The Book of Household Management
by
Mrs. Isabella Beeton
Part 32 out of 34
occupy her time. She should also understand the making-up of little
caps, although we can scarcely say this is one of the nurse's duties. As
most children wear no caps, except out of doors, her powers in this way
will not be much taxed.
2433. A nurse should endeavour to make her room as cheerful as possible,
and always keep it clean and tidy. She should empty the chamber utensils
as soon as used, and on no account put things under the bed. Soiled
baby's napkins should be rolled up and put into a pan, when they should
be washed out every morning, and hung out to dry: they are then in a fit
state to send to the laundress; and should, on no account, be left
dirty, but done every morning in this way. The bedroom should be kept
rather dark, particularly for the first week or ten days; of a regular
temperature, and as free as possible from draughts, at the same time
well ventilated and free from unpleasant smells.
2434. The infant during the month must not be exposed to strong light,
or much air; and in carrying it about the passages, stairs, &c., the
nurse should always have its head-flannel on, to protect the eyes and
ears from the currents of air. For the management of children, we must
refer our readers to the following chapters; and we need only say, in
conclusion, that a good nurse should understand the symptoms of various
ills incident to this period, as, in all cases, prevention is better
than cure. As young mothers with their first baby are very often much
troubled at first with their breasts, the nurse should understand the
art of emptying them by suction, or some other contrivance. If the
breasts are kept well drawn, there will be but little danger of
inflammation; and as the infant at first cannot take all that is
necessary, something must be done to keep the inflammation down. This is
one of the greatest difficulties a nurse has to contend with, and we can
only advise her to be very persevering, to rub the breasts well, and to
let the infant suck as soon and as often as possible, until they get in
proper order.
THE WET-NURSE.
2435. We are aware that, according to the opinion of some ladies, there
is no domestic theme, during a certain period of their married lives,
more fraught with vexation and disquietude than that ever-fruitful
source of annoyance, "the Nurse;" but, as we believe, there are
thousands of excellent wives and mothers who pass through life without
even a temporary embroglio in the kitchen, or suffering a state of moral
hectic the whole time of a nurse's empire in the nursery or bedroom. Our
own experience goes to prove, that although many unqualified persons
palm themselves off on ladies as fully competent for the duties they so
rashly and dishonestly undertake to perform, and thus expose themselves
to ill-will and merited censure, there are still very many fully equal
to the legitimate exercise of what they undertake; and if they do not in
every case give entire satisfaction, some of the fault,--and sometimes a
great deal of it,--may be honestly placed to the account of the ladies
themselves, who, in many instances, are so impressed with the propriety
of their own method of performing everything, as to insist upon the
adoption of _their_ system in preference to that of the nurse, whose
plan is probably based on a comprehensive forethought, and rendered
perfect in all its details by an ample experience.
2436. In all our remarks on this subject, we should remember with
gentleness the order of society from which our nurses are drawn; and
that those who make their duty a study, and are termed professional
nurses, have much to endure from the caprice and egotism of their
employers; while others are driven to the occupation from the laudable
motive of feeding their own children, and who, in fulfilling that
object, are too often both selfish and sensual, performing, without
further interest than is consistent with their own advantage, the
routine of customary duties.
2437. Properly speaking, there are two nurses,--the nurse for the mother
and the nurse for the child, or, the monthly and the wet nurse. Of the
former we have already spoken, and will now proceed to describe the
duties of the latter, and add some suggestions as to her age, physical
health, and moral conduct, subjects of the utmost importance as far as
the charge intrusted to her is concerned, and therefore demanding some
special remarks.
2438. When from illness, suppression of the milk, accident, or some
natural process, the mother is deprived of the pleasure of rearing her
infant, it becomes necessary at once to look around for a fitting
substitute, so that the child may not suffer, by any needless delay, a
physical loss by the deprivation of its natural food. The first
consideration should be as regards age, state of health, and temper.
2439. The age, if possible, should not be less than twenty nor exceed
thirty years, with the health sound in every respect, and the body free
from all eruptive disease or local blemish. The best evidence of a sound
state of health will be found in the woman's clear open countenance, the
ruddy tone of the skin, the full, round, and elastic state of the
breasts, and especially in the erectile, firm condition of the nipple,
which, in all unhealthy states of the body, is pendulous, flabby, and
relaxed; in which case, the milk is sure to be imperfect in its
organization, and, consequently, deficient in its nutrient qualities.
Appetite is another indication of health in the suckling nurse or
mother; for it is impossible a woman can feed her child without having a
corresponding appetite; and though inordinate craving for food is
neither desirable nor necessary, a natural vigour should be experienced
at meal-times, and the food taken should be anticipated and enjoyed.
2440. Besides her health, the moral state of the nurse is to be taken
into account, or that mental discipline or principle of conduct which
would deter the nurse from at any time gratifying her own pleasures and
appetites at the cost or suffering of her infant charge.
2441. The conscientiousness and good faith that would prevent a nurse so
acting are, unfortunately, very rare; and many nurses, rather than
forego the enjoyment of a favourite dish, though morally certain of the
effect it will have on the child, will, on the first opportunity, feed
with avidity on fried meats, cabbage, cucumbers, pickles, or other crude
and injurious aliments, in defiance of all orders given, or confidence
reposed in their word, good sense, and humanity. And when the infant is
afterwards racked with pain, and a night of disquiet alarms the mother,
the doctor is sent for, and the nurse, covering her dereliction by a
falsehood, the consequence of her gluttony is treated as a disease, and
the poor infant is dosed for some days with medicines, that can do it
but little if any good, and, in all probability, materially retard its
physical development. The selfish nurse, in her ignorance, believes,
too, that as long as she experiences no admonitory symptoms herself, the
child cannot suffer; and satisfied that, whatever is the cause of its
screams and plunges, neither she, nor what she had eaten, had anything
to do with it, with this flattering assurance at her heart, she watches
her opportunity, and has another luxurious feast off the proscribed
dainties, till the increasing disturbance in the child's health, or
treachery from the kitchen, opens the eyes of mother and doctor to the
nurse's unprincipled conduct. In all such cases the infant should be
spared the infliction of medicine, and, as a wholesome corrective to
herself, and relief to her charge, a good sound dose administered to the
nurse.
2442. Respecting the diet of the wet-nurse, the first point of
importance is to fix early and definite hours for every meal; and the
mother should see that no cause is ever allowed to interfere with their
punctuality. The food itself should be light, easy of digestion, and
simple. Boiled or roast meat, with bread and potatoes, with occasionally
a piece of sago, rice, or tapioca pudding, should constitute the dinner,
the only meal that requires special comment; broths, green vegetables,
and all acid or salt foods, must be avoided. Fresh fish, once or twice a
week, may be taken; but it is hardly sufficiently nutritious to be often
used as a meal. If the dinner is taken early,--at one o'clock,--there
will be no occasion for luncheon, which too often, to the injury of the
child, is made the cover for a first dinner. Half a pint of stout, with
a Reading biscuit, at eleven o'clock, will be abundantly sufficient
between breakfast at eight and a good dinner, with a pint of porter at
one o'clock. About eight o'clock in the evening, half a pint of stout,
with another biscuit, may be taken; and for supper, at ten or half-past,
a pint of porter, with a slice of toast or a small amount of bread and
cheese, may conclude the feeding for the day.
2443. Animal food once in twenty-four hours is quite sufficient. All
spirits, unless in extreme cases, should be avoided; and wine is still
more seldom needed. With a due quantity of plain digestible food, and
the proportion of stout and porter ordered, with early hours and
regularity, the nurse will not only be strong and healthy herself, but
fully capable of rearing a child in health and strength. There are two
points all mothers, who are obliged to employ wet-nurses, should
remember, and be on their guard against. The first is, never to allow a
nurse to give medicine to the infant on her own authority: many have
such an infatuated idea of the _healing excellence_ of castor-oil, that
they would administer a dose of this disgusting grease twice a week, and
think they had done a meritorious service to the child. The next point
is, to watch carefully, lest, to insure a night's sleep for herself, she
does not dose the infant with Godfrey's cordial, syrup of poppies, or
some narcotic potion, to insure tranquillity to the one and give the
opportunity of sleep to the other. The fact that scores of nurses keep
secret bottles of these deadly syrups, for the purpose of stilling their
charges, is notorious; and that many use them to a fearful extent, is
sufficiently patent to all.
2444. It therefore behoves the mother, while obliged to trust to a
nurse, to use her best discretion to guard her child from the
unprincipled treatment of the person she must, to a certain extent,
depend upon and trust; and to remember, in all cases, rather than resort
to castor-oil or sedatives, to consult a medical man for her infant in
preference to following the counsel of her nurse.
THE REARING, MANAGEMENT, AND DISEASES OF INFANCY AND CHILDHOOD.
CHAPTER XLII.
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 _debris_ 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.
THE LUNGS.--RESPIRATION.
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,
_in_spires air and _ex_pires 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.
THE STOMACH--DIGESTION.
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.
THE INFANT.
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 a _still-birth_.
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 deg., 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."
THE MILK.
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 _regime_ 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--
Teething.
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 distinct affection.
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 separate disease.
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.
Measles.
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.
4548. 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.
Hooping-Cough.
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.
Croup.
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.
Diarrhoea.
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.
THE DOCTOR.
CHAPTER XLIII.
2578. "Time," according to the old proverb, "is money;" and it may also,
in many cases, and with equal truthfulness, be said to be life; for a
few moments, in great emergencies, often turn the balance between
recovery and death. This applies more especially to all kinds of
poisoning, fits, submersion in water, or exposure to noxious gases; and
many accidents. If people knew how to act during the interval that must
necessarily elapse from the moment that a medical man is sent for until
he arrives, many lives might be saved, which now, unhappily, are lost.
Generally speaking, however, nothing is done--all is confusion and
fright; and the surgeon, on his arrival, finds that death has already
seized its victim, who, had his friends but known a few rough rules for
their guidance, might have been rescued. We shall, therefore, in a
series of papers, give such information as to the means to be employed
in event of accidents, injuries, &c., as, by the aid of a gentleman of
large professional experience, we are warranted in recommending.
List of Drugs, &c., necessary to carry out all Instructions.
2579. We append at once A LIST OF DRUGS, &c., and a few PRESCRIPTIONS
necessary to carry out all the instructions given in this series of
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