for the previous delay, and instantly confirming its existence by every effort in its nature.
2466. With these two exceptions,--restored by the means we have pointed out to the functions of life,--we will proceed to the consideration of the child HEALTHILY BORN. Here the first thing that meets us on the threshold of inquiry, and what is often between mother and nurse not only a vexed question, but one of vexatious import, is the crying of the child; the mother, in her natural anxiety, maintaining that her infant must be ill to cause it to cry so much or so often, and the nurse insisting that all children cry, and that nothing is the matter with it, and that crying does good, and is, indeed, an especial benefit to infancy. The anxious and unfamiliar mother, though not convinced by these abstract sayings of the truth or wisdom of the explanation, takes both for granted; and, giving the nurse credit for more knowledge and experience on this head than she can have, contentedly resigns herself to the infliction, as a thing necessary to be endured for the good of the baby, but thinking it, at the same time, an extraordinary instance of the imperfectibility of Nature as regards the human infant; for her mind wanders to what she has observed in her childhood with puppies and kittens, who, except when rudely torn from their nurse, seldom give utterance to any complaining.
2467. We, undoubtedly, believe that crying, to a certain extent, is not only conducive to health, but positively necessary to the full development and physical economy of the infant's being. But though holding this opinion, we are far from believing that a child does not very often cry from pain, thirst, want of food, and attention to its personal comfort; but there is as much difference in the tone and expression of a child's cry as in the notes of an adult's voice; and the mother's ear will not be long in discriminating between the sharp peevish whine of irritation and fever, and the louder intermitting cry that characterizes the want of warmth and sleep. All these shades of expression in the child's inarticulate voice every nurse should understand, and every mother will soon teach herself to interpret them with an accuracy equal to language.
2468. There is no part of a woman's duty to her child that a young mother should so soon make it her business to study, as the voice of her infant, and the language conveyed in its cry. The study is neither hard nor difficult; a close attention to its tone, and the expression of the baby's features, are the two most important points demanding attention. The key to both the mother will find in her own heart, and the knowledge of her success in the comfort and smile of her infant. We have two reasons--both strong ones--for urging on mothers the imperative necessity of early making themselves acquainted with the nature and wants of their child: the first, that when left to the entire, responsibility of the baby, after the departure of the nurse, she may be able to undertake her new duties with more confidence than if left to her own resources and mother's instinct, without a clue to guide her through the mysteries of those calls that vibrate through every nerve of her nature; and, secondly, that she may be able to guard her child from the nefarious practices of unprincipled nurses, who, while calming the mother's mind with false statements as to the character of the baby's cries, rather than lose their rest, or devote that time which would remove the cause of suffering, administer, behind the curtains, those deadly narcotics which, while stupefying Nature into sleep, insure for herself a night of many unbroken hours. Such nurses as have not the hardihood to dose their infant charges, are often full of other schemes to still that constant and reproachful cry. The most frequent means employed for this purpose is giving it something to suck,--something easily hid from the mother,--or, when that is impossible, under the plea of keeping it warm, the nurse covers it in her lap with a shawl, and, under this blind, surreptitiously inserts a finger between the parched lips, which possibly moan for drink; and, under this inhuman cheat and delusion, the infant is pacified, till Nature, balked of its desires, drops into a troubled sleep. These are two of our reasons for impressing upon mothers the early, the immediate necessity of putting themselves sympathetically in communication with their child, by at once learning its hidden language as a delightful task.
2469. We must strenuously warn all mothers on no account to allow the nurse to sleep with the baby, never herself to lay down with it by her side for a night's rest, never to let it sleep in the parents' bed, and on no account keep it, longer than absolutely necessary, confined in on atmosphere loaded with the breath of many adults.
2470. The amount of oxygen required by an infant is so large, and the quantity consumed by mid-life and age, and the proportion of carbonic acid thrown off from both, so considerable, that an infant breathing the same air cannot possibly carry on its healthy existence while deriving its vitality from so corrupted a medium. This objection, always in force, is still more objectionable at night-time, when doors and windows are closed, and amounts to a condition of poison, when placed between two adults in sleep, and shut in by bed-curtains; and when, in addition to the impurities expired from the lungs, we remember, in quiescence and sleep, how large a portion of mephitic gas is given off from the skin.
2471. Mothers, in the fullness of their affection, believe there is no harbour, sleeping or awake, where their infants can be so secure from all possible or probable danger as in their own arms; yet we should astound our readers if we told them the statistical number of infants who, in despite of their motherly solicitude and love, are annually killed, unwittingly, by such parents themselves, and this from the persistency in the practice we are so strenuously condemning. The mother frequently, on awaking, discovers the baby's face closely impacted between her bosom and her arm, and its body rigid and lifeless; or else so enveloped in the "head-blanket" and superincumbent bedclothes, as to render breathing a matter of physical impossibility. In such cases the jury in general returns a verdict of "Accidentally overlaid" but one of "Careless suffocation" would be more in accordance with truth and justice. The only possible excuse that can be urged, either by nurse or mother, for this culpable practice, is the plea of imparting warmth to the infant. But this can always be effected by an extra blanket in the child's crib, or, if the weather is particularly cold, by a bottle of hot water enveloped in flannel and placed at the child's feet; while all the objections already urged--as derivable from animal heat imparted by actual contact--are entirely obviated. There is another evil attending the sleeping together of the mother and infant, which, as far as regards the latter, we consider quite as formidable, though not so immediate as the others, and is always followed by more or less of mischief to the mother. The evil we now allude to is that most injurious practice of letting the child suck after the mother has fallen asleep, a custom that naturally results from the former, and which, as we hare already said, is injurious to both mother and child. It is injurious to the infant by allowing it, without control, to imbibe to distension a fluid sluggishly secreted and deficient in those vital principles which the want of mental energy, and of the sympathetic appeals of the child on the mother, so powerfully produce on the secreted nutriment, while the mother wakes in a state of clammy exhaustion, with giddiness, dimness of sight, nausea, loss of appetite, and a dull aching pain through the back and between the shoulders. In fact, she wakes languid and unrefreshed from her sleep, with febrile symptoms and hectic flushes, caused by her baby vampire, who, while dragging from her her health and strength, has excited in itself a set of symptoms directly opposite, but fraught with the same injurious consequences--"functional derangement."
2472. As Nature has placed in the bosom of the mother
the natural food of her offspring, it must be self-evident to every reflecting
woman, that it becomes her duty to study, as far as lies in her power, to keep
that reservoir of nourishment in as pure and invigorating a condition as
possible; for she must remember that the quantity is no proof of the quality
of this aliment.
2473. The mother, while suckling, as a general rule, should avoid all sedentary occupations, take regular exercise, keep her mind as lively and pleasingly occupied as possible, especially by music and singing. Her diet should be light and nutritious, with a proper sufficiency of animal food, and of that kind which yields the largest amount of nourishment; and, unless the digestion is naturally strong, vegetables and fruit should form a very small proportion of the general dietary, and such preparations as broths, gruels, arrowroot, &c., still less. Tapioca, or ground-rice pudding, made with several eggs, may be taken freely; but all slops and thin potations, such as that delusion called chicken-broth, should be avoided, as yielding a very small amount of nutriment, and a large proportion of flatulence. All purely stimulants should be avoided as much as possible, especially spirits, unless taken for some special object, and that medicinally; but as a part of the dietary they should be carefully shunned. Lactation is always an exhausting process, and as the child increases in size and strength, the drain upon the mother becomes great and depressing. Then something more even than an abundant diet is required to keep the mind and body up to a standard sufficiently healthy to admit of a constant and nutritious secretion being performed without detriment to the physical integrity of the mother, or injury to the child who imbibes it; and as stimulants are inadmissible, if not positively injurious, the substitute required is to be found in malt liquor. To the lady accustomed to her Madeira and sherry, this may appear a very vulgar potation for a delicate young mother to take instead of the more subtle and condensed elegance of wine; but as we are writing from experience, and with the avowed object of imparting useful facts and beneficial remedies to our readers, we allow no social distinctions to interfere with our legitimate object.
2474. We have already said that the suckling mother should avoid stimulants, especially spirituous ones; and though something of this sort is absolutely necessary to support her strength during the exhausting process, it should be rather of a tonic than of a stimulating character; and as all wines contain a large percentage of brandy, they are on that account less beneficial than the pure juice of the fermented grape might be. But there is another consideration to be taken into account on this subject; the mother has not only to think of herself, but also of her infant. Now wines, especially port wine, very often--indeed, most frequently--affect the baby's bowels, and what might have been grateful to the mother becomes thus a source of pain and irritation to the child afterwards. Sherry is less open to this objection than other wines, yet still it very frequently does influence the second participator, or the child whose mother has taken it.
2475. The nine or twelve months a woman usually suckles must be, to some extent, to most mothers, a period of privation and penance, and unless she is deaf to the cries of her baby, and insensible to its kicks and plunges, and will not see in such muscular evidences the griping pains that rack her child, she will avoid every article that can remotely affect the little being who draws its sustenance from her. She will see that the babe is acutely affected by all that in any way influences her, and willingly curtail her own enjoyments, rather than see her infant rendered feverish, irritable, and uncomfortable. As the best tonic, then, and the most efficacious indirect stimulant that a mother can take at such times, there is no potation equal to porter and stout, or, what is better still, an equal part of porter and stout. Ale, except for a few constitutions, is too subtle and too sweet, generally causing acidity or heartburn, and stout alone is too potent to admit of a full draught, from its proneness to affect the head; and quantity, as well as moderate strength, is required to make the draught effectual; the equal mixture, therefore, of stout and porter yields all the properties desired or desirable as a medicinal agent for this purpose.
2476. Independently of its invigorating influence on the constitution, porter exerts a marked and specific effect on the secretion of milk; more powerful in exciting an abundant supply of that fluid than any other article within the range of the physician's art; and, in cases of deficient quantity, is the most certain, speedy, and the healthiest means that can be employed to insure a quick and abundant flow. In cases where malt liquor produces flatulency, a few grains of the "carbonate of soda" may advantageously be added to each glass immediately before drinking, which will have the effect of neutralizing any acidity that may be in the porter at the time, and will also prevent its after-disagreement with the stomach. The quantity to be taken must depend upon the natural strength of the mother, the age and demand made by the infant on the parent, and other causes; but the amount should vary from one to two pints a day, never taking less than half a pint at a time, which should be repeated three or four times a day.
2477. We have said that the period of suckling is a season of penance to the mother, but this is not invariably the case; and, as so much must depend upon the natural strength of the stomach, and its power of assimilating all kinds of food into healthy chyle, it is impossible to define exceptions. Where a woman feels she can eat any kind of food, without inconvenience or detriment, she should live during her suckling as she did before; but, as a general rule, we are bound to advise all mothers to abstain from such articles as pickles, fruits, cucumbers, and all acid and slowly digestible foods, unless they wish for restless nights and crying infants.
2478. As regards exercise and amusement, we would certainly neither prohibit a mother's dancing, going to a theatre, nor even from attending an assembly. The first, however, is the best indoor recreation she can take, and a young mother will do well to often amuse herself in the nursery with this most excellent means of healthful circulation. The only precaution necessary is to avoid letting the child suck the milk that has lain long in the breast, or is heated by excessive action.
2479. Every mother who can, should be provided with a breast-pump, or glass tube, to draw off the superabundance that has been accumulating in her absence from the child, or the first gush excited by undue exertion: the subsequent supply of milk will be secreted under the invigorating influence of a previous healthy stimulus.
2480. As the first milk that is secreted contains a large amount of the saline elements, and is thin and innutritious, it is most admirably adapted for the purpose Nature designed it to fulfil,--that of an aperient; but which, unfortunately, it is seldom permitted, in our artificial mode of living, to perform.
2481. So opposed are we to the objectionable plan of physicking new-born children, that, unless for positive illness, we would much rather advise that medicine should be administered through the mother for the first eight or ten weeks of its existence. This practice, which few mothers will object to, is easily effected by the parent, when such a course is necessary for the child, taking either a dose of castor-oil, half an ounce of tasteless salts (the phosphate of soda), one or two teaspoonfuls of magnesia, a dose of lenitive electuary, manna, or any mild and simple aperient, which, almost before it can have taken effect on herself, will exhibit its action on her child.
2482. One of the most common errors that mothers fall into while suckling their children, is that of fancying they are always hungry, and consequently overfeeding them; and with this, the great mistake of applying the child to the breast on every occasion of its crying, without investigating the cause of its complaint, and, under the belief that it wants food, putting the nipple into its crying mouth, until the infant turns in revulsion and petulance from what it should accept with eagerness and joy. At such times, a few teaspoonfuls of water, slightly chilled, will often instantly pacify a crying and restless child, who has turned in loathing from the offered breast; or, after imbibing a few drops, and finding it not what nature craved, throws back its head in disgust, and cries more petulantly than before. In such a case as this, the young mother, grieved at her baby's rejection of the tempting present, and distressed at its cries, and in terror of some injury, over and over ransacks its clothes, believing some insecure pin can alone be the cause of such sharp complaining, an accident that, from her own care in dressing, however, is seldom or ever the case.
2483. These abrupt cries of the child, if they do not proceed from thirst, which a little water will relieve, not unfrequently occur from some unequal pressure, a fold or twist in the "roller," or some constriction round the tender body. If this is suspected, the mother must not be content with merely slackening the strings; the child should be undressed, and the creases and folds of the hot skin, especially those about the thighs and groins, examined, to see that no powder has caked, and, becoming hard, irritated the parts. The violet powder should be dusted freely over all, to cool the skin, and everything put on fresh and smooth. If such precautions have not afforded relief, and, in addition to the crying, the child plunges or draws up its legs, the mother may be assured some cause of irritation exists in the stomach or bowels,--either acidity in the latter or distension from overfeeding in the former; but, from whichever cause, the child should be "opened" before the fire, and a heated napkin applied all over the abdomen, the infant being occasionally elevated to a sitting position, and while gently jolted on the knee, the back should be lightly patted with the hand.
2484. Should the mother have any reason to apprehend that the cause of inconvenience proceeds from the bladder--a not unfrequent source of pain,--the napkin is to be dipped in hot water, squeezed out, and immediately applied over the part, and repeated every eight or ten minutes, for several times in succession, either till the natural relief is afforded, or a cessation of pain allows of its discontinuance. The pain that young infants often suffer, and the crying that results from it, is, as we have already said, frequently caused by the mother inconsiderately overfeeding her child, and is produced by the pain of distension, and the mechanical pressure of a larger quantity of fluid in the stomach than the gastric juice can convert into cheese and digest.
2485. Some children are stronger in the enduring power of the stomach than others, and get rid of the excess by vomiting, concluding every process of suckling by an emission of milk and curd. Such children are called by nurses "thriving children;" and generally they are so, simply because their digestion is good, and they have the power of expelling with impunity that superabundance of aliment which in others is a source of distension, flatulence, and pain.
2486. The length of time an infant should be suckled must depend much on the health and strength of the child, and the health of the mother, and the quantity and quality of her milk; though, when all circumstances are favourable, it should never be less than nine, nor exceed fifteen months; but perhaps the true time will be found in the medium between both. But of this we may be sure, that Nature never ordained a child to live on suction after having endowed it with teeth to bite and to grind; and nothing is more out of place and unseemly than to hear a child, with a set of twenty teeth, ask for "the breast."
2487. The practice of protracted wet-nursing is hurtful to the mother, by keeping up an uncalled-for, and, after the proper time, an unhealthy drain on her system, while the child either derives no benefit from what it no longer requires, or it produces a positive injury on its constitution. After the period when Nature has ordained the child shall live by other means, the secretion of milk becomes thin and deteriorated, showing in the flabby flesh and puny features of the child both its loss of nutritious properties and the want of more stimulating aliment.
2488. Though we have said that twelve months is about the medium time a baby should be suckled, we by no means wish to imply that a child should be fed exclusively on milk for its first year; quite the reverse; the infant can hardly be too soon made independent of the mother. Thus, should illness assail her, her milk fail, or any domestic cause abruptly cut off the natural supply, the child having been annealed to an artificial diet, its life might be safely carried on without seeking for a wet-nurse, and without the slightest danger to its system.
2489. The advantage to the mother of early accustoming the child to artificial food is as considerable to herself as beneficial to her infant; the demand on her physical strength in the first instance will be less severe and exhausting, the child will sleep longer on a less rapidly digestible aliment, and yield to both more quiet nights, and the mother will be more at liberty to go out for business or pleasure, another means of sustenance being at hand till her return. Besides these advantages, by a judicious blending of the two systems of feeding, the infant will acquire greater constitutional strength, so that, if attacked by sickness or disease, it will have a much greater chance of resisting its virulence than if dependent alone on the mother, whose milk, affected by fatigue and the natural anxiety of the parent for her offspring, is at such a time neither good in its properties nor likely to be beneficial to the patient.
2490. All that we have further to say on suckling is an advice to mothers, that if they wish to keep a sound and unchapped nipple, and possibly avoid what is called a "broken breast," never to put it up with a wet nipple, but always to have a soft handkerchief in readiness, and the moment that delicate part is drawn from the child's mouth, to dry it carefully of the milk and saliva that moisten it; and, further, to make a practice of suckling from each breast alternately.
Dress and Dressing, Washing, &c.
2491. As respects the dress and dressing of a new-born
infant, or of a child in arms, during any stage of its nursing, there are few
women who will require us to give them guidance or directions for their
instruction; and though a few hints on the subject may not be out of place here,
yet most women intuitively "take to a baby," and, with a small amount
of experience, are able to perform all the little offices necessary to its
comfort and cleanliness with ease and completeness. We shall, therefore, on this
delicate subject hold our peace; and only, from afar, hint "at what we
would," leaving our suggestions to be approved or rejected, according as
they chime with the judgment and the apprehension of our motherly readers.
2492. In these days of intelligence, there are few ladies who have not, in all probability, seen the manner in which the Indian squaw, the aborigines of Polynesia, and even the Lapp and Esquimaux, strap down their baby on a board, and by means of a loop suspend it to the bough of a tree, hang it up to the rafters of the hut, or on travel, dangle it on their backs, outside the domestic implements, which, as the slave of her master, man, the wronged but uncomplaining woman carries, in order that her lord may march in unhampered freedom. Cruel and confining as this system of "backboard" dressing may seem to our modern notions of freedom and exercise, it is positively less irksome, less confining, and infinitely less prejudicial to health, than the mummying of children by our grandmothers a hundred, ay, fifty years ago: for what with chin-stays, back-stays, body-stays, forehead-cloths, rollers, bandages, &c., an infant had as many girths and strings, to keep head, limbs, and body in one exact position, as a ship has halyards.
2493. Much of this--indeed we may say all--has been abolished; but still the child is far from being dressed loosely enough; and we shall never be satisfied till the abominable use of the pin is avoided in toto in an infant's dressing, and a texture made for all the under garments of a child of a cool and elastic material.
2494. The manner in which an infant is encircled in a bandage called the "roller," as if it had fractured ribs, compressing those organs--that, living on suction, must be, for the health of the child, to a certain degree distended, to obtain sufficient aliment from the fluid imbibed--is perfectly preposterous. Our humanity, as well as our duty, calls upon us at once to abrogate and discountenance by every means in our power. Instead of the process of washing and dressing being made, as with the adult, a refreshment and comfort, it is, by the dawdling manner in which it is performed, the multiplicity of things used, and the perpetual change of position of the infant to adjust its complicated clothing, rendered an operation of positive irritation and annoyance. We, therefore, entreat all mothers to regard this subject in its true light, and study to the utmost, simplicity in dress, and dispatch in the process.
2495. Children do not so much cry from the washing as from the irritation caused by the frequent change of position in which they are placed, the number of times they are turned on their face, on their back, and on their side, by the manipulations demanded by the multiplicity of articles to be fitted, tacked, and carefully adjusted on their bodies. What mother ever found her girl of six or seven stand quiet while she was curling her hair? How many times nightly has she not to reprove her for not standing still during the process! It is the same with the unconscious infant, who cannot bear to be moved about, and who has no sooner grown reconciled to one position than it is forced reluctantly into another. It is true, in one instance the child has intelligence to guide it, and in the other not; but the motitory nerves, in both instances, resent coercion, and a child cannot be too little handled.
2496. On this account alone, and, for the moment, setting health and comfort out of the question, we beg mothers to simplify their baby's dress as much as possible; and not only to put on as little as is absolutely necessary, but to make that as simple in its contrivance and adjustment as it will admit of; to avoid belly-bands, rollers, girths, and everything that can impede or confine the natural expansion of the digestive organs, on the due performance of whose functions the child lives, thrives, and develops its physical being.
REARING BY HAND.
Articles necessary, and how to use them,--Preparation of Foods.-- Baths.--Advantages of Rearing by Hand.
2497. As we do not for a moment wish to be thought an
advocate for an artificial, in preference to the natural course of rearing
children, we beg our renders to understand us perfectly on this head; all we
desire to prove is the fact that a child can be brought up as well on a spoon
dietary as the best example to be found of those reared on the breast; having
more strength, indeed, from the more nutritious food on which it lives. It will
be thus less liable to infectious diseases, and more capable of resisting the
virulence of any danger that may attack it; and without in any way depreciating
the nutriment of its natural food, we wish to impress on the mother's mind that
there are many cases of infantine debility which might eventuate in rickets,
curvature of the spine, or mesenteric disease, where the addition to, or total
substitution of, an artificial and more stimulating aliment, would not only give
tone and strength to the constitution, but at the same time render the
employment of mechanical means totally unnecessary. And, finally, though we
would never--where the mother had the strength to suckle her child--supersede
the breast, we would insist on making it a rule to accustom the child as early
as possible to the use of an artificial diet, not only that it may acquire more
vigour to help it over the ills of childhood, but that, in the absence of the
mother, it might not miss the maternal sustenance; and also for the parent's
sake, that, should the milk, from any cause, become vitiated, or suddenly cease,
the child can be made over to the bottle and the spoon without the slightest
apprehension of hurtful consequences.
2498. To those persons unacquainted with the system, or who may have been erroneously informed on the matter, the rearing of a child by hand may seem surrounded by innumerable difficulties, and a large amount of personal trouble and anxiety to the nurse or mother who undertakes the duty. This, however, is a fallacy in every respect, except as regards the fact of preparing the food; but even this extra amount of work, by adopting the course we shall lay down, may be reduced to a very small sum of inconvenience; and as respects anxiety, the only thing calling for care is the display of judgment in the preparation of the food. The articles required for the purpose of feeding an infant are a night-lamp, with its pan and lid, to keep the food warm; a nursing-bottle, with a prepared teat; and a small pap saucepan, for use by day. Of the lamp we need hardly speak, most mothers being acquainted with its operation: but to those to whom it is unknown we may observe, that the flame from the floating rushlight heats the water in the reservoir above, in which the covered pan that contains the food floats, keeping it at such a heat that, when thinned by milk, it will be of a temperature suitable for immediate use. Though many kinds of nursing-bottles have been lately invented, and some mounted with India-rubber nipples, the common glass bottle, with the calf's teat, is equal in cleanliness and utility to any; besides, the nipple put into the child's mouth is so white and natural in appearance, that no child taken from the breast will refuse it. The black artificial ones of caoutchouc or gutta-percha are unnatural. The prepared teats can be obtained at any chemist's, and as they are kept in spirits, they will require a little soaking in warm water, and gentle washing, before being tied securely, by means of fine twine, round the neck of the bottle, just sufficient being left projecting for the child to grasp freely in its lips; for if left the full length, or over long, it will be drawn too far into the mouth, and possibly make the infant heave. When once properly adjusted, the nipple need never be removed till replaced by a new one, which will hardly be necessary oftener than once a fortnight, though with care one will last for several weeks. The nursing-bottle should be thoroughly washed and cleaned every day, and always rinsed out before and after using it, the warm water being squeezed through the nipple, to wash out any particles of food that might lodge in the aperture, and become sour. The teat can always be kept white and soft by turning the end of the bottle, when not in use, into a narrow jug containing water, taking care to dry it first, and then to warm it by drawing the food through before putting it into the child's mouth.
Food, and its Preparation.
2499. The articles generally employed as food for
infants consist of arrowroot, bread, flour, baked flour, prepared groats,
farinaceous food, biscuit-powder, biscuits, tops-and-bottoms, and semolina, or
manna croup, as it is otherwise called, which, like tapioca, is the prepared
pith of certain vegetable substances. Of this list the least efficacious,
though, perhaps, the most believed in, is arrowroot, which only as a mere agent,
for change, and then only for a very short time, should ever be employed as a
means of diet to infancy or childhood. It is a thin, flatulent, and innutritious
food, and incapable of supporting infantine life with energy. Bread, though the
universal régime with the labouring poor, where the infant's stomach and
digestive powers are a reflex, in miniature, of the father's, should never be
given to an infant under three months, and, even then, however finely beaten up
and smoothly made, is a very questionable diet. Flour, when well boiled, though
infinitely better than arrowroot, is still only a kind of fermentative paste,
that counteracts its own good by after-acidity and flatulence.
2500. Baked flour, when cooked into a pale brown mass, and finely powdered, makes a far superior food to the others, and may be considered as a very useful diet, especially for a change. Prepared groats may be classed with arrowroot and raw flour, as being innutritious. The articles that now follow in our list are all good, and such as we could, with conscience and safety, trust to for the health and development of any child whatever.
2501. We may observe in this place, that an occasional change in the character of the food is highly desirable, both as regards the health and benefit of the child; and though the interruption should only last for a day, the change will be advantageous.
2502. The packets sold as farinaceous food are unquestionably the best aliment that can be given from the first to a baby, and may be continued, with the exception of an occasional change, without alteration of the material, till the child is able to take its regular meals of animal and vegetable food. Some infants are so constituted as to require a frequent and total change in their system of living, seeming to thrive for a certain time on any food given to them, but if persevered in too long, declining in bulk and appearance as rapidly as they had previously progressed. In such cases the food should be immediately changed, and when that which appeared to agree best with the child is resumed, it should be altered in its quality, and perhaps in its consistency.
2503. For the farinaceous food there are directions with each packet, containing instructions for the making; but, whatever the food employed is, enough should be made at once to last the day and night; at first, about a pint basinful, but, as the child advances, a quart will hardly be too much. In all cases, let the food boil a sufficient time, constantly stirring, and taking every precaution that it does not get burnt, in which case it is on no account to be used.
2504. The food should always be made with water, the whole sweetened at once, and of such a consistency that, when poured out, and it has had time to cool, it will cut with the firmness of a pudding or custard. One or two spoonfuls are to be put into the pap saucepan and stood on the hob till the heat has softened it, when enough milk is to be added, and carefully mixed with the food, till the whole has the consistency of ordinary cream; it is then to be poured into the nursing-bottle, and the food having been drawn through to warm the nipple, it is to be placed in the child's mouth. For the first month or more, half a bottleful will be quite enough to give the infant at one time; but, as the child grows, it will be necessary not only to increase the quantity given at each time, but also gradually to make its food more consistent, and, after the third month, to add an egg to every pint basin of food made. At night the mother puts the food into the covered pan of her lamp, instead of the saucepan--that is, enough for one supply, and, having lighted the rush, she will find, on the waking of her child, the food sufficiently hot to bear the cooling addition of the milk. But, whether night or day, the same food should never be heated twice, and what the child leaves should be thrown away.
2505. The biscuit powder is used in the same manner as the farinaceous food, and both prepared much after the fashion of making starch. But when tops-and-bottoms, or the whole biscuit, are employed, they require soaking in cold water for some time previous to boiling. The biscuit or biscuits are then to be slowly boiled in as much water as will, when thoroughly soft, allow of their being beaten by a three-pronged fork into a fine, smooth, and even pulp, and which, when poured into a basin and become cold, will cut out like a custard. If two large biscuits have been so treated, and the child is six or seven months old, beat up two eggs, sufficient sugar to properly sweeten it, and about a pint of skim milk. Pour this on the beaten biscuit in the saucepan, stirring constantly; boil for about five minutes, pour into a basin, and use, when cold, in the same manner as the other.
2506. This makes an admirable food, at once nutritious and strengthening. When tops-and-bottoms or rusks are used, the quantity of the egg may be reduced, or altogether omitted.
2507. Semolina, or manna croup, being in little hard grains, like a fine millet-seed, must be boiled for some time, and the milk, sugar, and egg added to it on the fire, and boiled for a few minutes longer, and, when cold, used as the other preparations.
2508. Many persons entertain a belief that cow's milk is hurtful to infants, and, consequently, refrain from giving it; but this is a very great mistake, for both sugar and milk should form a large portion of every meal an infant takes.
TEETHING AND CONVULSIONS.
Fits, &c., the consequence of Dentition, and how to be treated.--The number and order of the Teeth, and manner in which they are cut.--First and Second Set.
2509. About three months after birth, the infant's troubles may be said to begin; teeth commence forming in the gums, causing pain and irritation in the mouth, and which, but for the saliva it causes to flow so abundantly, would be attended with very serious consequences. At the same time the mother frequently relaxes in the punctuality of the regimen imposed on her, and, taking some unusual or different food, excites diarrhoea or irritation in her child's stomach, which not unfrequently results in a rash on the skin, or slight febrile symptoms, which, if not subdued in their outset, superinduce some more serious form of infantine disease. But, as a general rule, the teeth are the primary cause of much of the child's sufferings, in consequence of the state of nervous and functional irritation into which the system is thrown by their formation and progress out of the jaw and through the gums. We propose beginning this branch of our subject with that most fertile source of an infant's suffering--
2510. That this subject may he better understood by the
nurse and mother, and the reason of the constitutional disturbance that, to a
greater or less degree, is experienced by all infants, may be made intelligible
to those who have the care of children, we shall commence by giving a brief
account of the formation of the teeth, the age at which they appear in the
mouth, and the order in which they pierce the gums. The organs of mastication in
the adult consist of 32 distinct teeth, 16 in either jaw; being, in fact, a
double set. The teeth are divided into 4 incisors, 2 canine, 4 first and second
grinders, and 6 molars; but in childhood the complement or first set consists of
only twenty, and these only make their appearance as the development of the
frame indicates the requirement of a different kind of food for the support of
the system. At birth some of the first-cut teeth are found in the cavities of
the jaw, in a very small and rudimentary form; but this is by no means
universal. About the third month, the jaws, which are hollow and divided into
separate cells, begin to expand, making room for the slowly developing teeth,
which, arranged for beauty and economy of space lengthwise, gradually turn their
tops upwards, piercing the gum by their edges, which, being sharp, assist in
cutting a passage through the soft parts. There is no particular period at which
children cut their teeth, some being remarkably early, and others equally late.
The earliest age that we have ever ourselves known as a reliable fact was, six
weeks. Such peculiarities are generally hereditary, and, as in this case,
common to a whole family. The two extremes are probably represented by six and
sixteen months. Pain and drivelling are the usual, but by no means the general,
indications of teething.
2511. About the sixth month the gums become tense and swollen, presenting a red, shiny appearance, while the salivary glands pour out an unusual quantity of saliva. After a time, a white line or round spot is observed on the top of one part of the gums, and the sharp edge of the tooth may be felt beneath if the finger is gently pressed on the part. Through these white spots the teeth burst their way in the following order:--
2512. Two incisors in the lower jaw are first cut, though, in general, some weeks elapse between the appearance of the first and the advent of the second. The next teeth cut are the four incisors of the upper jaw. The next in order are the remaining two incisors of the bottom, one on each side, then two top and two bottom on each side, but not joining the incisors; and lastly, about the eighteenth or twentieth month, the four eye teeth, filling up the space left between the side teeth and the incisors; thus completing the infant's set of sixteen. Sometimes at the same period, but more frequently some months later, four more double teeth slowly make their appearance, one on each side of each jaw, completing the entire series of the child's first set of twenty teeth. It is asserted that a child, while cutting its teeth, should either dribble excessively, vomit after every meal, or be greatly relaxed. Though one or other, or all of these at once, may attend a case of teething, it by no means follows that any one of them should accompany this process of nature, though there can be no doubt that where the pain consequent on the unyielding state of the gums, and the firmness of the skin that covers the tooth, is severe, a copious discharge of saliva acts beneficially in saving the head, and also in guarding the child from those dangerous attacks of fits to which many children in their teething are liable.
2513. The Symptoms that generally indicate the cutting of teeth, in addition to the inflamed and swollen state of the gums, and increased flow of saliva, are the restless and peevish state of the child, the hands being thrust into the mouth, and the evident pleasure imparted by rubbing the finger or nail gently along the gum; the lips are often excoriated, and the functions of the stomach or bowels are out of order. In severe cases, occurring in unhealthy or scrofulous children, there are, from the first, considerable fever, disturbed sleep, fretfulness, diarrhoea, rolling of the eyes, convulsive startings, laborious breathing, coma, or unnatural sleep, ending, unless the head is quickly relieved, in death.
2514. The Treatment in all cases of painful teething is remarkably simple, and consists in keeping the body cool by mild aperient medicines, allaying the irritation in the gums by friction with a rough ivory ring or a stale crust of broad, and when the head, lungs, or any organ is overloaded or unduly excited, to use the hot bath, and by throwing the body into a perspiration, equalize the circulation, and relieve the system from the danger of a fatal termination.
2515. Besides these, there is another means, but that must be employed by a medical man; namely, scarifying the gums--an operation always safe, and which, when judiciously performed, and at a critical opportunity, will often snatch the child from the grasp of death.
2516. There are few subjects on which mothers have often formed such strong and mistaken opinions as on that of lancing an infant's gums, some rather seeing their child go into fits--and by the unrelieved irritation endangering inflammation of the brain, water on the head, rickets, and other lingering affections--than permit the surgeon to afford instant relief by cutting through the hard skin, which, like a bladder over the stopper of a bottle, effectually confines the tooth to the socket, and prevents it piercing the soft, spongy substance of the gum. This prejudice is a great error, as we shall presently show; for, so far from hurting the child, there is nothing that will so soon convert an infant's tears into smiles as scarifying the gums in painful teething; that is, if effectually done, and the skin of the tooth be divided.
2517. Though teething is a natural function, and to an infant in perfect health should be unproductive of pain, yet in general it is not only a fertile cause of suffering, but often a source of alarm and danger; the former, from irritation in the stomach and bowels, deranging the whole economy of the system, and the latter, from coma and fits, that may excite alarm in severe cases; and the danger, that eventuates in some instances, from organic disease of the head or spinal marrow.
2518. We shall say nothing in this place of "rickets," or "water on the head," which are frequent results of dental irritation, but proceed to finish our remarks on the treatment of teething. Though strongly advocating the lancing of the gums in teething, and when there are any severe head-symptoms, yet it should never be needlessly done, or before being satisfied that the tooth is fully formed, and is out of the socket, and under the gum. When assured on these points, the gum should be cut lengthwise, and from the top of the gum downwards to the tooth, in an horizontal direction, thus----, and for about half an inch in length. The operation is then to be repeated in a transverse direction, cutting across the gum, in the centre of the first incision, and forming a cross, thus +. The object of this double incision is to insure a retraction of the cut parts, and leave an open way for the tooth to start from--an advantage not to be obtained when only one incision is made; for unless the tooth immediately follows the lancing, the opening reunites, and the operation has to be repeated. That this operation is very little or not at all painful, is evidenced by the suddenness with which the infant falls asleep after the lancing, and awakes in apparently perfect health, though immediately before the use of the gum-lancet, the child may have been shrieking or in convulsions.
Convulsions, or Infantine Fits.
2519. From their birth till after teething, infants are
more or less subject or liable to sudden fits, which often, without any
assignable cause, will attack the child in a moment, and while in the mother's
arms; and which, according to their frequency, and the age and strength of the
infant, are either slight or dangerous.
2520. Whatever may have been the remote cause, the immediate one is some irritation of the nervous system, causing convulsions, or an effusion to the head, inducing coma. In the first instance, the infant cries out with a quick, short scream, rolls up its eyes, arches its body backwards, its arms become bent and fixed, and the fingers parted; the lips and eyelids assume a dusky leaden colour, while the face remains pale, and the eyes open, glassy, or staring. This condition may or may not be attended with muscular twitchings of the mouth, and convulsive plunges of the arms. The fit generally lasts from one to three minutes, when the child recovers with a sigh, and the relaxation of the body. In the other case, the infant is attacked at once with total insensibility and relaxation of the limbs, coldness of the body and suppressed breathing; the eyes, when open, being dilated, and presenting a dim glistening appearance; the infant appearing, for the moment, to be dead.
2521. Treatment.-The first step in either case is, to immerse the child in a hot bath up to the chin; or if sufficient hot water cannot be procured to cover the body, make a hip-bath of what can be obtained; and, while the left hand supports the child in a sitting or recumbent position, with the right scoop up the water, and run it over the chest of the patient. When sufficient water can be obtained, the spine should be briskly rubbed while in the bath; when this cannot be done, lay the child on the knees, and with the fingers dipped in brandy, rub the whole length of the spine vigorously for two or three minutes, and when restored to consciousness, give occasionally a teaspoonful of weak brandy and water or wine and water.
2522. An hour after the bath, it may be necessary to give an aperient powder, possibly also to repeat the dose for once or twice every three hours; in which case the following prescription is to be employed. Take of
Powdered scammony 6 grains. Grey powder 6 grains. Antimonial powder 4 grains. Lump sugar 20 grains.
Mix thoroughly, and divide into three powders, which are to be taken as advised for an infant one year old; for younger or weakly infants, divide into four powders, and give as the other. For thirst and febrile symptoms, give drinks of barley-water, or cold water, and every three hours put ten to fifteen drops of spirits of sweet nitre in a dessert-spoonful of either beverage.
THRUSH, AND ITS TREATMENT.
2523. This is a disease to which infants are peculiarly
subject, and in whom alone it may be said to be a disease; for when thrush shows
itself in adult or advanced life, it is not as a disease proper, but only as a
symptom, or accessory, of some other ailment, generally of a chronic character,
and should no more be classed as a separate affection than the petechae, or
dark-coloured spots that appear in malignant measles, may be considered a
2524. Thrush is a disease of the follicles of the mucous membrane of the alimentary canal, whereby there are formed small vesicles, or bladders, filled with a thick mucous secretion, which, bursting, discharge their contents, and form minute ulcers in the centre of each vessel. To make this formal but unavoidable description intelligible, we must beg the reader's patience while we briefly explain terms that may appear to many so unmeaning, and make the pathology of thrush fully familiar.
2525. The whole digestive canal, of which the stomach and bowels are only a part, is covered, from the lips, eyes, and ears downwards, with a thin glairy tissue, like the skin that lines the inside of an egg, called the mucous membrane; this membrane is dotted all over, in a state of health, by imperceptible points, called follicles, through which the saliva, or mucous secreted by the membrane, is poured out.
2526. These follicles, or little glands, then, becoming enlarged, and filled with a congealed fluid, constitute thrush in its first stage; and when the child's lips and mouth appear a mass of small pearls, then, as these break and discharge, the second stage, or that of ulceration, sets in.
2527. Symptoms.--Thrush is generally preceded by considerable irritation, by the child crying and fretting, showing more than ordinary redness of the lips and nostrils, hot fetid breath, with relaxed bowels, and dark feculent evacuations; the water is scanty and high-coloured; whilst considerable difficulty in swallowing, and much thirst, are the other symptoms, which a careful observation of the little patient makes manifest.
2528. The situation and character of thrush show at once that the cause is some irritation of the mucous membrane, and can proceed only from the nature and quality of the food. Before weaning, this must be looked for in the mother, and the condition of the milk; after that time, in the crude and indigestible nature of the food given. In either case, this exciting cause of the disease must be at once stopped. When it proceeds from the mother, it is always best to begin by physicking the infant through the parent; that is to say, let the parent first take the medicine, which will sufficiently affect the child through the milk: this plan has the double object of benefiting the patient and, at the same time, correcting the state of the mother, and improving the condition of her milk. In the other case, when the child is being fed by hand, then proceed by totally altering the style of aliment given, and substituting farinaceous food, custards, blanc-mange, and ground-rice puddings.
2529. As an aperient medicine for the mother, the best thing she can take is a dessert-spoonful of carbonate of magnesia once or twice a day, in a cup of cold water; and every second day, for two or three times, an aperient pill.
2530. As the thrush extends all over the mouth, throat, stomach, and bowels, the irritation to the child from such an extent of diseased surface is proportionately great, and before attempting to act on such a tender surface by opening medicine, the better plan is to soothe by an emollient mixture; and, for that purpose, let the following be prepared. Take of
Castor oil 2 drachms. Sugar 1 drachm. Mucilage, or powdered gum Arabic half a drachm.
Triturate till the oil is incorporated, then add slowly--
Mint-water One ounce and a half Laudanum Ten drops
Half a teaspoonful three times a day, to an infant from one to two years old; a teaspoonful from two to three years old; and a dessertspoonful at any age over that time. After two days' use of the mixture, one of the following powders should be given twice a day, accompanied with one dose daily of the mixture:--
Grey powder 20 grains. Powdered rhubarb 15 grains. Scammony 10 grains. Mix.
Divide into twelve powders, for one year; eight powders, from one to two; and six powders, from two to six years old. After that age, double the strength, by giving the quantity of two powders at once.
2531. It is sometimes customary to apply borax and honey to the mouth for thrush; but it is always better to treat the disease constitutionally rather than locally. The first steps, therefore, to be adopted are, to remove or correct the exciting cause--the mother's milk or food; allay irritation by a warm bath and the castor-oil mixture, followed by and conjoined with the powders.
2532. To those, however, who wish to try the honey process, the best preparation to use is the following:-Rub down one ounce of honey with two drachms of tincture of myrrh, and apply it to the lips and mouth every four or six hours.
2533. It is a popular belief, and one most devoutly cherished by many nurses and elderly persons, that everybody must, at some time of their life, between birth and death, have an attack of thrush, and if not in infancy, or prime of life, it will surely attack them on their death-bed, in a form more malignant than if the patient had been affected with the malady earlier; the black thrush with which they are then reported to be affected being, in all probability, the petechae or purple spots that characterize the worst form, and often the last stage, of typhoid fever.
2534. In general, very little medicine is needed in this disease of the thrush--an alterative powder, or a little magnesia, given once or twice, being all, with the warm bath, that, in the great majority of cases, is needed to restore the mucous membrane to health. As thrush is caused by an excess of heat, or over-action in the lining membrane of the stomach and bowels, whatever will counteract this state, by throwing the heat on the surface, must materially benefit, if not cure, the disease: and that means every mother has at hand, in the form of a warm bath. After the application of this, a little magnesia to correct the acidity existing along the surface of the mucous membrane, is often all that is needed to throw the system into such a state as will effect its own cure. This favourable state is indicated by an excessive flow of saliva, or what is called "dribbling," and by a considerable amount of relaxation of the bowels-a condition that must not be mistaken for diarrhoea, and checked as if a disease, but rather, for the day or two it continues, encouraged as a critical evacuant.
2535. Should there be much debility in the convalescence, half a teaspoonful of stee wine, given twice a day in a little barley-water, will be found sufficient for all the purposes of a tonic. This, with the precaution of changing the child's food, or, when it lives on the mother, of correcting the quality of the milk by changing her own diet, and, by means of an antacid or aperient, improving the state of the secretion. Such is all the treatment that this disease in general requires.
2536. The class of diseases we are now approaching are the most important, both in their pathological features and in their consequences on the constitution, of any group or individual disease that assails the human body; and though more frequently attacking the undeveloped frame of childhood, are yet by no means confined to that period. These are called Eruptive Fevers, and embrace chicken-pox, cow-pox, small-pox, scarlet fever, measles, milary fever, and erysipelas, or St. Anthony's fire.
2537. The general character of all these is, that they are contagious, and, as a general rule, attack a person only once in his lifetime; that their chain of diseased actions always begins with fever, and that, after an interval of from one to four days, the fever is followed by an eruption of the skin.
CHICKEN-POX, OR GLASS-POX; AND COW-POX, OR VACCINATION.
2538. CHICKEN-POX, or GLASS-POX, may, in strict
propriety, be classed as a mild variety of small-pox, presenting all the
mitigated symptoms of that formidable disease. Among many physicians it is,
indeed, classed as small-pox, and not a separate disease; but as this is not the
place to discuss such questions, and as we profess to give only facts, the
result of our own practical experience, we shall treat this affection of
glass-pox or chicken-pox, as we ourselves have found it, as a distinct and
2539. Chicken-pox is marked by all the febrile symptoms presented by small-pox, with this difference, that, in the case of chicken-pox, each symptom is particularly slight. The heat of body is much less acute, and the principal symptoms are difficulty of breathing, headache, coated tongue, and nausea, which sometimes amounts to vomiting. After a term of general irritability, heat, and restlessness, about the fourth day, or between the third and fourth, an eruption makes its appearance over the face, neck, and body, in its first two stages closely resembling small-pox, with this especial difference, that whereas the pustules in small-pox have flat and depressed centres--an infallible characteristic of small-pox--the pustules in chicken-pox remain globular, while the fluid in them changes from a transparent white to a straw-coloured liquid, which begins to exude and disappear about the eighth or ninth day, and, in mild cases, by the twelfth desquamates, or peels off entirely.
2540. There can be no doubt that chicken-pox, like small-pox, is contagious, and under certain states of the atmosphere becomes endemic. Parents should, therefore, avoid exposing young children to the danger of infection by taking them where it is known to exist, as chicken-pox, in weakly constitutions, or in very young children, may superinduce small-pox, the one disease either running concurrently with the other, or discovering itself as the other declines. This, of course, is a condition that renders the case very hazardous, as the child has to struggle against two diseases at once, or before it has recruited strength from the attack of the first.
2541. Treatment.--In all ordinary cases of chicken-pox--and it is very seldom it assumes any complexity--the whole treatment resolves itself into the use of the warm bath, and a course of gentle aperients. The bath should be used when the oppression of the lungs renders the breathing difficult, or the heat and dryness of the skin, with the undeveloped rash beneath the surface, shows the necessity for its use.
2542. As the pustules in chicken-pox very rarely run to the state of suppuration, as in the other disease, there is no fear of pitting or disfigurement, except in very severe forms, which, however, happen so seldom as not to merit apprehension. When the eruption subsides, however, the face may be washed with elder-flower water, and the routine followed which is prescribed in the convalescent state of small-pox.
2543. COW-POX, properly speaking, is an artificial disease, established in a healthy body as a prophylactic, or preventive agent, against the more serious attack of small-pox, and is merely that chain of slight febrile symptoms and local irritation, consequent on the specific action of the lymph of the vaccination, in its action on the circulating system of the body. This is not the place to speak of the benefits conferred on mankind by the discovery of vaccination, not only as the preserver of the human features from a most loathsome disfigurement, but as a sanitary agent in the prolongation of life.
2544. Fortunately the State has now made it imperative on all parents to have their children vaccinated before, or by the end of, the twelfth week; thus doing away, as far as possible, with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive; for though vaccination has been proved not to be always an infallible guard against small-pox, the attack is always much lighter, should it occur, and is seldom, if indeed ever, fatal after the precaution of vaccination. The best time to vaccinate a child is after the sixth and before the twelfth week, if it is in perfect health, but still earlier if small-pox is prevalent, and any danger exists of the infant taking the disease. It is customary, and always advisable, to give the child a mild aperient powder one or two days before inserting the lymph in the arm; and should measles, scarlet fever, or any other disease arise during the progress of the pustule, the child, when recovered, should be re-vaccinated, and the lymph taken from its arm on no account used for vaccinating purposes.
2545. The disease of cow-pox generally takes twenty days to complete its course; in other words, the maturity and declension of the pustule takes that time to fulfil its several changes. The mode of vaccination is either to insert the matter, or lymph, taken from a healthy child, under the cuticle in several places on both arms, or, which is still better, to make three slight scratches, or abrasions, with a lancet on one arm in this manner, ,,",, and work into the irritated parts the lymph, allowing the arm to dry thoroughly before putting down the infant's sleeve; by this means absorption is insured, and the unnecessary pain of several pustules on both arms avoided. No apparent change is observable by the eye for several days; indeed, not till the fourth, in many cases, is there any evidence of a vesicle; about the fifth day, however, a pink areola, or circle, is observed round one or all of the places, surrounding a small pearly vesicle or bladder. This goes on deepening in hue till the seventh or eighth day, when the vesicle is about an inch in diameter, with a depressed centre; on the ninth the edges are elevated, and the surrounding part hard and inflamed. The disease is now at its height, and the pustule should be opened, if not for the purpose of vaccinating other children, to allow the escape of the lymph, and subdue the inflammatory action. After the twelfth day the centre is covered by a brown scab, and the colour of the swelling becomes darker, gradually declining in hardness and colour till the twentieth, when the scab falls, off, leaving a small pit, or cicatrix, to mark the seat of the disease, and for life prove a certificate of successful vaccination.
2546. In some children the inflammation and swelling of the arm is excessive, and extremely painful, and the fever, about the ninth or tenth day, very high; the pustule, therefore, at that time, should sometimes be opened, the arm fomented every two hours with a warm bread poultice, and an aperient powder given to the infant.
MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH.
2547. This much-dreaded disease, which forms the next
subject in our series of infantine diseases, and which entails more evils on the
health of childhood than any other description of physical suffering to which
that age of life is subject, may be considered more an affection of the venous
circulation, tending to general and local congestion, attended with a diseased
condition of the blood, than either as a fever or an inflammation; and though
generally classed before or after scarlet fever, is, in its pathology and
treatment, irrespective of its after-consequences, as distinct and opposite as
one disease can well be from another.
2548. As we have already observed, measles are always characterized by the running at the nose and eyes, and great oppression of breathing; so, in the mode of treatment, two objects are to be held especially in view; first, to unload the congested state of the lungs,--the cause of the oppressed breathing; and, secondly, to act vigorously, both during the disease and afterwards, on the bowels. At the same time it cannot be too strongly borne in mind, that though the patient in measles should on no account be kept unduly hot, more care than in most infantine complaints should be taken to guard the body from cold, or any abrupt changes of temperature. With these special observations, we shall proceed to give a description of the disease, as recognized by its usual--
2549. Symptoms, which commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, deduction or running at the eyes and nose, nausea, sometimes vomiting, thirst, a furred tongue; the pulse throughout is quick, and sometimes full and soft, at others hard and small, with other indications of an inflammatory nature.
2550. On the third day, small red points make their appearance, first on the face and neck, gradually extending over the upper and lower part of the body. On the fifth day, the vivid red of the eruption changes into a brownish hue; and, in two or three days more, the rash entirely disappears, leaving a loose powdery desquamation on the skin, which rubs off like dandriff. At this stage of the disease a diarrhoea frequently comes on, which, being what is called "critical," should never be checked, unless seriously severe. Measles sometimes assume a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes both doubtful and dangerous. In this condition the eruption comes out sooner, and only in patches; and often, after showing for a few hours, suddenly recedes, presenting, instead of the usual florid red, a dark purple or blackish hue; a dark brown fur forms on the gums and mouth, the breathing becomes laborious, delirium supervenes, and, if unrelieved, is followed by coma; a fetid diarrhoea takes place, and the patient sinks under the congested state of the lungs and the oppressed functions of the brain.
2551. The unfavourable symptoms in measles are a high degree of fever, the excessive heat and dryness of the skin, hurried and short breathing, and a particularly hard pulse. The sequels, or after-consequences, of measles are, croup, bronchitis, mesenteric disease, abscesses behind the ear, ophthalmia, and glandular swellings in other parts of the body.
2552. Treatment.--In the first place, the patient should be kept in a cool room, the temperature of which must be regulated to suit the child's feelings of comfort, and the diet adapted to the strictest principles of abstinence. When the inflammatory symptoms are severe, bleeding, in some form, is often necessary, though, when adopted, it must be in the first stage of the disease; and, if the lungs are the apprehended seat of the inflammation, two or more leeches, according to the age and strength of the patient, must be applied to the upper part of the chest, followed by a small blister; or the blister may be substituted for the leeches, the attendant bearing in mind, that the benefit effected by the blister can always be considerably augmented by plunging the feet into very hot water about a couple of hours after applying the blister, and kept in the water for about two minutes. And let it further be remembered, that this immersion of the feet in hot water may be adopted at any time or stage of the disease; and that, whenever the head or lungs are oppressed, relief will always accrue from its sudden and brief employment. When the symptoms commence with much shivering, and the skin early assumes a hot, dry character, the appearance of the rash will be facilitated, and all the other symptoms rendered milder, if the patient is put into a warm bath, and kept in the water for about three minutes. Or, where that is not convenient, the following process, which will answer quite as well, can be substituted:--Stand the child, naked, in a tub, and, having first prepared several jugs of sufficiently warm water, empty them, in quick succession, over the patient's shoulders and body; immediately wrap in a hot blanket, and put the child to bed till it rouses from the sleep that always follows the effusion or bath. This agent, by lowering the temperature of the skin, and opening the pores, producing a natural perspiration, and unloading the congested state of the lungs, in most cases does away entirely with the necessity both for leeches and a blister. Whether any of these external means have been employed or not, the first internal remedies should commence with a series of aperient powders and a saline mixture, as prescribed in the following formularies; at the same time, as a beverage to quench the thirst, let a quantity of barley-water be made, slightly acidulated by the juice of an orange, and partially sweetened by some sugar-candy; and of which, when properly made and cold, let the patient drink as often as thirst, or the dryness of the mouth, renders necessary.
2553. Aperient Powders.--Take of scammony and jalap, each 24 grains; grey powder and powdered antimony, each 18 grains. Mix and divide into 12 powders, if for a child between two and four years of age; into 8 powders, if for a child between four and eight years of ago; and into 6 powders for between eight and twelve years. One powder to be given, in a little jelly or sugar-and-water, every three or four hours, according to the severity of the symptoms.
2554. Saline Mixture.--Take of mint-water, 6 ounces; powdered nitre, 20 grains; antimonial wine, 3 drachms; spirits of nitre, 2 drachms; syrup of saffron, 2 drachms. Mix. To children under three years, give a teaspoonful every two hours; from that age to six, a dessertspoonful at the same times; and a tablespoonful every three or four hours to children between six and twelve.
2555. The object of these aperient powders is to keep up a steady but gentle action on the bowels; but, whenever it seems necessary to administer a stronger dose, and effect a brisk action on the digestive organs,--a course particularly imperative towards the close of the disease,--two of these powders given at once, according to the age, will be found to produce that effect; that is, two of the twelve for a child under four years, and two of the eight, and two of the six, according to the age of the patient.
2556. When the difficulty of breathing becomes oppressive, as it generally does towards night, a hot bran poultice, laid on the chest, will be always found highly beneficial. The diet throughout must be light, and consist of farinaceous food, such as rice and sago puddings, beef-tea and toast; and not till convalescence sets in should hard or animal food be given.
2557. When measles assume the malignant form, the advice just given must be broken through; food of a nutritious and stimulating character should be at once substituted, and administered in conjunction with wine, and even spirits, and the disease regarded and treated as a case of typhus. But, as this form of measles is not frequent, and, if occurring, hardly likely to be treated without assistance, it is unnecessary to enter on the minutiae of its practice here. What we have prescribed, in almost all cases, will be found sufficient to meet every emergency, without resorting to a multiplicity of agents.
2558. The great point to remember in measles is, not to give up the treatment with the apparent subsidence of the disease, as the after-consequences of measles are too often more serious, and to be more dreaded, than the measles themselves. To guard against this danger, and thoroughly purify the system, after the subsidence of all the symptoms of the disease, a corrective course of medicine, and a regimen of exercise, should be adopted for some weeks after the cure of the disease. To effect this, an active aperient powder should be given every three or four clays, with a daily dose of the subjoined tonic mixture, with as much exercise, by walking, running after a hoop, or other bodily exertion, as the strength of the child and the state of the atmosphere will admit, the patient being, wherever possible, removed to a purer air as soon as convalescence warrants the change.
2559. Tonic Mixture.--Take of infusion of rose-leaves, 6 ounces; quinine, 8 grains; diluted sulphuric acid, 15 drops. Mix. Dose, from half a teaspoonful up to a dessertspoonful, once a day, according to the ago of the patient.
Scarlatina, or Scarlet Fever.
2560. Though professional accuracy has divided this
disease into several forms, we shall keep to the one disease most generally mot
with, the common or simple scarlet fever, which, in all cases, is characterized
by an excessive heat on the skin, sore throat, and a peculiar speckled
appearance of the tongue.
2561. Symptoms.--Cold chills, shivering, nausea, thirst, hot skin, quick pulse, with difficulty of swallowing; the tongue is coated, presenting through its fur innumerable specks, the elevated papillae of the tongue, which gives it the speckled character, that, if not the invariable sign of scarlet fever, is only met with in cases closely analogous to that disease. Between the second and third day, but most frequently on the third, a bright red efflorescence breaks out in patches on the face, neck, and back, from which it extends over the trunk and extremities, always showing thicker and deeper in colour wherever there is any pressure, such as the elbows, back, and hips; when the eruption is well out, the skin presents the appearance of a boiled lobster-shell. At first, the skin is smooth, but, as the disease advances, perceptible roughness is apparent, from the elevation of the rash, or, more properly, the pores of the skin. On the fifth and sixth days the eruption begins to decline, and by the eighth has generally entirely disappeared. During the whole of this period, there is, more or less, constant sore throat.
2562. The Treatment of scarlet fever is, in general, very simple. Where the heat is great, and the eruption comes out with difficulty, or recedes as soon as it appears, the body should be sponged with cold vinegar-and-water, or tepid water, as in measles, poured over the chest and body, the patient being, as in that disease, wrapped in a blanket and put to bed, and the same powders and mixture ordered in measles administered, with the addition of a constant hot bran poultice round the throat, which should be continued from the first symptom till a day or two after the declension of the rash. The same low diet and cooling drink, with the same general instructions, are to be obeyed in this as in the former disease.
2563. When the fever runs high in the first stage, and there is much nausea, before employing the effusions of water, give the patient an emetic, of equal, parts of ipecacuanha and antimonial wine, in doses of from a teaspoonful to a tablespoonful, according to age. By these means, nine out of every ten cases of scarlatina may be safely and expeditiously cured, especially if the temperature of the patient's room is kept at an even standard of about sixty degrees.
HOOPING-COUGH, CROUP, AND DIARRHOEA, WITH THEIR MODE OF TREATMENT.
2564. THIS is purely a spasmodic disease, and is only
infectious through the faculty of imitation, a habit that all children are
remarkably apt to fall into; and even where adults have contracted
hooping-cough, it has been from the same cause, and is as readily accounted for,
on the principle of imitation, as that the gaping of one person will excite or
predispose a whole party to follow the same spasmodic example. If any one
associates for a few days with a person who stammers badly, he will find, when
released from his company, that the sequence of his articulation and the fluency
of his speech are, for a time, gone; and it will be a matter of constant
vigilance, and some difficulty, to overcome the evil of so short an association.
The manner in which a number of school-girls will, one after another, fall into
a fit on beholding one of their number attacked with epilepsy, must be familiar
to many. These several facts lead us to a juster notion of how to treat this
spasmodic disease. Every effort should, therefore, be directed, mentally and
physically, to break the chain of nervous action, on which the continuance of
the cough depends.
2565. Symptoms.--Hooping-cough comes on with a slight oppression of breathing, thirst, quick pulse, hoarseness, and a hard, dry cough. This state may exist without any change from one to two or three weeks before the peculiar feature of the disease-the hoop-sets in. As the characteristics of this cough are known to all, it is unnecessary to enter here, physiologically, on the subject. We shall, therefore, merely remark that the frequent vomiting and bleeding at the mouth or nose are favourable signs, and proceed to the
2566. Treatment, which should consist in keeping up a state of nausea and vomiting. For this purpose, give the child doses of ipecacuanha and antimonial wines, in equal parts, and quantities varying from half to one and a half teaspoonful once a day, or, when the expectoration is hard and difficult of expulsion, giving the following cough mixture every four hours. Take of
Syrup of squills 1/2 ounce. Antimonial wine 1 ounce. Laudanum 15 drops. Syrup of Toulou 2 drachms. Water 1-1/2 ounce.
Mix. The dose is from half a spoonful to a dessertspoonful. When the cough is urgent, the warm bath is to be used, and either one or two leeches applied over the breastbone, or else a small blister laid on the lower part of the throat.
2567. Such is the medical treatment of hooping-cough; but there is a moral regimen, based on the nature of the disease, which should never be omitted. And, on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping, so the like means should be adopted with the hooping-cough patient; and, in the first stage, before the hooping has been added, the parent should endeavour to break the paroxysm of the cough by abruptly attracting the patient's attention, and thus, if possible, preventing the cough from reaching that height when the ingulp of air gives the hoop or crow that marks the disease; but when once that symptom has set in, it becomes still more necessary to endeavour, by even measures of intimidation, to break the spasmodic chain of the cough. Exercise in the open air, when dry, is also requisite, and charge of scene and air in all cases is of absolute necessity, and may be adopted at any stage of the disease.
2568. This is by far the most formidable and fatal of
all the diseases to which infancy and childhood are liable, and is purely an
inflammatory affection, attacking that portion of the mucous membrane lining the
windpipe and bronchial tubes, and from the effect of which a false or loose
membrane is formed along the windpipe, resembling in appearance the finger of a
glove suspended in the passage, and, consequently, terminating the life of the
patient by suffocation; for, as the lower end grows together and becomes closed,
no air can enter the lungs, and the child dies choked. All dull, fat, and heavy
children are peculiarly predisposed to this disease, and those with short necks
and who make a wheezing noise in their natural breathing. Croup is always sudden
in its attack, and rapid in its career, usually proving fatal within three days;
most frequently commences in the night, and generally attacking children between
the ages of three and ten years. Mothers should, therefore, be on their guard
who have children predisposed to this disease, and immediately resort to the
means hereafter advised.
2569. Symptoms.--Languor and restlessness, hoarseness, wheezing, and short, dry cough, with occasional rattling in the throat during sleep, the child often plucking at its throat with its fingers; difficulty of breathing, which quickly becomes hard and laboured, causing great anxiety of the countenance, and the veins of the neck to swell and become knotted; the voice in speaking acquires a sharp, crowing, or croupy sound, while the inspirations have a harsh, metallic intonation. After a few hours, a quantity of thick, ropy mucus is thrown out, hanging about the mouth, and causing suffocating fits of coughing to expel.
2570. Treatment.--Place the child immediately in a hot bath up to the throat; and, on removal from the water, give an emetic of the antimonial or ipecacuanha wine, and, when the vomiting has subsided, lay a long blister down the front of the throat, and administer one of the following powders every twenty minutes to a child from three to six years of age.
2571. Take of calomel, 12 grains; tartar emetic, 2 grains; lump sugar, 30 grains. Mix accurately, and divide into 12 powders. For a child from six to twelve years, divide into 6 powders, and give one every half-hour.
2572. Should the symptoms remain unabated after a few hours, apply one or two leeches to the throat, and put mustard poultices to the foot and thighs, retaining them about eight minutes; and, in extreme cases, a mustard poultice to the spine between the shoulders, and at the same time rub mercurial ointment into the armpits and the angles of the jaws.
2573. Such is a vigorous and reliable system of treatment in severe cases of croup; but, in the milder and more general form, the following abridgment will, in all probability, be all that will be required:--First, the hot bath; second, the emetic; third, a mustard plaster round the throat for five minutes; fourth, the powders; fifth, another emetic in six hours, if needed, and the powders continued without intermission while the urgency of the symptoms continues. When relief has been obtained, these are to be discontinued, and a dose of senna tea given to act on the bowels.
2574. The diarrhoea with which children are so
frequently affected, especially in infancy, should demand the nurse's immediate
attention, and when the secretion, from its clayey colour, indicates an absence
of bile, a powder composed of 3 grains of grey powder and 1 grain of rhubarb,
should be given twice, with an interval of four hours between each dose, to a
child from one to two years, and, a day or two afterwards, an aperient powder
containing the same ingredients and quantities, with the addition of 2 or 3
grains of scammony. For the relaxation consequent on an overloaded stomach, or
acidity in the bowels, a little magnesia dissolved in milk should be employed
two or three times a day.
2575. When much griping and pain attend the diarrhoea, half a teaspoonful of Dalby's Carminative (the best of all patent medicines) should be given, either with or without a small quantity of castor oil to carry off the exciting cause.
2576. For any form of diarrhoea that, by excessive action, demands a speedy correction, the most efficacious remedy that can be employed in all ages and conditions of childhood is the tincture of Kino, of which from 10 to 30 drops, mixed with a little sugar and water in a spoon, are to be given every two or three hours till the undue action has been checked. Often the change of diet to rice, milk, eggs, or the substitution of animal for vegetable food, or vice versa, will correct an unpleasant and almost chronic state of diarrhoea.
2577. A very excellent carminative powder for flatulent infants may be kept in the house, and employed with advantage, whenever the child is in pain or griped, by dropping 5 grains of oil of aniseed and 2 of peppermint on half an ounce of lump sugar, and rubbing it in a mortar, with a drachm of magnesia, into a fine powder. A small quantity of this may be given in a little water at any time, and always with benefit.