



Produced by Albert R. Mann Library. 2003. Home Economics Archive:
Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. Mann
Library, Cornell University. http://hearth.library.cornell.edu (Version
January 2003).





THE

MATERNAL MANAGEMENT

OF

CHILDREN,

IN HEALTH AND DISEASE.




By Thomas Bull, M.D.




Physician Accoucheur To The Finsbury Midwifery

Institution, And Lecturer On Midwifery,

And On The Diseases Of Women

And Children;



Author Of "Hints To Mothers On The

Management Of Their Health."




1840.




PREFACE.



This little book has been written for the young and inexperienced
mother. It is intended to furnish her with that information which the
experience and observation of some years convince the author, young
mothers, almost without any exception, do not possess; and yet, from
ignorance of which, the constitution of many an infant has received
irretrievable injury, and life itself but too frequently fallen a
sacrifice.

In the first chapters, devoted to the general management of the child
in health, the author has endeavoured to teach the young mother, that
the prevention of disease is her province, not its cure; that to this
object all her best efforts must be directed; and, moreover, that to
tamper with medicine, when disease has actually commenced, is to hazard
the life of her offspring.

In the fourth chapter it has been attempted to point out, how the
first symptoms of disease may be early detected by the parent. The
subject has been felt to be a difficult one, and to give particular
directions quite out of the question; but it is hoped that the
suggestions thrown out will, in some measure, answer the purpose
intended. On the advantage of an early and prompt application of
remedies in the diseases of childhood, generally so active in their
progress and severe in their character, it is unnecessary to offer any
observation.

The latter part of the work, consisting of the maternal management of
disease, the author regards as a subject of high and serious moment.
Small as is the attention which has been hitherto paid to it, yet, in
the diseases of infancy and childhood, how invaluable is a careful and
judicious maternal superintendence to give effect to the measures
prescribed by the physician.

The author has endeavoured to arrange the contents of the work in a
manner which shall be most easily understood and readily available; and
he now publishes it with the desire to supply, in some degree, a
deficiency in this important department of knowledge.



Finsbury Place, June, 1840.





CONTENTS.



Chapter I.


ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.



Sect. - Page



I. On the Dietetics of Infancy - 2

1. Maternal Nursing - 3

Plan of Suckling - 3

Deficiency of Milk - 11

The injurious Effects to Mother and Infant of undue and protracted
Suckling - 15

Mothers who ought never to suckle - 20


2. Wet-nurse Suckling - 27

Choice of a Wet-nurse - 28

Diet and Regimen of a Wet-nurse - 31


3. Artificial Feeding, (bringing up by hand) - 34

The Kind of artificial Food before the sixth Month - 35

The Kind of artificial Food after the sixth Month to the completion of
first Dentition - 44

The Kind of artificial Food most suitable under the different
Complaints to which Infants are liable - 48



II. Weaning - 51

The Time when - 51

The Mode - 52

The drying up of the Mother's Milk - 54



III. On the Dietetics of Childhood - 54

General Directions, and of animal Food - 55

Sugar - 60

Salt - 61

Fruits - 62

Water - 63

Wine, Beer, and Spirits - 63



IV. Sleep - 66

During Infancy - 66

During Childhood - 69



V. Bathing and Cleanliness - 72

During Infancy - 72

During Childhood - 75



VI. Clothing - 78

During Infancy - 78

During Childhood - 81



VII. Air and Exercise - 83

In Infancy - 83

In Childhood - 89




Chap. II.


ON THE USE AND ABUSE OF CERTAIN REMEDIES.


I. Aperient Medicine - 97

Castor Oil - 99

Manna - 101

Magnesia and Rhubarb - 102

The Lavement - 105

The Aperient Liniment - 107



II. Calomel - 107



III. Opiates - 110



IV. Leeching - 113



V. Blisters and Poultices - 114



VI. Baths - 117


The Cold-water Plunge Bath - 118

Sea Bathing - 120

The Shower Bath - 123

Ablution, or Sponging - 125

The Warm Bath - 188




Chap. III.


ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.


I. On Teething. - 134

The Manner in which the temporary or milk Teeth appear - 134

The Management of the Infant when Teething is without difficulty - 136

The Management of the Infant in difficult Teething - 139



II. Hints on the permanent or adult Teeth - 148

The Manner in which they appear - 248

Their Value and Importance - 152

Their Management and Preservation - 154




Chap. IV.


HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.


I. Signs of Health - 163


II. Signs of Disease - 164

Of the Countenance - 165

Of the Gestures - 169

Of the Sleep - 171

Of the Stools - 172

Of the Breathing and Cough - 175



III. Other Circumstances which will assist in the early Detection of
Disease - 178

The Influence of the Seasons in producing particular Forms of Disorder
- 178

The Influence of an hereditary Predisposition to certain Diseases - 179




Chap. V.


ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.


I. Accidents and Diseases which may occur to the Infant at Birth, or
soon after - 187


1. Still-born - 187

2. Injuries received during Birth - 193

3. Retention of Urine - 194

4. Swelling of the Breasts - 195

5. Inflammation of the Eyes - 196

6. Hare-lip - 199

7. Bleeding from the Navel-string - 201

8. Ulceration or imperfect Healing of the Navel - 20l

9. Bleeding from the Navel - 203

10. Jaundice - 204

11. Tongue-tied - 205

12. Moles and Marks on the Skin, etc. - 206



II. Disorders of the Stomach and Bowels; viz., Indigestion -
Flatulence - Vomiting - Griping and Looseness - 208


1. In the Infant at the Breast - 21O

2. At the period of Weaning - 217

3. In the child brought up by Hand - 221


Maternal Treatment - 222



III. Costiveness - 229

In Infancy - 229

In Childhood - 231



IV. Worms - 234

Not so frequent as popularly supposed; an error productive of mischief
- 234

How produced and how best prevented - 237



V. Scarlet Fever - 239

Mild Form - 239

With Sore Throat - 242

Scarlet Fever compared with Measles - 245

Maternal Management - 246



VI. Measles - 253

Description - 253

Compared with Scarlet Fever and Small Pox - 255

Maternal Management - 256



VII. Small-Pox - 262

Natural Small-Pox - 263

Small-Pox in the Vaccinated - 266

Maternal Management - 268

VIII. Hooping Cough - 275

Description - 276

Maternal Management - 279



IX. Croup - 286

Signs of its Approach - 286

Maternal Management - 289

Its prevention - 289



X. Water in the Head - 291

Its Prevention - 292

Maternal Management - 298





THE MATERNAL MANAGEMENT OF CHILDREN.



Chapter I.



ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.



The line of demarcation made between infancy and childhood, both by
ancient and modern writers, has always been arbitrary. I would draw the
line between the two, at a period of time which appears to me to be the
most natural, the most simple, and least likely to lead the reader into
the danger of misapplying any part of the practical directions of this,
or any future chapter of the work. We will consider, then, that--

Infancy, commencing with birth, extends to about the end of the second
year, when the first dentition is completed.

Childhood extends from about the second, to the seventh or eighth
year, when the second dentition is commenced.



Sect. I. DIETETICS OF INFANCY.



In the early months of infancy the organs of digestion are unsuited to
any other food than that derived from the breast of the mother. So
little capable are they, indeed, to digest any other, even of the
blandest and most digestible kind, that probably not more than one
infant in six or seven ever arrives at the more advanced periods of
life when deprived of the kind of nourishment nature intended for this
epoch.

It is not every parent, however, who is able to become a nurse; and
with many this office would not only be highly injurious to their own
health, but materially so to that of their offspring. This may arise
from various causes, hereafter to be noticed, but whenever they exist a
wet-nurse is demanded.

Again, the latter resource is not always attainable, so that the
hazardous experiment of an artificial diet, or bringing up by hand, as
it is then termed, is obliged to be resorted to.

Thus, infantile dietetics naturally divides itself into Maternal
Nursing, Wet-Nurse Suckling, And Artificial Feeding.



1. MATERNAL NURSING.

PLAN OF SUCKLING.



From the first moment the infant is applied to the breast, it must be
nursed upon a certain plan. This is necessary to the well-doing of the
child, and will contribute essentially to preserve the health of the
parent, who will thus be rendered a good nurse, and her duty at the
same time will become a pleasure.

This implies, however, a careful attention on the part of the mother
to her own health; for that of her child is essentially dependent upon
it. Healthy, nourishing, and digestible milk can be procured only from
a healthy parent; and it is against common sense to expect that, if a
mother impairs her health and digestion by improper diet, neglect
of exercise, and impure air, she can, nevertheless, provide as
wholesome and uncontaminated a fluid for her child, as if she were
diligently attentive to these important points. Every instance of
indisposition in the nurse is liable to affect the infant.

And this leads me to observe, that it is a common mistake to suppose
that, because a woman is nursing, she ought therefore to live very
fully, and to add an allowance of wine, porter, or other fermented
liquor, to her usual diet. The only result of this plan is, to cause an
unnatural degree of fulness in the system, which places the nurse on
the brink of disease, and which of itself frequently puts a stop to the
secretion of the milk, instead of increasing it. The right plan of
proceeding is plain enough; only let attention be paid to the ordinary
laws of health, and the mother, if she have a sound constitution, will
make a better nurse than by any foolish deviation founded on ignorance
and caprice.

The following case proves the correctness of this statement:--

A young married lady, confined with her first child, left the lying-in-
room at the expiration of the third week, a good nurse, and in perfect
health. She had had some slight trouble with her nipples, but this was
soon overcome.

The porter system was now commenced, and from a pint to a pint and a
half of this beverage was taken in the four and twenty hours. This was
resorted to, not because there was any deficiency in the supply of
milk, for it was ample, and the infant thriving upon it; but because,
having become a nurse, she was told that it was usual and necessary,
and that without it her milk and strength would ere long fail.

After this plan had been followed for a few days, the mother became
drowsy and disposed to sleep in the daytime; and headach, thirst, a hot
skin, in fact, fever supervened; the milk diminished in quantity, and,
for the first time, the stomach and bowels of the infant became
disordered. The porter was ordered to be left off; remedial measures
were prescribed; and all symptoms, both in parent and child, were after
a while removed, and health restored.

Having been accustomed, prior to becoming a mother, to take a glass or
two of wine, and occasionally a tumbler of table beer, she was advised
to follow precisely her former dietetic plan, but with the addition of
half a pint of barley-milk morning and night. Both parent and child
continued in excellent health during the remaining period of suckling,
and the latter did not taste artificial food until the ninth month, the
parent's milk being all-sufficient for its wants.

No one can doubt that the porter was in this case the source of the
mischief. The patient had gone into the lying-in-room in full health,
had had a good time, and came out from her chamber (comparatively) as
strong as she entered it. Her constitution had not been previously worn
down by repeated child-bearing and nursing, she had an ample supply of
milk, and was fully capable, therefore, of performing the duties which
now devolved upon her, without resorting to any unusual stimulant or
support. Her previous habits were totally at variance with the plan
which was adopted; her system became too full, disease was produced,
and the result experienced was nothing more than what might be expected.

The plan to be followed for the first six months.-Until the breast-
milk is fully established, which may not be until the second or third
day subsequent to delivery (almost invariably so in a first
confinement), the infant must be fed upon a little thin gruel, or upon
one third water and two thirds milk, sweetened with loaf sugar.

After this time it must obtain its nourishment from the breast alone,
and for a week or ten days the appetite of the infant must be the
mother's guide, as to the frequency in offering the breast. The stomach
at birth is feeble, and as yet unaccustomed to food; its wants,
therefore, are easily satisfied, but they are frequently renewed. An
interval, however, sufficient for digesting the little swallowed, is
obtained before the appetite again revives, and a fresh supply is
demanded.

At the expiration of a week or so it is essentially necessary, and
with some children this may be done with safety from the first day of
suckling, to nurse the infant at regular intervals of three or four
hours, day and night. This allows sufficient time for each meal to be
digested, and tends to keep the bowels of the child in order. Such
regularity, moreover, will do much to obviate fretfulness, and that
constant cry, which seems as if it could be allayed only by constantly
putting the child to the breast. A young mother very frequently runs
into a serious error in this particular, considering every expression
of uneasiness as an indication of appetite, and whenever the infant
cries offering it the breast, although ten minutes may not have elapsed
since its last meal. This is an injurious and even dangerous practice,
for, by overloading the stomach, the food remains undigested, the
child's bowels are always out of order, it soon becomes restless and
feverish, and is, perhaps, eventually lost; when, by simply attending
to the above rules of nursing, the infant might have become healthy and
vigorous.

For the same reason, the infant that sleeps with its parent must not
be allowed to have the nipple remaining in its mouth all night. If
nursed as suggested, it will be found to awaken, as the hour for its
meal approaches, with great regularity. In reference to night-nursing,
I would suggest suckling the babe as late as ten o'clock p. m., and not
putting it to the breast again until five o'clock the next morning.
Many mothers have adopted this hint, with great advantage to their own
health, and without the slightest detriment to that of the child. With
the latter it soon becomes a habit; to induce it, however, it must be
taught early.

The foregoing plan, and without variation, must be pursued to the
sixth month.


AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a
large supply of good and nourishing milk, and her child is healthy and
evidently flourishing upon it, no change in its diet ought to be made.
If otherwise, however, (and this will but too frequently be the case,
even before the sixth month[FN#1],) the child may be fed twice in the
course of the day, and that kind of food chosen which, after a little
trial, is found to agree best.



[FN#1]  See Deficiency of Milk, p. 11.



Leman's tops and bottoms, steeped in hot water, with the addition of a
little fresh milk, and sweetened or not with loaf sugar, is one of the
best description.

If the stomach reject this, farinaceous food boiled in water, and
mixed with a small quantity of milk, may be employed. Or weak mutton or
veal broth, or beef tea, clear and free from fat, and mixed with an
equal quantity of farinaceous food.

If this artificial diet is used before the sixth month, it must be
given through the sucking-bottle; after this period with a spoon: in
either case it must be previously passed through a sieve.

When the large or grinding teeth have appeared, the same food is still
to be continued, but need not any longer be expressed through the sieve.

Such is the plan of nursing to be followed by the mother until she
wean her infant altogether from the breast. The period when this ought
to take place, as also the manner of accomplishing it, are detailed
in the section on "Weaning."[FN#2]



[FN#2]  See page 51.



The diet from weaning to the termination of infancy is pointed out
under "Artificial Feeding."[FN#3]



[FN#3]  See page 34.



DEFICIENCY OF MILK.



If this deficiency exist from the earliest weeks after delivery, and
it is not quickly remedied by the means presently to be pointed out, a
wet-nurse must be obtained. It will be of no avail partially to nurse,
and partially to feed the infant at this period and under such
circumstances, for if it is not soon lost, it will only live for a few
months, or a year at most, and be an object of the greatest anxiety and
grief to its parent. This condition arises from the unwholesomeness of
the mother's milk, united with the artificial food; for when the milk
is deficient from the first, and continues so notwithstanding the means
used for its increase, it is invariably unhealthy in its quality.

This deficiency, however, may exist, and even at a very early period
after delivery, and yet be removed. This, however, is not to be
accomplished by the means too frequently resorted to; for it is the
custom with many, two or three weeks after their confinement, if the
supply of nourishment for the infant is scanty, to partake largely of
malt liquor for its increase. Sooner or later this will be found
injurious to the constitution of the mother: but how, then, is this
deficiency to be obviated? Let the nurse keep but in good health, and
this point gained, the milk, both as to quantity and quality, will be
as ample, nutritious, and good, as can be produced by the individual.

I would recommend a plain, generous, and nutritious diet; not one
description of food exclusively, but, as is natural, a wholesome,
mixed, animal, and vegetable diet, with or without wine or malt liquor,
according to former habit; and, occasionally, where malt liquor has
never been previously taken, a pint of good sound ale may be taken
daily with advantage, if it agree with the stomach. Regular exercise in
the open air is of the greatest importance, as it has an extraordinary
influence in promoting the secretion of healthy milk. Early after
leaving the lying-in room, carriage exercise, where it can be
obtained, is to be preferred, to be exchanged, in a week or so, for
horse exercise, or the daily walk. The tepid, or cold salt-water shower
bath, should be used every morning; but if it cannot be borne, sponging
the body withsalt-water must be substituted.

By adopting with perseverance the foregoing plan, a breast of milk
will be obtained as ample in quantity, and good in quality, as the
constitution of the parent can produce, as the following case proves:

On the 17th September, 1839, I attended a lady twenty-four years of
age, a delicate, but healthy woman, in her first confinement. The
labour was good. Every thing went on well for the first week, except
that, although the breasts became enlarged, and promised a good supply
of nourishment for the infant, at its close there was merely a little
oozing from the nipple. During the next fortnight a slight, but very
gradual increase in quantity took place, so that a dessert spoonful
only was obtained about the middle of this period, and perhaps double
this quantity at its expiration. In the mean time the child was
necessarily fed upon an artificial diet, and as a consequence its
bowels became deranged, and a severe diarrhoea followed. A wet-nurse
was advised for the child as the only means of saving its life, and
change of air for the mother as the most likely expedient (in
connection with the general treatment pointed out above) for obtaining
a good breast of milk. Accordingly, on the 5th October, the patient,
taking with her the infant and a wet-nurse, went a few miles from town.

For three or four days it was a question whether the little one would
live, for so greatly had it been reduced by the looseness of the bowels
that it had not strength to grasp the nipple of its nurse; the milk,
therefore, was obliged to be drawn, and the child fed with it from a
spoon. After the lapse of a few days, however, it could obtain the
breast-milk for itself; and, to make short of the case, on the 25th of
the same month, the mother and child returned home, the former having a
very fair proportion of healthy milk in her bosom, and the child
perfectly recovered and evidently thriving fast upon it.

Where, however, there has been an early deficiency in the supply of
nourishment, it will most frequently happen that, before the sixth or
seventh month, the infant's demands will be greater than the mother can
meet. The deficiency must be made up by artificial food, which must be
of a kind generally employed before the sixth month, and given through
the bottle. If, however, this plan of dieting should disagree, the
child must, even at this period, have a wet-nurse.

Women who marry comparatively late in life, and bear children,
generally have a deficiency of milk after the second or third month:
artificial feeding must in part be here resorted to.



THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED
SUCKLING.



UPON THE MOTHER.--The period of suckling is generally one of the most
healthy of a woman's life. But there are exceptions to this as a
general rule; and nursing, instead of being accompanied by health, may
be the cause of its being materially, and even fatally, impaired. This
may arise out of one of two causes, either, a parent continuing to
suckle too long; or, from the original powers or strength not being
equal to the continued drain on the system.

Examples of the first class I am meeting with daily. I refer to poor
married women, who, having nursed their infants eighteen months, two
years, or even longer than this, from the belief that by so doing they
will prevent pregnancy, call to consult me with an exhausted frame and
disordered general health, arising solely from protracted nursing,
pursued from the above mistaken notion.

I most frequently meet with examples of the second class in the
delicate woman, who, having had two or three children in quick
succession, her health has given way, so that she has all the symptoms
arising from undue suckling, when perhaps the infant at her breast is
not more than two or three months old.

Since the health of the mother, then, will suffer materially from this
circumstance, she ought not to be ignorant of the fact; so that, when
the first symptoms manifest themselves, she may be able to recognise
their insidious approach; and tracing them to their real cause, obtain
medical advice before her health be seriously impaired.


SYMPTOMS.--The earliest symptom is a dragging sensation in the back
when the child is in the act of sucking, and an exhausted feeling of
sinking and emptiness at the pit of the stomach afterwards. This is
soon followed by loss of appetite, costive bowels, and pain on the left
side; then, the head will be more or less affected, sometimes with much
throbbing, singing in the ears, and always some degree of giddiness,
with great depression of spirits.

Soon the chest becomes affected, and the breathing is short,
accompanied by a dry cough and palpitation of the heart upon the
slightest exertion. As the disease advances, the countenance becomes
very pale, and the flesh wastes, and profuse night perspirations, great
debility, swelling of the ankles, and nervousness ensue. It is
unnecessary, however, to enter into a more full detail of symptoms.


TREATMENT.--All that it will be useful to say in reference to
treatment, is this; that, although much may be done in the first
instance by medicine, change of air, cold and sea bathing, yet the
quickest and most effectual remedy is to wean the child, and thus
remove the cause.


THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful
reason why the child should be weaned, or rather, have a young and
healthy wet-nurse, if practicable. The effects upon the infant, suckled
under such circumstances, will be most serious. Born in perfect health,
it will now begin to fall off in its appearance, for the mother's milk
will be no longer competent to afford it due nourishment; it will be
inadequate in quantity and quality. Its countenance, therefore, will
become pale; its look sickly and aged; the flesh soft and flabby; the
limbs emaciated; the belly, in some cases, large, in others, shrunk;
and the evacuations fetid and unnatural; and in a very few weeks, the
blooming healthy child will be changed into the pale, sickly, peevish,
wasted creature, whose life appears hardly desirable.

The only measure that can save the life, and recover an infant from
this state, is that which would previously have prevented it a healthy
wet-nurse.

If the effects upon the infant should not be so aggravated as those
just described, and it subsequently live and thrive, there will be a
tendency in such a constitution to scrofula and consumption, to
manifest itself at some future period of life, undoubtedly acquired
from the parent, and dependent upon the impaired state of her health at
the time of its suckling. A wet-nurse early resorted to, will prevent
this.

It will be naturally asked, for how long a period a mother ought to
perform the office of a nurse? No specific time can be mentioned, and
the only way in which the question can be met is this: no woman, with
advantage to her own health, can suckle her infant beyond twelve or
eighteen months; and at various periods between the third and twelfth
month, many women will be obliged partially or entirely to resign the
office.[FN#4]



[FN#4]  See "Weaning," p. 51.



The monthly periods generally reappear from the twelfth to the
fourteenth month from delivery; and when established, as the milk is
found invariably to diminish in quantity, and also to deteriorate in
quality, and the child is but imperfectly nourished, it is positively
necessary in such instances at once to wean it.



OF MOTHERS WHO OUGHT NEVER TO SUCKLE.



There are some females who ought never to undertake the office of
suckling, both on account of their own health, and also that of their
offspring.


THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the
infant born of such a parent there will be a constitutional
predisposition to the same disease; and, if it is nourished from her
system, this hereditary predisposition will be confirmed.

"No fact in medicine is better established than that which proves the
hereditary transmission from parents to children of a constitutional
liability to pulmonary disease, and especially to consumption; yet no
condition is less attended to in forming matrimonial engagements. The
children of scrofulous and consumptive parents are generally
precocious, and their minds being early matured, they engage early in
the business of life, and often enter the married state before their
bodily frame has had time to consolidate. For a few years every thing
seems to go on prosperously, and a numerous family gathers around them.
All at once, however, even while youth remains, their physical powers
begin to give way, and they drop prematurely into the grave, exhausted
by consumption, and leaving children behind them, destined, in all
probability, either to be cut off as they approach maturity, or to run
through the same delusive but fatal career as that of the parents from
whom they derived their existence."[FN#5] There is scarcely an
individual who reads these facts, to whom memory will not furnish some
sad and mournful example of their truth; though they perhaps may have
hitherto been in ignorance of the exciting cause.



[FN#5]  Combe's Principles of Physiology applied to the Preservation of
Health, etc.



It is, however, with the mother as a nurse that I have now to do, and
I would earnestly advise every one of a consumptive or strumous habit
(and if there is any doubt upon this point, the opinion of a medical
adviser will at once decide it) never to suckle her offspring; her
constitution renders her unfit for the task. And, however painful it
may be to her mind at every confinement to debar herself this
delightful duty, she must recollect that it will be far better for her
own health, and infinitely more so for that of the child, that she
should not even attempt it; that her own health would be injured, and
her infant's, sooner or later, destroyed by it.

The infant of a consumptive parent, however, must not be brought up by
hand. It must have a young, healthy, and vigorous wet-nurse; and in
selecting a woman for this important duty very great care must be
observed.[FN#6] The child should be nursed until it is twelve or fifteen
months old. In some cases it will be right to continue it until the
first set of teeth have appeared, when it will be desirable that a
fresh wet-nurse should be obtained for the last six months.[FN#7] If
the child is partially fed during the latter months (from
necessity or any other cause), the food should be of the lightest
quality, and constitute but a small proportion of its nutriment.



[FN#6]  See "Choice of a Wet-nurse," p. 28.

[FN#7]  One that has been confined about six weeks or two months.



But not only must the nourishment of such a child be regarded, but the
air it breathes, and the exercise that is given to it; as also, the
careful removal of all functional derangements as they occur, by a
timely application to the medical attendant, and maintaining,
especially, a healthy condition of the digestive organs. All these
points must be strictly followed out, if any good is to be effected.

By a rigid attention to these measures the mother adopts the surest
antidote, indirectly, to overcome the constitutional predisposition to
that disease, the seeds of which, if not inherited from the parent,
are but too frequently developed in the infant during the period of
nursing; and, at the same time, she takes the best means to engender a
sound and healthy constitution in her child. This, surely, is worth any
sacrifice.

If the infant derives the disposition to a strumous constitution
entirely from the father, and the mother's health be unexceptionable,
then I would strongly advise her to suckle her own child.


THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There
are other women who ought never to become nurses. The mother of a
highly nervous temperament, who is alarmed at any accidental change she
may happen to notice in her infant's countenance, who is excited and
agitated by the ordinary occurrences of the day; such a parent will do
her offspring more harm than good by attempting to suckle it. Her milk
will be totally unfit for its nourishment: at one time it will be
deficient in quantity, at another, so depraved in its quality, that
serious disturbance to the infant's health, will ensue. The young and
inexperienced mother, who is a parent for the first time, and
altogether ignorant of the duties of her office, and at the same time
most anxious to fulfil them faithfully, is but too frequently an
instance in point; although at a future period she will generally make
a good nurse. The following is an illustration:--

In December, 1838, I attended a young married lady in her first
confinement, and in excellent health. She gave birth to a fine, plump,
healthy boy. Every thing went on well for three weeks, the mother
having an abundant supply of milk, and the infant evidently thriving
upon it. About this time, however, the child had frequent fits of
crying; the bowels became obstinately costive;--the motions being
lumpy, of a mixed colour, quite dry, and passed with great pain. It
became rapidly thin, and after a while its flesh so wasted, and became
so flabby, that it might be said literally to hang on the bones. The
fits of crying now increased in frequency and violence, coming on every
time after the little one left the breast, when it would commence
screaming violently, beat the air with its hands and feet, and nothing
that was done could appease it. Having lasted for half an hour or more,
it would fall asleep quite exhausted; the fit recurring again, when
again it had been to the breast.

It was very evident that the infant's hunger was not satisfied, as it
was also but too evident its body was not nourished by the parent's
milk, which, although abundant in quantity (the breast being large and
full of milk), was at this time seriously deteriorated in its nutritive
quality. This was caused, I believe, from great anxiety of mind. Her
nurse became suddenly deranged, and the whole responsibility and care
of the child thus devolved upon the mother, of the duties connected
with which she was entirely ignorant.

A wet-nurse was obtained. In a very few hours after this change was
effected, the screaming ceased, the child had quiet and refreshing
sleep, and in twelve hours a healthy motion was passed. The child
gained flesh almost as quickly as it had previously lost it, and is now
as fine and healthy an infant as it promised to be when born.

Whenever there has existed previously any nervous or mental affection
in the parent, wet-nurse suckling is always advisable; this, with
judicious management of childhood, will do much to counteract the
hereditary predisposition.


THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE
OUGHT NOT.--The mother who cannot make up her mind exclusively to
devote herself to the duties of a nurse, and give up all engagements
that would interfere with her health, and so with the formation of
healthy milk, and with the regular and stated periods of nursing her
infant, ought never to suckle. It is unnecessary to say why; but I
think it right, for the child's sake, to add, that if it does not
sicken, pine, and die, disease will be generated in its constitution,
to manifest itself at some future period.

The child, then, under all the foregoing circumstances, must be
provided with its support from another source, and a wet-nurse is the
best.



2. WET-NURSE SUCKLING.



Ill health and many other circumstances may prevent a parent from
suckling her child, and render a wet-nurse necessary. Now, although she
will do wisely to leave the choice of one to her medical attendant,
still, as some difficulty may attend this, and as most certainly the
mother herself ought to be acquainted with the principal points to
which his attention is directed in the selection of a good nurse, it
will be well to point out in what they consist.



CHOICE OF A WET-NURSE.



The first thing to which a medical man looks, is the general health of
the woman; next, the condition of her breast, the quality of her milk
its age and her own; whether she is ever unwell while nursing; and,
last of all, the condition and health of the child.


IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the
marks of a sound constitution, and ought to be free from all suspicion
of a strumous character; her tongue clean, and digestion good; her
teeth and gums sound and perfect; her skin free from eruption, and her
breath sweet.


WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and
well formed; its size not dependent upon a large quantity of fat, which
will generally take away from its firmness, giving it a flabby
appearance, but upon its glandular structure, which conveys to the
touch a knotted, irregular, and hard feel; and the nipple must be
perfect, of moderate size, but well developed.


WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish-
white colour; sweet to the taste; and when allowed to stand, should
throw up a considerable quantity of cream.


WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely
expired, the wet-nurse to be hired ought certainly not to have reached
her second month. At this time, the nearer the birth of the child, and
the delivery of its foster-parent, the better: the reason for which
is, that during the first few weeks the milk is thinner and more watery
than it afterwards becomes. If, consequently, a new-born infant be
provided with a nurse, who has been delivered three or four months, the
natural relation between its stomach and the quality of the milk is
destroyed, and the infant suffers from the oppression of food too heavy
for its digestive power.

On the other hand, if you are seeking a wet-nurse for an infant of
four or five months old, it would be very prejudicial to transfer the
child to a woman recently delivered; the milk would be too watery for
its support, and its health in consequence would give way.


THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from
twenty-one to thirty admits of no question. And the woman who has had
one or two children before is always to be preferred, as she will be
likely to have more milk, and may also be supposed to have acquired
some experience in the management of infants.


INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her
at once. You will have no difficulty in ascertaining this point; for
this class of persons have an idea that their milk is renewed, as they
term it, by this circumstance, monthly; and, therefore, that it is a
recommendation, rendering their milk fitter for younger children than
it would otherwise have been. It produces, however, quite a contrary
effect; it much impairs the milk, which will be found to disagree with
the child, rendering it at first fretful,--after a time being vomited
up, and productive of frequent watery dark green motions.


Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the
sprightly appearance of health, to bear the marks of being well
nourished, its flesh firm, its skin clean and free from eruptions. It
should be examined in this respect, particularly about the head, neck,
and gums.

If a medical man finds that both mother and child answer to the above
description, he has no hesitation in recommending the former as likely
to prove a good wet-nurse.



DIET AND REGIMEN OF A WET-NURSE.



The regimen of a wet-nurse should not differ much from that to which
she has been accustomed; and any change which it may be necessary to
make in it should be gradual. It is erroneous to suppose that women
when nursing require to be much more highly fed than at other times: a
good nurse does not need this, and a bad one will not be the better for
it. The quantity which many nurses eat and drink, and the indolent life
which they too often lead, have the effect of deranging their digestive
organs, and frequently induce a state of febrile excitement, which
always diminishes, and even sometimes altogether disperses, the milk.

It will be necessary then to guard against the nurse overloading her
stomach with a mass of indigestible food and drink. She should live as
much as possible in the manner to which she has been accustomed; she
should have a wholesome, mixed, animal and vegetable diet, and a
moderate and somewhat extra quantity of malt liquor, provided it agree
with her system.

A very prevailing notion exists that porter tends to produce a great
flow of milk, and in consequence the wet-nurse is allowed as much as
she likes; a large quantity is in this way taken, and after a short
time so much febrile action excited in the system, that instead of
increasing the flow of milk, it diminishes it greatly. Some parents,
however, aware of this fact, will go into an opposite extreme, and
refuse the nurse even that which is necessary. Either excess is of
course wrong. It is difficult in general terms to say what ought to be
considered a proper daily allowance, but some is in general necessary;
and whenever a woman has been used to drink malt-liquor, she will
rarely make a good wet-nurse if she is denied a reasonable quantity of
that beverage. Good sound ale sometimes agrees better than porter. It
may be well here to remark, that in London, I frequently meet with
severe cases of diarrhoea in infants at the breast, fairly traceable to
bad porter, which vitiating the quality of the milk, no medical
treatment cures the disease, until this beverage is left off or
changed, when it at once disappears.

The nurse should take exercise daily in the open air. Nothing tends
more directly to maintain a good supply of healthy milk, than air and
exercise; and the best wet-nurse would soon lose her milk, if
constantly kept within doors. Sponging the whole body also with cold
water with bay-salt in it every morning, should be insisted upon, if
possible: it preserves cleanliness, and greatly invigorates the health.
United with this, the nurse should rise early, and also be regularly
employed during the day in some little portion of duty in the family, an
attendance upon the wants of the child not being alone sufficient.

An amiable disposition and good temper are very desirable. A violent
fit of passion may exert so peculiar an influence in changing the
natural properties of the milk, that a child has been known to be
attacked with a fit of convulsions after being suckled by a nurse while
labouring under the effects of a fit of anger. The depressing passions
frequently drive the milk away altogether. It is hence of no small
moment, that a wet-nurse be of a quiet and even temper, and not
disposed to mental disturbance.



3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.



Extreme delicacy of constitution, diseased condition of the frame,
defective secretion of milk, and other causes, may forbid the mother
suckling her child; and unless she can perform this office with safety
to herself, and benefit to her infant, she ought not to attempt it. In
this case a young and healthy wet-nurse is the best substitute; but
even this resource is not always attainable. Under these circumstances,
the child must be brought up on an artificial diet "by hand,"--as it is
popularly called.

To accomplish this with success requires the most careful attention on
the part of the parent, and at all times is attended with risk to the
life of the child; for although some children, thus reared, live and
have sound health, these are exceptions to the general rule, artificial
feeding being in most instances unsuccessful.



THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.



It should be as like the breast-milk as possible. This is obtained by
a mixture of cow's milk, water, and sugar, in the following
proportions:--


Fresh cow's milk, two thirds;
Boiling water, or thin barley water, one third;
Loaf sugar, a sufficient quantity to sweeten.


This is the best diet that can be used for the first six months, after
which some farinaceous food may be combined.

In early infancy, mothers are too much in the habit of giving thick
gruel, panada, biscuit-powder, and such matters, thinking that a diet
of a lighter kind will not nourish. This is a mistake; for these
preparations are much too solid; they overload the stomach, and cause
indigestion, flatulence, and griping. These create a necessity for
purgative medicines and carminatives, which again weaken digestion,
and, by unnatural irritation, perpetuate the evils which render them
necessary. Thus many infants are kept in a continual round of
repletion, indigestion, and purging, with the administration of
cordials and narcotics, who, if their diet were in quantity and quality
suited to their digestive powers, would need no aid from physic or
physicians.

In preparing this diet, it is highly important to obtain pure milk,
not previously skimmed, or mixed with water; and in warm weather just
taken from the cow. It should not be mixed with the water or sugar
until wanted, and not more made than will be taken by the child at the
time, for it must be prepared fresh at every meal. It is best not to
heat the milk over the fire, but let the water be in a boiling state
when mixed with it, and thus given to the infant tepid or lukewarm.

As the infant advances in age, the proportion of milk may be gradually
increased; this is necessary after the second month, when three parts
of milk to one of water may be allowed. But there must be no change in
the kind of diet if the health of the child is good, and its appearance
perceptibly improving. Nothing is more absurd than the notion, that in
early life children require a variety of food; only one kind of food is
prepared by nature, and it is impossible to transgress this law without
marked injury.

If cow's milk disagree with an infant--and this is sometimes
unfortunately the case, even from its birth ass's milk,--diluted with
one third its quantity of water, may be given as a substitute. I am now
attending a lady in her fourth confinement, who is unable, from defect
in her nipples, to suckle her children. The first child had a healthy
wet-nurse, and has grown a fine healthy lad. The second, a girl, was
unfortunate in her nurse, she being of a strumous and unhealthy
constitution, although to a casual observer bearing the appearance of
health. The child lived only three months, and the nurse died of a
rapid consumption shortly after. This discouraged the mother from
adopting wet-nurse suckling for the third child (a great error); and an
artificial diet of cow's milk was resorted to. The third day from
commencing this plan, flatulence, griping, purging, and vomiting came
on, one symptom quickly following the other; the child wasted, and on
the sixth day had several convulsive fits. The diet was immediately
changed for ass's milk, and in less than twelve hours the sickness and
purging ceased; the flatulence was relieved; the motions, from being
green, watery, and passed with great violence and pain, became of a
healthy consistence and colour, and the screaming ceased. The symptoms
did not return, the child thrived, very soon consuming regularly one
quart of the ass's milk daily, and is now a fine healthy girl two years
old. A fortnight since the parent was confined with a fourth child.
Cow's milk was given to it for two or three days (from the difficulty
of obtaining that of the ass), the same train of symptoms, precisely,
came on with which the third child had been affected, which again gave
way upon following up the same plan of diet--the substitution of the
ass's milk for that of the cow. The evident conclusion from this is,
that the breast-milk of a healthy woman is incomparably the most
suitable diet for the infant; but that, if she be not of a healthy
constitution, it may be destructive to the child; and that where this
cannot be obtained, and cow's milk is found to disagree, ass's milk may
sometimes be resorted to with the happiest results.[FN#8]



[FN#8]  An infant will generally consume a quart, or a little more, of
ass's milk in the four and twenty hours; and as this quantity is
nearly as much as the animal will give, it is best to purchase an ass
for the express purpose. The foal must be separated from the mother,
and the forage of the latter carefully attended to, or the milk will
disagree with the child.



Sometimes the mother's breast, and every description of milk, is
rejected by the child; in which case recourse must be had to veal or
weak mutton broth, or beef tea, clear and free from fat, mixed with a
very small quantity of farinaceous food, carefully passed through a
sieve before it is poured into the sucking-bottle.


THE MODE OF ADMINISTERING IT.--There are two ways--by the spoon, and by
the nursing-bottle. The first ought never to be employed at this
period, inasmuch as the power of digestion in infants is very weak,
and their food is designed by nature to be taken very slowly into the
stomach, being procured from the breast by the act of sucking, in which
act a great quantity of saliva is secreted, and being poured into the
mouth, mixes with the milk, and is swallowed with it. This process of
nature, then, should be emulated as far as possible; and food (for this
purpose) should be imbibed by suction from a nursing-bottle: it is thus
obtained slowly, and the suction employed secures the mixture of a due
quantity of saliva, which has a highly important influence on digestion.

Too much care cannot be taken to keep the bottle perfectly sweet. For
this purpose there should always be two in the nursery, to be used
alternately; and, if any food remain after a meal, it must be emptied
out. The bottle must always be scalded out after use. The flat glass
nursing-bottle itself is too well known to need description; it may be
well, however, to say a word about the teat that covers its narrow
neck, and through which the infant sucks the food. If the artificial
or prepared cow's teat is made use of, it should be so attached to the
bottle that its extremity does not extend beyond its apex more than
half or three quarters of an inch; for if it projects more than this,
the child will get the sides of the teat so firmly pressed together
between its gums, that there will be no channel for the milk to flow
through. This remark applies equally to the teat made of soft wash-
leather, which many ladies prefer to that of the cow, and it is a good
substitute; but then a fresh piece of leather must be made use of
daily, otherwise the food will be tainted, and the child's bowels
deranged. It is also necessary that both of these, when used, should
have a small conical piece of sponge inclosed.

The most cleanly and convenient apparatus is a cork nipple, upon the
plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork,
being of a particularly fine texture, is supple and elastic, yielding
to the infant's lips while sucking, and is much more durable than the
teats ordinarily used.



[FN#9]  Sold by Weiss et Son, 62. Strand,



Whatever kind of bottle or teat is used, however, it must never be
forgotten that cleanliness is absolutely essential to the success of
this plan of rearing children.


THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.--This must be regulated
by the age of the child, and its digestive power. A little experience
will soon enable a careful and observing mother to determine this
point.--As the child grows older the quantity of course must be
increased.

The chief error in rearing the young is overfeeding; and a most
serious one it is; but which may be easily avoided by the parent
pursuing a systematic plan with regard to the hours of feeding, and
then only yielding to the indications of appetite, and administering
the food slowly, in small quantities at a time. This is the only way
effectually to prevent indigestion, and bowel complaints, and the
irritable condition of the nervous system, so common in infancy, and
secure to the infant healthy nutrition, and consequent strength of
constitution. As has been well observed, "Nature never intended the
infant's stomach to be converted into a receptacle for laxatives,
carminatives, antacids, stimulants, and astringents; and when these
become necessary, we may rest assured that there is something faulty in
our management, however perfect it may seem to ourselves."


THE FREQUENCY OF GIVING FOOD.--This must be determined, as a general
rule, by allowing such an interval between each meal as will insure the
digestion of the previous quantity; and this may be fixed at about
every three or four hours. If this rule be departed from, and the child
receives a fresh supply of food every hour or so, time will not be
given for the digestion of the previous quantity, and as a consequence
of this process being interrupted, the food passing on into the bowel
undigested, will there ferment and become sour, will inevitably produce
cholic and purging, and in no way contribute to the nourishment of the
child.


THE POSTURE OF THE CHILD WHEN FED.--It is important to attend to this.
It must not receive its meals lying; the head should be raised on the
nurse's arm, the most natural position, and one in which there will be
no danger of the food going the wrong way, as it is called. After each
meal the little one should be put into its cot, or repose on its
mother's knee, for at least half an hour. This is essential for the
process of digestion, as exercise is important at other times for the
promotion of health.



THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION
OF FIRST DENTITION.



As soon as the child has got any teeth,--and about this period one or
two will make their appearance,--solid farinaceous matter boiled in
water, beaten through a sieve, and mixed with a small quantity of milk,
may be employed. Or tops and bottoms, steeped in hot water, with the
addition of fresh milk and loaf sugar to sweeten. And the child may
now, for the first time, be fed with a spoon.

When one or two of the large grinding teeth have appeared, the same
food may be continued, but need not be passed through a sieve. Beef tea
and chicken broth may occasionally be added; and, as an introduction to
the use of a more completely animal diet, a portion, now and then, of a
soft boiled egg; by and by a small bread pudding, made with one egg in
it, may be taken as the dinner meal.

Nothing is more common than for parents during this period to give
their children animal food. This is a great error. "To feed an infant
with animal food before it has teeth proper for masticating it, shows a
total disregard to the plain indications of nature, in withholding such
teeth till the system requires their assistance to masticate solid
food. And the method of grating and pounding meat, as a substitute for
chewing, may be well suited to the toothless octogenarian, whose
stomach is capable of digesting it; but the stomach of a young child is
not adapted to the digestion of such food, and will be disordered by
it."[FN#10]



[FN#10]  Sir James Clarke on Consumption.



"If the principles already laid down be true, it cannot reasonably be
maintained that a child's mouth without teeth, and that of an adult,
furnished with the teeth of carnivorous and graminivorous animals, are
designed by the Creator for the same sort of food. If the mastication
of solid food, whether animal or vegetable, and a due admixture of
saliva, be necessary for digestion, then solid food cannot be proper,
when there is no power of mastication. If it is swallowed in large
masses it cannot be masticated at all, and will have but a small chance
of being digested; and in an undigested state it will prove injurious
to the stomach and to the other organs concerned in digestion, by
forming unnatural compounds. The practice of giving solid food to a
toothless child, is not less absurd, than to expect corn to be ground
where there is no apparatus for grinding it. That which would be
considered as an evidence of idiotism or insanity in the last instance,
is defended and practised in the former. If, on the other hand, to
obviate this evil, the solid matter, whether animal or vegetable, be
previously broken into small masses, the infant will instantly swallow
it, but it will be unmixed with saliva. Yet in every day's observation
it will be seen, that children are so fed in their most tender age; and
it is not wonderful that present evils are by this means produced, and
the foundation laid for future disease."[FN#11]



[FN#11]  Dr. John Clarke's Commentaries.



The diet pointed out, then, is to be continued until the second year.
Great care, however, is necessary in its management; for this period of
infancy is ushered in by the process of teething, which is commonly
connected with more or less of disorder of the system. Any error,
therefore, in diet or regimen is now to be most carefully avoided. 'Tis
true that the infant, who is of a sound and healthy constitution, in
whom, therefore, the powers of life are energetic, and who up to this
time has been nursed upon the breast of its parent, and now commences
an artificial diet for the first time, disorder is scarcely
perceptible, unless from the operation of very efficient causes. Not
so, however, with the child who from the first hour of its birth has
been nourished upon artificial food. Teething under such circumstances
is always attended with more or less of disturbance of the frame, and
disease of the most dangerous character but too frequently ensues. It
is at this age, too, that all infectious and eruptive fevers are most
prevalent; worms often begin to form, and diarrhoea, thrush, rickets,
cutaneous eruptions, etc. manifest themselves, and the foundation of
strumous disease is originated or developed. A judicious management of
diet will prevent some of these complaints, and mitigate the violence
of others when they occur.



THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT
COMPLAINTS TO WHICH INFANTS ARE LIABLE.



Artificial food, from mismanagement and other causes, will now and
then disagree with the infant. The stomach and bowels are thus
deranged, and medicine is resorted to, and again and again the same
thing occurs.

This is wrong, and but too frequently productive of serious and
lasting mischief. Alteration of diet, rather than the exhibition of
medicine, should, under these circumstances, be relied on for remedying
the evil. Calomel, and such like remedies, "the little powders of the
nursery," ought not to be given on every trivial occasion. More
mischief has been effected, and more positive disease produced, by the
indiscriminate use of the above powerful drug, either alone or in
combination with other drastic purgatives, than would be credited.
Purgative medicines ought at all times to be exhibited with caution to
an infant, for so delicate and susceptible is the structure of its
alimentary canal, that disease is but too frequently caused by that
which was resorted to in the first instance as a remedy. The bowels
should always be kept free; but then it must be by the mildest and
least irritating means.

It is a very desirable thing, then, to correct the disordered
conditions of the digestive organs of an infant, if possible, without
medicine; and much may be done by changing the nature, and sometimes
by simply diminishing the quantity, of food.

A diarrhoea, or looseness of the bowels, may frequently be checked by
giving, as the diet, sago thoroughly boiled in very weak beef-tea, with
the addition of a little milk. The same purpose is frequently to be
answered by two thirds of arrow-root with one third of milk, or simply
thin arrow-root made with water only; or, if these fail, baked flour,
mixed with boiled milk.

Costiveness of the bowels may frequently be removed by changing the
food to tops and bottoms steeped in hot water, and a small quantity of
milk added, or prepared barley,--mixed in warm water and unboiled milk.

Flatulence and griping generally arise from an undue quantity of food,
which passing undigested into the bowels, they are thus irritated and
disturbed. This may be cured by abstinence alone. The same state of
things may be caused by the food not being prepared fresh at every
meal, or even from the nursing-bottle or vessel in which the food is
given not having been perfectly clean. In this case weak chicken-broth,
or beef-tea freed from fat, and thickened with soft boiled rice or
arrow-root, may be given.



Sect. II. WEANING.



THE TIME WHEN TO TAKE PLACE.--The time when weaning is to take place
must ever depend upon a variety of circumstances, which will regulate
this matter, independently of any general rule that might be laid down.
The mother's health may, in one case, oblige her to resort to weaning
before the sixth month, and, in another instance, the delicacy of the
infant's health, to delay it beyond the twelfth. Nevertheless, as a
general rule, both child and parent being in good health, weaning ought
never to take place earlier than the ninth (the most usual date), and
never delayed beyond the twelfth month.

I should say further, that if child and parent are both in vigorous
health, if the infant has cut several of its teeth, and been already
accustomed to be partially fed, weaning ought to be gradually
accomplished at the ninth month. On the other hand, that if the child
is feeble in constitution, the teeth late in appearing, and the mother
is healthy, and has a sufficient supply of good milk, especially if it
be the autumnal season, it will be far better to prolong the nursing
for a few months. In such a case, the fact of the on-appearance of the
teeth indicates an unfitness of the system for any other than the
natural food from the maternal breast.

And again, if the infant is born of a consumptive parent, and a
healthy and vigorous wet-nurse has been provided, weaning should most
certainly be deferred beyond the usual time, carefully watching,
however, that neither nurse nor child suffer from its continuance.


THE MODE.--It should be effected gradually. From the sixth month most
children are fed twice or oftener in the four-and-twenty hours; the
infant is in fact, therefore, from this time in the progress of
weaning; that is to say, its natural diet is partly changed for an
artificial one, so that when the time for complete weaning arrives, it
will be easily accomplished, without suffering to the mother, or much
denial to the child.

It is, however, of the greatest importance to regulate the quantity
and quality of the food at this time. If too much food is given (and
this is the great danger) the stomach will be overloaded, the digestive
powers destroyed, and if the child is not carried off suddenly by
convulsions, its bowels will become obstinately disordered; it will
fall away from not being nourished, and perhaps eventually become a
sacrifice to the overanxious desire of the parent and its friends to
promote its welfare.

The kind of food proper for this period, and the mode of administering
it, is detailed in the previous section, on "Artificial Feeding."[FN#12]



[FN#12]  The kind of food after the sixth month to the completion of
first dentition, p. 44.



Much exercise in the open air (whenever there is no dampness of
atmosphere) is highly necessary and beneficial at this time; it tends
to invigorate the system, and strengthens the digestive organs, and
thus enables the latter to bear without injury the alteration in diet.


THE DRYING UP OF THE MOTHER'S MILK.--This will generally be attended
with no difficulty. When the weaning is effected gradually, the milk
will usually go away of itself without any measures being resorted to.
If, however, the breasts should continue loaded, or indeed painfully
distended, a gentle aperient should be taken every morning, so that the
bowels are kept slightly relaxed; the diet must be diminished in
quantity, and solid nourishment only taken. The breast, if painfully
distended, must be occasionally drawn, but only just sufficiently to
relieve the distention. In either case they must be rubbed for five or
ten minutes, every four or five hours, with the following liniment,
previously warmed:--

Compound soap liniment, one ounce and a half;
Laudanum, three drachms.



Sect. III. DIETETICS OF CHILDHOOD.



Childhood, as has been before intimated, extends from about the second
to the seventh or eighth year, when the second dentition is commenced.

No precise rules of diet can be laid down for this period, as this
requires to be adapted in every case to the particular constitution
concerned. There are, however, certain general principles which must be
acted upon, and which can be easily modified by a judicious and
observant parent, as circumstances and constitution may require.


GENERAL DIRECTIONS, AND OF ANIMAL FOOD.--The diet of the latter months
of infancy is still to be continued, but with the important addition of
animal food, which the child has now got teeth to masticate. This must
be given in small quantity; it should be of the lightest quality, only
allowed on alternate days, and even then its effects must be carefully
watched, as all changes in the regimen of children should be gradual.

A child at this age, then, should have its meals at intervals of about
four hours:--thus its breakfast between seven and eight o'clock, to
consist of tops and bottoms, steeped in hot water, a little milk added,
and the whole sweetened with sugar; or bread may be softened in hot
water, the latter drained off, and fresh milk and sugar added to the
bread. Its dinner about twelve o'clock, to consist, every other day, of
a small quantity of animal food (chicken, fresh mutton, or beef, being
the only meats allowed) with a little bread and water; on the alternate
days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow-
root pudding, containing one egg; or farinaceous food, with beef-tea.
Its afternoon mealy about four o'clock, the same diet as formed the
breakfast. At seven, a little arrow-root, made with a very small
proportion of milk, or a biscuit, or crust of bread, after which the
child should be put to bed.

The child must be taught to take its food slowly, retain it in it's
mouth long, and swallow it tardily. Nothing must be given in the
intervals of the meals. The stomach requires a period of repose after
the labour of digestion; and if the child is entertained by its nurse,
and its mind occupied, there will be no difficulty in following out
this important direction.

As the child grows older, the quantity at each meal should be
increased; the tops and bottoms changed for bread and pure milk, boiled
or not; meat may be taken daily, except circumstances forbid it; and a
small quantity of vegetable also.

If a child, then, be of a sound constitution, with healthy bowels, a
cool skin, and clean tongue, the diet may be liberal, and provided it
is sufficiently advanced in age, animal food may be taken daily. Too
low a diet would stint the growth of such a child, and induce a state
of body deficient in vigour, and unfit for maintaining full health:
scrofula and other diseases would be induced. At the same time let the
mother guard against pampering, for this would lead to evils no less
formidable, though of a different character. And as long as the general
health of this child is unimpaired, the body and mind active, and no
evidence present to mark excess of nutriment, this diet may be
continued. But if languor at any time ensue, fever become manifested,
the skin hotter than natural, the tongue white and furred, and the
bowels irregular, then, though these symptoms should bebonly in slight
degree, and unattended with any specific derangement amounting to what
is considered disease, not only should the parent lower the diet, and
for a time withdraw the animal part, but the medical adviser should be
consulted, that measures may be taken to correct the state of repletion
which has been suffered to arise. For some time after its removal, care
should also be taken to keep the diet under that, which occasioned the
constitutional disturbance.

But if the child be of a delicate and weakly constitution (and this is
unfortunately the more common case), it will not bear so generous a
diet as the foregoing. During the three or four earliest years, it
should be restricted chiefly to a mild farinaceous diet, with a small
allowance only of meat on alternate days. The constant endeavour of the
parent now should be, to seek to increase the digestive power and
bodily vigour of her child by frequent exercise in the open air, and by
attention to those general points of management detailed in the after-
part of this chapter. This accomplished, a greater proportion of animal
food may be given, and, in fact, will become necessary for the growth
of the system, while at the same time there will be a corresponding
power for its assimilation and digestion.

A great error in the dietetic management of such children is but too
frequently committed by parents. They suppose that because their child
is weakly and delicate, that the more animal food it takes the more it
will be strengthened, and they therefore give animal food too early,
and in too great quantity. It only adds to its debility. The system, as
a consequence, becomes excited, nutrition is impeded, and disease
produced, ultimately manifesting itself in scrofula, disease in the
abdomen, head, or chest. The first seeds of consumption are but too
frequently originated in this way. A child so indulged will eat
heartily enough, but he remains thin notwithstanding. After a time he
will have frequent fever, will appear heated and flushed towards
evening, when he will drink greedily, and more than is usual in
children of the same age; there will be deranged condition of the
bowels, and headach,--the child will soon become peevish, irritable, and
impatient; it will entirely lose the good humour so natural to
childhood, and that there is something wrong will be evident enough,
the parent, however, little suspecting the real cause and occasion of
all the evil. In such a child, too, it will be found that the ordinary
diseases of infancy, scarlet fever, measles, small pox, etc., will be
attended with an unusual degree of constitutional disturbance; that it
will not bear such active treatment as other children, or so quickly
rally from the illness.

"Strength is to be obtained not from the kind of food which contains
most nourishment in itself, but from that which is best adapted to the
condition of the digestive organs at the time when it is taken."


SUGAR.--This is a necessary condiment for the food of children, and it
is nutritious, and does not injure the teeth, as is generally imagined.
"During the sugar season," observes Dr. Dunglison, "the <DW64>s of
the West India islands drink copiously of the juice of the cane, yet
their teeth are not injured; on the contrary, they have been praised by
writers for their beauty and soundness; and the rounded form of the
body, whilst they can indulge in the juice, sufficiently testifies to
the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats,
on the other hand, are most indigestible, and seriously injurious.



[FN#13]  Elements of Hygiem. Philadephia, 1835.



SALT.--This is necessary for the health of a child; it acts as a
stimulant to the digestive organs, and if not allowed in sufficient
quantity with the food, worms will result.[FN#14] It may, therefore, be
added in small quantity, and with advantage, even to the farinaceous
food of infants. Salted meats, however, should never be permitted to
the child; for by the process of salting the fibre of the meat is so
changed, that it is less nutritive, as well as less digestible.



[FN#14]  Lord Sommerville, in his Address to the Board of Agriculture,
gave an interesting account of the effects of a punishment which
formerly existed in Holland. "The ancient laws of the country ordained
men to be kept on bread alone, un-mixed with salt, as the severest
punishment that could be inflicted upon them in their moist climate.
The effect was horrible: these wretched criminals are said to have been
devoured by worms engendered in their own stomachs."

"The wholesomeness and digestibility of our bread are undoubtedly
much promoted by the addition of the salt which it so universally
receives. A pound of salt is generally added to each bushel of flour.
Hence it may be presumed, that every adult consumes two ounces of salt
per week, or six pounds and a half per annum, in bread alone."

Dr. Paris on Diet.



FRUITS.--These, and of all kinds whether fresh or dried, a delicate
child is better without; except the orange, which when perfectly ripe
may be allowed to any child, but the white or inner skin should be
scrupulously rejected, as it is most indigestible.

A healthy child may be permitted to partake of most fresh fruits. Of
the stone-fruits, the ripe peach, the apricot, and nectarine, are the
most wholesome; but cherries, from the stones being but too frequently
swallowed, had better not be allowed. Apples and pears, when ripe and
well masticated, are not unwholesome; and the apple when baked affords
a pleasant repast, and where there is a costive habit, it is useful as
a laxative. The small-seeded fruits, however, are by far the most
wholesome. Of these, the ripe strawberry and raspberry deserve the
first rank. The grape is also cooling and antiseptic, but the husks and
seeds should be rejected. The gooseberry is less wholesome on account
of the indigestibility of the skin, which is too frequently swallowed.

Dried fruits a child should never be permitted to eat.


WATER.--This should be the only beverage throughout childhood. Toast-
and-water, if the child prefer it, which is rendered slightly more
nutritive than the more simple fluid. The water employed in its
preparation, however, must be at a boiling temperature, and it ought to
be drunk as soon as it has sufficiently cooled; for by being kept, it
acquires a mawkish and unpleasant flavour.


WINE, BEER, etc.--The practice of giving wine, or, indeed, any
stimulant, to a healthy child, is highly reprehensible; it ought never
to be given but medicinally.

The circulation in infancy and childhood is not only more rapid than
in the adult, but easily excited to greater vehemence of action; the
nervous system, too, is so susceptible, that the slightest causes of
irritation produce strong and powerful impressions: the result in
either case is diseased action in the frame, productive of fever,
convulsions, etc.; wine, accordingly, is detrimental to children.

An experiment made by Dr. Hunter upon two of his children illustrates,
in a striking manner, the pernicious effects of even a small portion of
intoxicating liquors in persons of this tender age. To one of the
children he gave, every day after dinner, a full glass of sherry: the
child was five years of age, and unaccustomed to the use of wine. To
the other child, of nearly the same age, and equally unused to wine, he
gave an orange. In the course of a week, a very marked difference was
perceptible in the pulse, urine, and evacuations from the bowels of the
two children. The pulse of the first was raised, the urine high
, and the evacuations destitute of their usual quantity of
bile. In the other child, no change whatever was produced. He then
reversed the experiment, giving to the first the orange, and to the
second the wine, and the results corresponded: the child who had the
orange continued well, and the system of the other got straightway
into disorder, as in the first experiment.[FN#15]



[FN#15]  Marcellin relates an instance of seven children in a family
whose bowels became infested with worms, from the use of stimulants.
They were cured by substituting water for the pernicious beverage.



In this town, spirits, particularly gin, are given to infants and
children to a frightful extent. I have seen an old Irish woman give
diluted spirits to the infant just born. A short time since one of
those dram-drinking children, about eight years of age, was brought
into one of our hospitals. The attendants, from its emaciated
appearance, considered the child was dying from mere starvation; which
was true enough in a certain sense. Food was accordingly offered and
pressed upon it, but the boy would not even put it to his lips. The
next day it was discovered that the mother brought the child very
nearly a pint of gin, every drop of which before night he had consumed.

It is easy to discover when children have been fed upon spirits: they
are always emaciated; have a lean, yellow, haggard look: the eyes
sunk, the lips pale, and the teeth discoloured, the cadaverous aspect
of the countenance being most fearful. They are continually suffering
from bowel complaints and convulsive disorders; which, under these
circumstances, terminate invariably in an early death.



Sect. IV. SLEEP.



DURING INFANCY.--For three or four weeks after birth the infant sleeps
more or less, day and night, only waking to satisfy the demands of
hunger; at the expiration of this time, however, each interval of
wakefulness grows longer, so that it sleeps less frequently, but for
longer periods at a time.

This disposition to repose in the early weeks of the infant's life
must not be interfered with; but this period having expired, great care
is necessary to induce regularity in its hours of sleep, otherwise too
much will be taken in the day-time, and restless and disturbed nights
will follow. The child should be brought into the habit of sleeping in
the middle of the day, before its dinner, and for about two hours,
more or less. If put to rest at a later period of the day, it will
invariably cause a bad night.

At first the infant should sleep with its parent. The low temperature
of its body, and its small power of generating heat, render this
necessary. If it should happen, however, that the child has disturbed
and restless nights, it must immediately be removed to the bed and care
of another female, to be brought to its mother at an early hour in the
morning, for the purpose of being nursed. This is necessary for the
preservation of the mother's health, which through sleepless nights
would of course be soon deranged, and the infant would also suffer from
the influence which such deranged health would have upon the milk.

When a month or six weeks has elapsed, the child, if healthy, may
sleep alone in a cradle or cot, care being taken that it has a
sufficiency of clothing, that the room in which it is placed is
sufficiently warm, viz. 60 degrees, and the position of the cot itself
is not such as to be exposed to currents of cold air. It is essentially
necessary to attend to these points, since the faculty of producing
heat, and consequently the power of maintaining the temperature, is
less during sleep than at any other time, and therefore exposure to
cold is especially injurious. It is but too frequently the case that
inflammation of some internal organ will occur under such
circumstances, without the true source of the disease ever being
suspected. Here, however, a frequent error must be guarded against,--
that of covering up the infant in its cot with too much clothing
throwing over its face the muslin handkerchief--and, last of all,
drawing the drapery of the bed closely together. The object is to keep
the infant sufficiently warm with pure air; it therefore ought to have
free access to its mouth, and the atmosphere of the whole room should
be kept sufficiently warm to allow the child to breathe it freely: in
winter, therefore, there must always be a fire in the nursery.

The child up to two years old, at least, should sleep upon a feather
bed, for the reasons referred to above. The pillow, however, after the
sixth month, should be made of horsehair; for at this time teething
commences, and it is highly important that the head should be kept cool.


DURING CHILDHOOD.--Up to the third or fourth year the child should be
permitted to sleep for an hour or so before its dinner. After this time
it may gradually be discontinued; but it must be recollected, that
during the whole period of childhood more sleep is required than in
adult age. The child, therefore, should be put to rest every evening
between seven and eight; and if it be in health it will sleep soundly
until the following morning. No definite rule, however, can be laid
down in reference to the number of hours of sleep to be allowed; for
one will require more or less than another.[FN#16] Regularity as to
the time of going to rest is the chief point to attend to; permit
nothing to interfere with it, and then only let the child sleep without
disturbance, until it awakes of its own accord on the following
morning, and it will have had sufficient rest.



[FN#16]  The amount of sleep necessary to preserve health varies
according to the state of the body, and the habits of the individual.
As already observed, infants pass much the greater portion of their
time in sleep. Children sleep twelve or fourteen hours. The schoolboy
generally ten. In youth, a third part of the twenty-four hours is spent
in sleep. Whilst, in advanced age, many do not spend more than four,
five, or six hours in sleep.



It is a cruel thing for a mother to sacrifice her child's health that
she may indulge her own vanity, and yet how often is this done in
reference to sleep. An evening party is to assemble, and the little
child is kept up for hours beyond its stated time for retiring to rest,
that it may be exhibited, fondled, and admired. Its usual portion of
sleep is thus abridged, and, from the previous excitement, what little
he does obtain, is broken and unrefreshing, and he rises on the morrow
wearied and exhausted.

Once awake, it should not be permitted to lie longer in bed, but
should be encouraged to arise immediately. This is the way to bring
about the habit of early rising, which prevents many serious evils to
which parents are not sufficiently alive, promotes both mental and
corporeal health, and of all habits is said to be the most conducive to
longevity.

A child should never be suddenly aroused from sleep; it excites the
brain, quickens the action of the heart, and, if often repeated,
serious consequences would result. The change of sleeping to waking
should always be gradual.

The bed on which the child now sleeps should be a mattress: at this
age a feather bed is always injurious to children; for the body,
sinking deep into the bed, is completely buried in feathers, and the
unnatural degree of warmth thus produced relaxes and weakens the
system, particularly the skin, and renders the child unusually
susceptible to the impressions of cold. Then, instead of the bed being
made up in the morning as soon as vacated, and while still saturated
with the nocturnal exhalations from the body, the bed-clothes should be
thrown over the backs of chairs, the mattress shaken well up, and the
window thrown open for several hours, so that the apartment shall be
thoroughly ventilated. It is also indispensably requisite not to allow
the child to sleep with persons in bad health, or who are far advanced
in life; if possible, it should sleep alone.



Sect. V. BATHING AND CLEANLINESS.




DURING INFANCY.--Too much attention cannot be paid to cleanliness; it
is essential to the infant's health. The principal points to which
especial attention must be paid by the parent for this purpose are the
following:--


TEMPERATURE OF THE WATER.--At first the infant should be washed daily
with warm water; and a bath every night, for the purpose of thoroughly
cleaning the body, is highly necessary. To bathe a delicate infant of a
few days or even weeks old in cold water with a view "to harden" the
constitution (as it is called), is the most effectual way to undermine
its health and entail future disease. By degrees, however, the water
with which it is sponged in the morning should be made tepid, the
evening bath being continued warm enough to be grateful to the feelings.

A few months having passed by, the temperature of the water may be
gradually lowered until cold is employed, with which it may be either
sponged or even plunged into it, every morning during summer. If
plunged into cold water, however, it must be kept in but a minute; for
at this period, especially, the impression of cold continued for any
considerable time depresses the vital energies, and prevents that
healthy glow on the surface which usually follows the momentary and
brief action of cold, and upon which its usefulness depends. With some
children, indeed, there is such extreme delicacy and deficient reaction
as to render the cold bath hazardous; no warm glow over the surface
takes place when its use inevitably does harm: its effects, therefore,
must be carefully watched.


DRYING THE SKIN.--The surface of the skin should always be carefully
and thoroughly rubbed dry with flannel,--indeed, more than dry, for the
skin should be warmed and stimulated by the assiduous gentle friction
made use of. For this process of washing and drying must not be done
languidly, but briskly and expeditiously; and will then be found to be
one of the most effectual means of strengthening the infant. It is
especially necessary carefully to dry the arm-pits, groins, and nates;
and if the child is very fat, it will be well to dust over these parts
with hair-powder or starch: this prevents excoriations and sores, which
are frequently very troublesome. Soap is only required to those parts
of the body which are exposed to the reception of dirt.


NAPKINS.--The frequency of the discharges from the bowels and bladder
requires a frequent change of napkins. A nurse cannot be too careful of
this duty from the first, so that she may be enabled to discover the
periods when those discharges are about to take place, that she may not
only anticipate them, but teach the child, at a very early age, to give
intelligent warning of its necessities. Thus a habit of regularity with
regard to those functions will be established, which will continue
through life, and tend greatly to the promotion of health. As the child
grows older, the system of cleanliness must in no particular be
relaxed, and it will be found the best preservative against those
eruptive disorders which are so frequent and troublesome during the
period of infancy.


DURING CHILDHOOD.--When this period arrives, or shortly after, bathing
is but too frequently left off; the hands and face of the child are
kept clean, and with this the nurse is satisfied; the daily ablution of
the whole body, however, is still necessary, not only for the
preservation of cleanliness, but because it promotes in a high degree
the health of the child.


PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.--A child of a
vigorous constitution and robust health, as he rises from his bed
refreshed and active by his night's repose, should be put into the
shower-bath, or, if this excites and alarms him too much, must be
sponged from head to foot with salt water. If the weather be very cold,
the water may be made slightly tepid, but if his constitution will bear
it, the water should be cold throughout the year. Then the body should
be speedily dried, and hastily but well rubbed with a somewhat coarse
towel, and the clothes put on without any unnecessary delay. This
should be done every morning of the child's life.

If such a child is at the sea-side, advantage should be taken of this
circumstance, and seabathing should be substituted. The best time is
two or three hours after breakfast; but he must not be fatigued
beforehand, for if so, the cold bath cannot be used without danger.
Care must be taken that he does not remain in too long, as the animal
heat will be lowered below the proper degree, which would be most
injurious. In boys of a feeble constitution, great mischief is often
produced in this way. It is a matter also of great consequence in
bathing children that they should not be terrified by the immersion,
and every precaution should be taken to prevent this. The healthy and
robust boy, too, should early be taught to swim, whenever this is
practicable, for it is attended with the most beneficial effects; it is
a most invigorating exercise, and the cold bath thus becomes doubly
serviceable.


PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.--If a child is of a
delicate and strumous constitution, the cold bath during the summer
is one of the best tonics that can be employed; and if living on the
coast, sea-bathing will be found of singular benefit. The effects,
however, of sea-bathing upon such a constitution must be particularly
watched, for unless it is succeeded by a glow,--a feeling of increased
strength,--and a keen appetite, it will do no good, and ought at once
to be abandoned for the warm or tepid bath. The opinion that warm baths
generally relax and weaken, is erroneous; for in this case, as in all
cases when properly employed, they would give tone and vigour to the
whole system; in fact, the tepid bath is to this child what the cold
bath is to the more robust.

In conclusion: if the bath in any shape cannot from circumstances be
obtained, then cold saltwater sponging must be used daily, and all the
year round, so long as the proper reaction or glow follows its use; but
when this is not the case, and this will generally occur, if the child
is delicate and the weather cold, tepid vinegar and water, or tepid
salt water, must be substituted.



Sect. VI. CLOTHING.



IN INFANCY.--Infants are very susceptible of the impressions of cold; a
proper regard, therefore, to a suitable clothing of the body, is
imperative to their enjoyment of health. Unfortunately, an opinion is
prevalent in society, that the tender child has naturally a great power
of generating heat and resisting cold; and from this popular error has
arisen the most fatal results. This opinion has been much strengthened
by the insidious manner in which cold operates on the frame, the
injurious effects not being always manifest during or immediately after
its application, so that but too frequently the fatal result is traced
to a wrong source, or the infant sinks under the action of an unknown
cause.

The power of generating heat in warm-blooded animals is at its minimum
at birth, and increases successively to adult age; young animals,
instead of being warmer than adults, are generally a degree or two
colder, and part with their heat more readily; facts which cannot be
too generally known. They show how absurd must be the folly of that
system of "hardening" the constitution (to which reference has been
before made), which induces the parent to plunge the tender and
delicate child into the cold bath at all seasons of the year, and
freely expose it to the cold, cutting currents of an easterly wind,
with the lightest clothing.

The principles which ought to guide a parent in clothing her infant
are as follows:--

The material and quantity of the clothes should be such as to preserve
a sufficient proportion of warmth to the body, regulated therefore by
the season of the year, and the delicacy or strength of the infant's
constitution. In effecting this, however, the parent must guard against
the too common practice of enveloping the child in innumerable folds of
warm clothing, and keeping it constantly confined to very hot and close
rooms; thus running into the opposite extreme to that to which I have
just alluded: for nothing tends so much to enfeeble the constitution,
to induce disease, and render the skin highly susceptible to the
impression of cold; and thus to produce those very ailments which it
is the chief intention to guard against.

In their make they should be so arranged as to put no restrictions to
the free movements of all parts of the child's body; and so loose and
easy as to permit the insensible perspiration to have a free exit,
instead of being confined to and absorbed by the clothes, and held in
contact with the skin, till it gives rise to irritation.

In their quality they should be such as not to irritate the delicate
skin of the child. In infancy, therefore, flannel is rather too rough,
but is desirable as the child grows older, as it gives a gentle
stimulus to the skin, and maintains health.

In its construction the dress should be so simple as to admit of being
quickly put on, since dressing is irksome to the infant, causing it to
cry, and exciting as much mental irritation as it is capable of
feeling. Pins should be wholly dispensed with, their use being
hazardous through the carelessness of nurses, and even through the
ordinary movements of the infant itself.

The clothing must be changed daily.--It is eminently conducive to good
health that a complete change of dress should be made every day. If
this is not done, washing will, in a great measure, fail in its object,
especially in insuring freedom from skin diseases.


IN CHILDHOOD.--The clothing of the child should possess the same
properties as that of infancy. It should afford due warmth, be of such
materials as do not irritate the skin, and so made as to occasion no
unnatural constriction.

In reference to due warmth, it may be well again to repeat, that too
little clothing (that state of semi-nudity which the vanity of some
parents encourage) is frequently productive of the most sudden attacks
of active disease; and that children who are thus exposed with naked
breasts and thin clothing in a climate so variable as ours are the
frequent subjects of croup, and other dangerous affections of the air-
passages and lungs. On the other hand, it must not be forgotten, that
too warm clothing is a source of disease,--sometimes even of the same
diseases which originate in exposure to cold,--and often renders the
frame more susceptible of the impressions of cold, especially of cold
air taken into the lungs. Regulate the clothing, then, according to the
season; resume the winter dress early; lay it aside late; for it is in
spring and autumn that the vicissitudes in our climate are greatest,
and congestive and inflammatory complaints most common.

With regard to material (as was before observed), the skin will at
this age bear flannel next to it; and it is now not only proper, but
necessary. It may be put off with advantage during the night, and
cotton maybe substituted during the summer, the flannel being resumed
early in the autumn. If from very great delicacy of constitution it
proves too irritating to the skin, fine fleecy hosiery will in general
be easily endured, and will greatly conduce to the preservation of
health.

It is highly important that the clothes of the boy should be so made
that no restraints shall be put on the movements of the body or limbs,
nor injurious pressure made on his waist or chest. All his muscles
ought to have full liberty to act, as their free exercise promotes both
their growth and activity, and thus insures the regularity and
efficiency of the several functions to which these muscles are
subservient.

The same remarks apply with equal force to the dress of the girl; and
happily, during childhood, at least, no distinction is made in this
matter between the sexes. Not so, however, when the girl is about to
emerge from this period of life; a system of dress is then adopted
which has the most pernicious effects upon her health, and the
development of the body, the employment of tight stays, which impede
the free and full action of the respiratory organs, being only one of
the many restrictions and injurious practices from which in latter
years they are thus doomed to suffer so severely.



Sect. VII. AIR AND EXERCISE.



IN INFANCY.--The respiration of a pure air is at all times, and under
all circumstances, indispensable to the health of the infant. The
nursery therefore should be large, well ventilated, in an elevated part
of the house, and so situated as to admit a free supply both of air
and light. For the same reasons, the room in which the infant sleeps
should be large, and the air frequently renewed; for nothing is so
prejudicial to its health as sleeping in an impure and heated
atmosphere. The practice, therefore, of drawing thick curtains closely
round the bed is highly pernicious; they only answer a useful purpose
when they defend the infant from any draught of cold air.

The proper time for taking the infant into the open air must, of
course, be determined by the season of the year, and the state of the
weather. "A delicate infant born late in the autumn will not generally
derive advantage from being carried into the open air, in this climate,
till the succeeding spring; and if the rooms in which he is kept are
large, often changed, and well ventilated, he will not suffer from the
confinement, while he will, most probably, escape catarrhal affections,
which are so often the consequence of the injudicious exposure of
infants to a cold and humid atmosphere."[FN#17] If, however, the child
is strong and healthy, no opportunity should be lost of taking it into
the open air at stated periods, experience daily proving that it has
the most invigorating and vivifying influence upon the system. Regard,
however, must always be had to the state of the weather; and to a damp
condition of the atmosphere the infant should never be exposed, as it
is one of the most powerful exciting causes of consumptive disease. The
nurse-maid, too, should not be allowed to loiter and linger about, thus
exposing the infant unnecessarily, and for an undue length of time;
this is generally the source of all the evils which accrue from taking
the babe into the open air.



[FN#17]  Sir James Clark on Consumption.



Exercise, also, like air, is essentially important to the health of
the infant. Its first exercise, of course, will be in the nurse's arms.
After a month or two, when it begins to sleep less during the day, it
will delight to roll and kick about on the sofa: it will thus use its
limbs freely; and this, with carrying out into the open air, is all
the exercise it requires at this period. By and by, however, the child
will make its first attempts to walk. Now it is important that none of
the many plans which have been devised to teach a child to walk, should
be adopted--the go-cart, leading-strings, etc.; their tendency is
mischievous; and flatness of the chest, confined lungs, distorted
spine, and deformed legs, are so many evils which often originate in
such practices. This is explained by the fact of the bones in infancy
being comparatively soft and pliable, and if prematurely subjected by
these contrivances to carry the weight of the body, they yield just
like an elastic stick bending under a weight, and as a natural
consequence become curved and distorted.

It is highly necessary that the young and experienced mother should
recollect this fact, for the early efforts of the little one to walk
are naturally viewed by her with so much delight, that she will be apt
to encourage and prolong its attempts, without any thought of the
mischief which they may occasion; thus many a parent has had to mourn
over the deformity which she has herself created.

It may be as well here to remark, that if such distortion is timely
noticed, it is capable of correction, even after evident curvature has
taken place. It is to be remedied by using those means that shall
invigorate the frame, and promote the child's general health (a daily
plunge into the cold bath, or sponging with cold salt water, will be
found signally efficacious), and by avoiding the original cause of the
distortion--never allowing the child to get upon his feet. The only way
to accomplish the latter intention, is to put both the legs into a
large stocking; this will effectually answer this purpose, while, at
the same time, it does not prevent the free and full exercise of the
muscles of the legs. After some months pursuing this plan, the limbs
will be found no longer deformed, the bones to have acquired firmness
and the muscles strength; and the child may be permitted to get upon
his feet again without any hazard of perpetuating or renewing the evil.

The best mode of teaching a child to walk, is to let it teach itself,
and this it will do readily enough. It will first crawl about: this
exercises every muscle in the body, does not fatigue the child, throws
no weight upon the bones, but imparts vigour and strength, and is thus
highly useful. After a while, having the power, it will wish to do
more: it will endeavour to lift itself upon its feet by the aid of a
chair, and though it fail again and again in its attempts, it will
still persevere until it accomplish it. By this it learns, first, to
raise itself from the floor; and secondly, to stand, but not without
keeping hold of the object on which it has seized. Next it will balance
itself without holding, and will proudly and laughingly show that it
can stand alone. Fearful, however, as yet of moving its limbs without
support, it will seize a chair or anything else near it, when it will
dare to advance as far as the limits of its support will permit. This
little adventure will be repeated day after day with increased
exultation; when, after numerous trials, he will feel confident of his
power to balance himself, and he will run alone. Now time is required
for this gradual self-teaching, during which the muscles and bones
become strengthened; and when at last called upon to sustain the weight
of the body, are fully capable of doing so.


IN CHILDHOOD.--When the child has acquired sufficient strength to take
active exercise, he can scarcely be too much in the open air; the more
he is habituated to this, the more capable will he be of bearing the
vicissitudes of the climate. Children, too, should always be allowed to
amuse themselves at pleasure, for they will generally take that kind
and degree of exercise which is best calculated to promote the growth
and development of the body. In the unrestrained indulgence of their
youthful sports, every muscle of the body comes in for its share of
active exercise; and free growth, vigour, and health are the result.

If, however, a child is delicate and strumous, and too feeble to take
sufficient exercise on foot,--and to such a constitution the respiration
of a pure air and exercise are indispensable for the improvement of
health, and without them all other efforts will fail,--riding on a
donkey or pony forms the best substitute. This kind of exercise will
always be found of infinite service to delicate children; it amuses the
mind, and exercises the muscles of the whole body, and yet in so
gentle a manner as to induce little fatigue.

The exercises of horseback, however, are most particularly useful
where there is a tendency in the constitution to pulmonary consumption,
either from hereditary or accidental causes. It is here beneficial, as
well through its influence on the general health, as more directly on
the lungs themselves. There can be no doubt that the lungs, like the
muscles of the body, acquire power and health of function by exercise.
Now during a ride this is obtained, and without much fatigue to the
body. The free and equable expansion of the lungs by full inspiration,
necessarily takes place; this maintains their healthy structure, by
keeping all the air-passages open and pervious; it prevents congestion
in the pulmonary circulation, and at the same time provides more
completely for the necessary chemical action on the blood, by changing,
at each act of respiration, a sufficient proportion of the whole air
contained in the lungs,--all objects of great importance, and all
capable of being promoted, more or less, by the means in question.

And be it remembered that these remarks apply with equal force to the
girl as to the boy. She should be allowed, and even encouraged, to take
the same active exercise. Fortunately, this course is followed during
childhood; not so, unfortunately (in the majority of cases, at least),
after this period. Young females are then subjected to those unnatural
restraints, both in exercise and dress, which fashion and vanity
impose, to be followed by effects which, though not immediately
obvious, are capable of laying the foundation of evils that cannot
afterwards be remedied.

A good carriage is the point aimed at (and to which I particularly
refer), and the means adopted for its cultivation fail, after all, in
their end, just in proportion to their rigid employment. For this
purpose the head is kept erect, and the shoulders drawn back, and they
are to be kept in this position not for an hour or so, but continually.
To preserve, however, this unnatural and constrained position, requires
considerable muscular powers, such as no girl can exercise without
long, painful, and injurious training; nor even by this, unless other
measures be resorted to in aid of her direct endeavours. For instead of
the muscles obtaining increased power and strength by these efforts (to
enforce a good carriage), they are enfeebled, and soon become more and
more incapable of performing what is required of them. This fact soon
becomes perceptible; weakness is noticed; but instead of correcting
this by the only rational mode, that of invigorating the weakened
muscles, mechanical aid is called in to support them, and laced
waistcoats are resorted to. These undoubtedly give support--nay, they
may be so used as almost wholly to supersede the muscular efforts, with
the advantage of not tiring, however long or continuously employed.
Improvement of carriage is manifested, the child is sensible of relief
from a painful exertion, the mother is pleased with the success of her
management, and this success appears to superficial observation fully
to confirm the judgment which superintends it. Yet what are the
consequences to which her measures tend, and which such measures are
daily and hourly producing? The muscles of the back and chest,
restrained in their natural and healthful exercise by the waistcoat
called in to aid them, and more signally, in after-life, by the tightly-
laced stays or corsets, become attenuated, and still further enfeebled,
until at length they are wholly dependent on the mechanical aid, being
quite incapable of dispensing with it for any continuance.

By and by a taper waist becomes an object of ambition, and the stays
are laced more closely than ever. This is still done gradually, and, at
first, imperceptibly to the parties. The effect, however, though slow,
is sure; and the powers of endurance thus exercised come in time to
bear, almost unconsciously, what, if suddenly or quickly attempted, no
heroism could possibly sustain. This increased pressure impedes the
motion of the ribs. For perfect respiration these motions should be
free and unrestrained, and perfect respiration is necessary to those
changes in the blood which fit it for nutrition, and the other purposes
of the animal frame. In proportion as respiration is impeded, is the
blood imperfectly vitalised, and in the same ratio are the nutrient and
other functions dependent on the blood inadequately performed. Here,
then, is one source of debility, which affects the whole frame,
reducing every part below the standard of healthful vigour. Quickened
respiration soon ensues, the heart becomes excited, the pulse
accelerated, and palpitation is in time superadded.

There are still further evils produced by tight lacing. For the
pressure being chiefly made on the lower part of the chest, the stomach
and liver are necessarily compressed, to the great disturbance of their
functions; and being pressed downwards too, these trespass on that
space which the other abdominal viscera require, superinducing still
further derangements. Thus almost every function of the body becomes
more or less impeded.

And again, the girl not being able always to have her body cased in
the tight-laced stays, some relaxation must take place. Under it the
muscles of the back, deprived of their accustomed support, and
incapable of themselves to sustain the incumbent weight, yield, and the
column of the spine bends, at first anteriorly, causing round shoulders
and an arched back; but eventually inclines to one or other side,
giving rise to the well-known and too frequently occurring state of
lateral curvature. This last change most frequently commences in the
sitting posture, such females being, through general debility, much
disposed to sedentary habits. Such, though but very slightly sketched,
are a few of the evils attending this baneful practice.

But how, then, is a good carriage to be obtained; which is not only
pleasing to the eye, but is, when natural, absolutely conducive itself
to health? To insure a good carriage, the only rational way is to give
the necessary power, especially to the muscles chiefly concerned; and
this is to be done, not by wearying those muscles by continual and
unrelieved exertion, but by invigorating the frame generally, and more
especially by strengthening the particular muscles through varied
exercise alternated with due repose. Attention to general health,
suitable diet, regular bowels, moderate but regular exercise, not of
particular muscles only, but of the whole frame, cold-bathing or
sponging, and other such measures, will maintain a good carriage, by
giving that power which the more direct means so generally practised
serve but to exhaust.[FN#18]



[FN#18]  The above remarks on "good carriage" are almost wholly taken
from a valuable article of Dr. Barlow's, in the "Cyclopaedia of
Practical Medicine."



Chap. II.



ON THE USE AND ABUSE OF CERTAIN REMEDIES.


Sect. I.--APERIENT MEDICINE.



One of the greatest errors of the nursery is the too frequent and
indiscriminate exhibition by the mother or nurse of purgative medicine
to the infant. Various are the forms in which it is given; perhaps the
little powders obtained from the chemist is the most frequent, as it is
certainly the most injurious, form, their chief ingredient being
calomel.

The choice of the aperient, or the dose, or the exact condition of the
health of the infant, or whether it is an aperient at all that is
required, are points entirely overlooked: a little medicine is thought
necessary, because the child appears unwell, and a purgative, or a
little white powder, is forthwith given. The great art of
medicine is the proper application of the proper medicine, in the
proper dose, at the proper time; points never considered in the
nursery. For example, I have known a large dose of magnesia given by a
nurse to an infant, that had been suffering from a diarrhoea of some
days' standing, and very quickly cause death. Now, magnesia is one of
the most useful and harmless medicines that can be given to an infant
when indicated; when prescribed in a dose suited to its age, and when
the proper time is fixed upon for its exhibition; in the foregoing
case, however, every thing forbad its use, but none of these points
were considered.

Aperient medicine, too, is sometimes unwittingly repeated to remove
those symptoms which it has itself produced. Some incidental pain and
uneasiness, some slightly greenish appearance of the motions, leads the
mother to believe that more purging is necessary, when, in fact, both
circumstances have probably been induced by the irritation caused by
the purgatives already too freely administered. How frequently is this
the case, during the first week or ten days of the infant's life, when
the nurse doses the child with tea-spoonful after tea-spoonful of
castor oil, for the relief of pain, which her repeated doses of
medicine have alone created.

The bowels of an infant in health should be relieved two, three, or
four times in the twenty-four hours. The stools should be of the
consistence of thin mustard, and of a lightish yellow colour, having
little smell, free from lumps or white curdy matter, and passed without
pain, or any considerable quantity of wind. And a parent is only
justified in giving aperient medicine, when any deviation from these
conditions exists; and only then, when what may be called healthy
costiveness is present, viz. either the stools less frequent than they
ought to be, or lumpy and partially solid. Then, the only purgative
medicines that can be given with safely to an infant, without medical
sanction, are, castor oil, manna, rhubarb, and magnesia; the
application of the lavement, and the aperient liniment.



CASTOR OIL


This is one of the mildest aperients, prompt in its action, and
effective in clearing out the contents of the bowels; it is a
medicine, therefore, particularly applicable to infants.

During teething there is generally much torpor of the bowels; here,
then, castor oil is a very appropriate and useful artificial means of
increasing the frequency of the alvine discharges.

Then, again, no purgative can be so much relied on for overcoming
habitual costiveness as castor oil; it may for this purpose be given
daily for some weeks, gradually reducing the dose until only a few
drops be taken; after which the bowels generally continue to act
without further artificial assistance. Even its occasional
administration leaves the bowels in a relaxed state; a great advantage
over other purgatives, which generally cause, after their action is
passed off, a confined state.

The proper dose will depend upon the age, and the known effect of
aperient medicine upon the childsome requiring more, others less:

Under one year, one small tea-spoonful.

Under three years, two ditto.

Under six years, three ditto.

Under ten years and upwards, a table spoonful. The quantity being more
or less according to the facility with which the bowels are purged.

It may be given in various ways; poured upon a little mint water, or
blended with a little moist sugar;--or, if the stomach is unusually
delicate, the oil may be made into an emulsion with some aromatic
water, by the intervention of the yolk of an egg and a little syrup of
roses or sugar combined with it. The following proportions make an
elegant and not at all a disagreeable mixture, of which a desert-
spoonful (or more, according to the age,) may be repeated every hour
until it operate:

Castor oil, six drachms;
The yolk of an egg;
Mix well together, and add
Dill water, two ounces,
Syrup of roses, two drachms.



MANNA.


This also may be given with impunity to the youngest infant; it is
sweet to the taste, and mild in its operation. It should be exhibited
in doses of one to two drachms in a little warm milk; or if it cause
flatulence in this form, in some aromatic water, a desert spoonful of
carraway-seed or dill water. For children above two years, it must
always be given with some other aperient: thus, it may be combined with
castor oil by the medium of mucilage or the yolk of an egg; in fact, it
might be substituted for the syrup of roses in the previous
prescription for castor oil.



MAGNESIA AND RHUBARB.


Magnesia, besides being a laxative, allays irritability of the
stomach; it is consequently useful during dentition, at which period
there is both much irritability and a prevailing acescency of the
stomach. The dose is from five grains to ten for an infant, increasing
the quantity to fifteen grains or twenty to children of nine or ten
years of age. When taken alone the best vehicle is hot milk, which
greatly quickens its aperient operation. And whenever the bowels are
distended with wind, the pure magnesia is preferable to the carbonate.

It is well to mention here, that when the infant throws up the nurse's
milk it is generally curdled; a fact which leads the inexperienced
mother to infer that the child is suffering from acidity; and to
counteract the supposed evil magnesia is given again and again. This is
a useless and pernicious practice, for curdling or coagulation of the
milk always takes place in the stomach, and is produced by the gastric
juice, and is so far from being a morbid process, that milk cannot be
properly digested without it.

Rhubarb, it should always be recollected, has an astringent as well as
purgative property, according to the extent of the dose in which it is
administered; the former of which never opposes or interferes with the
energy of the latter, since it only takes effect when the substance is
administered in small doses, or, if given in larger ones, not until it
has ceased to operate as a cathartic. This latter circumstance renders
it particularly eligible in cases of diarrhoea, as it evacuates the
offending matter before it operates as an astringent upon the bowels.

As a purgative it operates mildly, and may be given to the youngest
infant; if from two to twelve months old, from three to six grains; for
children above that age, the dose may range from ten grains to twenty.
Its operation, however, is much quickened by the addition of magnesia;
both of which are more effective when thus united than when given
separately. The following form, in a costive and flatulent state of the
bowels, will be found useful[FN#19]; a tea-spoonful or more may be given
every three or four hours until the desired effect is obtained:--


Powdered rhubarb, half a drachm;

Magnesia, two scruples;

Compound spirits of ammonia, twenty drops;

Dill water, two ounces;

Simple syrup, two drachms.



[FN#19]  This may be made up and kept in the nursery for a long time
without spoiling.



Rhubarb, mixed with flour and warm water, may be made into a poultice,
and applied to the abdomen of a child that obstinately refuses to
swallow medicine, and it will be found to produce the same effect as if
the medicine had been taken into the stomach; it will purge briskly.



THE LAVEMENT.


This is an excellent nursery remedy when the bowels are obstinately
costive. It may then be employed as a substitute for medicine, a
protracted and frequent use of which (even of the mildest aperients) is
apt to injure the digestive functions, and to give rise to some degree
of intestinal irritation. Lavements, however, like aperient medicine,
must not be resorted to for a long time together; for whilst the latter
irritate, the former most certainly tend, after a long continued use,
to debilitate the bowels, and thus render them less than ever disposed
to act for themselves. They are an excellent occasional remedy.

The simplest form of an aperient enema, is warm water; but barley-
water, or thin gruel, or even milk and water, are to be preferred at
all times, as they are of a more bland and less irritating nature. If
it be desirable to increase the strength of the injection, castor oil
may be added. The proportions of fluid which are necessary for the
different stages of life, under ordinary circumstances, maybe stated
as follows:--An infant at its birth requires about one fluid ounce; a
child between the age of one and five years, from three to four fluid
ounces; and a youth of ten or fifteen, from six to eight fluid ounces.

The mode of administering an injection to an infant deserves
particular attention, as injury might be caused by its being performed
in a careless or unskilful manner. A gum elastic pipe should be always
used instead of the hard ivory tube. Having smeared this over with
lard, and placed the infant on its left side, with its knees bent up in
the lap of the nurse, it is to be passed a couple of inches into the
bowel, in a direction not parallel to the axis of the body, but rather
inclined to the left. The latter circumstance should never be
neglected, for if not attended to, there will be difficulty in
administering the injection. The fluid must then be propelled very
gradually, or it will be instantly rejected; on the whole being thrown
up (the pipe carefully and slowly withdrawn), the child must be kept
quietly reposing on its nurse's lap, and in the same posture for some
little time.



THE APERIENT LINIMENT.


A liniment to be rubbed on the stomach is another resource in cases of
habitual costiveness, and will frequently be attended with great
success when repeated purgatives have been resisted.

Olive or castor oil may be used for this purpose; they must be warmed
and rubbed over the abdomen night and morning, for five or ten minutes.
Perhaps the best form of liniment that can be made use of is the
following:--

Compound soap liniment, one ounce;
Compound tincture of aloes, half an ounce.



Sect. II.--CALOMEL.



Calomel is one of the most useful medicines we possess; but though
powerful for good, it is by no means powerless for mischief, and pages
might be written upon the evil effects which have resulted from its
indiscriminate use in the nursery; medical men are daily and hourly
witnessing this fact. It is particularly eligible in the diseases of
children; but then it is quite impossible for unprofessional persons to
judge when it may be appropriately exhibited. And it cannot be too
generally known, that the effect of this medicine upon the evacuations
is always to make them appear unnatural. From ignorance of this fact,
calomel is often repeated again and again to relieve that very
condition which it has itself produced, causing, but too frequently, a
degree of irritation in the delicate lining membrane of the bowel,
which it may be very difficult for a medical man to remove, and perhaps
a source of misery to the child as long as it lives.

Its frequent exhibition has also another evil attending it, for "the
immoderate use of mercury in early infancy produces more, perhaps, than
any other similar cause, that universal tendency to decay, which, in
many instances, destroys almost every tooth at an early age."[FN#20]



[FN#20]  Bell on the Teeth.



In the diseases of childhood it is often administered by the mother or
nurse with a degree of careless excess which ultimately, if not
immediately, produces severe and irremediable injury. I have met with
such cases; but Mr. Bell details a remarkable instance in point: "A
child, about three years of age, was brought to me, having a most
extensive ulceration in the gum of the lower jaw, by which the alveolar
process (that portion of the jaw which forms the sockets of the teeth)
was partially denuded. The account given by the mother was, that the
child had some time previously been the subject of measles, for which a
chemist, whom she consulted, gave her white powders, one of which was
ordered to be taken every four hours. It appears by the result, that
this must have been calomel; for, after taking it for two or three
days, profuse salivation was produced, with swollen tongue, inflamed
gums, etc., followed by ulceration of the gum, lips, and cheek. On
examining the denuded alveolar process, I found that a considerable
necrosis (death of the bone) had taken place, including the whole
anterior arch of the jaw from the first double tooth on the left side
to the eye-tooth on the right. By degrees the dead portion of bone was
raised, and became loose, when I found that the mischief was not
confined to the alveolar process, but comprised the whole substance of
the bone within the space just mentioned," etc. Surely the knowledge of
such a case as this would induce every prudent mother to exclude
calomel from her list of domestic nursery medicines.



Sect. III.--OPIATES.



This class of medicine is often kept in the nursery, in the forms of
laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's
cordial.

The object with which they are generally given is to allay pain by
producing sleep; they are, therefore, remedies of great convenience to
the nurse; and I am sorry to be obliged to add, that, so exhibited,
they are but too often fatal to the little patient.

The fact is, that in the hands of the physician, there is no medicine
the administration of which requires greater caution and judgment than
opiates, both from the susceptibility of infants to their narcotic
influence, and their varying capability of bearing it; the danger,
therefore, with which their use is fraught in the hands of a nurse
should for ever exclude them from the list of domestic nursery
medicines.

Dalby's carminative and Godfrey's cordial are, perhaps, more
frequently used than any other forms; and some striking cases,
illustrative of the fatal results of exhibiting them indiscriminately,
and without medical sanction, are on record.[FN#21] The late Dr.
Clark, in his "Commentaries," mentions a case which he saw, where
"forty drops of Dolly's carminative destroyed an infant." Dr. Merriman
gives the following in a note in Underwood, "On the Diseases of
Children:"--



[FN#21]  Two or three fatal cases, and upon which coroners' inquests
were held, have occurred within the last two years.



"A woman, living near Fitzroy Square, thinking her child not quite
well, gave it a dose of Godfrey's cordial, which she purchased at a
chemist's in the neighbourhood. In a very short time after taking it
the child fell into convulsions, and soon died. In less than a month
the child of another woman in the same house was found to be ill with
disordered bowels. The first woman, not at all suspecting that the
Godfrey's cordial had produced the convulsions in her infant, persuaded
her friend to give the same medicine to her child. A dose from the same
bottle was given, and this child was likewise attacked almost
immediately with convulsions, and also died."

Convulsions and epilepsy, without such fatal results as the foregoing,
are not uncommon as the effect of a single dose of an opiate given
unadvisedly; and by their continued and habitual use (and the form of
syrup of poppies is but too often administered by an indiscreet and
lazy nurse, unknown by the parent), a low, irritative, febrile state is
produced, gradually followed by loss of flesh, the countenance becoming
pallid, sallow, and sunken, the eyes red and swollen, and the
expression stupid and heavy, and the powers of the constitution at last
becoming completely undermined. Such an object is to be seen daily
among the poorer classes,--the miniature of a sickly aged person: death
soon follows here.



Sect. IV.--LEECHING.



Difficulty sometimes arises in putting a stop to the bleeding from
leech-bites; a matter of considerable importance in the case of a
delicate infant. The following measures may be resorted to for this
purpose:--

1. Expose the surface of the part to the external air, so that a
coagulum of blood may form at the orifice: this simple mode will
frequently arrest it.

2. If this fail, make compression upon the part: this is one of the
most effectual means of restraining haemorrhage. It is to be effected
by taking a piece of lint folded three or four thicknesses, and the
size of the finger-nail, to be steadily pressed upon the open orifice
with the point of the finger until the blood has ceased to flow. The
pledget of lint, however, must not be removed for some hours
afterwards, or the bleeding will break out afresh.

3. If the compression fails in stopping the bleeding, or from the
situation of the leech-bites it cannot be adopted, because there is no
firm point of resistance upon which to make pressure, the part may be
dusted with starch or gum arabic powder, or, if this is of no avail,
the wound may be touched with lunar caustic.

If none of these measures are successful, the assistance of the
medical attendant must be obtained; and if firm pressure be made upon
the part, no serious loss of blood can ensue before his arrival.

Leeches should never be resorted to by a parent for any of the
diseases of infancy, without medical direction.



Sect. V.--BLISTERS AND POULTICES.



A blister should never be applied for any infantile disease, except
when ordered by a medical man, as its injudicious use might greatly
aggravate the complaint.

There are also one or two precautions in reference to the mode of the
application of a blister, which it is always right for a parent to
attend to. From the great irritability of the skin, it should never be
allowed to remain on longer than from two to four hours. At the
expiration of this time, the surface will usually become red and
inflamed; and, if the blister is removed, and the part dressed with
fresh spermaceti ointment spread on lint, or with a soft bread and
water poultice, a full blister will soon be raised: the little patient
is thus saved much suffering, and a very troublesome sore prevented. A
piece of tissue or silver paper, interposed between the blister and the
skin, will answer the same purpose; the blister will act well, and the
evils before alluded to will be prevented.

After a blister has been two or three hours applied, its edge should
be carefully raised, to ascertain the effect produced; and if the
surface be much inflamed, more particularly if little points of
vesication (watery bladders) are present, it should be removed, and the
above directions attended to.

Mustard poultices are invaluable in some of the diseases of infancy
and childhood, and therefore frequently ordered.

A mustard poultice is made by mixing two thirds of mustard flour and
one third of wheaten flour with warm water or vinegar, in sufficient
quantity to render the powder of the consistence of paste. It is then
spread on linen from the size of a half-crown to that of the palm of
the hand, according to the effect intended, and placed on the skin. How
long it is to be kept on will depend upon the individual sensibility of
the skin of the child; but, in general, from fifteen to twenty minutes
will be found amply sufficient. The application, however, must at all
times be carefully watched; for if it remain on too long, ulceration,
and death of the part, might ensue; therefore, directly the skin is
found tolerably red, the poultice should be removed. After its removal,
the part may be exposed, or, if very painful, smeared over with fresh
cream or common cerate.

A bread and water poultice, although one of the commonest applications
in use, is rarely well made or properly applied. It thus becomes
injurious rather than useful; adding to the inflammation or irritation
of the part, instead of soothing and allaying it. Nothing, however, is
more simple than the mode of its preparation.

Cut slices of stale bread of sufficient quantity, scald out a bason,
put the bread into it, pour upon it boiling water, cover it over, and
let it stand for ten minutes; next strain the water oft, gently squeeze
the saturated bread in a thin cloth, so that the poultice shall not be
too moist, and then spread it upon a cloth so that it shall be in
thickness half an inch, and of a size large enough to cover the whole
of the inflamed part, and a little more. Apply it just warm enough to
be borne, and cover it well with oiled silk. A poultice thus made, will
act as a local tepid bath to the inflamed part; and the oiled silk
preventing evaporation, it will be found, when taken off, as moist as
the first moment that it was put on.



Sect. VI.--BATHS.



Baths are much resorted to during infancy and childhood, both in
health and in disease. In the former state, they constitute an
important measure of hygeiene (this has been briefly alluded to under
the section "Bathing"), and in the latter, a valuable remedial agent.
Their indiscriminate use, however, might be followed by serious
consequences; it is therefore important to point out a few rules for
their judicious employment.



THE COLD WATER PLUNGE BATH.



It consists of water in its natural degree of heat; its temperature
varying, according to the season of the year or other circumstances,
from 30 degrees to 60 degrees.

The phenomena produced upon a strong and healthy boy plunging into
this bath will be as follows:--He will first experience a sensation of
cold, followed by slight shuddering, and, if the immersion has been
sudden, a peculiar impression in the nervous system, called a shock.
Almost immediately after the shock, the feeling of cold will vanish,
and give place to a sensation of warmth, speedily diffusing itself over
the whole frame. If the boy leaves the bath at this time, or, at all
events, before the warmth of the body goes off, and quickly dresses
himself, a renewal of the reaction which had followed the shock of
immersion will be experienced; he will be in a most delightful glow,--
there will be a general feeling of enjoyment, accompanied by a sensible
increase of animal power, and invigoration of the whole system. But, on
the other hand, if the boy greatly prolong his stay in the water, no
reaction will ensue, and he will become chilly, which will gradually
increase to a strong and general shivering;--his feet and legs will
become benumbed, and the whole body will soon be languid, exhausted,
and powerless. The same result will happen to the young and delicate
infant, if plunged into this bath; the same sensations will be
produced; except that here the shock is scarcely followed by any
reaction, and therefore from the first moment of the immersion, the
shivering and consequent train of sensations occur. This arises from
the infant at birth having less power of producing heat than when
further advanced in age.

From the foregoing remarks, then, it will be seen, that, in early
infancy, the cold bath is inadmissible, and water of a higher
temperature than that which feels cool to the hand of the nurse should
always be used at this age. But that, as the child grows older,--if of
a healthy and vigorous constitution,--the cold bath is unquestionably
most desirable; and, if used in a proper manner, will be found to act
as a most powerful tonic to the system. The summer is of course the
only period of the year when the cold plunging bath can be resorted to
for the child.



SEA BATHING.



When sea bathing can be obtained, it is even more conducive to the
health of the child than the fresh water plunge bath; for the sea water
is more tonic, stimulant, and bracing, than fresh. The period of the
year best adapted for sea bathing is the summer and autumn. The best
time of the day for bathing is two or three hours after breakfast;
except in very hot weather, when an earlier hour must be chosen.
Exercise is always useful previously to the bath; but it must be
gentle, so as not to induce fatigue or much perspiration, Then the bath
must be entered suddenly, with a plunge, inasmuch as an instantaneous
immersion produces a greater reaction than a gradual immersion.[FN#22]
The length of time of remaining in will depend upon circumstances. One
dip only is enough at the first bath. Subsequently the time of
remaining in the water may be prolonged, but this must be increased
gradually; the positive necessity of leaving the bath while there still
remains sufficient power of reaction being always kept in mind.
Exercise in the water, particularly that of swimming, is highly useful.
The body should be speedily and well dried, immediately upon coming
out; a rough jack towel is an excellent means of accomplishing this
purpose, while at the same time it insures considerable friction of the
surface of the skin. If the boy is in sound health, he may bathe daily.



[FN#22]  It is a matter of importance in bathing children, that they
should not be terrified by the immersion, and every precaution should
be taken to prevent this.



As a remedy, sea bathing is highly serviceable. Its employment,
however, requires much caution, and great mischief is sometimes
committed by its indiscriminate use.

The child of a strumous habit may be greatly benefited by sea bathing,
united with a few years' residence on the coast. Indeed, by carefully
following up a course of sea bathing, a suitable diet, and a judicious
mode of living, the very temperament of the individual may be all but
changed, and a power and activity imparted to the system, productive
eventually of comparatively strong and robust health. A parent will do
wisely, therefore, to send a child of such a habit to a school on the
coast. Great caution, however, must be observed when bathing is
commenced, lest the shock be too powerful for the energies of the
system, and be not followed by the necessary degree of reaction. It
will be prudent to begin with the tepid bath (85 degrees to 92
degrees), and gradually reduce the temperature until the open sea can
be resorted to without fear. The measures already mentioned for
promoting reaction--exercise previous to immersion; the immersion at
first only momentary, and followed by strong friction--must be
diligently regarded in such a case.

In the child of a delicate and feeble habit, much out of health, whose
general debility is dependent on some organic disease, sea bathing is
not only improper, but dangerous. Instead of being strengthened, such a
child will be rendered more weak and debilitated. On the other hand,
when the child is of a weak and relaxed habit, but free from organic
disease, the cold bath will be highly useful, provided sufficient power
of reaction exist in the system. In this case the skin and flesh of the
child is relaxed and flabby; there is a great tendency to warm
perspirations in bed, capricious appetite, confined or relaxed bowels,
indisposition to exertion, and weariness from the slightest effort.



THE SHOWER BATH.



The effects of the shower bath are, on the whole, similar to those of
the plunge bath of the same degree of temperature, except that the
immediate shock of the shower bath is in general felt to be greater
than that from simple immersion. This, however, may be met by putting
warm water into the bottom of the bath in sufficient quantity to cover
the ankles of the individual taking the bath, which tends at once to
lessen the shock, and to increase the reaction.

The apprehension and alarm experienced by young children in entering
this kind of bath is easily overcome, by using at first a modification
of it, lately brought into use. It consists of a tin vessel in the form
of a large bottle, pierced at the bottom like a colander, and
terminating in the upper part in a narrow tube, with an open mouth.
When put into water it becomes filled, which is retained by closing the
mouth of the tube with the finger; on removing which the water flows
gradually out of the sieve-like bottom in a gentle shower. This may be
used to the youngest child. At first the quantity of water employed
should be small, and its temperature warm; as, however, the child grows
older and accustomed to the bath, the former may be increased, and the
latter lowered. Its tonic effect may be augmented by the addition
ofbay salt, and by much active rubbing.

As the child gets older the common form of shower bath may be used,
and throughout the year, if he enjoy robust health; during the winter
season, however, the water should be made tepid. This bath should be
taken immediately upon rising from bed.



ABLUTION, OR SPONGING.



By ablution is meant the process of applying water to the surface of
the body by means of a sponge or towel. It is one of the best
substitutes for the cold bath; and if done quickly and thoroughly,
produces a glow and invigoration of frame almost equal to the former.
It is also the surest preventive against catching cold.

Every child in health ought to be obliged, every morning of its life
(when other means of bathing cannot be obtained), upon rising, and
while the body still retains all the warmth of the bed, to sponge the
whole body. If too young to do it for himself, it must be done for him.
Salt or vinegar should be added to the water; and if the boy be robust,
cold water may be used throughout the year; if not, in the winter
season it must be made tepid.

As a remedy, cold water sponging, and the application of ice and iced
water, are often ordered under certain states of disease by the medical
attendant, and frequently followed by delightful results. But it is
necessary that they should be properly applied to do good.

Cold water sponging is a convenient and grateful method of moderating
febrile heat of the surface, provided undoubted powers of reaction be
present in the system. It is frequently ordered, therefore, to be
employed in eruptive fevers, as measles, scarlet fever, smallpox, and
other fevers; and also in some local inflammations, particularly of the
brain. Vinegar may be added to the water under these circumstances
with advantage. It should at first be used tepid or cool, but
afterwards cold. As a general rule, the more dry and parched the heat
of the surface, the more urgent the necessity for the application of
the cold, and the more frequently and fearlessly ought it to be
renewed,--every hour or half-hour not being too often. Should the child
fall asleep during the process, and begin to perspire, it must be
intermitted, but resumed again on a recurrence of the parching heat.

Ice and iced water are most frequently employed in affections of the
brain. The former is most conveniently applied in a well-cleaned pig's
bladder, which should be half filled with broken fragments of the ice.
The bladder prevents moisture about the clothes, and, from its smooth
and pliant nature, readily accommodates itself to every part of the
child's head. If iced water is used, care must be taken that the cloths
are sufficiently large to cover the whole of the head, and they should
be doubled to prevent their getting rapidly warm. Indeed, in applying
cold locally, as in inflammation of the brain, one rule it is of the
utmost importance to observe, viz. that the application of the cold
shall be continuous; therefore a second set of cold cloths or bags of
ice should be applied before the former has become warm. This plan,
especially pursued during the night, along with judicious internal
treatment, will save many children from perishing under the most
insidious and fatal disease of childhood--water on the brain.

If neither water of a sufficiently low temperature, nor ice, can be
procured, then recourse may be had to refrigerating mixtures, of which
the following is a good form:--

Common water, five pints;
Vinegar, two pints;
Nitre, eight ounces;
Sal ammoniac, four ounces.



THE WARM BATH.



The warm bath judiciously prescribed is one of the most valuable
remedial agents we possess; but although powerful for good, when
misapplied, it is equally powerful for mischief. For instance, in
active inflammatory affections, before the loss of blood, the use of
the warm bath would greatly aggravate the disease; and yet, for an
infant with active inflammation of the respiratory organs, it is
continually resorted to. Again, nothing is more common than for a
child, when attacked with convulsions, to be put immediately in the
warm bath; and, generally speaking, it is extremely beneficial in this
class of diseases; but it is sometimes no less prejudicial, when
applied without due examination of the peculiarities of individual
cases. For, in plethoric and gross children, the local abstraction of
blood from the head, and the complete unloading of the alimentary
canal, are often necessary to render such a measure beneficial, or even
free from danger. In convulsions, however, and particularly when
arising from teething, a parent may, without hesitation, at any time
immerse the feet of the infant in water as warm as can be borne, at the
same time that cloths wet with cold water are applied to the head and
temples.

As a preventive, where there is a tendency to disease, the warm bath
may be employed without scruple, and will be found most serviceable.
Its value in this point of view is very great, and it is to be
regretted that it is not sufficiently appreciated and used. For
example, a severe cold has been taken, and inflammation of the air-
tubes is threatened: only put the child into a warm bath, and, with the
common domestic remedies, a very serious attack may be warded off.
Again, in the commencement of a diarrhoea, a warm bath, and
discontinuing the cause of the attack, will alone suffice to cure; and,
more-over, in the protracted diarrhoea attendant upon teething, where,
after various remedies have been tried in vain, the child has lost
flesh and strength to an apparently hopeless degree, Recovery has been
brought about by the simple use of the warm bath.

In the treatment of scrofulous children, warm and tepid bathing is of
great value. In such cases, a course of warm sea bathing, with active
friction over the whole surface after each bath, will at once relieve
that abdominal fulness which is generally present, improve the
functions of the skin, and give tone and vigour to the whole system.
Towards the termination of such a course of baths, their temperature
must be gradually reduced till they become tepid (85 degrees to 92
degrees).

The opinion that warm baths generally relax is erroneous: they are, no
doubt, debilitating when used by persons of a weak and relaxed
constitution, or when continued too long; but, on the contrary, they
invariably give tone when employed in the cases to which they are
properly applicable.

A partial warm bath, such as the foot-bath, is of much service in
warding off many complaints. If a child get the feet wet, plunging them
into warm water will often prevent any ill consequences; and even when
the first chill and slight shiverings which usher in colds, fevers, and
other inflammatory complaints, have been complained of, the disease may
be cut short by the use of a foot-bath, continued till free
perspiration occurs.



RULES FOR THE USE OF THE WARM BATH.



TEMPERATURE OF THE WATER.--When the warm bath is used as a measure of
hygeiene, as a general rule, any degree of temperature may be chosen
between 92 degrees and 98 degrees, which appears to be most agreeable
to the child; but on no account must 98 degrees be exceeded. When
ordered as a remedial measure, the temperature will of course be fixed
by the medical attendant.

The same degree of temperature must be kept up during the whole period
of immersion. For this purpose the thermometer must be kept in the
bath, and additions of warm water made as the temperature is found to
decrease. These additions of warm water, however, must be regulated by
the indications of the thermometer, and not by the feelings of the
child.


PERIOD OF REMAINING IN THE BATH.--This must depend upon circumstances.
As a measure of hygeiene, it must be varied according to the age of the
child. For the first four or five weeks, the infant should not be kept
in beyond three or four minutes; and the duration must afterwards be
gradually prolonged as the child advances in age, until it extends to a
quarter of an hour, a period which may be allowed after it has attained
the age of four years.

When the bath is employed as a remedial agent, the time of immersion
must be prolonged; this will be determined by the medical adviser.
Speaking generally, a quarter of an hour may be said to be the shortest
period, an hour the longest, and half an hour the medium.

When in the bath, care must be taken that the child's body is immersed
up to the shoulders or neck, otherwise that part of the body which is
out of the bath (the shoulders, arms, and chest), being exposed to the
cooler temperature of the air, will be chilled.

When the infant or child is taken out of the bath, the general
surface, especially the feet, must be carefully rubbed dry with towels
previously warmed; and when one of the objects of the bath is to excite
much perspiration, the child should be immediately wrapped in flannel
and put to bed. When, however, the object is not to excite
perspiration, the child may be dressed in his ordinary clothing, but
should not be allowed to expose himself to the open air for at least an
hour.


TIME OF USING THE BATH.--When resorted to for sudden illness, the bath
must of course be employed at any time needed. When used for any
complaint of long standing, or a measure of hygeiene, as a general
rule, it should be taken between breakfast and dinner, about two hours
after the former, or an hour and a half before the latter. This implies
that the infant should never be put into the bath after having been
freely nourished at the breast. Neither should it ever be used when the
child is in a state of free perspiration from exercise, or on awaking
from sleep.



Chap. III.

OF TEETHING, AND HINTS ON THE PERMANENT OR ADULT TEETH.



The infant at birth has no teeth visible: the mouth is toothless. It
possesses, however, hidden in the jaw, the rudiments of two sets. The
first of these which makes its appearance, are called the Temporary or
Milk Teeth; the second, the Permanent or Adult Teeth, and these come up
as the former fall out, and so gradually replace them.



Sect. I.--ON TEETHING.



THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set
of teeth, or milk-teeth as they are called, are twenty in number; they
usually appear in pairs, and those of the lower jaw generally precede
the corresponding ones of the upper. The first of the milk-teeth is
generally cut about the sixth or seventh month, and the last of the set
at various periods from the twentieth to the thirtieth months. Thus the
whole period occupied by the first dentition may be estimated at from a
year and a half to two years. The process varies, however, in different
individuals, both as to its whole duration, and as to the periods and
order in which the teeth make their appearance. It is unnecessary,
however, to add more upon this point.

Their developement is a natural process. It is too frequently,
however, rendered a painful and difficult one, by errors in the
management of the regimen and health of the infant, previously to the
coming of the teeth, and during the process itself.

Thus, chiefly in consequence of injudicious management, it is made the
most critical period of childhood. Not that I believe the extent of
mortality fairly traceable to it, is by any means so great as has been
stated; for it is rated as high as one sixth of all the children who
undergo it. Still, no one doubts that first dentition is frequently a
period of great danger to the infant. It therefore becomes a very
important question to an anxious and affectionate mother, how the
dangers and difficulties of teething can in any degree be diminished,
or, if possible, altogether prevented. A few hints upon this subject,
then, may be useful. I shall consider, first, the management of the
infant, when teething is accomplished without difficulty;--and,
secondly, the management of the infant when it is attended with
difficulty.



MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.



In the child of a healthy constitution, which has been properly, that
is, naturally, fed, upon the milk of its mother alone, the symptoms
attending teething will be of the mildest kind, and the management of
the infant most simple and easy.


SYMPTOMS.--The symptoms of natural dentition (which this may be fairly
called) are, an increased flow of saliva, with swelling and heat of the
gums, and occasionally flushing of the cheeks. The child frequently
thrusts its fingers, or any thing within its grasp, into its mouth. Its
thirst is increased, and it takes the breast more frequently, though,
from the tender state of the gums, for shorter periods than usual. It
is fretful and restless; and sudden fits of crying and occasional
starting from sleep, with a slight tendency to vomiting, and even
looseness of the bowels, are not uncommon. Many of these symptoms often
precede the appearance of the tooth by several weeks, and indicate that
what is called "breeding the teeth" is going on. In such cases, the
symptoms disappear in a few days, to recur again when the tooth
approaches the surface of the gum.


TREATMENT.--The management of the infant in this case is very simple,
and seldom calls for the interference of the medical attendant. The
child ought to be much in the open air, and well exercised: the bowels
should be kept freely open with castor oil; and be always gently
relaxed at this time. Cold sponging employed daily, and the surface of
the body rubbed dry with as rough a flannel as the delicate skin of the
child will bear; friction being very useful. The breast should be given
often, but not for long at a time; the thirst will thus be allayed, the
gums kept moist and relaxed, and their irritation soothed, without the
stomach being overloaded. The mother must also carefully attend, at
this time, to her own health and diet, and avoid all stimulant food or
drinks.

From the moment dentition begins, pressure on the gums will be found
to be agreeable to the child, by numbing the sensibility and dulling
the pain. For this purpose coral is usually employed, or a piece of
orris-root, or scraped liquorice root; a flat ivory ring, however, is
far safer and better, for there is no danger of its being thrust into
the eyes or nose. Gentle friction of the gums, also, by the finger of
the nurse, is pleasing to the infant; and, as it seems to have some
effect in allaying irritation, may be frequently resorted to. In
France, and in this country also, it is very much the practice to dip
the liquorice-root, and other substances, into honey, or powdered
sugar-candy; and in Germany, a small bag, containing a mixture of sugar
and spices, is given to the infant to suck, whenever it is fretful and
uneasy during teething. The constant use, however, of sweet and
stimulating ingredients must do injury to the stomach, and renders
their employment very objectionable.



THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.



In the child which has been partly or altogether brought up by hand,
or who is of a feeble and delicate constitution, or imbued with any
hereditary taint, the process of dentition will be attended with more
or less difficulty, and not unfrequendy with danger.


SYMPTOMS.--The symptoms of difficult dentition are of a much more
aggravated description than those which attend the former case; and it
is right that a mother should, to a certain extent, be acquainted
with their character, that she may early request that medical aid,
which, if judiciously applied, will mitigate, and generally quickly
remove them.

Difficult dentition will be attended with painful inflammation and
swelling of the gum, which is hotter, of a deeper red, than natural,
and intolerant of the slightest pressure. There is often great
determination of blood to the head, which a mother may recognise by the
cheeks being red, hot, and swollen; the eyes red, irritable, and
watery; and the saliva running from the mouth profusely. The fever is
great, and the thirst extreme. The child is at one time restless and
irritable, and at another heavy and oppressed: the sleep will be
broken, and the infant frequently awake suddenly and in alarm from its
short slumbers. Such are the chief symptoms of difficult teething, and
which will be present to a greater or less degree.


TREATMENT.--As most of the above symptoms are induced by the painful
tension of the gum, it would seem that the most rational mode of
attempting their relief is by freely lancing the swollen part. Great
prejudices, however, still exist in the minds of some parents against
this operation. They think it gives great pain, and, if the tooth is
not very near, makes its coming through the gum subsequently the more
difficult.

With regard to the first objection, the lancet is carried through the
gum so quickly, that this is hardly possible; and the fact that the
infant will often smile in your face after it is done, although
previously crying from pain, is sufficient evidence that it is not a
very painful operation. In reference to the second, that the scar which
ensues, opposes, by its hardness, the subsequent progress of the tooth,
it is quite groundless; for cicatrices, like all other new-formed
parts, are much more easily absorbed than the original structure.

Of the practical utility and perfect safety of this operation we have
ample proof in its daily performance with impunity, and in the instant
relief which it often affords to all the symptoms.

Mere scarifying the gums is sometimes all that is required, and will
afford great relief. This operation, therefore, should not be opposed
by the mother. She, at the same time, should be acquainted with its
precise object, lest the speedy return of the symptoms, and the non-
appearance of the expected tooth, might tend to bring the operation of
lancing the gums into disrepute.

The parental management of the infant, then, and by which much of the
pain and difficulty of teething may be removed or alleviated, consists
in attending to the following directions:--


FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of
the mother's duty to pay especial attention; and, by so doing, she will
save her child much suffering. The condition of the mouth should be
carefully inspected from time to time; and should a swollen gum be
discovered, it should immediately be attended to, not waiting till
constitutional symptoms appear before she employs proper aid for her
child. For this purpose the mother should make herself familiar with
the appearances of the gum under distention and inflammation; a matter
of no difficulty, accompanied, as this condition usually is, by a
profuse secretion of saliva, heat of mouth, and at a time when the age
of the child justifies the supposition that it is about to cut its
first tooth, or, if it have some teeth, that others are about to appear.


SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it
should always have its quantity of nourishment diminished. If it is
being fed, as well as nursed at the breast, at the time, the former
should be immediately withheld: if it is being fed alone, the only
kind of food that should be allowed is milk and water. These cases are
much aggravated by the not uncommon habit of parents giving the infant
food whenever it cries from the irritation attending upon the process;
and thus a slightly difficult dentition is converted into serious
disease.


THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched,
that they may not become confined; it being necessary that they should
be gently relaxed at this time. If a slight diarrhoea is present, it
must not be checked; if it pass beyond this, however, medicine must be
had recourse to, and great benefit will also arise from putting the
child into a warm hip-bath, and warmly clothing the body, but keeping
the head cool.


FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold
water night and morning, and no other covering than that which nature
has provided should be put upon it when within doors or asleep; and on
no occasion should warm felt or velvet hats be worn during mild or warm
weather, straw or white hats being much lighter and cooler. The child
should be much in the open air.

The sponging of the infant's body daily, either with cold or tepid
water, must depend upon the season of the year and constitution of the
child, as well as upon other circumstances. Sponging the head with cold
water night and morning is almost invariably atttended with great
benefit, and may be resorted to in every case without fear; and now and
then the use of the warm hip-bath, for several days together, will be
ordered by the physician, which, by acting upon the skin, diminishes
the determination of blood to the head, and thus forms an important
source of relief.


FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not
unfrequently excited by difficult teething, and then give great alarm
to the parent, relief will be afforded by immersing the hips, legs,
and feet of the infant in water as warm as can be borne, and at the
same time applying over the head and temples a piece of flannel wet
with cold water. I have also often cut the fit short by sprinkling cold
water in the child's face while in the bath. The gums should always be
looked to, and if they appear swollen, and painful, at once lanced. I
have known the most formidable convulsions to cease immediately after
this operation.


SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses
to administer narcotics to quiet infants while teething. It is not only
objectionable, but, from the uncertain effects of sedatives upon
infants, a very dangerous practice, and they ought never to be given,
except at the suggestion of a medical man. It is far better, if the
child is restless at night, to have it frequently taken out of its cot,
and carried about in an airy room; for the cool air, and change of
posture, will do much to allay the feverishness and restlessness of the
child.


From these few hints, it must have been seen how much the sufferings
from teething may be mitigated by judicious management. That, if the
parent is able to support her infant upon the breast alone, teething
will be found comparatively an easy process, and unattended with
danger; the mother thus reaping a delightful reward for all the
anxieties and privations nursing necessarily involves. That the child
brought up partially, or entirely, by hand will always pass through
dentition with more or less of pain and difficulty; but that even here,
if the diet has been properly regulated, much less suffering and
inconvenience will arise than when less attention has been paid to it.
And, lastly, that, when teething is difficult, how highly important it
is to call in proper aid at an early period, and to carry out fully the
directions of the medical attendant, allowing no foolish prejudices to
interfere with his prescriptions and management.

If I stood in need of any argument to impress upon the mind of a
parent the importance of attending to the last injunction, I would
simply state, that its neglect is but too frequently the cause of
disease of the brain, terminating in death, or a state of idiotcy far
worse than death, of which I know more than one living instance.

It may be as well to add, that eruptions about the ears, head, face,
and various parts of the body, very frequently appear during the
process of the first teething.[FN#23] If they are slight, they should
be left alone, being rather useful than otherwise; if they are
troublesome, they must receive that kind of attention from the parent
which will be pointed out under the chapter on diseases. The same
remark applies to enlargements of the glands of the neck, which
frequently appear at this time.



[FN#23]  In some infants a rash always precedes the cutting a tooth.
Sometimes it appears in the form of hard elevated pimples as large as
peas; in other instances in the form of red patches, of the size of a
shilling, upon the arms, shoulders, and back of the neck. They are
always harmless, require no particular attention, and prevent, I doubt
not, more serious complaints.



SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.



Parents are not sufficiently alive to the importance of attending to
the condition of the mouth of their children at the period of changing
the first for the second set of teeth; they do not seem to be aware
how much the comfort, appearance, and future health of the child
depends upon it. Nor do they subsequently impress upon the minds of
their children how necessary, on their part, is the observance of
certain rules for the preservation of the teeth, and how distressing
are the effects which result from their neglect. It is proposed, here,
to say a few words for the information and guidance of the parent upon
this subject.



THE MANNER IN WHICH THEY APPEAR.



The change of the temporary for the permanent or adult teeth
commences, in the majority of instances, at about seven years of age;
occasionally it occurs as early as five, and as late as eight years and
a half. The necessity which exists for this change, and the mode by
which it is effected, are striking and beautiful; it is, however, not
our object to enter fully upon its consideration here.

It has already been observed, that the infant is born with the
rudiments of two sets of teeth in the jaw, although neither make their
appearance till long after birth. The time when, and the manner in
which the first set appear has been pointed out. Now although these
admirably answer the purposes for which they were given up to the
seventh year, after this period they fail to do so: they are not
sufficiently numerous,--in their structure they are not strong or
durable,--nor is their power of mastication sufficiently great.

They are not sufficiently large or numerous. If the mouth of a child
at this age is examined, it will be seen, that a considerable interval
has taken place between the teeth in consequence of the growth and
expansion of the face; hence a larger set has become necessary to fill
the arch. But it may be asked, do not the teeth grow with the growth of
the body? and if not, why is it so? They do not, and for this reason:
the important office which these organs are destined to perform requires
that they should be composed of a substance too dense and of too low
an organization to allow of any subsequent growth and enlargement. Thus
the size of the teeth is determined and acquired before they make their
appearance through the gums. This being the case, it will be readily
seen, that the teeth which would be of appropriate size in the mouth of
the infant, would be quite inadequate to the enlarged dimensions of the
adult; hence the necessity of a second set, exceeding in number, and
size the teeth of the first.

That a necessity also exists at this age, that the weak and delicate
teeth of childhood should be exchanged for a set stronger and more
durable in their structure, more robust and more powerful, will be
sufficiently apparent, if we only recollect the great change which has
gradually been taking place in the nature of the food of the two epochs
of childhood and adult age.

The second set, or permanent teeth, then, lying under the milk-teeth
and hidden in the jaw, undergo in this situation their full
developement, before they appear above the gum. This occurrence
commences about seven years of age, at which period the first set
begin to fall out from their roots becoming absorbed, and no longer
retaining their hold of the jaw; to be entirely replaced in the course
of a few years by the permanent set, which thus succeeds them. The
first teeth of this set which make their appearance are the large
double teeth, which emerge from the gum immediately behind the last of
the temporary set. Next the two front teeth of the lower jaw fall out,
and are succeeded by two others of similar character and form, but of
larger size; then the two corresponding teeth of the upper row are cast
off, and their place supplied; shortly after the teeth immediately
adjoining these; then the double teeth of the first set are exchanged
for their smaller successors of the second. The eye-teeth after a time
begin to make their appearance; and then more double teeth; making in
all twenty-eight teeth, and occupying in their developement from the
seventh to the fourteenth year of age. They are not, however, yet
complete; for between the latter date and the twenty-first year four
more teeth appear, called the wisdom teeth, making the adult set or
permanent teeth to amount in all to thirty-two teeth. It should be
observed, that whilst this is the most usual course in which this set
appear, the line of succession is sometimes different.



THEIR VALUE AND IMPORTANCE.



It would seem almost unnecessary to say a word upon so self-evident a
truth, and yet perhaps the full extent of this statement is not
generally appreciated. It has not, perhaps, occurred to the minds of
all, that upon the right position and arrangement of the teeth the
beauty and expression of the countenance much depends. But so it is;
for however regular and perfect the general features, if the teeth are
irregular or deficient, an unpleasing expression, proportionate to the
extent of the displacement, is inevitably produced. Now every mother
should be alive to this fact, that she may early apply to the dentist
to have any error of the above nature rectified, before it is too late.

On their complete and entire state also depends the perfection of
utterance and articulation. The child, for instance, makes no attempt
at articulation until it has acquired several teeth; this faculty
becomes also exceedingly imperfect during the process of changing them;
from this time it continues to improve, until again it is permanently
impaired in old age, when they are finally lost. And so again, if a
child lose merely a single tooth from the front of its mouth, lisping
will result; or if a supernumerary or irregular tooth be present, the
articulation will be abrupt and imperfect:--the former plainly showing
the importance of the entireness of the series, and the latter, the
necessity of regularity in their arrangement and position.

The teeth, however, are chiefly important in relation to the part they
sustain in connection with digestion, viz. the mastication of the food.
By this act the food, after being received into the mouth, is mixed
with the saliva and broken down, till it becomes of an uniform pulpy
consistence, fit for being easily swallowed, and acted upon by the
gastric juice on its arrival in the stomach. That due mastication of
the food is essential to healthy digestion, which will be promoted or
retarded in exact proportion as it approaches or falls short of this
point, is a fact so generally known as scarcely to need comment.
Suffice it to add, that, if food be introduced into the stomach
unmasticated, the gastric juice will only act upon its surface; and
after a number of hours it will be either rejected by vomiting, or pass
on into the intestine, to give rise to cholic, bowel complaints, or
flatulence, and very frequently in children to a serious attack of
convulsions.



THEIR MANAGEMENT AND PRESERVATION.



IRREGULARITY OF ARRANGEMENT AND POSITION.--Every parent ought to have
the mouth of her child inspected occasionally, during the advance of
the permanent teeth, that any irregularity in their position or
arrangement may be prevented. And it is equally her duty to see to it,
that she choose a competent person to do this, since great mistakes are
not unfrequently made in this matter, and which themselves become the
source of evils far more serious than those they are intended to
obviate. "I have known," says Mr. Bell, "no less than eight or even ten
firm teeth forcibly removed from the jaws of a child at once, when
there was not the slightest reason to apprehend any evil result from
their being left alone." Here there was a most cruel, because
unnecessary, infliction of pain, as well as great hazard incurred of
seriously injuring the permanent teeth by interfering with the
secretion of their enamel. And besides all this there is another and
yet greater evil, for, if the temporary teeth be removed, before the
permanent ones are so advanced as to be ready to occupy their
situation, the arch of the jaw will assuredly contract, and when,
subsequently, the permanent teeth are fully formed, there will not be
room for them to range in their proper situation. Thus the operation
which was intended to prevent irregularity becomes the cause of its
occurrence, and that in its very worst form, producing a want of
accordance between the size of the teeth and that of the jaw.

The eye-teeth generally occasion most anxiety to a parent, from the
prominent position in which they present themselves; but in the
majority of cases nothing but time is required to reduce them to their
proper station. But, whatever may be the peculiarities of each
individual case, the dentist will decide what may be required; only, I
would again repeat, do not neglect the occasional inspection of the
mouth at this age, if you regard the future comfort and appearance of
your child.


THEIR PRESERVATION.--The preservation of the teeth requires attention to
several points; the first and principal of which is, to enforce the
habit in the child of thoroughly cleaning the teeth by means of water
and a brush night and morning, and rinsing out the mouth after each
meal. The brush should not be very hard, as it will not only be more
difficult to clean the interstices between the teeth, the
part in which the tartar[FN#24] is most likely to be deposited, but by
its friction, will occasion the gradual absorption of the gum and the
exposure of the neck of the teeth. The hair of the brush should be firm
and elastic, and not too closely set.



[FN#24]  A sort of calcareous substance, which becomes deposited at
the roots of the teeth, from a want of proper attention to
cleanliness; and, if allowed to remain, will destroy first their
beauty, and then the organ itself.



TARTAR.--If there is a tendency to the formation of tartar, then it will
be necessary to have recourse to some tooth-powder. Tooth-powders,
however, must be chosen with care, as many of them are composed of
substances highly injurious to the teeth. "Many of the tooth-powders
which are offered for sale, with the promise of rendering the teeth
beautifully white, perform, for a time, all that is promised, at the
expense of permanent and irremediable injury to the teeth; for they
often contain a quantity of tartaric or other acid, which effects a
gradual decomposition of the enamel."[FN#25] Prepared chalk is one of
the simplest and best tooth-powders.



[FN#25]  Bell on the Teeth.



The following form, also, may be used with advantage:--

Prepared chalk, three ounces;
Orris root, powdered, half an ounce;
Powdered myrrh, half an ounce;
Cuttle fish, powdered, one ounce;
Essential oil of cinnamon, four drops.--Mix.

The best preservative, then, against the formation of tartar, is to
see that the child cleans his teeth thoroughly night and morning with
the brush, powder, and water, and also (if possible) that he rinses out
the mouth after each meal.

If the gums should be tender, irritable, and bleed (as is frequently
the case when an individual gets out of health, or the tartar
accumulates) the mouth may be washed night and morning with a tumbler of
tepid water, containing from ten to twenty drops of the tincture of
myrrh, and the same quantity of spirits of camphor; or the following
form may be used:--

Alum, one drachm and a half;
Tincture of myrrh, two drachms;
Camphor mixture, five ounces and a half.--Mix.


ACIDS.--The use of acids to the teeth cannot be too strongly deprecated:
they decompose their substance, and lead to their rapid decay. Hence
the whiteness produced by acid tooth-powders and washes is not less
deceitful than ruinous in its consequences. As has been just observed,
they perform all that their vendors promise, causing the teeth, for a
little while, to become very white and beautiful in their appearance,
but, at the same time, injuring them irremediably: the enamel becomes
gradually decomposed, the bone of the tooth exposed, and its death is
the inevitable consequence.

It is therefore of great importance when acid medicines are ordered
for children that they should be taken through a glass tube, to prevent
their coming in contact with the teeth. From a want of this precaution,
I know a lady (and there are many such instances) who once had as sound
and fine a set of teeth as any one could boast of, but from this cause
has had nearly the whole of the upper row destroyed. She was in
delicate health: it was judged requisite that she should take for a
considerable time (with other medicines) sulphuric acid; but the glass
tube was not thought of, and the consequences followed which have been
described.


CALOMEL.--This medicine, as it is frequently given, alone, or in the
little white powders, in infancy and childhood, by mothers and nurses,
is productive of serious and indeed irremediable injury to the teeth.
"The immoderate use of mercury in early infancy produces, more perhaps
than any other similar cause, that universal tendency to decay, which,
in many instances, destroys almost every tooth at an early age. It is
certainly not unimportant to bear this fact in mind, in the
administration of this sovereign remedy, this panacea, as many appear
to consider it, in infantile diseases."[FN#26]



[FN#26]  Bell on the Teeth.



HEAT AND COLD.--The teeth are exceedingly apt to suffer from sudden
variations of temperature. Fluids, therefore, should never be taken
into the mouth so hot or so cold as to produce the slightest pain; and,
for the same reason, the water with which the mouth is cleansed should
in winter be always warm or tepid. When ices are taken, the precaution
of placing them in the centre of the mouth, so as to prevent contact
with the teeth, should be carefully observed.

There are many other causes which might be mentioned as tending to
induce decay of the teeth, but their consideration here is purposely
avoided.

It is hoped that enough has been said to draw the parent's attention
to the subject of the teeth, to prevent their neglect, and yet at the
same time to induce a cautious management.



CHAP. IV.


HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER.



Life is soon extinguished in infancy. At this epoch any disease is
formidable, and must be met most promptly. It is either sudden and
active in its assaults, or comes with slow and insidious approach. The
first signs of its coming on are not always visible to an unpractised
eye: it may have made dangerous advances before the mother's mind is
awakened to its presence; and medical aid may be solicited when
remedies and advice are no longer of any avail.

It is therefore highly important that a mother should possess such
information as will enable her to detect disease at its first
appearance, and thus insure for her child timely medical assistance.
This knowledge it will not be difficult for her to obtain. She has only
to bear in mind what are the indications which constitute health, and
she will at once see that all deviations from it must denote the
presence of disorder, if not of actual disease. With these changes she
must to a certain extent make herself acquainted.



Sect. I.--SIGNS OF HEALTH.



The signs of health are to be found, first, in the healthy performance
of the various functions of the body; the regular demands made for its
supply, neither in excess or deficiency; and a similar regularity in
its excretions both in quantity and appearance.

If the figure of the healthy infant is observed, something may be
learnt from this. There will be perceived such an universal roundness
in all parts of the child's body, that there is no such thing as an
angle to be found in the whole figure; whether the limbs are bent or
straight, every line forms a portion of a circle. The limbs will feel
firm and solid, and unless they are bent, the joints cannot be
discovered.

The tongue, even in health, is always white, but it will be free from
sores,--the skin cool,--the eye bright,--the complexion clear,--the head
cool,--and the abdomen not projecting too far,--the breathing regular,
and without effort.

When awake, the infant will be cheerful and sprightly, and, loving to
be played with, will often break out into its merry, happy, laugh;
whilst, on the other hand, when asleep, it will appear calm, every
feature composed, its countenance displaying an expression of
happiness, and frequently, perhaps, lit up with a smile.



Sect. II. SIGNS OF DISEASE.



Just in proportion as the above appearances are present and entire,
health may be said to exist; and just in proportion to their partial or
total absence disease will have usurped its place.

We will, however, for the sake of clearness examine the signs of
disease as they are manifested separately by the countenance,--the
gestures,--in sleep,--in the stools,--and by the breathing and cough.



OF THE COUNTENANCE.



In health the countenance of a thild is expressive of serenity in mind
and body; but if the child be unwell, this expression will be changed,
and in a manner which, to a certain extent, will indicate what part of
the system is at fault.

The brows will be contracted, if there is pain, and its seat is in the
head. This is frequently the very first outward sign of any thing being
wrong, and will occur at the very onset of disease; if therefore
remarked at an early period, and proper remedies used, its notice may
prevent one of the most fearful of infantile complaints--"Water in the
Head."

If this sign is passed by unheeded, and the above disease be
threatened, soon the eyes will become fixed and staring,--the head hot,
and moved uneasily from side to side upon the pillow, or lie heavily
upon the nurse's arm,--the child will start in its sleep, grinding its
teeth, and awake alarmed and screaming,--its face will be flushed,
particularly the cheeks (as if rouged),--its hands hot,--but feet cold,
its bowels obstinately costive, or its motions scanty, dark-,
and foul.

If the lips are drawn apart, so as to show the teeth or gums, the seat
of the pain is in the belly. This sign, however, will only be present
during the actual existence of suffering; if, therefore, there be any
doubt whether it exist, press upon the stomach, and watch the eifect on
the expression of the countenance.

If the pain arise simply from irritation of the bowels excited from
indigestion, it will be temporary, and the sign will go and come just
as the spasm may occur, and slight remedial measures will give relief.

If, however, the disease be more serious, and inflammation ensue, this
sign will be more constantly present, and soon the countenance will
become pale, or sallow and sunken,--the child will dread motion, and
lie upon its back with the knees bent up to the belly,--the tongue will
be loaded,--and in breathing, while the chest will be seen to heave
with more than usual effort, the muscles of the belly will remain
perfectly quiescent.

If the nostrils are drawn upwards and in quick motion, pain exists in
the chest. This sign, however, will generally be the accompaniment of
inflammation of the chest, in which case the countenance will be
discoloured,--the eyes more or less staring, and the breathing will be
difficult and hurried; and if the child's mode of respiring be watched,
the chest will be observed to be unmoved, while the belly quickly
heaves with every inspiration.

Convulsions are generally preceded by some changes in the countenance.
The upper lip will be drawn up, and is occasionally bluish or livid.
Then there may be slight squinting, or a singular rotation of the eye
upon its own axis; alternate flushing or paleness of the face; and
sudden animation followed by languor.

These signs will sometimes manifest themselves many hours, nay days,
before the attack occurs; may be looked upon as premonitory; and if
timely noticed, and suitable medical aid resorted to, the occurrence of
a fit may be altogether prevented.

The state of the eyes should always be attended to. In health they are
clear and bright, but in disease they become dull, and give a heavy
appearance to the countenance; though after long continued irritation
they will assume a degree of quickness which is very remarkable, and a
sort of pearly brightness which is better known from observation than
it can be from description.

The direction of the eyes, too, should be regarded, for from this we
may learn something. When the infant is first brought to the light,
both eyes are scarcely ever directed to the same object: this occurs
without any tendency to disease, and merely proves, that regarding one
object with both eyes is only an acquired habit. But when the child has
come to that age when the eyes are by habit directed to the same
object, and afterwards it loses that power, this circumstance alone may
be looked upon as a frequent prelude to disease affecting the head.



OF THE GESTURES.



The gestures of a healthy child are all easy and natural; but in
sickness those deviations occur, which alone will often denote the
nature of the disease.

Suppose an infant to have acquired the power to support itself, to
hold its head erect; let sickness come, its head will droop
immediately, and this power will be lost, only to be regained with the
return of health; and during the interval every posture and movement
will be that of languor.

The little one that has just taught itself to run alone from chair to
chair, having two or three teeth pressing upon and irritating the gums,
will for a time be completely taken off its feet, and perhaps lie
languidly in its cot, or on its nurse's arm.

The legs being drawn up to the belly, and accompanied by crying, are
proofs of disorder and pain in the bowels. Press upon this part, and
your pressure will increase the pain. Look to the secretions from the
bowels themselves, and by their unhealthy character your suspicions, in
reference to the seat of the disorder, are at once confirmed.

The hands of a child in health are rarely carried above its mouth; but
let there be any thing wrong about the head and pain present, and the
little one's hands will be constantly raised to the head and face.

Sudden starting when awake, as also during sleep, though it occur from
trifling causes, should never be disregarded. It is frequently
connected with approaching disorder of the brain. It may forebode a
convulsive fit, and such suspicion is confirmed, if you find the thumb
of the child drawn in and firmly pressed upon the palm, with the
fingers so compressed upon it, that the hand cannot be forced open
without difficulty. The same condition will exist in the toes, but not
to so great a degree; there may also be a puffy state of the back of the
hands and feet, and both foot and wrist bent downwards.

There are other and milder signs threatening convulsions and connected
with gesture, which should be regarded:--the head being drawn rigidly
backwards,--an arm fixed firmly to the side, or near to it,--as also one
of the legs drawn stifly upwards. These signs, as also those enumerated
above, are confirmed beyond all doubt, if there be present certain
alterations in the usual habits of the child:--if the sleep is
disturbed,--if there be frequent fits of crying,--great peevishness of
temper,--the countenance alternately flushed and pale,--sudden animation
followed by as sudden a fit of languor,--catchings of the breath
followed by a long and deep inspiration,--all so many premonitory
symptoms of an approaching attack.



OF THE SLEEP.



The sleep of the infant in health is quiet, composed, and refreshing.
In very early infancy, when not at the breast, it is for the most
part asleep in its cot; and although as the months advance it sleeps
less, yet when the hour for repose arrives, the child is no sooner laid
down to rest, than it drops off into a quiet, peaceful slumber.

Not so, if ill. Frequently it will be unwilling to be put into its cot
at all, and the nurse will be obliged to take the infant in her arms;
it will then sleep but for a short time, and in a restless and
disturbed manner.

If it suffer pain, however slight, the countenance will indicate it;
and, as when awake, so now, if there is any thing wrong about the head,
the contraction of the eye-brow and grinding of the teeth will appear;
if any thing wrong about the belly, the lips will be drawn apart,
showing the teeth or gums,--and in both instances there will be great
restlessness and frequent startings.



OF THE STOOLS.



In the new-born infant the motions are dark , very much like
pitch both in consistence and appearance. The first milk, however,
secreted in the mother's breast, acts as an aperient upon the infant's
bowels, and thus in about four-and-twenty hours it is cleansed away; or
if it should not, a tea-spoonful of castor oil accomplishes this
purpose.

From this time, and through the whole of infancy, the stools will be
of a lightish yellow colour, the consistence of thin mustard, having
little smell, smooth in appearance, and therefore free from lumps or
white curded matter, and passed without pain or any considerable
quantity of wind. And as long as the child is in health, it will have
daily two or three, or even four, of these evacuations. But as it grows
older, they will not be quite so frequent; they will become darker in
colour, and more solid, though not so much so as in the adult.

Any deviation, then, from the above characters, is of course a sign of
something wrong; and as a deranged condition of the bowels is
frequently the first indication we have of coming disease, the nurse
should daily be directed to watch the evacuations. Their appearance,
colour, and the manner in which discharged, are the points principally
to be looked to. If the stools have a very curdy appearance, or are too
liquid, or green, or dark-, or smell badly, they are unnatural.
And in reference to the manner in which they are discharged, it should
be borne in mind, that, in a healthy child, the motion is passed with
but little wind, and as if squeezed out, but in disease, it will be
thrown out with considerable force, which is a sign of great
irritation. The number, too, of stools passed within the four-and-
twenty hours it is important to note, so that if the child does not
have its accustomed relief, (and it must not be forgotten that
children, although in perfect health, differ as to the precise number,)
a little castor oil may be at once exhibited, and thus mischief be
prevented.

This, however, is not the place to discuss the question of disordered
bowels, but simply to point out how this circumstance may be
known.[FN#27]



[FN#27]  See section on Disorders of the Stomach and Bowels, p. 208.



OF THE BREATHING AND COUGH.



The breathing of a child in health is formed of equal inspirations and
expirations, and it breathes quietly, regularly, inaudibly, and without
effort. But let inflammation of the air-tubes or lungs take place, and
the inspiration will become in a few hours so quickened and hurried,
and perhaps audible, that the attention has only to be directed to the
circumstance to be at once perceived.

Now all changes which occur in the breathing from its healthy
standard, however slight the shades of difference may be, it is most
important should be noticed early. For many of the complaints in the
chest, although very formidable in their character, if only seen early
by the medical man, may be arrested in their progress; but otherwise,
may be beyond the control of art. A parent, therefore, should make
herself familiar with the breathing of her child in health, and she
will readily mark any change which may arise.

Of cough I should not have said any thing in this chapter, as it can
never fail to be noticed, except that it is highly necessary to throw
out one caution. Whenever a child has the symptoms of a common cold,
attended by hoarseness and a rough cough, always look upon it with
suspicion, and never neglect seeking a medical opinion. Hoarseness does
not usually attend a common cold in the child, and these symptoms may
be premonitory of an attack of "croup;" a disease excessively rapid in
its progress, and which, from the importance of the parts affected,
carrying on, as they do, a function indispensably necessary to life,
requires the most prompt and decided treatment.

The following observations of Dr. Cheyne are so strikingly
illustrative, and so pertinent to my present purpose, that I cannot
refrain inserting them:--"In the approach of an attack of croup, which
almost always takes place in the evening, probably of a day during
which the child has been exposed to the weather, and often after
catarrhal symptoms have existed for several days, he may be observed to
be excited, in variable spirits, more ready than usual to laugh than to
cry, a little flushed, occasionally coughing, the sound of the cough
being rough, like that which attends the catarrhal stage of the
measles. More generally, however, the patient has been for some time in
bed and asleep, before the nature of the disease with which he is
threatened is apparent; then, perhaps, without waking, he gives a very
unusual cough, well known to any one who has witnessed an attack of the
croup; it rings as if the child had coughed through a brazen trumpet;
it is truly a tussis clangosa; it penetrates the walls and floor of the
apartment, and startles the experienced mother,--'Oh! I am afraid our
child is taking the croup!' She runs to the nursery, finds her child
sleeping softly, and hopes she may be mistaken. But remaining to tend
him, before long the ringing cough, a single cough, is repeated again
and again; the patient is roused, and then a new symptom is remarked;
the sound of his voice is changed; puling, and as if the throat were
swelled, it corresponds with the cough," etc.

How important that a mother should be acquainted with the above signs
of one of the most terrific complaints to which childhood is subject;
for, if she only send for medical assistance during its first stage,
the treatment will be almost invariably successful; whereas, if this
"golden opportunity" is lost, this disease will seldom yield to the
influence of measures, however wisely chosen or perseveringly employed.



SECT. III.--OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION
OF DISEASE.



1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF
DISORDER.--The recollection of the fact, that at the different seasons
of
the year some diseases are more prevalent than at other periods, will
greatly aid a judicious parent in the early detection of the presence
of disorder, and its kind, in her child.

Thus, in the early part of the winter, what is called catarrh, viz. an
increased secretion of mucus from the membranes of the nose, fauces,
and air-tubes, with fever, and attended with sneezing and cough,
thirst, lassitude, and want of appetite, is generally prevalent.

As the winter advances, the air-tubes of the lungs, and the lungs
themselves, are liable to become the seat of disorder; and those signs
will present themselves, which have been pointed out in the previous
section as characteristic of such attacks.

In the spring, we have still the same diseases prevalent, and in
addition, measles, scarlet fever, small-pox, and chicken pox, which
increase in liability towards the close of this season, and with the
first weeks of summer.

In the summer, disease is less prevalent than at any other period of
the year; but towards its middle and close, and through the whole of
the autumnal months, bowel complaints may be expected, in the forms of
diarrhoea, cholera, and dysentery.


2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.--
Without entering into this subject at large, still it may be useful to
remark, that in some families there is a predisposition to some
diseases, which, occurring in the first child, will, as each succeeding
child is born, attack at the same age. Amongst other diseases of this
class are, croup, hooping-cough, and water in the head.

This observation should not only lead a mother to be alive to the
possibility of the successional occurrence of these diseases in her
family, and so early note their appearance, and seek medical advice,
but should at the same time make her most anxious, on the one hand, to
shield her child from all their exciting causes, and on the other, to
adopt those measures which may contribute indirectly to overcome the
constitutional predisposition to them.


Of the scrofulous constitution, I will merely mention here, that it is
of the greatest importance, where a predisposition to this disease
exists in a family, that a mother should immediately attend to any
alteration in the gait or contour of her child, and give prompt
attention also to any complaint made of swelling about a joint,
although it may be unattended with pain. The importance of this remark
will be seen by contrasting the result of the following cases which
occurred in children of the same family.



Case I.


A. B., a female child, having blue eyes, light hair, and a fair
complexion, in the early part of the year 1838, being then two years of
age, had an enlargement of the left knee joint. For some weeks previous
to this time, there had been a degree of heat about the part; but as no
pain apparently existed, it was not regarded as of any consequence, and
nothing was done. The child, living in the neighbourhood of London, was
afterwards placed under medical treatment. Two or three months having
elapsed, it was brought to town, and shown to me, in consequence of a
slight tumefaction over the lower part of the spine. This soon
disappeared under the measures employed, and eventually the disease of
the knee (evidently scrofulous) was arrested, so that now the case
promises to be cured; but the joint will for ever be stiff, and the
limb thus affected shorter than the other.



Case II.


G. B., the brother of the above, a handsome boy, with light hair, fine
blue eyes,--indeed, very much like his little sister,--in the year
1836, had enlargements of the glands in his neck, which were relieved
by the treatment resorted to.

In April, 1839, being then eight years old, he was observed by his
mother to limp slightly in walking, but complained of little or no
pain. From the caution, however, which had been given to the parent at
the time I was consulted about the previous case, to notice at an early
period any symptom of this nature in her children, the fact was
immediately attended to. The affection was evidently in the hip; there
was imperfection in the gait, and pain upon pressing over the joint. A
blister was applied, perfect rest to the limb enjoined, and steel
medicines ordered; and in a fortnight the motions of the joint were
restrained more effectually by the application of strips of soap
plaster and a bandage. In three months the child was ordered to the sea-
side, and eventually was able to walk without the slightest limp or
pain, and may be said to be quite well.

I would not say that in the first case, if the disease had been
discovered early, and at that time met by judicious medical treatment,
a stiff knee and shortened limb would have been prevented, although
this is my belief; but in reference to the latter case, I have no
hesitation in saying, that without the disease had been early detected
by the mother, and as promptly attended to by her, the remedial
measures might have failed,--certainly the result would not have been
so highly satisfactory as it was.



Chap. V.


ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.



The especial province of the mother is the prevention of disease, not
its cure. To the establishment and carrying out of this principle,
every word contained in the preceding pages has directly or indirectly
tended.

This, however, is not all. When disease attacks the child, the mother
has then a part to perform, which it is especially important during the
epochs of infancy and childhood should be done well. I refer to those
duties which constitute the maternal part of the management of disease.

Medical treatment, for its successful issue, is greatly dependent upon
a careful, pains-taking, and judicious maternal superintendence. No
medical treatment can avail at any time, if directions be only
partially carried out, or be negligently attended to; and will most
assuredly fail altogether, if counteracted by the erroneous prejudices
of ignorant attendants. But to the affections of infancy and childhood,
this remark applies with great force; since, at this period, disease is
generally so sudden in its assaults, and rapid in its progress, that
unless the measures prescribed are rigidly and promptly administered,
their exhibition is soon rendered altogether fruitless.

The amount of suffering, too, may be greatly lessened by the
thoughtful and discerning attentions of the mother. The wants and
necessities of the young child must be anticipated; the fretfulness
produced by disease, soothed by kind and affectionate persuasion; and
the possibility of the sick and sensitive child being exposed to harsh
and ungentle conduct, carefully provided against.

Again, not only is a firm and strict compliance with medical
directions in the administration of remedies, of regimen, and general
measures, necessary, but an unbiased, faithful, and full report of
symptoms to the physician, when he visits his little patient, is of
the first importance. An ignorant servant or nurse, unless great
caution be exercised by the medical attendant, may, by an unintentional
but erroneous report of symptoms, produce a very wrong impression upon
his mind, as to the actual state of the disease. His judgment may, as a
consequence, be biased in a wrong direction, and the result prove
seriously injurious to the welldoing of the patient. The medical man
cannot sit hour after hour watching symptoms; hence the great
importance of their being faithfully reported. This can alone be done
by the mother, or some person equally competent.

There are other weighty considerations which might be adduced here,
proving how much depends upon efficient maternal management in the time
of sickness; but they will be severally dwelt upon, when the diseases
with which they are more particularly connected are spoken of.



Sect. 1.--ACCIDENTS AND DISEASES WHICH MAY OCCUR TO THE INFANT AT
BIRTH, OR SOON AFTER.


STILL-BORN.



Sometimes the child comes into the world apparently dead, and, unless
the most active exertions are made by the attendants, is lost. The
superintendence of the means used devolves upon the medical man; but it
would be often well if his assistants were already acquainted with the
measures pursued under these circumstances, for they would be more
likely to be carried into effect with promptitude and success, than
they now frequently are. And again, the still-born child is frequently
in this state from having been born very rapidly, and before the
medical man can have arrived, it will be more especially useful in
such a case, that the attendants in the lying-in-room should know how
to proceed.

The various causes producing this condition it is unnecessary to
mention.

The condition itself may exist in a greater or less degree: the infant
may be completely stillborn, with no indication of life, except,
perhaps, the pulsation of the cord, or a feeble action of the heart;--or
it may make ineffectual efforts at breathing, or even cry faintly, and
yet subsequently perish for want of strength to establish perfectly the
process of respiration. Under all these circumstances, a good deal can
often be effected by art. In every instance, therefore, in which we
have not positive evidence of the child being dead, in the existence of
putrefaction, or of such malformation as is incompatible with life, it
is our duty to give a fair trial to the means for restoring suspended
animation; and as long as the slightest attempt at motion of the
respiratory organs is evinced, or the least pulsation of the heart
continues, we have good grounds for persevering and hoping for ultimate
success.

The measures to be employed to restore a still-born child will be a
little modified by the circumstances present.


IF THERE IS NO PULSATION--NO BEATING IN THE CORD, when the child comes
into the world, it may at once be separated from the mother. This is
to be effected by first tying the navel-string with common sewing
thread (three or four times doubled), about two inches from the body of
the child, and again two inches from the former ligature, and then
dividing the cord with a pair of scissors between the two. And now the
means for its restoration are to be made use of, which are detailed
below, viz. inflation of the lungs, and perhaps the warm bath. If, with
the above circumstances, the child's face be livid and swollen, some
drops of blood should previously be allowed to escape before the
ligature is applied to that part of the navel-string which is now only
attached to the child.


IF THERE IS PULSATION IN THE CORD, BUT RESPIRATION IS NOT FULLY
ESTABLISHED, it must not be divided; and as long as pulsation
continues, and the child does not breathe perfectly and regularly, no
ligature should be applied. The first thing to be done here, is to pass
the finger, covered with the fold of a handkerchief or soft napkin, to
the back of the child's mouth, to remove any mucus which might obstruct
the passage of air into the lungs, and at the same time to tickle
those parts, and thereby excite respiratory movements. The chest
should then be rubbed by the hand, and a gentle shock given to the body
by slapping the back. If these means fail, the chest and soles of the
feet must next be rubbed with spirits, the nostrils and back of the
throat irritated with a feather previously dipped in spirits of wine,
and ammonia or hartshorn may be held to the nose.


INFLATION OF THE LUNGS.--These means not having been successful, and
the pulsation in the cord having ceased, the infant must be separated,
and inflation of the lungs resorted to. This is to be effected gently
and cautiously as follows:--

The child, wrapped in flannel, is to be laid on its back upon a table
placed near the fire. Its head is to be slightly extended, and the
nostrils held between the fingers and thumb of one hand, whilst with
the fingers of the other slight pressure is to be made upon the pit of
the stomach, so as to prevent the air from passing into that organ. The
lungs of the child are now to be filled with air, by the operator
applying his own lips--with a fold of silk or muslin intervening, for
the sake of cleanliness--to those of the child, and then simply blowing
in its mouth, he is to propel the air from his own chest into that of
the infant. Previously, however, to his doing this, he should make
several deep and rapid inspirations, and, finally, a full inspiration,
in order to obtain greater purity of air in his own lungs.

When the chest of the child has been thus distended, it is to be
compressed gently with the hand, so as to empty the lungs; and then the
inflation, with the alternately compressing the chest, must be repeated
again and again, until either the commencement of natural respiration
is announced by a sneeze or deep sigh, or until after long-continued,
steady, persevering, but unavailing, efforts to effect this object
shall have removed all ground of hope for a successful issue.

Whilst these efforts are being made, some other individual must
endeavour to maintain or restore the warmth of the infant's body, by
gently but constantly pressing and rubbing its limbs between his warm
hands. And after respiration is established, the face must still be
freely exposed to the air, whilst the warmth of the limbs and body is
carefully sustained.

It will sometimes happen--and to this circumstance the operator should
be fully alive--that when the child begins to manifest symptoms of
returning animation, its tongue will be drawn backwards and upwards
against the roof of the mouth, filling up the passage to the throat,
and preventing further inflation of the lungs. This is to be remedied
by the introduction of the fore-finger to the upper and back part of
the child's tongue, and gently pressing it downwards and forwards, by
which the difficulty will be removed, and the air again passes.


THE WARM BATH.--More reliance may be placed upon the above measure to
restore animation, than upon the warm bath. Still this is sometimes
useful, and therefore must not be neglected. Whilst inflation is going
on, the bath may be got ready, then resorted to, and if unsuccessful,
inflation may and ought again to be followed up.[FN#28] If the bath is
useful at all, it will be so immediately upon putting the infant into
it; respiration will be excited, followed by a cry; and if this does
not occur at once, it would be wrong to keep the child longer in the
bath, as it would be only losing valuable time which ought to be
devoted to other efforts. The temperature of the bath should be about
100 degrees; and if, upon plunging the infant into it, it fortunately
excite the respiratory effort, it should then be taken out, rubbed with
dry but hot flannels, and, when breathing is fully established, laid in
a warm bed, or, what is still better, in its mother's bosom; letting
it, however, have plenty of air.



[FN#28]  We should not relinquish our endeavours at resuscitation
under two or three hours, or even longer; and if ultimately
successful, the state of the infant should be carefully watched for two
or three days.



INJURIES RECEIVED DURING BIRTH.

If a labour be long and tedious, the head and body of the child may be
bruised and disfigured.

The shape of the head is frequently altered by the compression it has
undergone, so that it may be elongated, and measure from the chin to
the back of the head as much as six or seven inches. This always
excites surprise, sometimes apprehension, in the minds of the
attendants: there is no ground for it. It must be allowed to regain its
natural shape without interference.

Tumours or swellings upon the head are very common. They arise from
pressure upon the part during the labour. The only treatment that is
required, or safe, is, freedom from all pressure, and the application
of cold lotions composed of brandy or vinegar and water. The swelling
will gradually subside. It will be right to direct the attention of the
medical man to this circumstance.

The face may be frightfully disfigured from the above cause,
exceedingly black, and the features distorted. Nothing is necessary
here; in a few days the face will recover its proper appearance.



RETENTION OF URINE.



Occasionally an infant will not pass any urine for many hours after
its birth. This most frequently arises from the fact of none being
secreted. In the last case of this kind that I was called to, three
days had elapsed since birth, and no urine had been passed; it proved
that none had been secreted. Sometimes, however, it is the effect of
another cause, which the use of the warm bath will be found to remove,
which should always therefore be employed four and twenty hours after
the birth of the infant, if it has not by that time passed any water.

It now and then happens, but fortunately very rarely, that some
physical obstruction exists. It is always important, therefore, for the
nurse to pay attention to the above point; and it is her duty to direct
the attention of the medical man to the subject, if anything unusual or
unnatural be present. The same observation applies to the bowel also;
and if twelve hours pass without any motion, the parts should be
examined.



SWELLING OF THE BREASTS.



At birth, or two or three days subsequently, the breasts of the infant
will frequently be found swollen, hard, and painful, containing a fluid
much resembling milk. Nurses generally endeavour to squeeze this out,
and thus do great mischief; for by this means inflammation is excited
in the part, and sometimes abscess is the result.

If the breasts are simply slightly enlarged, it is unnecessary to do
any thing more than rub them occasionally and very gently with warm
almond oil, and a little time will restore them to their proper size.

If, however, they are inflamed, hot, painful, with a red surface, and
unusually large, a bread and water poultice must be applied every three
or four hours, which will generally prevent either the formation of
matter, or any other unpleasant consequence. In a few days, under this
treatment, they will usually subside, and be quite well.



INFLAMMATION OF THE EYES.



ITS IMPORTANCE.--About the second or third day after the child's birth,
an inflammation sometimes attacks the eye, which is of considerable
consequence. The more so, from its commencing in a way not calculated
to excite the attention, or alarm the fears, of the mother or nurse.
The child cannot express its sensations, and the swelling of the eye
conceals the progress of the disease, so that serious mischief is
frequently done before the medical man sees the patient. In the first
place, the inflammation is not immediately noticed; and, in the second,
the measures employed are frequently insufficient to check its
progress: hence it causes more blindness (I refer to the lower classes
of society more particularly) than any other inflammatory disorder that
happens to the eye; and the number of children is very considerable,
whose sight is partially or completely destroyed by it. The parent or
nurse is apt to suppose, when this inflammation first appears, that it
is merely a cold in the eye, which will go off; and the consequences
which I have just mentioned take place, in many cases, before they are
aware of the danger, and before the medical man is resorted to for
assistance.

I only desire, in mentioning this complaint, to inform the attendants
of the lying-in-room of its great importance, that it may not be
trifled with, that upon its first approach the physician may be
informed of it, and that the treatment he directs for its cure may be
sedulously and rigidly followed.


SYMPTOMS.--The inflammation commonly comes on about three days after
birth, but it may take place at a later period. It may be known by its
commencing thus:--When the child wakes from sleep, the eyelids will be
observed to stick together a little; their edges will be redder than
natural, and especially at the corners; the child experiences pain from
the access of light, and therefore shuts the eye against it. A little
white matter will also be observed lying on the inside of the lower
lid. After a short time, the lids swell, become red on their external
surface, and a large quantity of matter is secreted, and constantly
poured from the eye; the quantity of discharge increasing until it
becomes very great.

But enough has been said to point out the importance of the disease,
and the signs by which it may be recognised at its first approach.

TREATMENT.--Keeping the eye free from discharge, by the constant
removal of the matter secreted, is what the medical attendant will
chiefly insist upon; and without this is done, any treatment he may
adopt will be useless; with it, there is no doubt of a successful issue
of the case, provided his attention has only been called to it at a
sufficiently early period.



HARE-LIP.



This is a blemish too well known to require a formal description. The
questions most interesting to a mother in relation to it, are,--How is
her child to be nourished, that is born with it? and when ought an
operation to be performed for its removal?


THE MODE OF FEEDING THE INFANT.--If the defect is but trifling, the
infant will be able to suck, provided the mother's nipple is large, and
the milk flows freely from it. If this is not the case, the difficulty
may be obviated by using the cork nipple shield.[FN#29] I have known
this to answer the purpose admirably, when the mother had previously
despaired of nursing her infant, the nipple being too small for it to
grasp.



[FN#29]  See p. 41.



If, however, the defect exists in a still greater degree, feeding by
means of the spoon must be resorted to; the greatest care being
necessary as to the quantity, quality, and preparation of the
food.[FN#30]



[FN#30]  See "Artificial Feeding," p. 34.



CAUTION IN REFERENCE TO THE OPERATION.--With regard to the operation
for the removal of this deformity, I would strongly warn parents
against desiring its too early performance. Various considerations
contribute to make the distressed parents anxious for this. But very
seldom indeed--except the deformity be very great, and implicating other
parts beside the lip--will the operation be required, or ought it to be
resorted to, before the second year and a half of the infant's life;
and for this very cogent reasons exist. For instance, convulsions may
thus be induced, which often terminate fatally.

The most proper age for removing this deformity by operation, is from
that of two years and a half to four years.



BLEEDING FROM THE NAVEL-STRING.



Bleeding from the navel-string will sometime take place hours after it
has been supposed to be carefully secured. This will arise, either from
the cord being carelessly tied, or from its being unusually large at
birth, and in a few hours shrinking so much that the ligature no
longer sufficiently presses on the vessels. In either case, it is of
importance that the attendants in the lying-in-room should understand
how to manage this accident when it occurs, that it may not prove
injurious or fatal to the child.


THE MODE OF ARRESTING THE BLEEDING.--The clothes of the child and the
flannel roller must be taken off;--the whole cord without delay must be
unwrapped, and then a second ligature be applied below the original
one, (viz. nearer to the body of the infant,) taking great care that
it shall not cut through the cord when drawn very tight, but at the
same time drawing it sufficiently tight to compress the vessels.

The ligature should be composed of fine linen threads, three or four
thicknesses, and not of tape or bobbin, or any substance of this
nature, as it cannot be relied on for this purpose.



ULCERATION OR IMPERFECT HEALING OF THE NAVEL.



The cord separates from the navel generally some time between the
fifth and fifteenth day from delivery, and the part usually heals
without giving the slightest trouble.

This, however, is not always the case, for sometimes a thin discharge
will take place, which, if the part be examined, will be found to
proceed from a small growth about the size, perhaps, of a pea, or even
less. This must be removed by applying a little powdered alum,--or, if
this fail, it should be once or twice slightly touched with blue-stone,
and afterwards dressed with calamine cerate.

At other times, though fortunately very rarely, excoriation of the
navel and the parts around takes place, which quickly spreads, and
assumes an angry and threatening character. If, however, the attention
of the medical man is called to it early, it will always do well: until
his directions are given, apply a nicely made bread and water poultice.



BLEEDING FROM THE NAVEL.



Sometimes, a day or two after the cord separates, or at the time of
separation, bleeding takes place from the navel: fortunately, this very
seldom occurs; indeed, it is very rarely met with; and I only mention
it, to observe that, upon its occurrence, the point of the finger
should be placed over the part, and pressure steadily applied until
medical assistance is obtained.

Now and then, in these cases, a growth sprouts up and bleeds. Let this
be touched with lunar caustic, or any other astringent application, or
let pressure be employed, still it will bleed,--not freely or in a
stream, but there will be a constant drain from the part, and the
infant, as a consequence, will waste, and be brought to death's door.
Excise it, it will only make matters worse. The treatment in this case
consists in simply winding a piece of very narrow tape round the
growth, and then leaving it untouched. The bleeding will soon cease;
the fungus will sprout over the upper margin of the tape; in a very
short time it will, as it were, strangle the disease, which
subsequently falling off, a complete cure is accomplished.



JAUNDICE.



It frequently happens, during the first or second week after birth,
that the skin of the child becomes very yellow, and it has all the
appearance of having the jaundice. This gives rise to great distress to
the parent when she perceives it, and she becomes very anxious for the
medical man's next visit.

Now, ordinarily, it is of no consequence; commonly disappearing
spontaneously, and requiring no medical treatment. If, however, it
does not go off in two or three days, a tea-spoonful of castor oil
should be given once, or oftener, if necessary.

It is, of course, possible for an attack of real jaundice to occur at
this early period, and a disease of a very serious nature will then
have to be dealt with; but, except as a consequence of malformation (a
very infrequent occurrence), it is not likely to arise; and therefore
jaundice during the first and second week after delivery need not
create alarm.



Tongue-tied.



FROM WHAT IT ARISES.--This arises from the bridle under the tongue being
so short, or its attachment to the tongue extended so near the tip, as
to interfere with the motions of the organ in sucking, and, in after
years, in speaking. It is a rare occurrence, although nothing is more
common than for medical men to have infants brought to them supposed to
be labouring under the above defect.

HOW ITS EXISTENCE MAY BE DETERMINED.--The best guide for a parent to
determine whether it exist or not, is for her to watch whether the
infant can protrude the tip of the tongue beyond the lips: if so, it
will be able to suck a good nipple readily, and nothing need or ought
to be done. No mother will unnecessarily expose her infant to an
operation, which, unless very carefully performed, is not altogether
unattended with danger; and, if she suspects any defect of this kind to
exist, she has only to observe the circumstance mentioned above, to
satisfy her mind upon the subject.



MOLES AND MARKS ON THE SKIN, ETC.



The supposed influence of the imagination of the mother, in the
production of the above appearances in the texture of the skin of her
infant, has been fully discussed in the author's work "Hints to
Mothers, etc." This part of the subject is, however, foreign to the
present inquiry, which chiefly has reference to the probable effect of
their presence upon the health of the child.

They may be divided into two classes: the brownish mole, and claret-
stain; and small but somewhat elevated tumours, either of a dark blue,
livid colour, or of a bright vermilion hue.


MOLES AND STAINS.--They are of no importance, as far as the health of
the infant is concerned. If situated in the face, however, they
frequently cause great disfigurement, as the claret-stain, which may be
seen sometimes to occupy nearly half the face. But they happily do not
increase in size, remaining stationary through life; and as any
operation that might be proposed for their removal, would only cause an
equal, if not greater, deformity, they ought to be left alone.


 SPOTS OR TUMOURS.--These vary in their number, size, and
situation. The same child is sometimes born with many of them. They may
be as small as a pea, or as large as a crown piece. They are not only
found on the skin, but on the lips, in the mouth, etc. etc.

These, also, sometimes remain stationary in their size, having no
tendency to enlarge, unless, indeed, they are subjected to friction or
pressure. But as they frequently require surgical aid, in which case,
the earlier the application of remedial measures, the less severe in
their kind, and the greater the probability of a speedy and successful
result,--so is it always important for the mother early to obtain a
medical opinion, that the measure of interference or non-interference
may be decided.



Sect. II. DISORDERS OF THE STOMACH AND BOWELS OF THE INFANT.



INDIGESTION, FLATULENCE, VOMITING, GRIPING, AND LOOSENESS.



Disorder of the stomach and bowels is one of the most fruitful sources
of the diseases of infancy. Only prevent their derangement, and, all
things being equal, the infant will be healthy and flourish, and need
not the aid of physic or physicians. Experience daily proves, that a
large proportion of the children who die in infancy are lost from
derangement of these organs, as the primary cause.

There are many causes which may give rise to these affections; many of
them appertain to the mother's system, some to that of the infant. All
are capable, to a great extent, of being prevented or remedied. It is,
therefore, most important that a mother should not be ignorant or
misinformed upon this subject. It is the prevention of these
affections, however, that will be principally dwelt upon in this
chapter; for let the mother ever bear in mind, and act upon the
principle, that the prevention of disease alone belongs to her; the
cure to the physician.

For the sake of clearness and reference, these disorders will be
spoken of as they occur:--

To the infant at the breast.
At the period of weaning.
And to the infant brought up by hand.



1. TO THE INFANT AT THE BREAST.



UNHEALTHY MILK.--The infant's stomach and bowels may become deranged
from the breast-milk becoming unwholesome.

This may arise from the parent getting out of health, a circumstance
which will be so manifest to herself, and to those more immediately
interested in her welfare, that it is only necessary just to allude to
it here. Suffice it to say, that there are many causes of a general
kind to which it may owe its origin; but that the most frequent is
undue lactation, a subject to which reference has already been made,
and the effects both upon mother and child fully dwelt upon.[FN#31] To
cure derangement of the bowels from this cause, a wet-nurse is the
only remedy.



[FN#31]  See page 15.



Anxiety of mind in the mother will cause her milk to be unhealthy in
its character, and deficient in quantity, giving rise to flatulence,
griping, and sometimes even convulsions in the infant.[FN#32] A fit of
passion in the nurse will frequently be followed by a fit of bowel
complain in the child.[FN#33] These causes of course are temporary, and
when removed the milk becomes a healthy and sufficient for the child as
before.



[FN#32]  See page 25.

[FN#33]  See page 33.



Sudden and great mental disturbance, however, will occasionally drive
away the milk altogether, and in a few hours. A Mrs. S., aet. 21, a
fine healthy woman, of a blonde complexion, was confined of a boy in
October, 1836. She had a good time, and a plentiful supply of milk for
the child, which she continued to suckle till the following January, a
period of three months, when her milk suddenly disappeared. This
circumstance puzzled the medical attendant, for he could not trace it
to any physical ailment; but the milk never returned, and a wet-nurse
became necessary. In the following spring the husband of this lady
failed, an adversity which had been impending since the date when the
breast-milk disappeared, upon which day the deranged state of the
husband's affairs was made known to the wife,--a fact which at once
explained the mysterious disappearance of the milk.

Unwholesome articles of diet will affect the mother's milk, and
derange the infant's bowels. On the 25th May, 1836, I was called to see
an infant at the breast with diarrhoea. The remedial measures had but
little effect so long as the infant was allowed the breast-milk; but
this being discontinued, and arrow-root made with water only allowed,
the complaint was quickly put a stop to. Believing that the mother's
milk was impaired from some accidental cause which might now be passed,
the infant was again allowed the breast. In less than four-and-twenty
hours, however, the diarrhoea returned. The mother being a very healthy
woman, it was suspected that some unwholesome article in her diet might
be the cause. The regimen was accordingly carefully inquired into, when
it appeared that porter from a neighbouring publican's had been
substituted for their own for some little time past. This proved to be
bad, throwing down, when left to stand a few hours, a considerable
sediment; it was discontinued; good sound ale taken instead; the
infant again put to the breast, upon the milk of which it flourished,
and never had another attack.

In the same way aperient medicine, taken by the mother, will act on
the child's bowels, through the effect which it produces upon her milk.
This, however, is not the case with all kinds of purgative medicine,
nor does the same purgative produce a like effect upon all children. It
is well, therefore, for a parent to notice what aperient acts thus
through her system upon that of her child, and what does not, and when
an aperient becomes necessary for herself, unless she desire that the
infant's bowels be moved, to avoid the latter; if otherwise, she may
take the former with good effect.

Again; the return of the monthly periods whilst the mother is a nurse
always affects the properties of the milk, more or less, deranging the
stomach and bowels of the infant. It will thus frequently happen, that
a few days before the mother is going to be unwell, the infant will
become fretful and uneasy; its stomach will throw up the milk, and its
motions will be frequent, watery, and greenish. And then, when the
period is fully over, the milk will cease to purge. It is principally
in the early months, however, that the infant seems to be affected by
this circumstance; for it will be generally found that although the
milk is certainly impaired by it, being less abundant and nutritious,
still, after the third or fourth month it ceases to affect the infant.
Is then a mother, because her monthly periods return after her
delivery, to give up nursing? Certainly not, unless the infant's health
is seriously affected by it; for she will generally find that, as the
periods come round, by keeping the infant pretty much from the breast,
during its continuance, and feeding him upon artificial food, she will
prevent disorder of the child's health, and be able in the intervals to
nurse her infant with advantage. It must be added, however, that a wet-
nurse is to be resorted to rather than any risk incurred of injuring
the child's health; and that, in every case, partial feeding will be
necessary at a much earlier period than when a mother is not thus
affected.

The milk may also be rendered less nutritive, and diminished in
quantity, by the mother again becoming pregnant. In this case,
however, the parent's health will chiefly suffer, if she persevere in
nursing; this, however, will again act prejudicially to the child. It
will be wise, therefore, if pregnancy should occur, and the milk
disagree with the infant, to resign the duties of a nurse, and to put
the child upon a suitable artificial diet;--if, however, pregnancy
should take place before the infant is six month's old, a wet-nurse
ought to be procured.


FROM IRREGULAR NURSING.--This is one of the most frequent sources of
derangement of the stomach and bowels of the child. The infant that is
constantly at the breast will always be suffering, more or less, from
flatulence, griping, looseness of the bowels, and vomiting. This is
caused by a sufficient interval not being allowed between the meals for
digestion. The milk, therefore, passes on from the stomach into the
bowels undigested, and the effects just alluded to follow. Time must
not only be given for the proper digestion of the milk, but the stomach
itself must be allowed a season of repose. This evil, then, must be
avoided most carefully by the mother strictly adhering to those rules
for nursing which have been already laid down.[FN#34]



[FN#34]  See page 5.



FROM TEETHING.--The bowels of the infant at the breast, as well as
after it is weaned, are generally affected by teething. And it is
fortunate that this is the case, for it prevents more serious
affections. Indeed, the diarrhoea that occurs during dentition, except
it be violent, must not be subdued; if, however, this is the case,
attention must be paid to it. It will generally be found to be
accompanied by a swollen gum; the freely lancing of which will
sometimes alone put a stop to the looseness: further medical aid may,
however, be necessary.

FROM COLD AND DAMP, ETC.--Of course there are other causes besides
these already alluded to, giving rise to bowel complaints, during this
epoch,--causes not cognisable by the mother, however, and not mentioned
therefore here. It is right, however, that she should be aware that
these affections are sometimes the result simply of impressions of cold
or damp, particularly at certain seasons of the year; in the autumn,
for instance, when, as is well known, bowel complaints are very
frequent. When thus produced, it is important early to seek medical
aid, as inflammation is generally the result.



2. AT THE PERIOD OF WEANING.



There is great susceptibility to derangements of the stomach and
bowels of the child at the period when weaning ordinarily takes place,
so that great care and judgment must be exercised in effecting this
object. Usually, however, the bowels are deranged during this process
from one of these causes; from weaning too early, from effecting it too
suddenly and abruptly, or from over-feeding and the use of improper and
unsuitable food. There is another cause which also may give rise to
diarrhoea at this time, independently of weaning, viz. the irritation
of difficult teething.


WEANING TOO EARLY.--The substitution of artificial food for the breast-
milk of the mother, at a period when the digestive organs of the infant
are too delicate for this change, is a frequent source of the
affections now under consideration.

The attempt to wean a delicate child, for instance, when only six
months old, will inevitably be followed by disorder of the stomach and
bowels. Unless, therefore, a mother is obliged to resort to this
measure, from becoming pregnant, or any other unavoidable cause, if she
consult the welfare of her child, she will not give up nursing at this
early period. But if she should be no longer competent to suckle, and
her infant be delicate, a wet-nurse must be obtained; for, the infant's
bowels becoming disordered, medicine or remedies will avail little
without healthy breast milk.

The age at which weaning ought to take place must ever depend upon
circumstances; the ninth month would not be too early for some, the
twelfth would be for others.[FN#35]



[FN#35]  See page 51.



FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once
of the breast, and substituting artificial food, however proper under
due regulations such food may be, will invariably cause bowel
complaints. Certain rules and regulations must be adopted to effect
weaning safely, the details of which are given elsewhere.[FN#36]



[FN#36]  See page 52.



OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These
causes are more productive of disorder of the stomach and bowels at the
time of weaning than any yet referred to.

If too large a quantity of food is given at each meal, or the meals
are too frequently repeated, in both instances the stomach will become
oppressed, wearied, and deranged; part of the food, perhaps, thrown up
by vomiting, whilst the remainder, not having undergone the digestive
process, will pass on into the bowels, irritate its delicate lining
membrane, and produce flatulence, with griping, purging, and perhaps
convulsions.

Then, again, improper and unsuitable food will be followed by
precisely the same effects; and unless a judicious alteration be
quickly made, remedies will not only have no influence over the
disease, but the cause being continued, the disease will become most
seriously aggravated.

It is, therefore, of the first importance to the well-doing of the
child, that at this period, when the mother is about to substitute an
artificial food for that of her own breast, she should first ascertain
what kind of food suits the child best, and then the precise quantity
which nature demands. Many cases might be cited, where children have
never had a prescription written for them, simply because, these points
having been attended to, their diet has been managed with judgment and
care; whilst, on the other hand, others might be referred to, whose
life has been hazarded, and all but lost, simply from injudicious
dietetic management. Over-feeding, and improper articles of food, are
more frequently productive, in their result, of anxious hours and
distressing scenes to the parent, and of danger and loss of life to the
child, than almost any other causes.


TEETHING.--The irritation caused by difficult teething may give rise to
diarrhoea at the period when the infant is weaned, independently
of the weaning itself. Such disorder of the bowels, if it manifestly
occur from this cause, is a favourable circumstance, and should not be
interfered with, unless indeed the attack be severe and aggravated,
when medical aid becomes necessary. Slight diarrhoea then, during
weaning, when it is fairly traceable to the cutting of a tooth (the
heated and inflamed state of the gum will at once point to this as the
source of the derangement), is of no consequence, but it must not be
mistaken for disorder arising from other causes. Lancing the gum will
at once, then, remove the cause, and generally cure the bowel complaint.



3. TO THE CHILD BROUGHT UP BY HAND.



Children brought up on an artificial diet are very liable to
indigestion and bowel complaints; indeed none more so: and it is from
these affections that so many of these infants perish. When, then, it
is absolutely necessary from untoward circumstances to have recourse to
this mode of nourishing the child, the rules and regulations laid down
in the section on "Artificial Feeding" must be most strictly followed
out, if the parent would hope to avoid disease and rear her
child.[FN#37] And if these affections should at any time unfortunately
manifest themselves, the mother ought carefully and diligently to
examine whether the plan of feeding pursued is in every particular
correct, particularly bearing in mind that the two causes most
frequently productive of disorder in the child are overfeeding and the
exhibition of unsuitable food--the two grand errors of the nursery.
These results, however, have already been sufficiently dwelt upon as
likely to take place at weaning, and they may of course occur to a
child who is brought up on an artificial diet at any period.



[FN#37]  See page 34.



MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.



As must have been already seen, the maternal treatment chiefly
consists in the removal of the cause of the disorder; medicine may
occasionally be exhibited by the mother, but its use in her hands must
be very limited indeed.

Unfortunately the general resource and only remedy of most mothers in
affections of the stomach and bowels is an aperient, and a combination
containing calomel is the one too frequently selected. The primary
cause of the disorder is undetected, and consequently no measures taken
for its removal, but purgative powder after purgative powder is given,
the evil being supposed to rest in the bowels alone, and that such
means must eventually get rid of it. The mother is not aware all this
time that the real source of the derangement is probably in the diet
itself; that there is some error here, and that unless this is
corrected, the remedies must be worse than useless. The consequence of
such a plan of proceeding is usually very sad; a confirmed and
obstinate diarrhoea but too commonly ensues, and the infant is
sometimes reduced to the last extremity.

The removal of the cause of the disorder, then, in a large number of
instances of derangement of the stomach and bowels, if effected early,
will cure the disease, and without further remedy. But it will be
asked, by what method is this cause to be detected? In this way. In all
human probability the primary cause of the disorder is connected with
the diet; this is the case in ninety-nine instances out of a hundred.
Well, then, is the sick child at the breast? If so, ascertain whether
the breast-milk is healthy and wholesome, or whether any circumstances
exist which have rendered it otherwise? If nothing faulty is found
here, the next question would naturally be, whether the rules and
regulations laid down for suckling have been strictly adhered to? Or,
whether the infant is sufficiently old to render it at all probable
that a tooth may be irritating the gum?

Perhaps the child is being weaned; well, is there any error here? Is
the change being attempted too early? or too suddenly and abruptly? If
this is not the case, then, has the child been overfed, or is the food
given of the proper description?

Is the child being brought up by hand? Then, there is every reason to
suspect, either that the quality of the food given is not the most
suitable, or, that the quantity exhibited is too great; in fact, that
the rules laid down for "artificial feeding" have not been strictly
acted upon.

By a mode of investigation like this, any defect or error in the
dietetic management of the infant producing the disorder will be easily
detected by a careful mother; and its correction alone will, in very
many instances, be all that is necessary to remove the symptoms.

For example, if flatulence and griping, followed by diarrhoea, occur
to an infant at the breast; if at the same time it becomes pale, its
flesh flabby, its disposition fretful, always crying until it is put to
the breast, the nipple of which it grasps eagerly, sucking eagerly, yet
never satisfied, for its hunger continues, it is not nourished; if,
too, the more it sucks, the more the stomach and bowels are deranged,
the more it vomits and is purged; depend upon it the cause of all the
evil will be found to be unwholesome milk. No medicine will avail any
thing here; the cause must be removed; the best medicine, and the only
remedy, is a breast of healthy milk. And if this is not procured
early, there will be great danger of a diarrhoea setting in, which may
probably prove fatal to the child.

Again; if there is simply vomiting of the breast-milk almost
immediately after the child has been suckled, the milk coming up pure
and unchanged, and discharged without any apparent effort, and the
moment after the child is cheerful and happy, this will be found to
depend upon repletion, and not upon unwholesome milk; in fact, the
stomach has received too much. This must be prevented in future, not by
giving medicine, but simply by removing the infant from the nipple
immediately it ceases to draw strongly, the moment it begins to dally
with the breast.

Again; if flatulence and griping occur to the child brought up by
handy this derangement will generally be found to result from
overfeeding: abstinence and diminution of the quantity of the food will
generally be all that is necessary here. It will be well, however, for
the mother in this case, and she may do it with the utmost safety, to
unload the bowels of their indigestible contents by the exhibition of a
tea-spoonful of castor oil. A dose or two of this medicine will
effectually clear them out, without increasing the irritation, or
weakening the child, whilst it will in most instances altogether remove
the symptoms. If the flatulence, however, should continue, four or five
grains of magnesia may be mixed with the last meal at night, and a
little warm water thrown up into the bowel as an injection the next
morning.

Diarrhoea occurring in a child brought up by hand, if it be not the
result of overfeeding, will very frequently be found to arise from
unsuitable diet, the food given not being of a kind suited to the
infant's stomach; for what will agree with one child often disagrees
with another. Alteration of diet will sometimes alone suffice in these
cases to cure, if this alteration is only made early enough, before any
considerable irritation of the stomach and bowels has been induced.
Thin arrow-root made with water (prepared very carefully, or the child
will refuse it,) should be given for five or six days; the warm bath
used every night for the same period, a new flannel bandage rolled
round the body, and the child cautiously protected from a damp
atmosphere. The arrow-root, upon the cessation of the diarrhoea, may
have cows' milk added to it, if milk is not found to disagree: when
this is the case, chicken or weak mutton broth, free from fat, or beef-
tea, thickened with farinaceous food, with a little salt added, are the
best substitutes. Should not the diarrhoea yield to the foregoing
measures, and that readily, medical aid ought to be sought. Diarrhoea
is very frequent from the time of weaning to the third year of age, and
certainly in its effects forms so important a disease, that, unless in
the slight form noticed above, a mother is not justified in attempting
its relief.

In conclusion, I would observe, that I do not think a mother justified
in attempting more than what has been laid down here for her guidance.
It is believed that the few and plain common-sense directions given, if
followed, will do much to prevent disease, and even to relieve it in
its milder forms; they will not, however, cure disease itself when
really established: and again I would repeat, let the mother recollect
that to prevent disease is her province--to cure it, is the physician's.



Sect. III.--COSTIVENESS.



1. IN INFANCY.



The principle to act upon in the management of the infant's bowels is
this,--that they should be kept free, and by the mildest and least
irritating means.

If therefore they become accidentally confined (less than two stools
in the four-and-twenty hours), and the infant is suckled, the mother
may ascertain whether an aperient taken by herself will render her milk
of a sufficiently purgative quality to act upon the bowels of her
child. This is the mildest mode of all.

If, however, this does not answer, or is not practicable from the
child being fed artificially, then the mildest aperient medicines must
be chosen to accomplish this purpose. The kind of medicine to be
selected, and the doses in which to be adminstered, will be found in
the section on "Aperient Medicine."[FN#39]



[FN#39]  See page 97.



If, however, the bowels of the infant are disposed to be habitually
confined, it should be ascertained whether this may not be dependent
upon its diet. The same food that agrees perfectly well with one child
will frequently cause costiveness in another. An intelligent and
observing mother will soon discover whether this is the source of the
mischief, or not. Boiled milk, for instance, will invariably cause
confined bowels in some children; the same result will follow sago
boiled in beef tea, with others; whilst, on the other hand, the bowels
may frequently be brought into regular order, and their confined state
overcome, by changing the food to Leman's tops and bottoms steeped in
hot water, and a small quantity of unboiled milk added; or prepared
barley, mixed in warm water and unboiled milk, will have the same
effect.

Sometimes children are constitutionally costive, that is, the bowels
are relieved every third or fourth day, not oftener, and yet perfect
health is enjoyed. This occasionally will happen in large families, all
the children, though perfectly healthy and robust, being similarly
affected. When such is found by a mother to be really the habit of her
child, it would be very unwise, because injurious to its health, to
attempt by purgatives to obtain more frequent relief. At the same time
it will be prudent and necessary for her to watch that the regular time
is not exceeded. This condition seldom occurs to the very young infant.



2. IN CHILDHOOD.



Children of sound health, who are judiciously fed, and have sufficient
exercise, very seldom need aperient medicine. Errors in diet, a want of
proper attention to the state of the skin, insufficiency of air and
exercise, in fine, a neglect of those general principles which have
been laid down for the management of health, and upon the observance of
which the due and healthy performance of every function of the body
depends, are the sources of bowel derangements, and particularly, at
this age, of costiveness.

I feel assured, however, that some children are more troubled with
costiveness than others, from the simple but important circumstance of
their not being early taught the habit of relieving the bowels daily,
and at a certain hour. There is a natural tendency to this periodical
relief of the system, and it exists at the earliest age. And if the
mother only cause this habit to be fairly established in infancy, she
will do much towards promoting regularity of her child's bowels
throughout life. The recollection of this fact, and the mother's acting
upon it, is of the greatest importance to the future health and comfort
of her children.

If the bowels are accidentally confined at this age, castor oil is
certainly the best aperient that can be given: it acts mildly but
efficiently, clearing out the bowels without irritating them. The dose
must be regulated by the age, as also by the effect that aperients
generally have upon the individual. Great care must in future be taken
to avoid the cause or accidental circumstance which produced the
irregularity.

When the bowels are habitually costive, much care and judgment is
necessary for their relief and future management. Fortunately this
condition is very rare in youth. The activity and exposure to the air,
usual at this period of life, render purgatives unnecessary, unless,
indeed (as just mentioned), some error in diet, or some unusual
circumstance, render them accidentally confined. Should, however, the
foregoing state exist, medicine alone will avail little; there are
certain general measures which must also be acted up to, and most
strictly, if the end is to be accomplished. They consist, principally,
in an observance of great regularity with respect to the time of taking
food, its quality, quantity, and due mastication; regular and
sufficient exercise, horse exercise being particularly serviceable; the
shower-bath, or daily ablution; early rising (the indulgence in the
habit of lying in bed always predisposing to constipation); and,
lastly, the patient habituating himself to evacuate the bowels at a
certain hour of the day. After breakfast appears to be the time when
the bowels are more disposed to act than at any other part of the day;
this is the time, then, that should be chosen.

All these points must be sedulously observed, and upon the principles
laid down in the various chapters upon these subjects, if habitual
costiveness is expected to be overcome.



SECT. IV.--WORMS.



NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF
MISCHIEF.--Almost all diseases have been, at one time or other,
attributed to the generation of worms in the intestines. And at the
present day it is not at all an uncommon occurrence for medical men to
be called in to prescribe for children, to whom the strongest purgative
quack medicines have been previously exhibited by parents, for the
removal of symptoms which, upon investigation, are found in no way
connected with or produced by worms. The results of such errors are
always, more or less, mischievous, and sometimes of so serious a nature
as to lay the foundation of disease which ultimately proves fatal. This
observation, moreover, it behoves a mother carefully to regard, since
the symptoms, popularly supposed to indicate the existence of worms,
are so deceptive, (and none more so than that which is usually so much
depended upon--the picking of the nose,) that it may be positively
asserted to be impossible for an unprofessional person to form a
correct and sound opinion in any of these cases.

It was at one time imagined, and the idea is still popularly current,
that worms were the occasion of a troublesome and lingering species of
fever, which was therefore designated worm-fever. This notion is now
entirely exploded; for if worms be present under such circumstances, it
is a mere accidental complication; the fever referred to being
generally of a remitting character, and neither caused by or causing
the generation of worms. The symptoms of this fever, however, have led
and continue to lead very many astray. This is not surprising, since
they so closely resemble those which characterise the presence of
worms, that an unprofessional person is almost sure to be misled by
them. Amongst other symptoms, there is the picking of the nose and
lips, offensive breath, occasional vomiting, deranged bowels, pain in
the head and belly, with a tumid and swollen condition of the latter, a
short dry cough, wasting of the flesh, etc.; symptoms continually
attendant upon the disorder now under consideration. These cases have
hitherto been perpetually looked upon by mothers as worm-cases, and
after having been treated by them as such, by the use of the popular
worm-powders of the day, have, as perpetually, presented themselves to
the physician greatly and grievously aggravated by such injudicious
treatment. It is folly, at any time, for an unprofessional person to
prescribe for a case where worms are actually known to exist: surely
where there is any doubt upon the latter point it must be greater folly
still.

The infant at the breast is seldom, if ever, the subject of this
disorder, whilst an artificial diet, or bringing up by hand,
predisposes to it. Worms most frequently occur, however, during
childhood; much more so at this epoch than in adult age. They do not
invariably occasion indisposition, for they are now and then passed
without pain or distress by children who are in the enjoyment of
perfect health, and in whom previously there was not the slightest
suspicion of their existence. The idea, formerly so prevalent, of their
being attended with danger, is without foundation; for unless the case
be mismanaged, they rarely give rise to serious consequences.


HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not
very easy to explain; at the same time it is very certain that some
known circumstances favour their production.

If the general health of a child be enfeebled, particularly if the
child be strumous, such a condition will favour the generation of these
animals. The protracted use of unwholesome and innutritious articles of
food, or a deficient supply of salt (the most necessary stimulant to
the digestive organs), or other condiments, predisposes to worms. This
observation is strikingly illustrated by an occurrence which formerly
took place in Holland, where an ancient law existed forbidding salt in
the bread of certain criminals; they were in consequence horribly
infested with worms, and quickly died. Sugar, too, whilst a necessary
condiment for the food of children, if given in the form of sweetmeats,
and their indulgence, long persisted in, may so enfeeble the organs of
digestion as to cause worms. And, lastly, (though many other causes
might be referred to) the injudicious means occasionally employed to
effect the removal of these animals, by the debility produced in the
intestinal canal, favours not only their re-appearance but their
increase.

These, then, are so many causes which may occasion worms in the child,
and of course the best and most effectual method to prevent their
production is their avoidance. A mother, therefore, should at all times
be careful in the regulation of the diet and general management of her
child's habits and health, even if no stronger obligations existed than
the dread of this disorder; and she must be more than ordinarily
vigilant on this head, when the slightest disposition to such disorder
is manifested. Again; she must not forget that the symptoms so commonly
ascribed as characteristic of worms are much more frequently caused by
other diseases; that at no time, therefore, is she justified in giving
worm powders, or strong doses of medicine for such symptoms; for if
they do exist, their use is always attended with risk, and if they do
not, the debility which they occasion in the stomach and bowels may
itself become the source of their production.



Sect. V. SCARLET FEVER.



There are several varieties of this disease; it will be more
perspicuous, however, for our purpose to speak of it under the two
following forms:--


Mild scarlet fever;

Scarlet fever, with sore throat.



MILD SCARLET FEVER.--In this form of the disease there is only the rash
with fever.


SYMPTOMS.--The anticipating symptoms are those of fever: they precede
the eruption. The degree of fever, however, is variable; for the
symptoms are sometimes so moderate as scarcely to attract attention,
slight and irregular shivering, nausea, perhaps vomiting, thirst, and
heat of skin; whilst, at others, there is considerable constitutional
disturbance, indicated by pungent heat of skin, flushing of the face,
suffusion of the eyes, pain in the head, great anxiety and
restlessness, and occasionally slight delirium.

These symptoms are followed on the second day (in the majority of
instances) by the rash. This first appears in numerous specks or minute
patches of a vivid red colour on the face, neck, and chest. In about
four-and-twenty hours it becomes gradually diffused over the whole
trunk. On the following day (the third) it extends to the upper and
lower extremities, so that at this period the whole surface of the body
is of a bright red colour, hot and dry. The efflorescence, too, is not
always confined to the skin, but occasionally tinges the inside of the
lips, cheeks, palate, throat, nostrils, and even the internal surface
of the eyelids. Sometimes the efflorescence is continuous and
universal; but more generally on the trunk of the body there are
intervals of a natural hue between the patches, with papulous dots
scattered over them, the colour being most deep on the loins and
neighbouring parts, at the flexure of the joints, and upon those parts
of the body which are subjected to pressure. It is also generally most
vivid in the evening, gradually becoming paler towards morning.

The eruption is at its height on the fourth day;--it begins to decline
on the fifth, when the interstices widen, and the florid hue fades;--on
the sixth, the rash is very indistinct; and on the eighth day it is
wholly gone.

The various symptoms with which the eruption is accompanied, gradually
disappear with the efflorescence; but the tongue still remains morbidly
red and clean. The peeling off of the cuticle (the outer layer of the
skin), which begins about the end of the fifth day on the parts on
which the eruption first appeared, proceeds; so that about the eighth
or ninth, portions of the cuticle are thrown off, the thickest and
largest being those detached from the skin of the hands and feet.



SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the
fever and rash are accompanied with inflammation of the throat.


SYMPTOMS.--The symptoms are more severe than in the mild form of this
disease, and, in the majority of instances, the inflammation of the
throat appears with the eruption, and goes through its progress of
increase and decline with the cutaneous eruption. Sometimes, however,
it precedes the fever; whilst at others it does not appear until the
rash is at its height.

It is generally in the course of the second day that the child
complains of considerable stiffness in the muscles of the neck,
extending to the lower jaw, and under the ears;--of a roughness of the
throat, and difficulty in swallowing;--and some degree of hoarseness
will be noticed: all so many indications that the throat is affected.
Very shortly, an increased secretion of the mucus of these parts
occurs, and, collecting about the tonsils, aggravates the child's
sufferings, from the frequent and ineffectual efforts made to expel it.
If the inflammatory action be more severe, exudations of lymph will
also be poured out, and intermingling with the mucus, greatly augment
the difficulty of swallowing. At this time the lining membrane of the
mouth, as also the tongue, assume a florid red colour; the red points
of the latter becoming much elongated.

The febrile symptoms are severe from the first; amongst others, there
will be headach, sometimes accompanied by slight delirium, nausea,
intense heat of skin, languor, and considerable inquietude and anxiety:
and as the inflammation approaches its height, the fever increases, the
pulse rises, the breathing becomes oppressed, the skin becomes more
pungently hot and dry, and the thirst urgent. All these symptoms being
increased towards evening, when the febrile restlessness is often
succeeded by delirium.

The rash is seldom perceptible before the third day, and then comes
out in irregular patches on various parts of the body, particularly
about the elbows and wrists; thus differing as to the time and mode of
its appearance, from the mild form of the disease. It frequently
recedes, or entirely vanishes, the day after it first comes out, and
then reappears partially, and at uncertain times. This generally
protracts the duration of the disorder, without, however, producing any
perceptible change in the other symptoms. On the fifth or sixth day of
the disease, the fever and inflammation of the throat begin to abate;
at the same time the rash declines, and the peeling off of the cuticle
soon follows.

This is the ordinary course of scarlet fever with sore throat; but in
many cases the symptoms run still higher, and the disease is alarmingly
dangerous from its commencement. In some instances, there is an acrid
discharge from the nostrils or ears, often accompanied with deafness;
as also enlargements of the glands in the neck, followed by the
formation of abscesses in their immediate neighbourhood. It is
unnecessary, however, to follow out the symptoms of scarlet fever more
fully; as all that has been attempted here, has been so to sketch out
the more prominent symptoms of this disease, that the directions upon
the parental management may be readily comprehended: they will be very
brief, but a strict attention thereto will be found all-important to
the well-doing and comfort of the child.


CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be
seldom difficult to distinguish this disease from other acute eruptive
disorders. The one to which it bears the greatest resemblance is the
measles; but from this it is readily distinguished by the absence of
the cough, the inflamed and watery eye, running at the nose and
sneezing, which are the predominant symptoms in the early stage of the
measles; but which do not usually attend on scarlet fever--at least, in
any high degree. In measles, also, there is an absence of that
restlessness, anxiety, and depression of spirits, by which scarlet
fever is peculiarly distinguished.--The rash, too, in measles, does not
appear till two or three days later than that of scarlet fever. It also
differs in its characters. In scarlet fever, the eruption consists of
innumerable minute dots or points, diffused in patches with uneven
edges of various sizes and forms; and gives to those portions of the
skin on which it appears, a diffused bright red colour. In measles, the
rash comes out in irregular semi-lunar or crescentic shaped patches,
distinctly elevated; the spots being of a deeper red in the centre
than in the circumference, and leaving intervening spaces in which the
skin retains its natural pale colour.


MATERNAL MANAGEMENT.--The chief points to which the parent's attention
must be directed, irrespective of a strict attention to the more
immediate medical treatment directed by the physician, are the
following:--


VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must
be kept in bed from the first accession of the fever. He must not be
loaded, however, as was formerly the practice, with a quantity of
bed-clothes, in order to encourage the fever and increase the quantity
of eruption. A moderate quantity of clothing is all that is required,
adapted to the heat of skin and feelings of the patient.

The bed-room must be kept cool and well ventilated. This is of
importance in the mildest cases; but in the more severe forms of this
disease, in which the throat is much affected, the constant and free
admission of pure air will have a most decided and marked good effect
upon the symptoms. The air should be renewed, therefore, from time to
time. The linen, both of the bed and the patient, should also be
frequently changed daily,--if practicable.

However mild the symptoms of this disease may be at the commencement,
the child must always be carefully and vigilantly watched by the
parent, as inflammation of some internal organ may suddenly arise
(which is generally indicated by symptoms sufficiently obvious), and
thus change an apparently mild form of this disease into one of an
alarming character.


COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole
surface of the body should be sponged with cold water, or with vinegar
and water. The heat is by this means rapidly abstracted, and the child
refreshed; and this may again and again be resorted to, as the heat
again returns. By this application alone, "the pulse has been
diminished in frequency, the thirst has abated, the tongue has become
moist, a general free per spiration has broken forth, the skin has
become soft and cool, and the eyes have brightened; and these
indications of relief have been speedily followed by a calm and
refreshing sleep. In all these respects, the condition of the patient
presented a complete contrast to that which preceded the cold washing;
and his languor was exchanged for a considerable share of vigour. The
morbid heat, it is true, when thus removed, is liable to return, and
with it the distressing symptoms; but a repetition of the remedy is
followed by the same beneficial effects as at first."[FN#40]



[FN#40]  Bateman's Practical Synopsis of Cutaneous Diseases.



GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected,
gargles are sometimes ordered; but the pain and inconvenience which
their employment gives rise to, frequently precludes their use: and
children seldom understand how to employ them, even if the state of the
throat permitted it. Under these circumstances, the inhalation of the
steam of hot water, or hot vinegar and water, may be substituted, and
with decided benefit. Mudge's inhaler is a good contrivance to effect
this.

When the throat is found by the mother to be early affected, an
immediate application to the medical adviser is especially important.
For, if he be called upon to treat this form of scarlet fever at its
very commencement, by judicious treatment, the duration and violence of
the disease may be both shortened and greatly mitigated.


REGIMEN.--Cooling drinks, as plain water, toast and water, barley water
flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may
all be resorted to in their turn. The child may also be allowed
oranges, grapes, or lemons sweetened with sugar, particularly when the
mouth is foul and dry; but care must be taken that neither the pulp nor
the stones are swallowed. These will both refresh and feed the patient
as much as is necessary until the decline of the disease. The parent
must strictly forbid the attendants in the sick chamber giving, at this
period, any heating or stimulating fluid, as also animal food; and this
injunction must be strictly regarded, even in the mildest form of the
disease.

When the child is convalescent, mild nourishment will be required,
such as arrow-root, tapioca, chicken or mutton broth, beef tea,
jellies, and roasted apples; and by and by a mutton chop. Wine is
seldom necessary, except under circumstances of unusual debility after
a protracted illness, when its moderate use tends much to assist the
convalescence; but, if given unadvisedly, there will be great hazard of
exciting internal inflammatory disease.

Relapses are sometimes caused by the child getting about too soon, and
by indulgence of the appetite, particularly for food: a proper degree
of restraint, therefore, must be placed upon the child by the parent,
who cannot too strictly carry out the directions of the medical
attendant upon the diet and regimen during this period.

Great attention must still be paid to the state of the bowels, and,
indeed, to all the secretions and excretions.


PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote
the more easy separation of the cuticle from the surface of the body, a
warm or tepid bath may be usefully employed at the close of the
disease. It will, moreover, greatly contribute to the comfort of the
child, and induce a more healthy condition of the skin. Occasionally
the cuticle of the whole hand and fingers will peel off unbroken, when
it will resemble precisely a glove in shape.

As is the case in all fevers, more or less, so particularly after
scarlet fever, there is a great tendency to the falling off of the
hair. It will be always well, therefore, to shave the head at this
time, and exhibit daily a tepid shower bath, as early as the strength
of the child will permit.


CAUTIONS, ETC.--The contagious character of this disease requires the
separation of the invalid from the rest of the family; and, when it is
practicable, the children should be removed to a distance. This measure
is imperatively called for, when the form of the disease is very severe
in its character.

Great caution must also be exercised, after the convalescence of the
patient, that the other children are not brought into too early contact
with him: for infection may be thus produced, though several weeks may
have elapsed from the period of the peeling off of the skin.

The period at which the disease shows itself after the exposure of an
individual to sources of contagion, is exceedingly various. One child
will be seized within a few hours; another, not for some days; and now
and then (though rarely), five or six weeks have intervened between the
period of exposure and the manifestation of the disease.

When this disease is rife in a family, it will frequently affect the
individuals composing it very differently. Some escape altogether;--
others have the mild form of the complaint;--others the severe;--and,
again, the attendant in the sick room may be attacked with the sore
throat and fever only, both of which may subside without any appearance
of a rash.

In conclusion, this disease is a complaint of infancy and childhood,
rather than of adult age; generally affects the same individual but
once during his life; and, though examples of a second attack have
occurred, such a circumstance is extremely rare.



Sect. VI.--MEASLES.



Measles consists of a fever, in which the mucous lining of the air-
passages is principally affected, and which, after about three days'
duration, results in an eruption of a red rash over the surface.

It depends upon a specific contagion;--occurs most frequently during
childhood and adolescence, though no age is exempt from it;--and affects
the system but once; a peculiarity to which an exception is very rare,
proved by the few instances of the kind which have been recorded.

The period at which the disease manifests itself after infection is
various,--generally about the ninth day; it has, however, been delayed
until the sixteenth.


DESCRIPTION OF THE DISEASE.--The child infected will be observed not to
be as well as usual, less active, and out of spirits; his appetite
will fail, and his sleep be restless and disturbed. It will soon be
evident that he has apparently taken a cold in his head, and that this
is accompanied by fever. His voice will be hoarse; there will be
frequent cough, headach, sneezing, running from the nose and eyes,--the
eyelids being somewhat swollen, and the eyes inflamed;--the skin will be
hot and dry, and he will complain of occasional chilliness. In the
course of the next two or three days, these symptoms will increase in
severity, and perhaps be accompanied by oppression at the chest and
hurried breathing, and towards evening by slight delirium.

On the fourth day, the rash will appear, but the symptoms will be
little, if at all, mitigated; indeed, they will sometimes increase in
severity. The eruption will first be perceived about the head and face,
in the form of small red spots, at first distinct from each other, but
soon coalescing, and forming patches of an irregular crescent-like or
semilunar figure, of a dull red colour, and slightly elevated (giving a
sensation of hardness to the finger), while portions of the skin
intervening between them will retain their natural appearance. At this
time the eruption will also be found on the inside of the mouth and
throat, and the hoarseness will consequently increase.

On the fifth day, the rash usually covers the whole surface of the
body, with the exception of the legs and feet; and is now very vivid on
the face, which is not unfrequently so much swelled, especially the
eyelids, that the eyes are quite closed up, as in small-pox. On the
sixth day, it is fully out on the extremities, and is beginning to fade
on the face. On the eighth, it is fading from all parts; on the ninth,
it is hardly perceptible; and has entirely disappeared on the tenth day
from the commencement of the fever, or the sixth from its own first
appearance. As the fading proceeds, the spots drop off in the form of
little branny scales, which are sometimes, from their minuteness,
scarcely perceptible. They leave a slight discolouration on the skin,
with considerable itching.

Such is the ordinary course of this disease; occasionally, however,
deviations are met with.


CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under
the description given of Scarlet Fever, are noticed several signs by
which that disease may be distinguished from measles: to these may be
added the absence of cough, of water flowing from the eyes, and of
redness and swelling of the eyelids as in measles. Again, in measles,
the eruption is more pointed, of a crimson instead of a scarlet hue,
and does not appear until two days later than in scarlet fever.

In small-pox, the fever abates as soon as the eruption makes its
appearance. In scarlet fever, this is by no means the case; and as
little so in measles: the vomiting, indeed, subsides; but the cough,
fever, and headach grow more violent; and the difficulty of breathing,
weakness of the eyes, and, indeed, all the catarrhal symptoms, remain
without any abatement till the eruption has all but completed its
course.


MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a
mild, and by no means dangerous, disease: it is sometimes, however,
accompanied or immediately followed by symptoms of a very serious
character, and which, it is to be feared, in many instances, owe their
origin to the carelessness of the attendants in the sick chamber. A
mother's superintendence, therefore, is much required at this time to
insure a careful attention to the medical directions, as also to those
general points of management upon which the well-doing of her child
much depend, of which the following are the most important:--


VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from
the onset of the attack. He must have so much clothing only as will
secure his comfort, avoiding equally too much heat or exposure to cold.
To these points the parent's attention must be particularly directed.
It is the practice with some nurses, in the belief that a breath of
cool air is most pernicious, to keep the child constantly enveloped in
a smothering heap of bed-clothes, with curtains closely drawn, and the
room well heated by fire, by which means the fever and all its
concomitant dangers are greatly augmented. It is equally a popular
error (and yet by many it is still held and acted upon) to suppose that
because in small-pox exposure to cold is useful, that therefore it
must be of equal advantage in measles. It cannot be too generally known
that the nature of the fevers accompanying the two diseases are widely
different, and that the adoption of this error is productive of the
most serious consequences; for it would most likely produce in measles
inflammation of the lungs, which, in truth, is commonly the result of
carelessness upon this point.

The bed-room should be large and airy; free from currents of cold, but
well ventilated, and not hot. The room, also, must be darkened, on
account of the tenderness of the eyes; all noise excluded, and mental
excitement or irritation carefully avoided.


REGIMEN.--Little or no food must be allowed, and whatever is taken must
be of the simplest kind, and in a liquid form. Mild mucilaginous
drinks, and warm, may be given liberally; as barley-water, or thin
gruel, etc.


SPONGING, ETC.--The face, chest, arms, and hands should be sponged
occasionally with vinegar and warm water (one fourth and three
fourths). This will be productive of great comfort to the little
patient; it removes the heat, dryness, and itching of the skin, which
are often very distressing; and is especially useful at night in
relieving wakefulness. If the cough be troublesome, it will be useful
for the child to breathe the steam of warm water; not through an
inhaler, but over a large basin, with the head covered with flannel
large enough to hang over its edges. By this means the tender and
inflamed eyes will at the same time derive advantage from the soothing
effect of the vapour.


CAUTIONS.--Whenever the measles is known to be prevalent in a
neighbourhood, and a child manifests symptoms of cold in the head and
fever, it should at once be a reason for carefulness on the part of the
parent. The diet should be light, cooling, and scanty; and the child
should be carefully kept in doors.

It has been before remarked, that in its ordinary course measles is a
disease unaccompanied with danger, but that the mildest form may be
speedily converted into the most dangerous. That is to say, a sudden
change may lake place in the symptoms, arising out of circumstances
which could not have been foreseen, and therefore unavoidable; or may
be produced by improper management on the part of the nurse, such as
the giving of stimulants, by too much heat, or by exposure to cold. Now
it is for the parent early to notice any change which may occur from
the first source, and by her watchfulness to guard against the
possibility of its arising from either of the second.

In reference to the first, if the child should complain at any period
of the disease of severe headach, with piercing pain through the
temples, and if this is accompanied by wandering of mind, great
increase of suffusion of the eyes, as also intolerance of light, the
immediate attention of the medical man is demanded. So, if towards the
dose of the eruption, that is, from the seventh to the ninth day, the
breathing should again become hurried (this symptom is very generally
present during the height of the eruption, and is not necessarily
connected with disease of the lungs), with pain and oppression felt at
the chest, the cough becoming hacking and incessant, etc. (all symptoms
cognizable by the mother, and indicative of inflammation of the
lungs), no time must be lost in seeking medical aid.

With regard to the last cause (improper management), it may be well,
in reference to it, to observe, that it sometimes happens that the rash
comes out imperfectly, or, having appeared properly, suddenly
retrocedes and disappears; and that under such circumstances the nurse
will almost certainly, if not well watched, give the child "a good
dose of sulphur in diluted spirit, or a glass of punch containing
saffron," which are considered specifics for bringing out the eruption.
Nothing can be more injurious than such remedies, for generally the
disappearance of the rash will be dependent upon the existence of some
internal inflammation, or of too high a fever; for the removal of
which the medical man ought to be instantly applied to. Sometimes,
however, it may be fairly traced to a careless exposure to cold: under
such circumstances the child should be instantly, and without
hesitation, put into the warm bath.

Measles are frequently followed by cough, and deranged bowels; and
there is always great susceptibility about the child for some time. On
this account he should be carefully screened from a cold or damp
atmosphere; the diet should be carefully regulated; and flannel worn
next to the skin. If the cough should continue, it must not be
neglected on the supposition that it will wear off; for it demands the
skilful and careful attention of the medical man.

In conclusion, it may be remarked that very frequently during infancy
and childhood, and particularly during the period of teething,
eruptions very similar in appearance to this disease occur; unless,
however, they are accompanied by the specific fever, and run the
regular course, they may at once be decided upon as not being the
measles.



Sect. VII.--SMALL-POX.



This disease, the most dreaded of all eruptive fevers, is not so
commonly met with in the present day as formerly; thanks to that
Providence which led to the discovery of Jenner. But although its
occurrence is not so frequent, it still does occasionally present
itself; when it will assume either a mild or severe form. If it attack
a child that has not previously been vaccinated, it is called natural
small-pox; and the chances are that the disorder will be severe in
character;--if, on the other hand, it occur in the vaccinated, the
disease will generally be much modified in its symptoms; the attack
will be mild, and without danger.


NATURAL SMALL-POX.--The infection of small-pox having been received
into the system of a child that has not been vaccinated, fourteen days
(on an average) will transpire before the commencement of the febrile
symptoms, or eruptive fever. A distinct rigor or shivering fit then
takes place, accompanied by pain in the back or in the stomach, with
sickness, giddiness, or headach; as also great drowsiness. And if an
infant be the subject of the disease, a convulsive fit will sometimes
take place, or several in succession.

At the end of eight-and-forty hours from the occurrence of the rigor
(in the majority of cases), the eruption comes out; and shows itself
first on the face and neck in minute flea-bite spots. In the course of
the next four-and-twenty hours in some cases, and in others not until
the expiration of two or three days, it completely covers the body; not
being confined exclusively to the skin, but frequently extending to the
mouth and throat, and even to the external membrane of the eye.

In the course of two or three days from their first appearance the
little pimples, increasing in size, will be found to contain a thin
transparent fluid, to pit or become depressed in their centre, and the
skin in the spaces between them will be found red. On the seventh or
eighth day from the commencement of the fever, the fluid contained in
the pimples will be no longer transparent, but opaque; and they will
consequently appear white, or of a light straw colour. Each pimple or
pock will be no longer depressed in its centre, but will become raised
and pointed, being more fully distended by the increased quantity of
fluid within; and the skin around each pock will now be of a bright
crimson. The head, face, hands, and wherever else the eruption shows
itself, gradually swell; and the eyelids are often so much distended as
to close the eyes and produce temporary blindness. There will always at
this time be some degree of fever present, and its amount will vary
with the circumstances of each individual ease. The skin too will be
very tender, so much so sometimes as greatly to harass and distress the
child.

On the eleventh day the swelling and inflam of the skin of the body
and face subside; the pimples upon these parts dry up and form scabs,
which fall off about the fourteenth or fifteenth day. Those on the
hands, as they come out later, commonly continue a short time longer.
The eruption leaves behind, in some cases, the peculiar marks of the
disease; and in others merely discoloured spots, which disappear in the
progress of a short time.

The natural small-pox is sometimes much more severe in its character
than the foregoing, and what is called confluent small-pox is said to
exist. This form will be marked by great constitutional disturbance,
and the eruption coming out earlier than in the milder form; instead of
being distinct, that is, each pimple standing distinct and separate
one from the other, they will coalesce, and appear flat and doughy, not
prominent: they will more particularly run into each other on the face,
where they will form one continuous bag, which soon becoming a sore,
will discharge copiously.


SMALL-POX IN THE VACCINATED.--When small-pox occurs to those that have
been formerly vaccinated, the disease, in almost every instance, is
much altered or modified in its character. Indeed in children, in whom
of course vaccination has been but comparatively lately performed,
small-pox when it occurs will, in the majority of cases, be so mild
that the real nature of the disease will be with difficulty determined:
so mild, that again and again has a parent been heard to exclaim,
"Surely these few scattered pimples cannot be the small-pox!" If,
however, as the pimples progress, they are narrowly watched, and are
seen to become depressed in their centre; if there has been the
precursory rigor, etc.; and if the source of the disorder can be traced
to some case of undoubted small-pox, the child in fact having been
exposed to contagion, no doubt ought to exist in reference to the
nature of such a case, however slight may be the character of the
disease.

The usual progress, however, of small-pox modified by vaccination is
as follows. The first stage is the same usually as in the natural form
of the disease. As soon, however, as the eruption appears, the
modifying power of the vaccination becomes apparent. The eruption will
be found to be generally both less in quantity and more limited in its
extent; or if even it should come out profusely, and cover a large
extent of the surface of the body, still the controuling power of the
vaccination will immediately show itself after its appearance,--first,
in the complete subsidence of all the febrile symptoms which will now
take place; and, secondly, in reference to the eruption, part of which
will die away at once, and the remainder will by the fifth day be
filled with the opaque yellowish fluid, then dry up, becoming hard and
horny, and falling off will leave a mottled red appearance of the skin,
and now and then slight pitting.

Such is the usual progress of the disease: subsequent to vaccination,
it is a mild and tractable disorder. It is right, however, to mention
that small-pox has occurred even to the vaccinated in almost as severe
a form as the confluent natural small-pox, and running its regular
course unaltered or unmodified. Such instances, however, are extremely
rare, and form the exceptions to the general rule; for "no reasonable
doubt can be entertained, from the abundance of facts now before the
world, that such modification is the law of the animal economy, and
that the regular or natural progress is the exception."


MATERNAL MANAGEMENT.--The grand principle in the treatment of small-pox
is to moderate and keep under the fever; and however the plans adopted
by different medical men may vary in particular points to accomplish
this purpose, they uniformly make this principle their chief aim and
object. To carry out this intention, however, the medical adviser is
greatly dependent upon the aid and assistance of a judicious parent,
and without this it is impossible to hope for a successful issue to
the case. A clear knowledge, therefore, of those points of general
management in which in fact a great part of the above principle
consists (few and simple as these directions are), it must be
all-important for the mother to be acquainted with: for the rest,
she must and ought to look to the medical man.

In the more rare and severe form of this disease, viz. the confluent
small-pox, although in some instances it runs the same course as the
milder form, the distinct or natural small-pox, still, usually, the
constitutional symptoms are much more aggravated, and the medical and
general treatment required will so much depend upon the character of
the individual case, that we do not think it well to notice it here.


BED AND BED-ROOM.--It will not be necessary at first for the child to
be confined to his bed, but generally about the third or fourth day he
will gladly resort to it; and if he does not, it will be prudent to
keep him there. He must not, however, be loaded with bed-clothes, but
lightly covered; and the bed and body linen should be changed daily, if
possible.

The bed-room should be capacious and well ventilated; fresh air
frequently admitted; and if the season of the year permit, and there is
no dampness of atmosphere, a window should be constantly open during
the day: it is also desirable to keep the chamber darkened in all
cases, as there is always a tendency to inflammation of the eyes.

If these directions are not regarded, and a great heat of the
apartment is permitted, with abundance of bed-clothes heaped upon the
child, the hot bath is used, and hot and stimulating regimen given
(upon the old and erroneous notion of bringing out the eruption), the
mildest case will inevitably be converted into one of the most severe
and dangerous. Facts have abundantly shown that such measures
invariably prove the most effectual means of exasperating the disease,
and endangering life.


REGIMEN.--This must be most sparing. Cold water may be given whenever
the child asks for it. Lemonade should form the common drink during the
fever; and gruel, barley-water, and roasted apples are all else that is
required during this period, and not until the disease is going off
must any change be made in the diet.

The above period having arrived, mildly nutritious food should be
given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or
sago; to be followed in a few days by the wing of a chicken or a mutton
chop; remembering always, that solid animal food must at first be given
cautiously and sparingly. Wine or stimulants must be positively
forbidden; unless, indeed, ordered by the medical man, for
circumstances may arise which render them advisable.

The state of the bowels must be carefully attended to at this time.


THE ERUPTION.--In the natural and mild form of this disorder the
pustules generally break from the sixth to the eighth day; dry scabs
succeed; and in about nine or ten days the parts heal perfectly,
requiring no treatment. In the more aggravated cases, however, in which
the pustules are very numerous, running one into the other, and,
bursting, discharge greatly, the whole surface of the body should be
frequently and liberally dusted over with dried flour, or, what is
better, starch powder. The sores in this instance are always tedious in
healing, and followed by the well-known pits or marks: these arise from
a loss of substance in the true skin, and occur more particularly on
the face, from the great vascularity of this part causing the pustules
to be more numerous here than elsewhere. It is a popular error to
suppose that by wearing masks of fine linen or cambric illined with
particular ointments, these scars or pits may be prevented: it is
impossible to prevent them; and any local application, except a little
cold cream or oil of almonds applied to the scabs when they harden,
will prove more injurious than useful. The child's hands, however,
should always be muffled to prevent its scratching or breaking the
sores, for otherwise he will not be kept from thus attempting to allay
the excessive itching which they occasion.

The hair should be closely cut at an early period of the disease, and
so kept throughout its continuance. This will contribute very much to
the comfort of the child, by preventing the hair becoming matted
together with the discharge from the pustules when they break, which
gives rise to great pain and irritation. In the confluent and worst
forms of this disease, this measure it is particularly necessary to
attend to, as also to the application of cold lotions to the head when
hot and dry (with other remedial means), as there is always a tendency
in these cases to the formation of abscesses, the healing of which is
troublesome and attended with difficulty.


CAUTIONS, ETC.--It has already been stated that a free ventilation of
the bed-room is necessary to the well-doing of the patient. This
measure, however, must not be confined to the chamber of the sick, but
acted upon through the whole house.

In conjunction with ventilation, fumigations by means of aromatic
substances kept slowly burning should be resorted to. A solution of the
chloride of lime too, a most powerful disinfectant, should be used to
purify the different apartments. This is best accomplished by steeping
in the solution pieces of linen, and hanging them about the rooms, as
also frequently and freely sprinkling the walls themselves; and as soon
as the invalid is removed, the chamber should be white-washed, the
various articles of furniture well scoured with soap and water, and the
room be well and freely ventilated prior to its being again occupied.

The clothes of the patient and the bed linen should be frequently
removed, and when taken away immediately immersed in boiling water, and
whilst hung up in the open air sprinkled occasionally with a weak
solution of the chloride of lime. If these directions are not observed,
and the clothes are closely wrapped up, they will retain and give out
the disease to others at a great distance of time.

Again: as the contagious property of smallpox hangs about the child as
long as any scabs remain (which indeed may be said to retain the poison
in its concentrated form), a parent must be most careful that the
invalid is not too early brought in contact with the healthy members of
the family.

An observance of these precautions is imperatively demanded; they not
only protect the healthy, but aid the infected.



Sect. VIII.--HOOPING-COUGH.



My chief inducement to notice the above disorder arises out of the
well-known fact, that there is no complaint of childhood more
frequently subjected to quackery and mismanagement than is this.
Indeed, there are few maladies against which a greater array and
variety of means have been recommended, than against hooping-cough.

I suppose from the circumstance of the simple and mild form of the
complaint being so tractable (provided it remain such) that the
simplest and mildest measures effect its cure, parents are tempted to
undertake its management in the more severe and complicated forms; and
the result is but too often the establishment of disease dangerous to
life, and sometimes fatal to it.

But although most imprudent for a parent to assume the office of the
physician, her aid is essentially necessary in carrying out the
measures prescribed. By her watchfulness and care the duration of the
disease may not only be abridged, but, what is of much greater
importance, a more serious and aggravated form of disease prevented;
for although hooping-cough in itself is not a dangerous disorder, still
the most simple and slight case, if neglected or mismanaged, may
quickly be converted into one both complicated and dangerous.


DESCRIPTION OF THE DISEASE.--Hooping-cough commences with the symptoms
of a common cold, which is more or less frequent. These symptoms
continue from five days to fifteen; at the end of which time the cough
changes its character, and assumes the convulsive form, which
distinguishes the disorder. It occurs in paroxysms, varying with the
severity of the disease from five to six in the twenty-four hours to
one every ten or fifteen minutes; being generally more severe and
frequent during the night than in the day.

During a paroxysm the expirations are made with such violence, and
repeated in such quick succession, that the child cannot breathe, and
seems in danger of suffocation. The face and neck become swollen and
purple from suffusion; and the eyes prominent, injected, arid full of
tears. The little one, with a forewarning of the attack, which it
dreads, falls on his knees, or clings closely to any thing near him.
The paroxysm terminates with one or two long inspirations, attended
with that peculiar noise, or "whoop," from which the disease has
derived its designation.

Sometimes the fit of coughing is interrupted for a minute or two, so
that a little rest is obtained; and is then succeeded by another fit
of coughing and another hoop, until after a succession of these actions
the paroxysm terminates by vomiting, or a discharge of mucus from the
lungs, or both.

The disease having continued at its height for two or three weeks, it
begins naturally to decline; the paroxysms become less frequent and
violent; the expectoration increases; the cough loses its
characteristic hoop, and gradually wears away altogether; until at
length, in two or three months from the first onset of the disease, the
child is restored to perfect health. Sometimes, however, particularly
in the autumn, and at other seasons on the occurrence of easterly
winds, the paroxysms of cough will return,--it will assume its
spasmodic character, and be accompanied with the "whoop," after a
month, or even two or three months, of perfect and apparent recovery.
Errors in diet will sometimes alone have a similar effect.

It is a disease which usually occurs during childhood, rarely affects
the same individual twice, and is seldom seen in the very young infant.

In reference to the probable result of the disease, when it occurs in
its mild and simple form in a healthy child, the termination is usually
favourable; but it may at first assume this form, and afterwards become
complicated, and consequently more or less dangerous, owing to
injudicious management, or to various influences over which the mother
has no control.

It generally appears as an epidemic, and at those seasons when
catarrhal complaints are most prevalent, and affects many or several at
the same time. Isolated cases, however, frequently occur, which seem to
prove the disease to be infectious. Some persons deny that it is so.
Mothers and nurses, however, who have not had the disease, will often
contract it from the child under such circumstances, and thus it will
be quickly propagated through the family. The nursing mother will
occasionally take it from the infant at her breast. The child who has
caught it from others whilst at school, and brought home in
consequence, will communicate it readily to his brothers and sisters,
although the disease did not exist previously in the family or
neighbourhood, and was brought from a distant part of the country. All
these instances are surely proofs of its infectious character, and
point out the necessity of caution whenever hooping-cough may present
itself in a family, and the necessity which exists for an early removal
of the unaffected children from the sphere of its contagious influence.
The infectious property diminishes as the disease declines.


MATERNAL MANAGEMENT.--In the mild and simple form of this disease the
medical treatment is one rather of prevention than cure, and the
maternal management consists in assisting, by watchfulness and care,
the fulfilment of this design.

In these slighter cases little more is required of the mother during
the Jirst stage of the disorder (that is, before the cough becomes
spasmodic) than attention to diet, regimen, and the excretions. The
diet should be farinaceous, with milk, or as may be otherwise directed.
The child must be confined to a mild equable temperature; in fact, to
his apartment. It is a popular error to suppose that at this time
change of air is beneficial to the disease: at a later period it
certainly is so, but now injurious, and attended with great risk.
Should the weather be cold, the little patient must be warmly clad, and
flannel worn next the skin; this latter precaution should always be
taken in the winter, spring, and autumn. Purgatives and other medicines
will be required, and ordered by the medical attendant; the chief
attention, however, of the parent must be directed to any change she
may observe in the symptoms, breathing, etc.; she must be all on the
alert to notice the first signs of local inflammation. Of this,
however, we shall speak presently.

During the early part of the second stage, that is, when the cough
becomes spasmodic, assuming its peculiar sound, the same diet and
regimen must be continued, and the same watchfulness observed, lest
any inflammatory symptoms manifest themselves.

Under the foregoing treatment the disease generally runs its course
without any untoward event, and the child recovers perfectly.
Sometimes, however, although the patient is quite well, and the disease
on the decline, the cough still continues. In these cases, and at this
time, it is that change of air often proves so very serviceable. The
sea-side is preferable, if the season of the year permit; and salt-
water bathing, commencing with the warm or tepid bath, and passing
gradually to the cold-bath (if no complication forbid it), will also
prove certainly and rapidly remedial.

Crying, mental irritation, or opposition, frequently bring on a fit;
and even the sight of another in a paroxysm will induce it in those
affected by the disease. Running or other active exercise will
generally cause the fits to be more severe. Young children, too, must
be carefully watched at night, and be raised up by the nurse as soon as
the fit is threatened. These hints the mother should bear in mind.

So much for the simple form of the disease, and that in which it most
frequently and commonly presents itself to our notice: a mild disease;
and, if carefully managed and watched over, certainly not a dangerous
one.

Of what, then, is a parent to be afraid, or against what is she to
guard? Lest other disease insidiously come on, and advance to an
irremediable degree, masked by the cough, without attracting her
attention. This is the great source of danger in hooping-cough. The
physician, in a case of simple hooping-cough, is not in daily
attendance upon his patient, and therefore not present to notice the
commencement or first symptoms of those diseases which so frequently
occur at this time, and the successful treatment of which will mainly
depend upon their early detection, and the decision with which they are
treated. When you hear of a child or several children in a family dying
of hooping-cough, it is not this disease which proves fatal; but death
is caused by some disease of lungs or brain, which has been super-added
to the hooping-cough. The progress of hooping-cough, then, must be
closely attended to by the parent, even in the most favourable cases.

The most frequent complication with hooping-cough is inflammation of
the air-tubes of the lungs. This is extremely frequent during spring
and winter, especially in the months of February, March, and April,
owing to the prevalence of easterly winds at this season. It is not my
intention to detail the symptoms of this affection, only to point out
those which will enable a parent to recognise its approach. A parent
then may take warning, and fear the approach of mischief, when she
observes the fits of coughing become more frequent and more distressing
to the child, and the breathing hurried in the intervals of the
paroxysm; when any exertion or speaking causes increased difficulty of
breathing or panting; when the expectoration becomes less abundant, and
difficult to get up; when there is no longer, or at all events less
frequent, vomiting after the cough, and more or less febrile symptoms
present.

If the lungs themselves are attacked by inflammation, most of the
symptoms already pointed out will occur; the cough will be frequent,
in short paroxysms; the vomiting will not take place; the breathing
will be very quick and hurried; and as the disease advances the hoop
will cease.

If hooping-cough attack a child whilst teething, or from six months to
two or three years of age, it is very common for the brain to suffer,
and convulsions and water on the head to occur, particularly if the
latter disease prevails in the family. Whenever the paroxysm of cough
is increased in violence, the characteristic hoop disappearing, and the
face becomes very livid; the hands clenched, and the thumbs drawn into
the palms; the head hot, and marked fits of drowsiness and languor; and
the child, during sleep, screaming out, or grinding its teeth,--
something wrong about the head ought to be anticipated. Of the
treatment we have here nothing to say, except that the gums must be
carefully examined, and scarified if they require it, and the
temperature of the head reduced by cold sponging, or the application of
a bag of ice when necessary. The chief duty, however, of the parent is
to be alive to these symptoms, and early to detect the incipient
mischief, that by a prompt application of efficient means the accession
of so formidable a malady may be prevented.

To specific remedies for this disease it is scarcely necessary to
allude, after what has been advanced, except by way of warning. In the
simple form of the complaint such medicines are superfluous, or rather
some of them, from their violent properties, most dangerous; in the
complicated forms of the disease they are inadmissible.

The indiscriminate use of purgatives, also, a parent should avoid.
Bowel affections are not an infrequent attendant upon hooping-cough,
and always aggravate the primary disorder.

Of external applications all that need be said is this, that if they
are not violently stimulating they do no harm; if, however, they
contain tartar emetic, in addition to their doing no good to the
disease, they cause unnecessary suffering to the patient, and are
sometimes productive of dangerous and even fatal sores.



Sect. IX.--CROUP.



This disease is one of the most formidable of childhood; sudden
(generally) in its attacks, most active in its progress, and if not
met by a prompt and decided treatment, fatal in its termination. Hence
the paramount importance of parents being acquainted with the signs
which indicate its approach, that medical aid may be secured at the
very onset of the disease. Upon this early application of suitable
remedies every thing depends.


SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either
preceded for two or three days by the symptoms of a common cold,
accompanied with hoarseness and a rough cough; or it may attack with
the most alarming suddenness, during the night for instance, although
the child had been merry and well the previous evening.

Hoarseness, however, is the premonitory and important symptom of
croup; for although it is not every hoarseness that is followed by
this formidable malady, still this symptom rarely attends a common cold
in young children, and therefore always deserves when present the
serious attention of the mother, particularly if accompanied by a rough
cough.

The symptoms or signs of the approach of this disease have been ably
and graphically depicted by the late Dr. Cheyne,

"In the approach of an attack of croup, which almost always takes
place in the evening, probably of a day during which the child has been
exposed to the weather, and often after catarrhal symptoms have existed
for several days, he may be observed to be excited; in variable
spirits; more ready than usual to laugh or to cry; a little flushed;
occasionally coughing, the sound of the cough being rough, like that
which attends the catarrhal stage of the measles. More generally,
however, the patient has been for some time in bed and asleep before
the nature of the disease with which he is threatened is apparent;
then, perhaps without awaking, he gives a very unusual cough, well
known to any one who has witnessed an attack of the croup: it rings as
if the child had coughed through a brazen trumpet; it is truly a tussis
clangosa; it penetrates the walls and floors of the apartment, and
startles the experienced mother--'Oh, I am afraid our child is taking
the croup!' She runs to the nursery, finds her child sleeping softly,
and hopes she may be mistaken. But remaining to tend him, before long
the ringing cough, a single cough, is repeated again and again. The
patient is roused, and then a new symptom is remarked: the sound of his
voice is changed; puling, and as if the throat were swelled, it
corresponds with the cough; the cough is succeeded by a sonorous
inspiration, not unlike the kink in hooping-cough--a crowing noise, not
so shrill, but similar to the sound emitted by a chicken in the pip
(which in some parts of Scotland is called the roup, hence probably the
word croup); the breathing, hitherto inaudible and natural, now becomes
audible, and a little slower than common, as if the breath were forced
through a narrow tube; and this is more remarkable as the disease
advances," etc. etc.

It is unnecessary for me to add to the foregoing picture.


MATERNAL MANAGEMENT.--Having early obtained medical assistance attend
with the strictest obedience to the directions given. And in this
disease, more than any other, it is particularly important that the
mother should give her personal superintendence; for the activity of
the progress of the disease leaves no time to retrieve errors or atone
for neglect. The practitioner may be prompt and decided in the measures
he prescribes, but they will avail little, unless they are as promptly
and decidedly acted upon.

The parent will have her reward; for, if timely aid has been afforded,
and adequate means used, the event will be almost invariably favourable.

ITS PREVENTION.--Croup, when it has once attacked a child, is very
liable to recur at any period before the thirteenth or fourteenth year
of age. It may even do so several times, and after intervals of various
duration. It is very desirable, therefore, that a parent should be
acquainted with the means of prevention.

They consist simply in the following measures:--The careful protection
of the child from cold or damp weather, particularly the north-east
winds of spring following heavy rains. Croup is most prevalent in those
seasons which are cold and moist, or when the alternations of
temperature are sudden and remarkable. If the residence of the child is
favourable to the production of croup, (for instance, near a large body
of water, or in low damp spots,) he should, if possible, be removed to
a healthier situation. Sponging or the shower-bath, with cold water and
bay-salt, with considerable friction in drying the body, should be
commenced in summer, and employed every morning upon the child's rising
from bed. The clothing should be warm in the winter and spring, the
neck always covered, and flannel worn next the skin throughout the
year; but hot rooms, and much clothing when in bed, must be avoided.
The diet must be light and nourishing; no beer or stimulant given; and
the state of the bowels must be carefully watched.

The above precautions are of course particularly necessary to enforce
immediately after a recovery from an attack, for there is a great
tendency to relapse. If the attack takes place during the winter or
spring months, the invalid must be kept, until milder weather, in the
house, and in a room of an equable and moderately warm temperature. If
in the summer, change of air, as soon as it can be safely effected,
will be found very useful.



Sect. X.--WATER IN THE HEAD.



Water in the head is a formidable disease, and not unfrequent in its
occurrence. It is often destructive to life, and the instances are
numerous in which it has appeared again and again in the same family,
carrying off one child after another, as they have successively arrived
at the same age.

But notwithstanding its frequency and fearful character, a mother may
do much to overcome a constitutional predisposition to this disease,
and thus prevent its appearance; as also she may assist greatly in
promoting its cure, when it does occur. Hence it is most important that
a mother should be acquainted with the measures of prevention; and
also, when it does manifest itself, that clear and accurate information
should be possessed, upon what may be said to constitute the maternal
management of the disorder.


ITS PREVENTION.--Whenever there is found to exist in a family a
predisposition to this malady, one or more children having suffered
from it, a mother must make up her mind, and in the strictest sense of
the word, to be the guardian of the health of any child she may
subsequently give birth to. And not only during the period of infancy,
but during that of childhood also, must she continue the same careful
and vigilant superintendence.

The infant must be brought up on the breast, and if the mother is not
of a decidedly healthy and robust constitution, she must obtain a
wet-nurse possessing such qualifications. The breast-milk, and nothing
beside, must form the nutriment of the child for at least nine months;
and if the infant is delicate or strumous, it will be prudent to
continue it even six months longer. When the period arrives for the
substitution of artificial food, it must be carefully selected; it must
be appropriate to the advancing age of the child; nutritious and
unirritating. Good air and daily exercise, and the bath or sponging,
are of much importance; in short, all those general measures which have
a tendency to promote and maintain the tone and general health of the
system, and thus induce a vigorous and healthy constitution, and to
which reference has been so fully made in the first chapter of this
work, must be strictly regarded and followed out by the parent.

The condition of the digestive organs must be the mother's especial
care. Costiveness must be guarded against; and if at any time the
secretions from the bowels indicate the presence of derangement, the
medical attendant must be applied to, that appropriate remedies may
without delay be exhibited. Their disordered condition is frequently
productive of head-disease. Again and again have I clearly traced the
origin of the complaint, of which I am now writing, as more
immediately resulting from disorder of the digestive apparatus. To a
child thus predisposed to water in the head, the healthy state of these
organs is not only of first consequence, but any deviation from health
to be dreaded, to be immediately attended to, and guarded against in
future; and, as there is a great liability to these attacks at the time
of weaning, the above remarks especially apply to that period, when due
attention must be particularly paid to the plan of diet adopted.

During teething the mother must be especially watchful, for it is at
this time that the disease so commonly appears; the irritation produced
by this process being a frequent exciting cause. Every thing,
therefore, that will tend to allay excitement of the system, must be
strictly enforced, as well as all causes avoided, which would produce
derangement of the stomach and bowels. The head should be kept cool.
For this purpose it must be sponged night and morning throughout the
whole period of teething; a horse-hair pillow used in the cot; and
nothing but a light straw hat should be worn, except in winter, The
diet should be moderate, and carefully regulated after leaving the
breast, and the child should be as much as possible in the open air.
The mouth must be occasionally examined, and if the gums become hot or
distended, they must be scarified or lanced, as may be advised. If the
parent finds at any time an unusual heat about the head, the medical
man must be at once consulted; or if there is watchfulness or
indisposition to sleep at the proper periods, or frequent startings in
the sleep, irritability of temper, and much crying, danger should be
apprehended, and prompt and judicious means employed.

Eruptions about the head, or sores behind the ears, discharging more
or less, will sometimes make their appearance just before the cutting
of a tooth, and disappear after it is cut; or it will sometimes happen
that, if not interfered with, they will continue throughout the whole
period of dentition. Great caution should always be exercised in
reference to these eruptions in all children; and when there is a
predisposition to water in the head, it is dangerous to interfere with
them at all, except they run to such an extent as to become very
troublesome. The sudden healing of these cutaneous affections has again
and again been followed by head-disease. They are unsightly in the
eyes of a parent, but it must be recollected that they render the
situation of such children much more safe; and when teething is
completed they will generally disappear spontaneously; or, if they
should not, they will readily do so by proper medical treatment. I have
no doubt that many a child's life has been saved by the appearance and
continuance of these eruptions; and so sensible are medical men of the
benefit derived from them, that in individuals in whom they do not
appear, and in whose family there exists a predisposition to the
disease now under our consideration, an issue or seton, in the arm or
neck, has sometimes been made, and had a remarkable influence in
warding off this affection. Dr. Cheyne refers to the circumstance of
ten children in one family having died of this disease; the eleventh,
for whom this measure was employed, having been preserved.

Stimulants, throughout the whole period of infancy and childhood, and
of every description, must be prohibited. Children nursed by drunken
parents, and who have indulged in the use of spirituous liquors during
suckling, are never healthy; are the frequent subjects of convulsions,
and many of them die eventually of water in the head. The practice of
administering spirits to the child itself; a habit unfortunately not
very uncommon among the lower classes; produces a similar result.
Narcotics may operate in a like manner: they derange the whole system
when persevered in, particularly affecting the brain; promote disease;
and sometimes give rise to the one in question. This remark should be
borne in mind by the mother, as Godfrey's Cordial and other
preparations of opium are too often kept in the nursery, and secretly
given by unprincipled nurses to quiet a restless and sick child.

All causes of mental excitement should be carefully avoided, and
particularly the too early or excessive exercise of the intellectual
faculties. If the child be endowed with a precocious intellect, the
parent must restrain rather than encourage its exercise. Nothing is
more likely to light up this disease in a constitution predisposed to
it, than a premature exertion of the brain itself.


MATERNAL MANAGEMENT OF THE DISEASE.--The early detection of this
disease is of great importance. The chances that the medical treatment
will terminate successfully much depend upon the early and prompt
application of remedial means. The reason why these cases have so often
terminated fatally has arisen from the physician being consulted when
irremediable mischief had already taken place. It would be difficult,
however, to point out the signs of its approach in all its forms (for
this disease does not always commence in the same way, sometimes with
fever, etc.), still it most frequently occurs preceded by certain
striking and well-marked symptoms; and whenever the following are
noticed by the parent apprehensive of mischief, she should at once send
for her medical adviser:--watchfulness, or starting from sleep with a
cry of alarm; prolonged screaming without any obvious cause; moaning
and drowsiness; rolling the head from side to side on the nurse's
arm, or thrusting it back against the pillow; knitting the brows and
aversion from light, with heat of head, and constant carrying the
little hand up to it; half closing the eyelids, and frequent vomiting.

The chief and principal point in the maternal management (for it
includes every other) is promptly and faithfully to administer the
remedies prescribed by the medical attendant. A vigilant maternal
superintendence is more necessary in this than almost any other
disease; and it is highly desirable, therefore, that the mother should
have a day and night nurse--individuals upon whom she can depend. A
careful notice of symptoms and changes in the patient, in the intervals
of the medical man's visits, and a true and faithful report to him upon
his return, are of essential importance. A sleepy nurse will neglect
the application of the most important remedies, and necessarily give an
unfaithful report of symptoms; hours the most valuable to the child's
well-doing are thus lost, and the chances of saving its life worse than
problematical.

The temperature of the room should be kept rather cool than warm, and
the bed-clothes only sufficient to preserve the natural heat of the
body. Strong light must be excluded. Great quiet should be observed.
Freedom from all excitement of the senses, and irritation of the
temper, should be carefully avoided: this is particularly necessary
where the child is naturally of a quick and sensitive disposition.

All the excretions must be put aside for the inspection of the
physician, but not kept in the sick chamber, which must be well aired,
and perfectly free from closeness. The regimen must be only such as is
ordered, and any departure therefrom will be attended with mischievous
consequences. During the early periods of the disease, all that is
required are cooling diluents, given frequently, and in small
quantities at a time; and upon approaching convalescence great
carefulness must be paid to the amount of nourishment allowed, lest the
disease be rekindled: strict compliance, therefore, to medical
directions must be given.

A very useful and indeed powerful remedy prescribed in this disease,
is sometimes rendered utterly useless from a want of a persevering and
also proper mode of applying it, viz. cold applications to the head.
It is to be effected either by means of cloths kept constantly wet with
cold water, or evaporating lotions; or by means of a bladder containing
pounded ice mixed with water. If the two former are employed they
require frequent renewal, or they become dry, hot, and more injurious
than useful; and whichever is used, it must be kept in constant contact
with the forehead, temples, and upper part of the head. Here is another
error; they are seldom used large enough, and only partially cover
these parts. With the further view of keeping the head cool, and
preventing the accumulation of heat, a flat horse-hair pillow should be
employed, and the head and shoulders somewhat raised.

Perseverance in the measures prescribed, even when the case appears
beyond all hope, must ever be the rule of conduct. Recovery, even in
the most advanced periods of the disease, in cases apparently
desperate, occasionally takes place. There is great reason to fear that
many a child has been lost from a want of proper energy and
perseverance on the part of the attendants in the sick room. They fancy
the case is hopeless, and, to use their own expression, "they will not
torment the child with medicine or remedies any longer."

"Whilst there is life, there is hope," is a sentiment which may with
great truth be applied to all the diseases of infancy and childhood.
Striking, indeed, are the recoveries which occasionally present
themselves to the notice of medical men; and those individuals may with
great justice be charged with unpardonable neglect who do not persevere
in the employment of the remedies prescribed, even up to the last hours
of the child's existence.





INDEX.



Ablution, or sponging, 125.

Abstinence, its good effect, in flatulence and griping in the infant,
50. 226.

Accidents and diseases which may occur to the infant at birth or soon
after, 187.

Acids, injurious to the teeth, 159.

Air and exercise, in infancy, 83.
--, in childhood, 89.
--, its importance to the mother whilst a nurse, 33.

Animal food, in childhood, 55.
--, its injurious effects upon the young and delicate child, 58.

Aperient liniment, 107.
--, medicine, 97.
--, poultice, 104.

Artificial feeding; the causes rendering it necessary, 34.

Artificial food; the proper kind for the child before the sixth
month, 35.
--; the mode of administering it, 39.
--; the quantity to be given at each meal, 42.
--; the frequency of giving it, 43.
--; the posture of the child when fed, 43.
--; the proper kind for the child after the sixth month, to the
completion of first dentition, 44.
--; the kind most suitable under the different complaints to which
infants are liable, 48.


Bath, the cold-water, plunge-bath, 118.
--, the shower, 123.
--, the warm, 128.
--, rules for the use of the warm bath, 131.

Bathing, sea, 120.
--, and cleanliness, during infancy, 72.
--, during childhood, 75.

Bleeding, from leech-bites, how controlled, 113.
--, from the navel string, 201.
--, navel, 203.

Blisters, mode of application, 114.

Bottle, nursing, 40.

Bowels, disorder of, in the infant, 208.

Breasts of the infant, swelling of, 195.

Breathing, how affected by disease, 175.


Calomel, danger in its use, 167.
--, injurious to the teeth, 160.

Carminative, Dalby's, 111.

Carriage, "a good carriage;" how best obtained, 95.
--; the sad results of the mode frequently adopted, 91.

Castor oil, 99.

Choice of a wet-nurse, rules for, 28.

Cleanliness and bathing, 72.

Clothing, in infancy, 78.
--, in childhood, 81.

Clysters, what kind best for children, 105.
--, mode of application, 106.

Cold, infants very susceptible of, 78.

Convulsions, 112, 167.

Cork-nipple teat, 41.

Costiveness, in infancy, 50. 229.
--, in childhood, 231.

Cough, as a sign of disease, 175.

Countenance, in health, 165.

Countenance, in disease, 165.

Croup, 176. 286.


Dalby's Carminative, 111.

Damp, induces disease in the infant, 85.

Dentition, easy, 136.
--, difficult, 139.

Diarrhoea, in the infant, 50. 227.

Dietetics of infancy, 2.
--, of childhood, 54.
--, general directions upon, and of animal food, 55.
--, sugar, 60.
--, salt, 61.
--, fruits, 62.
--, water, 63.
--, wine, beer, spirits, 63.

Diet, under the different complaints to which infants are liable, 48.
--, and regimen of a wet-nurse, 31.

Digestion, in the infant; time requisite for its performance, 42.

Discharge, from the eyes of the infant, 196.

Disease, the importance of its early detection, and hints upon, 162.

Dress, in infancy, 78.
--, in childhood, 81.


Enema. See Clysters.

Eruptions on the skin in infancy; how best prevented, 74.
--, about the head, and sores behind the ears, 295.
--, during teething, 147.

Exercise and air, in infancy, 85.
--, in childhood, 89.
--, horse-exercise; its importance to delicate children, 89.

Eyes, of the infant, discharge from, after birth, 196.


Fever, scarlet, 239.

Flannel clothing, 80.

Flatulence and griping in the infant, 50. 208. 226.

Food, for infants. See Artificial Feeding.
--, for children. See Dietetics of Childhood.
--, and regimen, for nurses, 31.

Fruits, 62.


Gestures, of the infant, in health and disease, 169.

Godfrey's cordial, 111.

Grief, its effects upon the mother's milk, 34.

Gums, of the infant in difficult dentition, the importance of their
being lanced, 140.


Hare-lip, how the infant may be nourished with this defect, 199.

Head, of the infant, swellings upon, when born, 193.

Hereditary transmission of scrofula and consumption; the best antidote
to, 20.

Hooping-cough, 275.

Horse-exercise, its importance to delicate children, 89.

Hunter's, Dr., experiments on the effects of wine upon children, 64.


Jaundice, in the infant after birth, 204.


Ice, how to be applied to the head, 127.

Indigestion, in the infant, 208.

Infant, food for. See Artificial Feeding.
--; when still-born, how to be managed, 187.
--; of injuries received during its birth, 193.
--; retention of its urine after its birth, 194.
--; swelling of the breasts after birth, 195.
--; discharge from the eyes, 196.
--; hare-lip, 199.
--; bleeding from the navel string, 201.
--; ulceration, or imperfect healing of the navel, 202.

Infant; bleeding from the navel, 203.
--, jaundice in, 204.
--, tongue-tied, 205.
--, moles and marks on the skin, 206.

Inflation of the lungs of the infant, the mode, 190.


Lavement, the proper kind for infants and children, 105.

Leech-bites; the mode of controlling the bleeding of, 113

Liniment, aperient, 107.

Looseness, 208.

Lungs of the infant, inflation of, 190.


Magnesia, 102.

Manna, 101.

Maternal nursing, 3.
--, management of the diseases of children, 184.

Measles, 258.
--, how distinguished from scarlet fever and small-pox, 255.

Medicine, aperient, 97.

Mercury, 107.

Milk, the mother's; how to be preserved healthy during suckling, 3.
--; deficiency of, 11.
--; drying up of, 54.
--, cow's; for infant's food, 35.
--, ass's; for infant's food, 37.
--, all kinds of, sometimes disagrees with the infant, 39.

Mind, anxiety of; effects upon the parent's milk, 24.

Moles and marks on the skin, 206.

Mothers, their duty in relation to suckling, 3.
--; those who ought never to suckle their children, 20. 24. 26.

Motions of the infant; what the appearance of, and how frequent, in
health, 99. 172.
--; their deranged condition, a sign of disease, 173.


Napkins, the infant's, 74.

Navel, bleeding from, 203.
--, ulceration or imperfect healing of, 202.

Navel-string, bleeding from, 201.

Naevi, or moles, 206.

Nurses, wet, rules for the choice of, 28.
--, diet and management of, 31.

Nursery medicines, 97.

Nursing, maternal, 3.
--; the plan to be adopted for the first six months, 7.
--; the plan to be followed after the sixth month to the time of
weaning, 9.
--; the injurious effects to the mother of undue and protracted
suckling, 15.
--; the injurious effects of undue and protracted suckling to the
infant, 18.


Opiates, 110. 297.
--, in teething, dangerous, 145.


Passion, its effect upon the breast-milk, 33.

Porter, of its use, by the mother during suckling, 1
--, when mischievous, 4.

Poultice, bread-and-water, how made, 116.
--, mustard, how made and applied, 115.

Purgative medicine, 97.


Retention of urine in the infant, 194.

Rhubarb, 103.

Rules for nursing, 3.
--, for the use of the warm bath, 181.


Salt, as a condiment, 61.

Scarlet fever, 239.
--, how distinguished from measles, 245.

Scrofulous constitution, 180.

Sea-bathing, 120.

Seasons (the), their influence in producing particular forms of
disorder, 178.

Shower-bath, 123.

Signs of health in the infant, what, 168.
--, of disease in the infant, what, 169.

Skin of the infant, importance of its perfect cleanliness, 72.
--, friction and sponging of, beneficial, 73.

Sleep, during infancy, 66.
--, childhood, 69.
--, how affected when the child is ill, 171.

Small-pox, 262.

Spirituous liquors, their pernicious effects to children, 63. 296.

Sponging, 125.

Spoon-feeding, 39.

Still-born, 187.

Stomach and bowels, their derangement, a fruitful source of disease,
208.
--, disorders of, in the infant at the breast, 210.
--, disorders of, at the period of weaning, 217.
--, disorders of, in the infant brought up by hand, 221.
--, their treatment, 222.

Stools of the infant, what the appearance of, and how frequent, in
health, 99. 172.
--, their deranged condition, a sign of disease, 173.

Suckling, plan of, 3.
--, by a wet-nurse, 27.

Sugar, 60.

Swelling of the breasts in the infant, 195.


Teat of the cow--the artificial--the cork, 41.

Teeth, of the permanent or adult teeth, 148.
--, the manner in which they appear, 148.
--, their value and importance, 152.
--, their management and preservation, 154.

Teething, easy; management of the child, 136.
--, difficult; hints upon, 139.

Tight-lacing, evils of, 92.

Tongue-tied, 205.


Ulceration or imperfect healing of the navel, 201.

Urine, retention of it in the infant after birth, 194.


Ventilation of the sleeping-rooms of children, 84.
--, its importance in sickness, 246.


Walking, the best mode of teaching a child, 87.

Warm bath, 128.
--, rules for the use of, 131.
--, directions for the use of, when the infant is stillborn, 192.

Water, as a beverage for children, 63.
--, in the head, 291.

Weaning, the time when to take place, 51.
--, the mode of effecting it, 52.
--; drying up the mother's milk, 53.

Wet-nurse suckling, 27.
--, rules for the choice of, 28.
--, diet and management of, 31.

Wine, its pernicious effects in childhood, 63.

Worms, 234.





THE END.






Also by Dr. Bull,




HINTS TO MOTHERS

FOR THE

MANAGEMENT OF THEIR HEALTH.


Second Edit, greatly enlarged, foolscap 8vo.
7s. cloth lettered.



Opinions of the Press.


"A very valuable compendium for all who expect to become mothers.--In
the short preface prefixed to this little work, Dr. Bull judiciously
remarks, that feelings of delicacy often prevent many young married
females from making to their medical attendant, a full disclosure of
the circumstances connected with their state, and which render medical
assistance necessary. The object of the work is to meet this
difficulty, by furnishing a species of information for which married
women are often very unwilling to ask, although they readily search for
it in books. The matter of Dr. Bull's treatise is arranged completely
in a popular form--in one that is best calculated to be understood by
the fair readers to whom it is addressed; and contains a variety of
useful information, so clearly conveyed as to render it a very valuable
compendium for all women who expect to become mothers."--Lancet.


"A valuable monitor to the fair sex. It contains so much useful
advice for every woman likely to become a mother, that married men
would do well to provide it for their partners."--Spectator.


"This little volume is the benevolent contribution of good sense and
professional skill, to the well-being of those who have the strongest
claims on our sympathy. Unfortunately a vast mass of erroneous notions
exists in the class to whom it is addressed; to which, and to the
concealment prompted by delicacy, until the time for medical aid is
gone by, we are indebted for very much of the danger and suffering
incident to the periods they are destined to pass through. Dr. Bull, in
the true spirit of a physician and a gentleman, has by his perspicuous
statements removed the first, and by his judicious and simple
directions, anticipated the last of these fruitful sources of evil.
There is no mother that will not be heartily thankful that this book
ever fell into her hands; and no husband who should not present it to
his wife. We cannot urge its value too strongly on all whom it
concerns."--Eclectic Review.


"We recommend it to our readers; and they will confer a benefit on
their new-married patients by recommending it to them."--British and
Foreign Medical Review.


"Dr. Bull has performed a very kind and important office in the
publication before us."--Patriot.


"We never read any popular treatise, or directions rather, that bear
more strongly the stamp of scientific and expert mental knowledge. The
mere reading of our Author's book will do more good in the way of
encouraging the fearful, and banishing nervous anxiety, than a whole
conclave of the wisest and most sanguine matrons that society can
anywhere bring together."--Monthly Review.


"This little manual will prove useful exactly in proportion to the
extent of its circulation."--Medical Gazette.





End of the Project Gutenberg EBook of The Maternal Management of Children,
in Health and Disease., by Thomas Bull, M.D.

*** 