UNITED STATES OF AMERICA. ME& FOUNDED 1836 WASHINGTON, D.C. GPO 16—67244-1 THE MATERNAL MANAGEMENT OF CHILDREN. ^ THE MATERNAL MANAGEMENT CHILDREN, HEALTH AND DISEASE; THOMAS BULL, M.D., MEMBER OF THE ROTAL COLLEGE OF PHYSICIANS, AUTHOR OF ' niNTS TO MOTHERS " FOR THE MANAGEMENT OF THEIR HEALTH, &C. &.C. ifrom ti>e Efmlr Sontron Htiitfon. . -MSJ^' PHILADELPHIA LINDSAY &.BLAKISTON, 1849. ,A '-^/v U I ?4 7 PREFACE TO THE THIRD EDITION. A considerable portion of the present edition has been re-written, several new chapters added, and the whole work revised with great care, and with an anxious desire to make it as useful as possible. It has been a great object so to arrange the con- tents that they may be readily got at, and, to aid the reader still farther, a copious index has been ap- pended. If any one should think that the author has entered too much into details, he has only to observe that this was done at the request of a missionary in CafFreland, and, from communications which have been received since the first edition was published, he cannot regret that he complied with the suggestion. Hence he wishes it to be distinctly remembered, that he has not written merely for those who are within reach of i good medical and surgical advice, but for those also 1* vi PREFACE. whose lot has been cast in uncivilized places, and where they are totally unable to obtain professional assistance. Some of the subjects introduced are necessarily touched upon in the writer's "Hints to Mothers:" there they have, however, been only briefly alluded to; to this work their more full exposition properly belongs. Finslury Square, 1848. CONTENTS. INTRODUCTORY REMARKS ON THE GREAT MORTALITY OF CHILDREN, AND THE CONSEQUENT DUTY OF MOTHERS. PART I. THE MANAGEMENT OF CHILDREN IN HEALTH. CHAPTER I. MATERNAL NURSING. Sect. Page. I. The Duty and Advantages of the Mother nursing her Infant, . . • • • . 2G II. Of Mothers who ought not to suckle, . . 29 III. Rules for nursing the Infant, . • • .34 IV. Rules for the Health of the Nursing Mother, . . 44 V. The Injurious Effects to the Mother and Infant of un- due and protracted suckling, . . .51 VI. Of Weaning, . . . • • .57 vm CONTENTS. CHAPTER H. OF WET-NURSES. Sect. raSe" I. Choice of a Wet-nurse, . • • .63 II. Diet of a Wet-nurse, . . • • .66 III. General Directions for the Management of a Wet-nurse, 68 CHAPTER III. ARTIFICIAL FEEDING. I. The Pood suitable until the first Teeth appear, . 74 II. The Food suitable after the first Teeth have appeared, 83 CHAPTER IV. DIET OF CHILDHOOD, VIZ. FROM THE SECOND YEAR TO THE EIGHTH. I. General Directions, II. Animal Food, III. Vegetables, .... IV. Sugar and Salt, V. Fresh and Dried Fruits and Sweetmeats, VI. Water, Wine, Beer, and Spirits, 90 93 9G 98 100 103 CHAPTER V. GENERAL MANAGEMENT OF INFANTS UP TO THE SECOND YEAR, AND OF CHILDREN UP TO THE EIGHTH. I. Of the Apartments and Servants, II. Sleep, 107 120 CONTENTS. IX Sect. III. Bathing and Cleanliness, IV. Clothing, V. Air and Exercise, Page. 125 133 139 CHAPTER VI. OF MEDICINES--THEIR USE AND ABUSE. I. Aperient Medicine, .... . 154 II. Calomel, . 162 III. Opiates, . 164 IV. Leeches, . 168 V. Blisters, . 171 VI. Poultices, . 173 VII. Baths, CHAPTER VII. . 175 OF VACCINATION, . . 188 CHAPTER VIII. MANAGEMENT DURING TEETHING, AND OF THE PERMANENT TEETH. I. Management of the Infant during Teething, . . 197 II. Hints on the Permanent Teeth, . . .207 CONTENTS. PART II. MANAGEMENT OF CHILDREN IN DISEASE. CHAPTER IX. Page. GENERAL REMARKS ON ILLNESS, . • 218 CHAPTER X. HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER. Sect. I. Signs of Health, . . . • -227 II. Signs of Disease, ..... 227 III. Other circumstances which assist in the early detec- tion of Disease, ..... 240 CHAPTER XI. ACCIDENTS ANr/*)ISEASES WHICH MAY OCCUR AT BIRTH, OR SOON AFTER. I. Still-born, .... II. Injuries received during Birth, III. Retention of the Urine and Motions, IV. Swelling of the Breasts, V. Inflammation of the Eyes, . VI. Hare-lip, .... VII. Bleeding from the Navel-string, VIII. Ulceration and Bleeding from the Navel, . 247 . 252 . 252 . 253 . 254 . 255 . 256 . 257 CONTENTS. XI Sect. IX. Jaundice, X. Tongue-tied, XI. Moles and Marks on the Skin, Page. 250 253 2G0 CHAPTER XII. OTHER ACCIDENTS OF INFANCY AND CHILDHOOD. I. Scalds and Burns, . 263 II. Swallowing boiling Water, . . 265 III. Bruises, .... . 266 IV. Wounds, .... . 267 V. Broken Limbs, . 269 VI. Sprains, .... . 270 VII. Foreign Bodies in the Ear and Nose, . 271 VIII. Choking, . . 273 IX. Stings of Insects, . . . . . 275 X. Poisons, .... . 276 CHAPTER XIII. DISORDERS OF THE STOMACH AND BOWELS OF INFANTS. I. In the Infant at the Breast, . . . .280 II. At the period of Weaning, .... 284 III. In the Infant brought up by Hand, . . .287 IV. Maternal Management of these Disorders, . . 288 CHAPTER XIV. DISEASES OF CHILDREN. I. Colds and Coughs, II. Costiveness, 293 295 Xll CONTENTS. Sect. III. IV. V. VI. VII. VIII IX. X. XL XII. XIII. XIV. XV. XVI. XVII. XVIII. XIX. XX. Prolapsus or Protrusion of the Bowel, Rupture, Worms, Thrush, Involuntary Discharge of Urine in the Ni Eruptions, Red-gum, Tooth-rash, Sore Ears, Milky-scale, Nettle-rash, Dandruff, Ring-worm, Inflammation and Abscess in the Ear, Deformities: Of the Feet, Of the Chest, rht, Bleeding from the Chilblains, Scarlet Fever, Measles, Small-pox, Chicken-pox, Hooping-cough, Croup, Water in the Head, Convulsions, Nose, CHAPTER XV. ON THE PREVENTION OF SCROFULA AND CONSUMPTION, 380 THE MATERNAL MANAGEMENT OF CHILDREN IN HEALTH AND DISEASE. INTRODUCTORY REMARKS ON THE GREAT MORTALITY OF CHILDREN, AND THE CONSEQUENT DUTY OF MO- THERS. One child in five dies within a year after birth, and one in three before the completion of the fifth year. This is the average rate of mortality for the whole of England and Wales. That of some of our great towns and of the metropolis gives a still more frightful proportion. It is true this book is not likely to be consulted by mothers who are so unfortunately placed as to justify the alarming expectation of losing one out of three before their children have learnt to call them by their names. But it is certain that the condi- tions which alone render the child vigorous at its birth, and enable it to advance to a happy maturity and a long life, are neither understood nor attended 2 14 MORTALITY OF CHILDREN to, and that they cannot be neglected with impunity. There exists no means of ascertaining the rate of mortality in the children of the class I suppose my- self to address. It may not be any thing like one in three before the age of five years. But whatever it is, it may be greatly diminished. The distress of witnessing a suffering infancy cut short by an early death, just as the child was beginning to reward all the parent's care and anxiety, might be pre- vented in multitudes of cases. But the early death of offspring is not the only penalty that must be paid. For, what is still worse, they survive only to struggle with all the consequences of weak consti- tutions, and to perish just as they begin to fulfil all the hopes of their friends. Or, if this does not happen, they carry through life, as long as it lasts, a state of health which deprives their minds of elas- ticity, their tempers of serenity, and their duties of enjoyment. Since the diligent observance of what is to be recommended to her involves so great a reward, and its neglect such a painful retribution, no appeal to the mother's sense of duty can be needed. It is true she must be content to take the representations here given on trust, unless she extend her studies beyond these pages. If she is alive to her respon- sibilities, she will not withhold her earnest and conscientious attention, until she has mastered the evidence on which the medical profession urge com- pliance with all the means of ensuring health. AND DUTY OF MOTHERS. 15 The causes which affect the health and life of offspring fall under two heads: those which have reference to the state of the parents before the birth of the child; and those which act directly upon the child after the commencement of its independent existence. The first class includes, of course, those tenden- cies to disease which are derived from both parents at the time of conception, and those which act through the medium of the mother's system alone, and which are especially under her control, viz., her state of health and conduct during pregnancy. Of the in- fluence of those which operate at the time of con- ception the most striking contrasts are met with in different families. Amongst the wealthy of the land, where the nurture of the body is sedulously pursued, and under the greatest advantages, it is sometimes found to be difficult, and in many in- stances impossible, to rear the children to-maturity. Consumption, or strumous disease in one or other of its manifold phases, or some other hereditary dis- order, carries off one child after another; the utmost care not being more than enough to save one sickly child. Whilst in the families of another class, and where the external circumstances are not so fa- vourable to the cultivation of health, you may see one child after another born with a perfectly healthy system, and growing up to a vigorous manhood, such a thing as disease being scarcely known in their nursery, if you except those disorders which 16 MORTALITY OF CHILDREN all in infancy are more or less liable to. The dis- ease in the former case is transmitted from the pa- rents to the offspring,the stock is unhealthy; whilst in the latter, the children are healthy because the constitutions of those from whom they have derived their being are so. External circumstances and management will not explain the different result; in- deed we have supposed them in favour of the delicate and sickly. In all ages this fact of hereditary influ- ence upon the constitution of offspring has been admitted; and although here and there you may meet with an apparent exception, the general rule holds true. If this exception be traced on for a few years, it will sometimes prove to be no exception at all, for hereditary disease after awhile manifests itself. Its seeds had evidently existed at birth, and have only been lying dormant in the system. But over this source of mischief to infant life, I confess the mother has little immediate control. She has, how- ever, a very absolute control over those tendencies which arise from her conduct and state of health during the pregnant state. • The young mother is, perhaps, little aware how much the health and vigour of her expected off- spring depend upon her care and prudence, and how she may entail on it the evils of a weak, suffering, and brief existence by an ignorant or wilful neg- lect. Let it be impressed on her mind that she must consider herself a mother, not only from the birth of her child, but even from the first moment AND DUTY OF MOTHERS. 17 of its conception, and that from that moment her du- ties commence. "Phj'sical education commences with the pregnancy of the mother. There is so remarkable and intimate a connexion between the child and its parent, that it is difficult to say whether any important change can take place in the physical or mental condition of the mother, which is not lia- ble to produce some corresponding change upon the condition of the child; and even supposing some physiologists to have carried the theory of this con- nexion too far, yet the mere possibility of such im- portant consequences as are involved in its being true, ought to be quite sufficient motive with every rational woman for the extremest discretion. It is certain, however, that the future health and consti- tution of the offspring are greatly, though it may be to an indefinite extent, dependent upon the conduct of the mother. If she carefully adopts the means of management to which allusion has been made, experience shows that she takes the most likely steps to ensure a healthy progeny. If, however, she is careless and negligent upon this head, and also fails in attention to the measures which her new condi- tion demands, perhaps indulging in thatcourse, which under ordinary circumstances would be directly op- posed to the maintenance of health, her child will inevitably be variously and injuriously affected, these causes operating through her system upon that of the child."* But this subject is one which concerns * Hints to Mothers, p. 5. 18 MORTALITY OF CHILDREN the parent's health, and does not immediately be- long to the presenUnquiry, and has been fully dwelt upon in the work just quoted. I need only once for all observe, that the great aim and object of the mother ought to be, to maintain the general health in the state of the greatest vigour, and that this can only be accomplished by a daily and strict compli- ance with the laws of health. One word only in regard to the mental health of the mother. It is of curious significancy that in the lower animals, habits which are the result of training in the parent will manifest themselves in the young without that process—as, for instance, particular modes of hunting. It is quite agreeable to analogy, to think that the disposition and temper of the expected offspring may be influenced (inde- pendently of its bodily healthiness) by the moral feelings which the mother either permits or culti- vates in herself. This consideration may well be allowed to give additional energy to all efforts of self-government on the part of those who expect to be mothers; though irascibility, ill-temper, and all the other foes to cheerfulness and peace, had better be encountered and subdued before this fresh re- sponsibility arrives. Of the causes which after birth act directly upon the system of the child, and undermine its health, it is not too much to affirm that by far the greater part are owing to ignorance and mismanage- ment. The infectious and unavoidable diseases to AND DUTY OF MOTHERS. 19 which infantile life is liable, are of course produc- tive of a certain amount of mortality; but this bears no proportion whatever to that produced by the causes just mentioned. That the latter are the grand source of destruction (however unwilling we may be to admit it,) the experience of the past and present times afford most undeniable proof. If it would not tire the reader, facts might be given of the most striking character. To mention one exam- ple only. About a century ago the workhouses in London presented the astounding result of twenty- three deaths in every twenty-four infants under the age of one year! In consequence of a parliamen- tary inquiry, an improved system of management was adopted, and the proportion of deaths was quick- ly reduced from 2600 to 450 a year. In these in- stitutions alone, then, there was an annual loss of 1150 lives clearly traceable to ignorance and mis- management. The various returns of the causes of death which have been compiled from time to time, not only in England but in various parts of the con- tinent of Europe, most unequivocally show that in- fant existence is mostly cut short by a want of the necessaries of life and of rational procedure, than by causes which cannot be avoided. It is very manifest to those who are at the post of observation, that few families, even of the wealthier class, act on the principles and laws of health. Hence in some the services of a medical man are scarcely ever re- quired, whilst in others he is scarcely ever out of 20 MORTALITY OF CHILDREN the house. It must not be said that the children of the two families have not equally healthy constitu- tions. The observation of many years has proved that this explanation will not always apply. The real secret of the difference is traceable to the kind of domestic treatment followed in each. Again and again have I seen a delicate and sickly child become vigorous and healthy under a judicious system; whilst in another family, the child that was born strong and healthy has withered, pined, and died, simply from bad management. Here, surely, the probabilities were in favour of the latter. Or it may be, the first-born child grows up delicate and weak- ly; but the parents are wise enough to use their dear- bought experience, and the adoption of a more ra- tional course secures a better lot for the future chil- dren. Such instances unequivocally prove that health is not a mere matter of chance, but the na- tural reward of an intelligent and persevering pru- dence. Then again, in reference to teething and to those complaints of infant life to which all are more or less subject, it is most important that the mother should distinctly understand that the adoption from the first of a mode of management in accordance with the nature and wants of the infant constitution, is by far the most effectual way to diminish their danger. A large proportion of the diseases which destroy life in early infancy are more or less direct- ly connected with the condition of the digestive or- AND DUTY OF MOTHERS. 21 gans and bowels, and one of its principal sources of derangement is undoubtedly errors in diet. Mis- taken kindness, sacrificing the health of the child to the indulgence of the false love of the parent, constantly occasions this evil. I have seen a child, who, from the careful management of the mother, had never had a day's illness, sustain an attack of diarrhoea which endangered its life, from the father giving an improper article of food. Now this mis- take, in a minor degree, is constantly practised by parents, and, although the mischief may not be manifested so quickly, a sure and permanent injury is being inflicted. The consideration of all the points in which " bad management" may be exemplified, would be pre- mature in an introductory chapter. But let us take that of ventilation. The want of it, in the apart- ments occupied by children, is fruitful of evil. To be convinced of the influence of atmosphere on health, it is only necessary to consult the tables of the Re- gistrar General. Take two districts, Lewisham and Liverpool, for instance. The mortality of the former compared with that of the latter up to two years of age, is only as five to eight, or one out of four in the former, and two out of five in the latter. The significance of this inequality in the two con- trasted localities is found in the difference of circum- stances which characterizes them respectively. The Lewisham district, not densely populated, but open and airy, and in part situated on hills, is preserved 22 MORTALITY OF CHILDREN from the effects of a stagnant and impure atmos- phere, and to a great extent from those of imperfect drainage; its inhabitants are also raised above the squalid poverty which almost of necessity includes in its mode of existence the greatest number of deleterious influences; while in Liverpool all these causes of disease operate with great intensity. Now, on a smaller scale, the same state of things may be found to exist in the nurseries of the rich: and what mothers have to be convinced of is, that very much rests with themselves, whether the homes of their children will bear a resemblance to Lew- isham or Liverpool. In the healthiest neighbour- hood much may be done to emulate the unwhole- someness of a Liverpool cellar. And in localities where necessity, not choice, compels her to re- side, the mother may, by judicious arrangements, successfully combat all that is unfriendly to health and long life. It is enough that most of the condi- tions on which the health of offspring depends can be more or less completely secured by the gene- rality of parents. They may not be able to remove to a detached villa in a choice locality, but most of those who will purchase a book of instructions, such as this professes to be, have the means of providing their children with all that is required for more than an average degree of healthiness. This con- viction is surely sufficient to animate the parent's resolution to act up to her responsibilities. The majority of young married women usually AND DUTY OF MOTHERS. 23 leave this sort of knowledge to be acquired at the cost of a dear experience. It ought not, and it need not, be paid for at such a rate. "She becomes a mother without a suspicion of her deficiency in even the most ordinary information concerning the na- ture and functions of the infant being whom she is so suddenly called upon to cherish and bring up." She has then to educate herself, or rather she be- comes educated very often at the sacrifice of her first-born. How much wiser, if from the moment the wife finds herself likely to become a mother, she commenced seeking the knowledge which would fit her for her duties! It cannot be supposed for a moment that I be- lieve in the possibility of banishing illness from the nursery. Illness must and will come more or less to all. Hereditary disease will produce it,—infec- tion will give rise to it,—and other causes over which we have but little control. All I argue for is the use of the best means to prevent that large amount of sickness and death due to ignorance and mismanagement, which may be assuredly greatly diminished by the mother early fitting herself for all the title of mother implies. So live that your offspring shall inherit a healthy body,—so bring them up, that health shall be preserved, and life worth having,—and if disease attack them, study to help and not to impede the efforts made to restore them. I will only farther observe, that in looking around 24 MORTALITY OF CHILDREN me I can safely affirm, as the result of an experience of above twenty years, that, in those families in which the principles laid down in this work have been followed out with persevering care, patience, and judgment,—with the exception of disease from unavoidable causes, the children have grown up strong and healthy. But then parents and depend- ents have steadily acted day by day up to these principles, in themselves simple enough, but de- manding the exercise of constant self-control, until they become the very habit of nursery government. It is necessary to apprize the reader that through- out this book the period of Infancy is considered to be under two years of age;—and that of Child- hood from two to eight years of age. PART I. MANAGEMENT OF CHILDREN IN HEALTH. CHAPTER I. MATERNAL NURSING. SECT. I. — THE DUTY AND ADVANTAGES OF THE MOTHER NURSING HER INFANT. It may be called a fixed law of Nature that a healthy woman should suckle her offspring. There are exceptions; but as a general rule it holds good, and like all other laws in nature, it cannot be broken with impunity. To refuse to comply with this ar- rangement of Providence, is to forego the first re- ward of previous suffering. It is plainly intended to cherish and increase the love of the parent her- self, and to establish in the dependent and helpless infant from the first hours of its existence those as- sociations on which its affection and confidence after- wards will be most securely founded. The evidence of design is manifest. So long as the child is un- born, no milk is secreted in the mother's breast, but no sooner does she give it birth, than this fluid is 3 26 MATERNAL NURSING. prepared and poured forth; admirably fitted in its qualities for the rapid growth of its delicate organ- ism. It embraces the three principles (the albumi- nous, the oleaginous, and saccharine,) of which the diet of man consists in his most perfect physical development and greatest intellectual vigour; and moreover is the only food supplied by nature, in which such a combination does exist. "It is a mo- del," says Dr. Prout, "of what an alimentary sub- stance ought to be—a kind of prototype, as it were, of nutritious materials in general." And thus it continues to be secreted day by day, until the time arrives, when, the digestive organs having acquired the power of preparing for themselves from the va- rious substances which constitute our diet this com- pound necessary for our sustenance and growth, milk, is no longer required. Nursing would also seem to be as beneficial to the system of the healthy woman as to her child. In the lying-in month it undoubtedly is the means of preventing or diminishing the tendency to dis- ease. During the whole period of nursing it con- tributes greatly to preserve and promote the mother's health, for no period of the woman's life, generally speaking, is so healthy as this; and many a woman who has previously been delicate will become robust and strong at this time. In most women it prevents the too frequent recurrence of pregnancy, than which nothing tends so surely to undermine the constitution, and to induce a premature old a°-e. MATERNAL NURSING. 27 It diminishes the disposition to cancerous affections of the breast, for although women who have had children are still liable to these; "yet it is undoubt- edly true, that breasts which have been unemployed in suckling in women who have been married, but are childless, and in those who have remained single, are more prone to malignant diseases than those of women who have nursed large families."* It is clear that there is no nourishment so well suited to the constitution of the individual child as its own mother's milk: there is a natural relation between the two which is not so perfectly realized when the child is transferred to another breast. This practice, however, when it does not arise from necessity, is not nearly so prevalent as in former times. There are few women in the present day disposed to devolve the dearest and greatest privilege of a mother on a stranger. But whenever, with- out due reason, the healthy woman of fashionable life, from caprice, the fear of trouble, the loss of pleasure, the anxiety to avoid the confinement which suckling necessarily imposes, or any cause of a like frivolous kind,—feels disposed to break this law of her being, it behooves her to look to the possible consequences to herself of being out of har- mony with it,—for no one can fail to perceive the significance of the facts to which allusion has just been made. Animals, even those of the most fero- cious character, show affection for their young; they * Sir Astley Cooper on Diseases of the Breast, p. 137. 28 MATERNAL NURSING. do not forsake or neglect them, but yield them their milk and watch over them with the tenderest care; —woman, who is possessed of reason as well as in- stinct, must not manifest a love below that of the brute creature. There are circumstances undoubtedly which dis- qualify the parent from the performance of this duty, and I believe such individuals for the most part will be found less liable to the consequences of such neglect (just referred to) than the robust and healthy. Sometimes a healthy but delicate state of the system will forbid it. Here, however, it will be well to make the attempt, if sanctioned by the medical attendant; and if persevering attention is given to the various measures that invigorate the system, it may be that the delicate woman will be- come strong, and be enabled to nurse, beneficially to herself and her child. The experiment should always be fairly tried, and never given up hastily; and if it fail, the consequences of the trial, under judicious medical superintendence, will not be at- tended with injury. Sometimes a defect in the structure of the breasts or nipples renders them un- fit to yield milk; here there is no remedy, and the disqualification must be submitted to. Sometimes the defect is simply in the nipple. It may be too small and sunken,—or, from disease, it may be ex- coriated or cracked, and whenever the attempt to suckle is made, it is attended with great agony ;__ perseverance in the use of proper means will fre- MATERNAL NURSING. 29 quently remedy this in both cases.* There are now and then, however, instances in which experience strongly proves the parent ought most assuredly not to attempt nursing her offspring, when it would inflict irremediable injury; and to these cases I shall devote the next section. SECT. II.--OF MOTHERS WHO OUGHT NOT TO SUCKLE. There are some women who ought never to un- dertake the office of suckling, not so much on ac- count of their own health, as that of their offspring. The woman of a consumptive and strumous constitution.—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 matri- monial 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 * See Hints to Mothers, p. 244. 3* 30 MATERNAL NURSING. while youth remains, their physical powers begin to give way, and they drop prematurely into the grave, exhausted by consumption, and leaving children be- hind 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 pa- rents from whom they derived their existence."* There is scarcely an individual who reads these statements who will not recall some illustration of their truth, though they perhaps may have hither- to been in ignorance of the cause. The constitu- tion, then, of such a female renders her unfit for the task of nursing; and however painful to her feelings it may be, she must recollect that it will be far bet- ter 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 se- lecting a woman for this important duty very great care must be observed, t 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 desira- ble that a fresh wet-nurse should be obtained for the * Combe's Principles of Physiology applied to the Preservation of Health, &c t See Choice of a Wet Nurse, p, 52. MATERNAL NURSING. 31 last six months, and one that has been confined about six weeks or two months will be most suitable. 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. Such a child must have a perfectly pure atmosphere to breathe, and sufficient exercise. All derangement of the diges- tive functions should be brought under the notice of the medical attendant. By a rigid attention to these measures, the mother adopts the surest antidote in- directly to subdue the constitutional predisposition to that disease, the seeds of which, if not inherited from the parent, are frequently developed in the in- fant 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 mo- ther's health be unexceptionable, then I would strongly advise her to suckle her own child. This subject is fully dwelt upon in the chapter on the pre- vention of scrofula and consumption. The mother of a highly susceptible nervous tem- perament.—The mother 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 32 MATERNAL NURSING. by attempting to suckle it. Her milk will be to- tally 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 habit of " giving way," on which for the most part all this depends, is now wrong, if it never was before. Self-control is in general the thing that is needed. There are, how- ever, exceptions to this as the cause. 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 ful- fil them faithfully, is but too frequently an instance in point; although at a future period she will gene- rally make a good nurse. The following is an illus- tration:—a young married lady gave birth to a 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 obstinate- ly costive; — the motions being lumpy, of a mixed colour, quite dry and passed with great pain. It became rapidly thin, and after a short time its flesh was 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 it left the breast, when it would commence screaming violently, beat the air with its hands and feet, and nothing could appease MATERNAL NURSING. 33 it. This would last for half an hour or more, when it would fall asleep quite exhausted; the fit recur- ring again and again after every nursing. It was very evident that the infant's hunger was not satis- fied or its body nourished by the parent's milk, which although abundant in quantity (the breast being large and full of milk,) was at this time seri- ously deteriorated in its nutritive quality. This was caused, I believe, from great anxiety of mind. Her monthly nurse became suddenly deranged, and the whole responsibility and care of the child thus de- volved upon the mother, while she was entirely ig- norant of her duties. A wet-nurse was obtained. In a very few hours after this change was effected, the screaming ceased, the child had quiet and re- freshing sleep, and in twelve hours a healthy mo- tion was passed. The child gained flesh almost as quickly as it had previously lost it, and is now a fine and healthy boy. The mother has since had two children, and proved a good nurse. Whenever there has previously existed any ner- vous or mental affection in the parent, wet-nurse suckling is imperatively required, and with a judi- cious management of childhood will do much to counteract the hereditary disposition in the offspring. The mother who only nurses her infant when it suits her convenience ought not to engage in this duty at all.—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 • 34 RULES FOR NURSING. interfere with her health, and so with the formation of healthy milk, and with the regular and stated period 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 sick- en, pine, and die, it will not have to thank its pa- rent,—and disease, in all human probability, will be generated in its constitution, to manifest itself at some future time. The child, then, under all the foregoing circum- stances, must be provided with its support from another source, and a wet-nurse is the best. SECT. III. — RULES FOR NURSING THE INFANT. From the first moment the infant is applied to the breast, it must be nursed upon a certain plan : this is essential to the well-doing of the child. One of the most fruitful sources of disease in the early part of infantile life is improper management in re- lation to diet; and a large portion of the suffering and mortality which occurs during this period, arises from this cause alone. Regularity, moreover, is ne- cessary to the parent's health. The plan to be followed until the breast milk is established.—As soon as the infant is dressed, many nurses are in the habit of dosing it with castor oil, or honey of roses and almond oil. This is objectionable on many accounts: it is quite uncalled for so early, and it may be altogether unnecessary, if they only RULES FOR NURSING. 35 wait. The infant should at once be put quietly to sleep in a cot or bed, so situated that it shall not be exposed to draughts of cold air, and that the eyes of the babe shall be protected from a strong light, which as yet they are unable to bear.* It should be allowed to repose for some hours; when the mother having also obtained some sleep, it is proper to place the child to the breast, provided the mo- ther has at some former time performed the office of a nurse. This should always be done within the first four and twenty hours, partly to draw out and form the nipple before any hardness of the breast occurs, and renders that difficult, and partly to en- courage the flow of milk, for every effort made by the infant to obtain it will in this case excite its se- cretion. It has been supposed by some that the milk first secreted (the colostrum) is improper for the child, — that it teases the bowels. The fact is, that it differs in an important quality from that which is soon after secreted; but then it is a difference which na- ture has ordained and designed for a wise purpose. The bowels of the infant when born are loaded with a dark black secretion, called meconium, of which it is essentially necessary that they should be re- lieved, or it proves a source of great irritation. The means for its removal are found in the aperient quali- ties of the colostrum, so that instead of its being in- * Full directions are given upon this subject in the "Hints to Mothers," in the chapter on the lying-in room. 36 RULES FOR NURSING. jurious, it is highly necessary the child should take it. It is therefore only in those cases where the first milk of the parent's breast is not obtained, from the child being put to a wet-nurse or from any other cause, and now and then when the first milk fails to be sufficiently purgative, the administration of a gentle aperient is justifiable. Half a tea-spoonful of castor-oil, repeated or not as may be necessary, is the best that can be given. Occasionally from disease or some unappreciable cause, the colostric character is retained by the milk for a considerable period, and the health of the in- fant greatly suffers. Milk in this condition will to the eye present all the usual appearances of healthy secretion, but by the microscope an important dif- ference is very readily discovered, the nature of which it would be out of place to describe here, whilst to know the fact is important. Dr. Donne relates the following case in point:—" A young wo- man was confined with her second child, July 23, 1836; she was apparently very healthy. On the 1st August the milk was abundant and its aspect healthy, except that it was somewhat viscid. The child was quite healthy and well formed, but it frequently re- fused the breast without any appreciable cause. For twenty days after delivery the milk remained in the condition of colostrum, as above described, but its colour was normal, its consistence as in the healthy state, and externally this milk appeared as healthy as that of the wet-nurse. Eighteen days RULES FOR NURSING. 37 after delivery the child had diarrhcea; the milk did not change its character; and twelve days subse- quently the child died, having gradually become emaciated. The former child by the same female died at the age of five months." Dr. Donne merely mentions this fact, without wishing to infer any ne- cessary connexion between the deaths of the chil- dren and the conditions of the mother's milk; but he justly regards the coincidence as well deserving attention. From the mother's breast alone, then, in some cases, the child will be able from the first to derive its nourishment; but, in the majority of instances, particularly in first confinements, only in part, until the third or fourth day after deliverj% Where this deficiency exists, it must be supplied by an artifi- cial diet, as like the breast milk as can be found. This is obtained by taking either of ass's milk and boiling water equal parts,—or of cow's milk one- third and boiling-water two-thirds, slightly sweeten- ing the latter mixture with loaf-sugar. A few spoonfuls of one or the other of these (and the ass's milk is to be preferred) are to be given through the sucking-bottle, and not from the boat or spoon. This will secure the infant's stomach from repletion. It will not suck more than it requires—appetite being at this age a better guide than perhaps ever after. The act of sucking promotes the flow of sali- va, and its mixture with the aliment that is being swallowed, which is necessary to digestion. Atten- 4 38 RULES FOR NURSING. tion to this point will prevent derangement of sto- mach, with its train of acidity, flatulence, and colic. The breast milk being fully established, and fur- nished in sufficient quantity, the artificial food is to be put aside, and from this time the nourishment is to be obtained from the breast alone. The plan to be followed until the first teeth ap- pear.—For a week or ten days the appetite of the infant must be the mother's guide as to the fre- quency 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 di- gesting the little swallowed is obtained before the appetite again revives, and a fresh supply is de- manded. The week or ten days having expired, the infant is to be nursed until the end of the lying-in month at regular intervals of every four hours night and day. This will allow sufficient time for each meal to be digested, and the stomach to regain the time necessary for the digestion of the next, and tend very essentially to promote the due and healthy action of the bowels. Such regularity, moreover, will do much to obviate fretfulness, and to prevent that constant cry which it appears to the parent and to all about her, that nothing but perpetually giving the breast to the infant can allay. This evil, indeed, generally grows out of irregular nursing. The young mother, considering every expression of uneasiness RULES FOR NURSING. 39 as an indication of appetite, runs into the very se- rious error of offering the breast at all times and seasons, so that frequently the child has not left the breast ten minutes before it is again put there. From this injurious and dangerous practice the stomach of the infant becomes overloaded, the food remains un- digested, the bowels disordered, fever excited, and, by-and-by, the infant becomes seriously ill, and is, perhaps, eventually lost; when, by simply observing from the first the rules ofniursing laid down, it might have continued healthy, and grown into a vigorous child. These cases of indigestion in the infant, caused by irregular and too frequent nursing, are continually occurring, and medicine is given with- out permanent relief, because the cause of the mis- chief is not obviated—it is overlooked. Fortunately, in most cases, the mother, tired of a fruitless repeti- tion of medicine, seeks further aid; when, by simply adopting a more rational course, the child's symp- toms are removed, healthy digestion restored, and no relapse occurs; this happy issue being, perhaps, obtained without any further exhibition of medicine. The lying-in month having expired, it is ad- visable to alter the periods of night-nursing, or rather to do away with night-nursing altogether; that is, to suckle the infant as late as ten o'clock, p. m., and not put the child to the breast again until five o'clock the next morning. I am constantly in the habit of advising this measure, and I have always found it, when adopted, of great 'advantage to the mother's 40 RULES FOR NURSING. health, and never attended by the slightest injury to the child. With the latter it soon becomes a habit; to induce it, however, it must be taught early. It is true, that where there is much delicacy and a feeble constitution, it will be necessary sometimes to postpone it a little longer. This very delicacy, however, whilst it demands a more frequent supply, calls for the greatest care in affording it, lest it be too frequent and too great in quantity. And be it remembered by the reader, that this is only an oc- casional exception to a most important principle, the adoption of which should never be delayed, except from paramount necessity. Indeed, so convinced am I of the importance to the nursing mother of calm, quiet, and undisturbed repose during the night, that whenever circumstances will allow of it, I would advise that the child from this time no longer sleep in the bed-room of its parent, but in charge of its nurse. Sleep is as necessary for the restoration of strength as nourishment itself, and the deprivation of it will soon diminish and deteriorate the quantity and quality of the mother's milk, and sometimes— the cause being little suspected—will drive it away altogether. I am fully aware of the repugnance of some mothers to this measure, and that even in the wealthiest families, where the best services can be obtained, and every convenience exists, they are unwilling to intrust the child, that they desire should be constantly under their own eye, to a servant's care. Sooner or later, however, this change must RULES FOR NURSING. 41 take place, the most devoted mother must submit to it, and the peril is not greater at this time of life than at any other. The grand point is, to select a proper person for this duty, and then to exercise over her an active, firm, and wise surveillance. This is seldom sufficiently regarded. A sensible and experienced nurse-maid is the exception, not the rule. The short-sighted economy of a few pounds per annum is preferred before the services of one whose watchfulness and care over the physi- cal and moral education of the child would repay a hundred-fold any sacrifice it might be necessary to make to obtain them. Upon this subject Dr. Donne remarks: "Loin d'approuver I'usage adopte par beaucoup de meres pleines de devouement et de ten- dresse, de faire coucher leurs enfants pres d'elles, je suis si convaincu de la necessite de menager, aulant que possible, leur sommeil et leur repos pendant la nuit, queje ne puis trop recommander, toutes les fois que le chose pourra se faire, que l'etat de la fortune et la disposition de l'habitation le permittront, de tenir l'enfant eloigne de sa mere pendant la nuit."* This course, then, is to be followed until the ap- pearance of the first teeth (about the sixth or se- venth month ;) and if the parent be a healthy woman the quantity of milk supplied by the breast will ge- nerally be found sufficient to afford adequate nou- rishment to the child, without additional assistance from artificial food. The latter is on no account to * Conseils aux Meres sur 1'Allotment, p. 53. 4* 42 RULES FOR NURSING. be given (up to this period) unless, from deficiency of milk or some other cause, it be positively required. If, however, after the expiration of some months, this deficiency should exist, it must be made up by the mixture of cow's milk and water, and of this alone, if it agree with the child. It must be given, too, through the sucking-bottle until the teeth ap- pear; after which time an alteration in the kind of food, and the mode of exhibiting it, similar to that proposed below, may be adopted. The plan to be followed after the first teeth have appeared.—When the mother, at this period, has still an abundant supply of nourishing milk, and the child is healthy and evidently flourishing upon it, I would not recommend any immediate change. The parent may, with benefit to her own health, as well as with advantage to the child, pursue the same plan as heretofore for a few weeks longer. In general, however, the mother will require some little aid at this time, and artificial food may now be given twice in the course of the day, without risk or injury to the child. Good fresh cow's milk, with the addi- tion of water or not, as it is found to agree best; Hard's farinaceous food; Leman's tops and bottoms; sago or arrow-root; or, if these disagree with the stomach, weak beef tea, veal or mutton broth, clear and free from fat, and mixed with an equal quantity of farinaceous food and a few grains of salt,—any one of these which the parent finds to agree best may be given with benefit. RULES FOR NURSING. 43 As this is the first time that artificial food has been particularly referred to, it is right to observe, as a general remark applicable to its use at all times, that the greatest care must ever be taken in the se- lection of it, in its preparation, in the quantity given, and in the mode of giving it. In the choice of the food, the mother must be guided by circumstances: she must find out that which suits best; and, so long as the child flourishes, she should from no trivial cause change it. The different kinds just pointed out may be tried in the order given till one is found to agree. The mode of making these preparations is detailed at length at page 83: this has been done because the defective manner in which artificial food is prepared is not unfrequently the sole cause of its failure. It is only necessary farther to observe upon this point, that the vessel in which it is made, as well as that out of which it is given to the child, must be perfectly sweet and clean. The quantity given must be small, lest the stomach be overloaded, which seldom fails, after a little while, to impair its tone, and give rise to the distressing dyspeptic symp- toms before alluded to. The child must be fed slowly; and, minding this precaution, the sucking- bottle may now be discontinued, and the spoon used in its stead: but more full instructions upon all the foregoing points will be found in the chapter on "Artificial Feeding." In about six weeks or two months after the arti- ficial food has been in part commenced it may be 44 RULES FOR THE HEALTH given, if necessary, more frequently—three or four times in the twenty-four hours, and the breast of course less frequently. This will prepare the infant for weaning, which, under these circumstances, when the time arrives, will be easily accomplished. Such is the plan of nursing to be followed by the mother until the infant is weaned entirely from the breast. The period when this ought to take place, as also the manner of accomplishing it, are detailed in the last section of this chapter. SECT. IV.--RULES FOR THE HEALTH OF THE NURSING MOTHER. A careful attention on the part of the mother to her health is especially called for during nursing. Nourishing and digestible milk can be procured only from a healthy parent; and it is against com- mon sense to expect that if a mother impairs her system by improper diet, neglect of exercise, and impure air, she can nevertheless provide as whole- some and uncontaminated a fluid for her child, as if she were diligently attentive to these points. Every ailment of the nurse is liable to affect the infant. If good health has always been enjoyed, there should be no alteration in the diet; it should be the same as before confinement. If the natural appetite increase, the extra demand must be met by an in- crease in that kind of food which is wholesome, nourishing, and simple in quality, and not in that which is of a rich and pampering description. Sti- OF THE NURSING MOTHER. 45 muli are to be avoided, and it will be well both for parent and child to adopt a barley-milk beverage. It is a very prevalent and most mischievous error, to suppose that because a woman is nursing she ought therefore to live fully, and to add an allow- ance of wine, porter, or other fermented liquors, 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, instead of increasing, the secretion of milk. This practice of taking fermented liquors generally commences in the lying-in room. The young mother is there told that it is essential to the production of a plentiful supply of good breast-milk. And from a sense of duty this course is adopted, however disagreeable, as it really is to many who submit to it. The ad- vice, however well meant, is not good advice, but frequently most mischievous. Malt liquor or wine is only useful to the woman who, possessing a heal- thy constitution and a system free from disease, is rather delicate than robust, but who, nevertheless, with advantage to herself or without detriment to the child, may suckle. Such an individual may make a trial of wine, or of a pint of good sound ale or porter in the four and twenty hours, and if it is found to have a favourable effect upon her health, and not produce discomfort or disturbance to the system, it should be persevered in. But here, as in the former case, more good will result from the as- 46 RULES FOR THE HEALTH siduous employment day by day of general measures than from any stimuli. The bowels must be duly regulated, and if at any time an aperient is required, the selection is not unimportant. If it be desirable to act at the same time upon the infant's bowels, a saline purgative, as Epsom or Cheltenham salts, should be taken; this, through its effect on the milk, will act on the child; if otherwise, a vegetable ape- rient should be chosen, as castor oil, confection of senna, or five grains of the compound extract of co- locynth, with two grains of the extract of henbane, to prevent its griping. I need scarcely remind the nursing parent of the importance of attending to the state of the skin, and of the invigorating effects of the tepid or cold salt-water shower bath, taken every morning upon rising. If the latter cannot be borne, sponging the body with tepid or cold salt-water must be substi- tuted. Exercise and fresh air are essential to the production of good and nourishing breast-milk, as they also contribute to increase the quantity secreted. No one can have seen much of practice in this me- tropolis, and not have been fully convinced of this fact. Wet or fine, if the mother be in good health, she should take the daily walk. The injurious in- fluence of an indulgence in late hours night or morning, and the luxuries of dissipation and high life, will soon become manifest. Such habits not only lessen the mother's attention to her offspring, but really diminish her power of affording it nourish- OF THE NURSING MOTHER. 47 ment; so that she is often a worse mother in these respects than the inhabitant of the meanest hovel. A tranquil temper, and a happy, cheerful disposi- tion, tend greatly to promote the production of healthy milk. Indeed there is no secretion of the human body that exhibits so quickly the injurious influence of the depressing emotions as that of the breast. And although we are not able at all times to detect by an)' agent we possess the changes which take place in its physical properties, so delicate an apparatus for testing its qualities is the digestive system of the infant, that it will sometimes instantly show that such changes have occurred by the serious symptoms which now and then arise. I might cite many instances that I have met with illustrative of this fact. In one case, the child had had repeated fits of convulsions from noon of the previous day; the parent had been suddenly summoned to her mother, attacked with apoplexy; anxious and excited, she gave the child the breast, and within half an hour the convulsions commenced;—other breast-milk was suggested and obtained, and the fits ceased; all the previous measures had been unsuccessful. In ano- ther instance convulsions occurred evidently from disorder of the breast-milk, but the source of de- rangement was not discovered until a few weeks after, when it appeared that on the morning of the day when the child was attacked, the mother was made acquainted with the deranged condition of her husband's affairs. Fear has a powerful influence on 48 RULES FOR THE HEALTH the secretion; first changing its properties, and then frequently stopping the secretion altogether. I was sent for to an infant between two and three months old in an attack of convulsions, so severe as to threaten a fatal termination. This child I had seen at the same time the day before sucking at the breast of its wet-nurse in perfect health, never having had a moment's illness. It had shown the first symp- toms of indisposition the previous night after the nurse had retired to rest; when, having been at the breast, it became restless, crying frequently, evident- ly from pain. In the course of the night the bowels were violently purged; towards morning the stomach would not retain the milk; and as the day advanced the general symptoms of uneasiness increased, and in the afternoon the convulsions above referred to came on. Upon inquiry I found the father of the young nurse had called on the previous evening, and not only violently abused his daughter, using severe and unwarrantable language, but had struck the poor girl, he being under the influence of liquor at the time. This interview produced such mental distress in the young woman as to attract the atten- tion of her mistress, when an explanation of the cause ensued. Strict orders were given to forbid the man the house for the future: but the mischief was done; for it was too evident that the alarming state of the child had been produced by the delete- rious change which had taken place in the nurse's milk. Remedial measures were used; the breast- OF THE NURSING MOTHER. 49 milk withheld; and the infant, although it continued for many days in a doubtful state, eventually re- covered: the young woman's milk, however, was altogether driven away, and another wet-nurse with- out delay was obliged to be obtained. Perhaps the most remarkable instance on record of the effect of strong mental excitement on the secretion of the breast, is one mentioned by Dr. Von Ammon; so remarkable, that the event could hardly be regarded as more than a simple coinci- dence, if it were not borne out by the less striking but equally decisive facts already mentioned. " A carpenter fell into a quarrel with a soldier billeted in his house, and was set upon by the latter with his drawn sword. The wife of the carpenter at first trembled from fear and terror, and then suddenly threw herself furiously between the combatants, wrested the sword from the soldier's hand, broke it in pieces, and threw it away. During the tumult, some neighbours came in and separated the men. Whilst in this state of strong excitement, the mother took up her child from the cradle, where it lay playing, and in the most perfect health, never having had a moment's illness; she gave it the breast, and in so doing sealed its fate. In a few minutes the infant left off sucking, became restless, panted, and sank dead upon its mother's bosom. The physician who was called in found the child lying in the cradle as if asleep, and with its features undisturbed; but all his resources were fruitless. It was irrecove- 5 50 RULES FOR THE HEALTH rably gone." The milk in this striking case must have undergone a change, which gave it a powerful sedative action upon the susceptible nervous system of the infant. A fretful temper will lessen the quantity of milk, make it thin and serous, and cause it to disturb the child's bowels, producing fever and griping. Fits of anger produce a very irritating milk, followed by griping in the infant, with green stools. Grief or anxiety of mind often so dimi- nish the secretion as to render other aid necessary for the sustenance of the child. Fear and terror would seem to produce a powerful sedative effect upon the milk, as proved in Von Amnion's case just quoted, and which in a minor degree 1 have noticed elsewhere. A knowledge of these facts ought to serve as a salutary warning to a mother not to in- dulge in, but carefully to guard against, either the exciting or depressing passions. The quantity and quality of the breast-milk may be affected by other causes. Sometimes the month- ly periods return while the mother still continues a nurse. This occurrence much impairs the milk in its probable duration, and more or less in its proper- ties at the period itself. The infant sometimes be- comes unusually fretful, brings up the milk, and has frequent watery motions, more or less of a spinach- green colour. If this takes place early after delivery, it will in most cases so alter the qualities of the milk as seriously to affect the health of the child, and oblige the mother to transfer it to a wet-nurse. But OF THE NURSING MOTHER. 51 if it does not occur until the sixth or seventh month, no inconvenience of importance will generally arise. As a general rule, the breast must be withheld from the child as much as possible during its continuance, and artificial food substituted. The taste and qualities of the milk are easily af- fected by diet. If the mode of living be full and luxurious, the milk may become too rich, having too large a quantity of cream, but without its being otherwise altered in its character. The remedy is simple enough: purgative medicine, once or twice, —plenty of active exercise, and a more spare diet in future. On the other hand, women who labour hard, provided they are well nourished, have abun- dance of milk; but if their food be scanty in quantity and poor in quality, they soon sink under fatigue and lose their milk. In London, severe attacks of diarrhoea occur in infants at the breast, fairly trace- able to bad porter. 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 artificial food substituted, the complaint was quickly put a stop to. Believing that the mother's milk was impaired from some accidental cause which might now be past, 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 unwhole- some article in her diet might be the cause; the re- 52 RULES FOR THE HEAxr»«_ gimen was accordingly carefully inquired into, when it appeared that porter from a neighbouring publi- can'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 ano- ther attack. Sometimes the breast-milk has a de- cidedly saline taste; at other times bitter, so that the child (to the astonishment and vexation of the parent, who does not suspect the cause) will turn away from the breast in disgust. In all these cases it will more or less disorder the child: and hence the importance of attention to the diet; particularly the avoidance of salads, pickles, sour fruit, cucum- bers, melons, acids, and the like. Medicines will often affect the milk, and in a very striking manner. This has already been alluded to when speaking of aperients, and beyond this does not concern us here, although a very important use is made of the fact in attempting the cure of serious disease which sometimes occurs both in mother and child. If pregnancy take place with the nursing mother, it will so affect the milk as to render suckling inju- rious to the child. If it occur in the early months, a wet-nurse ought to be obtained. Ji deficiency of milk will, in some mothers, exist from the earliest weeks after delivery. If this is OF THE NURSING MOTHER. 53 not quickly remedied by the means already pointed out, a wet-nurse must be obtained. It will be of no avail partially to nurse and partially to feed the in- fant at this period, and under such circumstances; for if it is not soon lost, it will only live a few months, and be a constant object of anxiety and grief to its parent. The constitution of the mother, in this case, is frequently unhealthy, and the condi- tion into which the child is brought arises from the unwholesomeness of her milk. Women who marry comparatively late in life, and bear children, gene- rally have a deficiency of milk after the third or fourth month: artificial feeding must in part be here resorted to. Many mothers give themselves unnecessary fa- tigue in suckling, from the awkward manner in which they hold the child. Until it is old enough to sit while suckling, or the mother is accustomed to raise the child cleverly in her arms to the breast, it is best for her to lie down when the infant has occasion to suck. At all times, if in bed, the child should take the breast as it lies, and not incommode the mother by obliging her to sit up in bed. When up and nursing, the mother should sit upright and raise the child to her breast, and not bend forward to suckle the infant in her lap. This greatly tires and fatigues the mother, and causes severe pain in her back, without in any degree relieving the child. Again, a parent should avoid giving one breast more frequently than the other: the infant should 5* 54 INJURIOUS EFFECTS OF be applied to each in its turn. If this is not done, and one breast is sucked more than the other, it becomes much larger than its fellow, and the secre- tion of milk is not equally promoted in each breast. There is danger, also, if suckled upon one breast only, of the child contracting the habit of squinting, from having its eyes constantly directed to one side. It may also become somewhat crooked, growing unequally, one side of the body not being so mus- cular as the other. For direction, upon sore nipples, uncontrollable flow of the milk, and milk abscess, the reader is referred to " Hints to Mothers." SECT. V.--THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED SUCK- LING. As already observed, the period of suckling is, ordinarily, 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 are met with daily. I refer to poor married women, who nurse their infants eighteen months, two years, or even longer than this, from the belief that by so PROTRACTED SUCKLING. 55 doing they will prevent pregnancy. The conse- quences are a state of exhaustion and disorder of the general health, which often leads to most alarm- ing maladies. The second is most frequently met with in delicate women, who, having had two or three children in quick succession, her health suffers, and 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 can be impaired by suckling, she ought not to be in ignorance of the fact; so that she may be able to recognise the first symptoms, and obtain medical advice before her health be seriously affected. 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 gid- diness, 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 nervous- ness ensue. I have known the retina so weakened 56 INJURIOUS EFFECTS OF as to produce blindness for a time. It is unneces- sary, however, to enter into a more full detail of symptoms. 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 re- move the cause. 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 circum- stances, will be most serious. Born in perfect health, and having continued so up to this period, it will now begin to fall off in its appearance; for the mother's milk, both in respect of quantity and quality, will no longer afford due nourishment. Its countenance will become pale, its look sickly and aged, the flesh soft and flabby, the limbs emaci- ated, the stomach large, 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 ag- gravated as those just described, and it subsequently PROTRACTED SUCKLING. 57 live and thrive, there will be a tendency in such a constitution to scrofula and consumption, to mani- fest 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 suck- ling. 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, and many women will be obliged partially or entirely to resign the office. The monthly periods generally reappear from the twelfth to the fourteenth month from delivery; and when established, as the milk is found invaria- bly to diminish in quantity, and also to deteriorate in quality, and the child is but imperfectly nou- rished, it is positively necessary in such instances at once to wean -it. SECT. VI.--WEANING. j3t what time.—The time when weaning is to take place must ever depend upon a variety of cir- cumstances, which will regulate this matter, inde- pendently of any general rule that can be laid down. The mother's health may, in one case, oblige her to resort to weaning before the sixth month, and, in 58 WEANING. another instance, from the delicacy of the infant's health, to delay it beyond the twelfth. Neverthe- less, as a general rule, both child and parent be- ing 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 par- tially fed, weaning ought to be gradually accom- plished at the ninth month. On the other hand, if the child is feeble in constitution, the teeth late in appearing, and the mother is healthy and has a suffi- cient supply of good milk, especially if it be the winter season, it will be far better to prolong the nursing for a few months. In such a case, the fact of the non-appearance of the teeth indicates an un- fitness of the system for any other than the natural food from the maternal breast. It should never be effected while the child is suffering under the irrita- tion of teething; it will derange the bowels and perhaps induce convulsions. And again, if the in- fant 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 WEANING. 59 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 ac- complished, 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 impaired; and, if the child is*not carried off' suddenly by con- vulsions, its bowels will become obstinately disor- dered; it will fall away from not being nourished, and perhaps eventually become a sacrifice to the over-anxious 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, are detailed in the section on "Artificial Feeding." Much exercise in the open air (whenever there is no dampness of atmosphere) is highly necessary 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. Drying up the milk.—It may be necessary to dry up or "backen the milk," as it is popularly called, directly after delivery—from the delicate health of the mother,—from local defect, the nipple for instance, being too small, or obliterated by the pressure of tight stays,—and from death of the in- fant, or some equally urgent cause. 60 WEANING. Now it is a very frequent practice to apply cold evaporating lotions to the breast for this purpose. It is true they may produce a rapid dispersion of the milk: but they ought never to be resorted to, as they frequently give rise to symptoms of an alarming and dangerous character. The best and safest local application consists in the following lini- ment:—Compound soap liniment, three ounces; laudanum, three drachms; camphor liniment, one drachm. Or, if this is found too irritating, compound soap liniment alone. Either of these liniments must be applied warm, and constantly, by means of a layer or two of linen or flannel, covered by a piece of oiled silk; and the breast gently pressed or rubbed for five or ten minutes, every four or five hours, with warm almond oil. Sometimes the skin is so thin and sensitive, that even the compound soap liniment proves too stimu- lating, and covers the breast with an irritable erup- tion. In these cases bread and water poultices must be substituted, but the warm almond oil must also be used as directed in the former instances. While the breasts remain only moderately hard, easy, and but little distended with milk, they must not be emptied; for this would encourage fur- ther secretion, and they would'soon fill again. If, however, they become very hard and painful, and give much uneasiness from their distension, they must be partially emptied, so as just to relieve the distension—nothing more; and this is to be repeated WEANING. 61 as often as is absolutely necessary. A gentle saline aperient should be taken every morning, and, if ne- cessary, at night, the object being to keep the bowels slightly relaxed. The diet must be very scanty, and solid nourishment only taken. If, however, the thirst is distressing, it must be allayed by fre- quently washing out the mouth with toast and wa- ter; and an orange or two, or a few ripe grapes, may be taken in the course of the day. Following up this plan, the distress arising from the extreme dis- tention of the breasts, if it was present, will be re- moved; although several days will transpire before the milk is thoroughly dispersed, or the remedies can be discontinued; and a sensation described by females as of " a draught of milk " in the breasts, will sometimes be felt two or three times a-day for weeks afterwards. In reference to drying up the milk at the time of weaning, from the circumstance of the child being partially fed for some time before it is com- pletely weaned, the mother will experience little trouble in dispersing it. She must, however, not neglect to take opening medicine, not only to assist the foregoing object, but also to prevent that de- pression of spirits, lassitude, loss of appetite, and general derangement of health, which so frequently follow weaning when these medicines are omitted. If the breasts should continue loaded, or indeed painfully distended, the aperient must not only be used to keep the bowels gently relaxed, but the diet 6 62 WEANING. must be diminished in quantity, and solid nourish- ment only taken. The breasts, too, if painfully dis- tended, must be occasionally drawn, but only just sufficiently to relieve the distention; they must also 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. CHOICE OF A WET-NURSE. 63 CHAPTER II. OF WET-NURSES. SECT. I.—CHOICE OF A WET-NURSE. Ill health and many other circumstances may prevent a parent from suckling her child, and ren- der 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 things to be at- tended to in the selection of a good nurse, it will be well to point out in what they consist. The first thing to which a medical man looks, is the general health of the woman: next, the condi- tion 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 ap- pearance ought to betoken a robust constitution, free from all suspicion of a strumous character or any hereditary taint; 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 her breast?—A good breast should be firm and well formed; its size not dependent upon a large quantity of fat, which will 64 CHOICE OF A WET-NURSE. 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 mo- derate 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 con- siderable quantity of cream. . Dropped in water, it should form a light cloudy appearance, and not sink at once to the bottom in thick drops. 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 se- cond 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 newly-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. In fact it has been observed to be very injurious. 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. CHOICE OF A WET-NURSE. 65 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 pre- ferred, as she will be likely to have more milk, and may also be supposed to have acquired some expe- rience 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 recommenda- tion, 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 newly born child, rendering it fretful from the first. After a time it is vomited up, and produces 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 eruption. 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. 6* 66 DIET OF A WET-NURSE. The principal points which the parent must in- vestigate for herself, (independent of the medical attendant's inquiries) have reference to the moral qualifications of the applicant; and if there is found to be any defect here, however healthy or otherwise desirable, her services ought to be declined. Tem- perance, cleanliness, a character for good conduct, fondness for children, and aptness in their manage- ment, are among the most important requisites. An amiable disposition and cheerful temper are also very desirable; for of course the remarks made in the preceding chapter, on the injurious«influence of mental disturbance on the breast-milk of the parent, apply with equal force to that of the wet-nurse. It is unnecessary to allude to other qualities which a woman who is sought as a wet-nurse should pos- sess; they will naturally suggest themselves to any thoughtful mind. SECT. II.--DIET OF A WET-NURSE. The diet should not differ much from that to which the individual 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 DIET OF A WET-NURSE. 67 are allowed to 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 always necessary for the mother to be watch- ful, lest the wet-nurse overload her stomach with a mass of indigestible food and drink. She should have a wholesome mixed animal and vegetable diet, and a moderate quantity of malt liquor, provided it be found necessary. As I have before said, a very prevailing notion exists that porter tends to produce a great flow of milk. In consequence of this prejudice, the wet- nurse is often 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. Sometimes, without diminishing the quantity, it imperceptibly but seriously deteriorates its quality. For instance, a wet-nurse became ne- cessary for an infant of two months old, and a healthy young woman was obtained. At first the nurse's milk seemed to suit the child, and every thing went on well for three weeks. At this time I was sent for, the infant having had diarrhoea for three or four days, with green motions and occa- sional vomiting. I looked for the cause, and, amongst other inquiries, to the health of the nurse. I was told that she was in perfect health; but perceiving that she looked ruddier and more full in the face 68 WET-NURSES. than heretofore, I inquired about the quantity of beverage allowed, and found it exceeded two pints of porter daily. I then prescribed—for the infant, no medicine; for the nurse, one pint of porter only. As the patient lived some little distance from town, I did not see the child for three days: it was then somewhat better, but still not well. I directed the malt liquor to be discontinued altogether, and the nurse to have the shower-bath every morning, and plenty of out-door exercise. In three days more the infant was perfectly well, and the nurse had still an ample supply of milk, which now agreed with and nourished the child. As a general rule, porter, wine, or any stimu- lant, is quite as unnecessary for the wet-nurse as for the nursing mother, if she be in sound and vigorous health. There may be cases benefited by the moderate use of malt liquor, but these are the ex- ceptions. If taken, three half-pint tumblers are as much as any nurse ought to be allowed, and if she requires more, either it will be injurious, or she is unfit for her office. I very much suspect that the process of teething in some cases is rendered pain- ful and difficult, by the" stimulant taken by the nurse; the child, in fact, pays in suffering for the pampering of the nurse. SECT. Ill--GENERAL DIRECTIONS. The nurse should take exercise daily in the open air; nothing tends more directly to maintain a good GENERAL DIRECTIONS. 69 supply of healthy milk, and the best wet-nurse would soon lose it, if constantly kept within doors. Sponging the whole body with cold water with bay salt in it, every morning, should be insisted upon, if possible: it preserves cleanliness, and greatly in- vigorates the system. 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 on the wants of the child not being alone sufficient. For some time after the wet-nurse enters upon her duties, the mother should closely superintend her management of the child; more or less this will be advisable throughout the whole period of the wet-nurse's suckling, but it will be particularly called for until the nurse has deservedly secured the mother's confidence and respect. If the nurse has been judiciously chosen, there is no doubt she will endeavour to act conscientiously and rightly, but it is too much to expect, remembering the station of life from which she has been taken, that she will possess the necessary knowledge. Indeed, if she has had children previously, you will most probably have to combat with many existing prejudices, which will render such vigilance and superintend- ing care the more necessary. Give from day to day the instructions required, and go frequently and un- expectedly to the nursery, and see that your direc- tions are scrupulously regarded, with that cheerful- ness and tenderness which alone can and ought to satisfy a mother. 70 WET-NURSES. It will be well to add two or three cautions which have immediate reference to this class of persons. As the months advance, it may happen that the nurse's milk becomes insufficient for the demands of the child; and, unless she be a woman of good principles, there will be a danger of her hiding this circumstance from the parent, lest she should lose her situation, and she will secretly sup- ply the deficiency with some artificial food, made in secret, and therefore, badly, unfit for the child, and quickly causing suffering and disturbance to its system. On the other hand, a very healthy and very ignorant woman, with a great abundance of milk, is now and then met with, whose great aim will be to make the child as fat as possible; and she will not only urge the child to take breast-milk all day long, but give artificial food too, and sometimes even a portion of her own beverage, malt liquor. As a consequence, either the child's stomach rebels against this extraordinary system of repletion, and constantly vomits up the over supply, having, it may be, repeated attacks of diarrhoea, which after a while seriously affect its health,—or the wishes of the nurse are realized, and the child does become excessively fat, and is placed thereby on the brink of disease, which if it takes place, the chances of re- covery are greatly diminished. Again, the monthly periods in these nurses will sometimes after awhile re-appear, deteriorating the quality and diminishing the quantity of the milk,—a result of which they GENERAL DIRECTIONS. 71 are generally aware, and therefore they often at- tempt to conceal the fact. The course to be taken will depend upon the date when this function re- curs: if it be early in the nursing, the child being yet very young, it will be sure to suffer, and the nurse must be changed;—but if it does not take place until the seventh or eighth month is passed, it will scarcely affect the child, and all that will be required, will be to keep it as much as possible from nursing while the woman continues unwell, substi- tuting for the breast-milk artificial food. A wet-nurse should never be allowed to have medicine of any kind at her command to administer to the child whenever she may think fit; and it is right that a parent should be aware that an unprin- cipled woman will give laudanum in one or other of its preparations to quiet a restless child, and se- cure for herself a good night's repose. If it should at any time happen that the nurse's rest is disturbed from this cause, the exhaustion which is naturally felt the following day, must not be met by the fre- quently adopted remedy of an extra supply of por- ter, but by rest, she must be allowed to lie down for an hour or so, the nurse-maid taking charge of the child in the interval. Sleep will restore the strength, and thus increase the amount and improve the quality of the breast-milk, while the stimulant would injure both. When there are children already in a family, there is danger in many ways of the wet-nurse de- 72 WET-NURSES. ranging the order of the nursery. The mother should at the first assign her place and duties, and see that she keeps the one and performs the other. If there is an upper nurse, the wet-nurse in a cer- tain sense must be her assistant, and take the second place as it is termed. She will always do her duty to the baby, for her affections will quickly become engaged, but there will be an unwillingness to con- form to nursery regulations, unless enjoined from the first, which may cause great discomfort, and have a bad influence upon the children. If the tone and manner in which injunctions are given, imply both firmness and kindness, the willing co-operation of the wet-nurse may be secured, who must not be looked on merely as a living dairy, without love of esteem or desire of approbation. ARTIFICIAL FEEDING. 73 CHAPTER III. ARTIFICIAL FEEDING. Extreme delicacy of constitution, diseased con- dition 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 re- source is not always attainable. Under these cir- cumstances the child must be brought up on an arti- ficial diet—"by hand," as it is popularly called. To accomplish this, however, with success, requires the most careful attention on the part of the parent. It is at all times attended with risk, particularly in large cities. Upon this point Dr. Donne remarks: "Ce mode d'alimentation que je condamne absolu- ment et sans reserve a Paris et dans les villes, et que je tolere & peine dans les campagnes, malgre les ex- amples favorables que l'on peut cites: ces succes isoles ne prouvent rien. Je ne pretends pas qu'il soit impossible d'elever certains enfants de cette maniere; mais c'est mettre gratuitement une foule de chances contre soi, dans une entr6prise qui, dans less circonstances les plus advantageuses, presente toujours d'assez grandes difficultes par elle-meme.'" * Donne sur l'Allaitment, p. 170. 7 74 ARTIFICIAL FEEDING. It is of great importance, therefore, that the parent superintend the dietetic management of the child herself—at all events, for the early months—and that the rules laid down for her guidance be strictly followed out. SECT. I.--THE FOOD SUITABLE UNTIL THE FIRST TEETH APPEAR. The kind of artificial nourishment most suited to the infant will be that which is most like the breast- milk, viz., the milk of animals: the ass, the cow, the ewe, and goat. The milk of the cow is in most fa- miliar use, and the ass next, but all are employed more or less for the above purpose in various parts of the world. The milk of all animals is composed of the same ingredients, but their proportions vary considerably,—a fact of much practical importance in guiding our selection and preparation of it as food for our children, when good human milk cannot be obtained. In general terms, milk may be said to contain all the elements required for the mainte- nance and development of the life of the young ani- mal, viz., 1. Casein or cheese, which affords matter of nutrition and growth; 2. Butter, which supplies fat, and united with 3. Sugar, yields the carbon and hydrogen, which produce animal heat by their com- bustion ; and 4. Saline matters, necessary for the development of the osseous system. The relative proportions of the different ingredients in the milk of various animals, in 100 parts, are as follows:— ARTIFICIAL FEEDING. 75 Milk of the A. Constituents. Woman. Ass. Cow. Ewe. Goat. Casein - 250 1-82 4-48 4-50 402 Butter - 518 ■Oil 313 4-20 3-32 Sugar of milk) ._ Various salts } b t}Z 6-08 4-77 500 5' 28 0-34 060 0-68 0-58 Water - 85-50 9165 87-02 8562 86-80 From this table it will be seen that no milk more nearly approaches that of woman than the sheep and goat. Both possess, however, a larger proportion of casein, which forms a very dense curd, and the milk of the goat is tainted with the peculiar odour of the animal—both circumstances objectionable: the one making the milk difficult of digestion to the child, and the other, disagreeable to it. The same remark in reference to casein, applies to the milk of the cow, but it does not possess so much butter, and by di- lution may be brought to answer very well for in- fant's food. In some respects, however, there is a greater similarity between the milk of the woman and that of the ass, and in the early months, accord- ingly, we find it the most suitable artificial food that can be chosen. When ass's milk is employed, for the first ten days, it should be mixed with an equal part of boil- ing water; no sugar is necessary, as this exists in abundance, as the table shows. When the ten days have expired, two-thirds milk and one-third water will be the proportions; and a few weeks later, the milk should be pure. It must be given at the same temperature as the breast-milk, viz., from 96° to 98°; 76 ARTIFICIAL FEEDING. this is best effected by always adding the water in a boiling state, and when the latter is discontinued, by placing the milk in boiling water. In hot weather, care must be taken that the milk is not affected by it; and when practicable it should be given warm from the animal. It should never be mixed with the water till wanted, and no more made than will be taken by the child, for it must be prepared fresh at every meal. If convenience will permit, an ass should be kept for the child; the foal muzzled, and the forage of the mother carefully attended to, or its milk will disagree with the infant. If this plan can- not be adopted, then, if possible, the animal should be brought to the door of the house night and morn- ing, and there milked. Cow's milk in the early weeks is objectionable from the large proportion of casein it contains. If, however, it is used, for the first ten days one-third of cow's milk and two-thirds of boiling water are the proportions, sweetening the mixture with a small quantity of loaf sugar, as it is rather deficient in this milk. Then, for the next four or five months, equal parts of milk and water, and at the expiration of this time, which brings us to about the sixth month, pure milk. The same care in preparing this food must be observed as with the ass's milk. In large cities it is a difficult thing to obtain pure and wholesome cow's milk. Much of it is supplied from cows, which, fed in stalls, never breathe the pure air, and becoming diseased, (scrofulous matter is found de- ARTIFICIAL FEEDING. 77 posited on their lungs,) they produce unhealthy milk,—or if it comes from the outskirts of the city, however pure and wholesome when drawn from the udder, it is afterwards so diluted with water, and adulterated with starch, flour, chalk, and other sub- stances, as to render it almost as innutritious and un- wholesome as the diseased milk itself. Both are most unfit for the delicate and susceptible stomach of the infant. There is no doubt that this circum- stance is the fruitful source of disordered health to children artificially fed in large cities, and, with a deficiency of pure air, of the great mortality which takes place in the early months. It is hardly necessary to allude again to the milk of the goat and eive; they are both much employed in other countries, but seldom in this. In quality, they are richer than any other, and require in the early weeks of the child's life considerable dilution, with a small addition of sugar. Milk, then, much diluted in the early weeks, and less and less so as they advance, accommodating the strength of the aliment to the increasing digestive powers of the infant, forms the best artificial diet that can be given until two or three teeth are cut. Children nourished exclusively upon this simple food will be found to enjoy more perfect health, and thrive far better, than upon any other diet that can be given. Unfortunately this is not the popular belief, and in the earliest days of the child, mothers are too much in the habit of giving thick gruel, pa- T 78 ARTIFICIAL FEEDING. nada, biscuit food, and such matters, thinking that a diet of a lighter and thinner kind will not nourish. This is a great 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 rendered them necessary. Thus many infants are kept in a con- tinual round of repletion, indigestion, and purging, with the administration of cordials and narcotics, who, if their aliment were in quantity and quality suited to their digestive powers, would need no aid from physic or physicians. It will occasionally happen, however, that every kind of milk disagrees with the stomach of the child. If such a case occur, arrow-root, sago, semolina, ground rice, and barley or grit gruel, either of these well boiled in water, with the addition of a tea- spoonful of cream to four ounces of one or other of these preparations, and a little sugar and salt may be given. In such children, if the flesh be soft and flabby, after a few months the cream may be dis- continued, and equal parts of one of the foregoing preparations, and some animal broth, as chicken or mutton broth, or beef tea. All this, however, must be done with considerable care and caution. In the first weeks the food must be very thin, the consist- ence of cream, and always passed through a fine sieve before it is poured into the sucking-bottle, and ARTIFICIAL FEEDING. 79 afterwards, if animal broth forms part of the diet, its effect upon the system must be watched; for it must always be kept in mind, that before the first teeth are cut, the exhibition of this diet forms the exception and not the rule to the plan ordinarily to be pursued. The mode of administering the food.—There are two ways—by the spoon, and by the nursing bottle. The first is objectionable at this period, in- asmuch as the power of digestion in infants is very weak. In the natural mode of nourishment, by re- peated acts of sucking, provision is made for the slow introduction of food into the stomach of the child. In this act a great quantity of saliva is se- creted, which, mixing with the milk, passes down into the stomach, and there greatly aids digestion. This process of nature then is to be emulated as far as possible; and for this purpose the food should be imbibed by suction from a nursing bottle: it is thus obtained slowly, and the suction employed se- cures the mixture of a due quantity of saliva. The flat-glass nursing bottle is too well known to need description. It should be of glass, that being trans- parent we may be assured of its perfect cleanliness —that the amount of food taken at each meal may be accurately measured—that the nurse may see that it is not taken too fast, and when the bottle is emptied, that she may no longer allow the child to suck. The narrow neck of the bottle, which is about the size of the nipple, with a small orifice, is SO ARTIFICIAL FEEDING. covered by an artificial teat, through which the in- fant sucks the food, Various kinds are used: a pre- pared cow's teat, a piece of washed chamois leather, or a few folds of fine soft linen; whichever is pre- ferred, it must be secured firmly to the bottle with thread, and care must be taken 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 artificial teat so firmly pressed together between its gums, that there will be no channel for the milk to pass. It must be pierced with two or three very fine open- ings, and lest the milk should flow through too ra- pidly, a small conical piece of sponge must be placed in the teat. After every meal, if any food is left, it must be thrown away, the teat and sponge carefully washed with hot water, and the bottle scalded out; of the latter, there should always be two in the nursery, to be used alternately. These precautions are very important, otherwise the food will be tainted, and the child's bowels become deranged. The most perfect cleanliness is absolutely essential to the suc- cess of this plan of rearing children. The most cleanly and convenient apparatus of all is a cork- nipple fixed in the sucking-bottle, upon the plan of Mons. Darbo of Paris.* The cork being of a par- ticularly fine texture, is supple and elastic, yielding to the infant's lips while sucking, and is much more durable than the teats ordinarily used. * Sold by Weiss, 62, Strand. ARTIFICIAL FEEDING. SI Of the quantity and frequency of giving food. —These must be regulated by the age of the child and its digestive power. In the early weeks, as in ordinary nursing, the quantity must be small, say six or eight table-spoonfuls, and the supply more frequent than afterwards, as the stomach can bear only a small amount of nourishment at a time. As the child grows older, the quantity must be gradually increased, and a little experience will soon enable a careful and observing mother to determine the amount required. The frequency (after the first month) as a general rule should be fixed at about every four hours; this will allow a sufficient inter- val between each meal to ensure the digestion of the previous quantity. If this rule is not observed, the process of digestion will be interrupted, and the food passing along undigested, and fermenting, will derange the bowels without nourishing the child. The great error in rearing the young is over-feeding. It may, however, 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, bowel complaints, the irritable condition of the nervous system so common in infancy, £md to secure the child healthy nutrition and consequent strength of constitution.' If it be found requisite to give aperients and astrin- gents, antacids and carminatives, frequently, there is 82 ARTIFICIAL FEEDING. something faulty in the management of the diet, however perfect it may seem. The posture of the child when fed.—-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 child should be put into its cot, or repose on its mother's knee for half an hour or so. The practice of dandling and jolting the infant soon after taking nourishment is hurtful. Rest is essen- tial to digestion, as exercise is important at other times for the promotion of health. Nature con- stantly verifies the truth of this remark. All ani- mals manifest an inclination for repose and quietude after a full repast; and experience has shown, that the process of digestion is impeded by strong mental or corporeal exercise or agitation, immediately after a meal. SECT. II.--THE FOOD SUITABLE AFTER THE FIRST TEETH HAVE APPEARED. As soon as the child has got any teeth, and about the sixth or seventh month, one or two will make their appearance, the artificial food may be increased in quantity and strength. If the child has hitherto been living upon cow's milk'and water, the latter may be discontinued, and pure milk alone given, to be continued for a month or two longer if the child continues to thrive. More solid food, however, will ARTIFICIAL FEEDING. S3 now in most cases be demanded, such as the mixture of some farinaceous preparation with milk. The following, in the order in which they stand, may be resorted to, and that fixed upon which suits best:— Hard's Farinaceous Food.—Mix a table-spoonful with a small quantity of cold water, add half a pint of boiling water, constantly stirring, then boil it eight minutes, strain through a sieve, add a small quantity of pure and fresh cow's milk, loaf sugar, and a few grains of salt. This preparation is re- commended in preference to biscuit powder, and many other articles of diet of this class, from the deservedly high character it has obtained; and so long as it continues to be carefully prepared by the maker, it will be found a very valuable article of food for infants. Tops and Bottoms.—Steep in boiling water a couple for ten minutes, add a little pure and fresh cow's milk, strain through a sieve, and mix with it a few grains of salt. Sometimes this food agrees better when prepared as follows:—Have a sauce-pan on the fire with exactly the quantity of water re- quired ; when fast boiling throw two of these into it; let it boil five or six minutes; it will then be a clear smooth jelly, and when strained, nothing will remain in the sieve; thin it with a little fresh and pure cow's milk, and add a few grains of salt. Sago.—Take a dessert-spoonful of pearl sago, macerate it for two hours in half a pint of water in a pan on the hob, and then boil it for a quarter S4 ARTIFICIAL FEEDING. of an hour, stirring it well;—strain through a sieve, add cow's milk and a few grains of salt, and sweeten with a little loaf sugar. Arrow-root.—Take a dessert-spoonful of arrow- root powder, and carefully mix it with a little cold water in a basin with a spoon; then pour upon it half a pint of boiling water, assiduously stirring until it is thoroughly mixed;—boil it for five minutes, add fresh cow's milk and a few grains of salt, and sweeten with a little loaf sugar. Tous les Mois.—This food is to be prepared in the same manner and proportions as the arrow-root. When one or two of the large grinding teeth have appeared, beef tea, chicken, mutton, or veal broth may be given once in the day. The ordinary mode of making these preparations, that of pouring boiling water on the meat, is objectionable. It has been proved experimentally that boiling water al- lowed to act even for as long as five hours on finely chopped flesh, does not dissolve more than the fifth part of the matters soluble in cold water. During maceration in cold water an interchange takes place between the juices of the meat and the cold water external to it, and lasts until there is nothing more to be got out of the meat. While, on the old method, the surface of the latter becomes hardened by the heat, and the water is prevented from permeating to the interior of each separate mass; the nutritious juices becoming sealed up by the action of the heat, instead of passing out of the meat into the water. ARTIFICIAL FEEDING. 85 The plan to be adopted is as follows:—Take a pound of lean beef, free from fat and separated from the bones, chop it up as mince meat; pour upon it a pint of cold water, let it stand for two or three hours, and then slowly heat to boiling, and after boiling briskly for a minute or two, strain the liquid through a fine sieve or cloth, and add a sufficiency of salt. The same plan may be adopted with mutton, veal, or chicken. As the child advances in age, that is to say, after a month or two from the time we are now referring to, and as an introduction to the use of a more com- pletely animal diet, a portion, now and then, of a soft-boiled egg may be given; and by and by a small bread-pudding, made with one egg in it, may form the dinner meal. Nothing is more common than for parents, during this period, to give their children solid animal food. This is a great and mischievous error. It has been well said by Sir James Clark, that "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 with- holding such teeth till the system requires their as- sistance to masticate solid food. And the method of grating and pounding meat, as a substitute for chewing, may be well suited to the toothless octo- genarian, 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." Upon the same subject Dr. John Clarke S 86 ARTIFICIAL FEEDING. observes in his Commentaries:—"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 carnivo- rous and graminivorous animals, are designed by the Creator for the same sort of food. If the mastica- tion 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 un- digested state it will prove injurious to the stomach and to other organs concerned in digestion, by form- ing 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 appa- ratus for grinding it. That which would be con- sidered 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 chil- dren 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." During the period of infancy to which the fore- going plan of diet refers, viz., from the sixth month ARTIFICIAL FEEDING. 87 to the termination of the second year, it must be constantly kept in mind that the important process of teething is going on, and that as this is commonly connected with more or less of disorder of the sys- tem, any error in diet is to be most carefully avoided. For while it is true, that in the strong and healthy infant who has been nursed upon the breast, and not tasted artificial food until this period, disorder will be scarcely perceptible; so happy an exemption can- not be anticipated for the child that has been nou- rished upon artificial food alone from the first hour of its birth. Teething under such circumstances is always attended with more or less of disturbance of the frame, and disease of the most dangerous cha- racter sometimes 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, and cutaneous eruptions manifest themselves, and strumous disease is originated or developed. A judicious management of diet will do much to pre- vent these complaints, and mitigate their violence, if they do occur. If at any time the artificial food disagrees with the infant, causing the stomach and bowels to be disordered, the parent must in the first instance seek to correct this by an alteration of the diet, rather than by medicine. Much may be done by changing the nature, and sometimes by simply di- minishing the quantity, of the food. A diarrhoea, or looseness of the bowels, may frequently be 88 ARTIFICIAL FEEDING. 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 sometimes to be answered by two-thirds of arrow-root, with one- third of milk; or, for a few days, arrow-root made with water only; or, if these fail, Hard's Farina- ceous Food mixed with boiled milk. Costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in boiling water, and a small quantity of milk added. Or Densham's Farinaceous Food (which is a mixture of three parts of the best wheaten flour and one part of the best barley-meal) may be used. The barley makes this preparation somewhat laxative. Mix a table spoonful with a small quantity of cold water, add half a pint of boiling water, constantly stirring, then boil eight minutes, strain through a sieve, add a small quantity of unboiled, pure, and fresh cow's milk, a little loaf-sugar, and a few grains of salt. Flatulence and griping generally arise from an undue quantity of food, which passing undigested into the bowels, they are thus irritated and disturbed. This irfay be cured by abstinence alone. The same state of things may be caused by the food being over-sweetened—sometimes from its not being pre- pared 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. ARTIFICIAL FEEDING. 89 It is a grievous mistake for a mother to resort to medicine upon every slight derangement of the digestive system. Calomel, and remedies of a like kind, "the little powders of the nursery," ought not to be given on every trivial occasion. By the above powerful drug, given in this way, more mis- chief has been effected,and positive disease produced, than would be credited. Purgative medicines, especially, 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 and in a healthy condition; but then it must be by the mildest and least irritating means. 8* 90 DIET OF CHILDHOOD. CHAPTER IV. DIET OF CHILDHOOD, (FROM THE SECOND YEAR TO THE EIGHTH.) Childhood, as has been before intimated, extends from about the second year to the seventh or eighth. A careful management of diet during this period of life is essential. It is difficult, however, to lay down any precise rules, as they should be adapted in every case to the particular constitution concerned. There are, however, certain general principles which must be acted upon, and which can easily be modified by a judicious and observant parent, as constitution and circumstances may require. I will first give some general directions, applicable more or less to all children, and then speak separately of the various articles which usually form a part of the diet of this period. From the whole I trust the parent will gather the information suited to the particular con- stitution of each of her children. SECT. I.—GENERAL DIRECTIONS. 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 GENERAL DIRECTIONS. 91 masticate. This must be given in small quantity, —it should be of the lightest quality;—at first only allowed on alternate days, and even then its effects must be carefully watched, as all changes in the re- gimen of children should be gradual. The meals should be given at intervals of about four hours: thus—breakfast between seven and eight o'clock, to consist of tops and bottoms, steeped in boiling water, a little fresh and pure cow's milk added, as also a few grains of salt, and loaf-sugar to sweeten, if necessary;—or pour upon some bread just enough boiling water to soften it, cover it up for a minute or two in the steam, then add the fresh milk, a little salt, and sweeten with sugar;—or oat- meal porridge and milk is sometimes to be preferred; it is unstimulating, easily digested, contains a con- siderable proportion of nutriment, and usually acts slightly on the bowels. 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 wa- ter; on the alternate days, a well-boiled rice and milk pudding, or a plain bread, sago, tapioca, or ar- row-root pudding, containing one egg; or farinaceous food, with beef tea. The afternoon meal, 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 a crust of bread, after which the child should be put to bed. As the child grows older, the quantity at each 92 DIET OF CHILDHOOD. meal should be increased, and the quality somewhat altered. Pure milk, boiled or not, as it is found best to agree, may with bread form the breakfast and afternoon meals. And at dinner, meat and bread, with a small quantity of vegetable, and toast and water, may be taken daily. And now the child should be taught a golden rule in connexion with his diet, which, if it only once becomes a habit, will be of the most essential service to his health as long as he lives: he must be taught to take his food slowly, to retain it in his mouth long, and swallow it tardily; and to take no- thing in the intervals of his meals. The mother must carefully, day by day, attend to the quality and quantity of the food given. She will be amply re- warded by the health of her children, and their free- dom from disease. I might cite many instances to prove the truth and importance of the foregoing re- marks, and to show how fruitful of evil is their ne- glect. I select the following case:—I was sent for at nine o'clock at night, to visit a child supposed to be dying. I found a fine boy, four years old, lying on his back in bed in a violent fit of convulsions; the front and upper part of his night dress, shirt, and pillow-case covered with a large quantity of unmasticated and undigested food which had been vomited a short time before. It appeared that he had been put to bed at eight o'clock, apparently in good health, and that about an hour afterwards his brother, lying by his side, had been awoke by a ANIMAL FOOD. 93 piercing and loud cry, when the little patient was found by his father in convulsions. A succession of fits continued till four in the morning, the child being unconscious the whole time. At this hour the remedies employed began to produce a good ef- fect, the convulsions ceased, and consciousness re- turned. Feverish and other symptoms ensued, but health was regained after a few days. Now this attack, which was most severe, and gave great alarm to the parents, and very reasonably so, was brought about entirely by the child being allowed to eat at its dinner meal (seven hours before the fits occurred) immoderately,—and much too fast, the food being bolted, not masticated, as proved by what was brought up ;—and from a want of due care in the selection of the food, which was boiled pork and apple pudding. SECT. II.--ANIMAL FOOD. If a child be of a sound constitution, with healthy bowels, a cool skin, and clean tongue, the diet may be liberal, and provided he 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 to resist impressions unfavourable to health, and scrofula and other diseases would be induced. At the same time, let the mother avoid pampering, for this would lead to evils no less formidable, though of a different character. And as long as the general 94 DIET OF CHILDHOOD. health of this child is unimpaired, the body and mind active, and no evidence present to mark ex- cess of nutriment, this diet may be continued. But if languor at any time ensue, fever become mani- fested, the skin hotter than natural, the tongue white and furred, and the bowels irregular, then, though these symptoms should be only in slight degree, and unattended with any specific derangement amount- ing 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 oc- casioned the constitutional disturbance. But if the child be of a delicate and weakly con- stitution, 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 alter- nate 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 next chapter. This accomplished, a greater proportion of animal food may be given, and, in fact, will be- come necessary for the growth of the system, while at the same time there will be greater power of as- ANIMAL FOOD. 95 similation and digestion. A great error in the die- tetic management of such children is frequently com- mitted 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. This is to add to its debility. The system, as a consequence, becomes excited, nu- trition is impeded, and disease produced, ultimately manifesting itself in scrofula, disease in the abdo- men, head or chest. The first seeds of consumption are often sown in this way. A child so indulged will eat heartily enough, but he remains thin not- withstanding. After a time he will have frequent fever, will appear heated and flushed towards even- ing, when he will drink greedily, and more than is usual in children of the same age; there will be a deranged condition of the bowels, and headache,— the child will soon become peevish, irritable, and impatient; he 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, mea- sles, small pox, &c, 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 96 DIET OF CHILDHOOD. most nourishment in itself, but from that which is best adapted to the condition of the digestive or- gans at the time when it is taken." Of animal food mutton and beef are the best fitted for the nursery; no meat is so digestible as tender mutton; beef, although equally nutritious, from its texture being firmer, is not quite so easily digested. Lamb may occasionally be taken, veal never; it is difficult of digestion, and less nutritive than the older meats. Pork ought equally to be avoided; also all salted meats, the fibre of which becomes so changed by this process, as to render them very difficult of digestion by a young stomach. Fish may occasion- ally be given; it is however much less nutritive than beef or mutton, and frequently made very in- digestible by the addition of either melted butter, lobster, shrimp, or egg sauce, which should therefore never be given to children. SECT. III.—VEGETABLES. The potato, when in good condition, and well boiled, so as to become mealy, forms a nutritious and easily digested article of food for children; and a few weeks therefore after solid animal food is commenced, a small portion of this vegetable may with advantage be taken with it. It is hardly ne- cessary to observe that the hard and waxy, as well as the new potato, are equally indigestible and inju- rious. This vegetable ought to be the one in com- VEGETABLES. 97 mon use, still there are others for which it may occasionally be exchanged. The carrot is very nutritive, but must be tho- roughly boiled, or it is indigestible, and it should only be eaten when young. The turnip, although not very nutritive, is in general easily digested, and when well boiled and the watery part separated by pressure, does not produce flatulence as some sup- pose. Asparagus is a nutritive and light kind of aliment, and the only objection to its use is the melted butter, for which pure gravy had always better be substituted. Old asparagus, however, is very unwholesome. Cauliflower and brocoli are not very nutritive, but may occasionally be given. Greens require great care in the cooking; and if given, they should always be in small quantity, and never to a dyspeptic child, in whom they will be apt to disagree, by producing acidity, flatulence, and their consequences. It should be remembered that vegetables too little boiled always prove inju- rious to children: they are indigestible. Rice will at all times be a grateful addition to meat, and is particularly useful where potatoes and vegetables are found to disagree with the stomach. It must always be completely cooked; each grain thoroughly swelled and yet unbroken. Peas-meal contains a large proportion of vege- table casein, and is therefore a very nutritious arti- cle of food. It is not easily digested, however, but 9 98 DIET OF CHILDHOOD. may be used with advantage to thicken and flavour soups and broths. SECT. IV.—SUGAR AND SALT. Sugar is a necessary condiment for the food of children; it is wholesome and nutritious. It must, however, be given at all times in moderation, and to a child at all dyspeptic with caution, as it is apt to give rise to flatulence and acidity. "The fondness of children for saccharine substances," says Dr. Pereira, "may be regarded as a natural instinct; since nature, by placing it in milk, evidently in- tended it to form a part of their nourishment during the first period of their existence. Instead, there- fore, of repressing this appetite for sugar, it ought rather to be gratified in moderation." Its free use does not injure the teeth as is generally imagined. " During the sugar season," observes Dr. Dunglison, "the negroes of the West India islands drink copi- ously 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." Sweetmeats, on the other hand, are most indigestible and seri- ously injurious; but this is referred to in the follow- ing section. Salt is a necessary article of food, being essential to the preservation of health, and the maintenance SUGAR AND SALT. 99 of life. Nature has therefore furnished an appetite for it. One of the ill effects of an unsalted diet is the generation of worms. In Ireland, where from the bad quality of the food the lower classes are ge- nerally infested with these insects, a draught of salt and water is a popular and efficacious anthelmintic. 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 or- dained men to be kept on bread alone, unmixed 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 only. It has been calculated, indeed, that the average annual consumption of salt by an adult amounts to 16 lbs; equal to about five ounces per week. In early infancy salt in small quantity may always be added with great advantage to the farina- ceous food. 100 DIET OF CHILDHOOD. SECT. V.--FRESH AND DRIED FRUITS AND SWEET- MEATS. Fresh fruits, as a general rule, are injurious to a delicate child, with the exception of the orange. This fruit, when quite ripe, is rarely inadmissible; the skin and seeds however must be scrupulously rejected. The juice, too, forms a refreshing and grateful beverage, and in some of the complaints of childhood is useful in allaying thirst and diminish- ing preternatural heat. When unripe, it is almost sure to cause griping, and should not be allowed even with the addition of sugar. A healthy child, whose digestive organs are vigorous, and in whom there is no liability to bowel derangement, may be permitted occasionally to partake of most fresh fruits, but it must be in moderate quantity. Apples and pears, when perfectly ripe, and well masticated, are not unwholesome. It is somewhat hazardous, however, to allow these fruits in the raw state to a very young child, lest they should not be properly masticated; and it need scarcely be added, that the unripe apples which children are so frequently allowed to take are not only indigestible, but some- times seriously hurtful. The apple when roasted forms a pleasant repast, and where there is a costive habit is useful as a laxative. Of the stone-fruits, the ripe peach, the apricot, and nectarine are the most wholesome, but cherries ought never to be allowed: FRUITS AND SWEETMEATS. 101 they do not agree with children, and besides this the stones are not unfrequently swallowed, when they sometimes produce very alarming and occa- sionally fatal results. The grape is delicious, as well as cooling and antiseptic, but the skin and seeds must be carefully rejected. Of the small- seeded fruits, the ripe strawberry and raspberry are most wholesome; the latter, when taken freely,pro- motes the action of the bowels. The gooseberry is less wholesome, on account of the indigestibility of the skin, which is too frequently swallowed. The fresh currant I object to for young children on ac- count of the seeds, which I have known to be re- tained in the bowels for days and even weeks, irritating the lining membrane, and thus exciting and keeping up a diarrhoea which immediately got well upon their expulsion. Dried fruits and sweetmeats a young child should never be permitted to take; they are a con- stant source of disorder. And yet no indulgence is so common in some families as this; and because it is not generally attended with an immediate bad effect, it is never thought to be injurious. The practice of having young children down after the parents' late dinner and giving them the dried and preserved fruits and other confectionary which may be on the table, is very productive of indigestion and bowel complaints. Again and again have I traced to this habit illness of a serious and protracted character. Dr. Eberle very justly says: "The 9* 102 DIET OF CHILDHOOD. conduct of parents in relation to this subject is often extremely irrational and pernicious in its conse- quences. They would not themselves venture on the frequent and free use of confectionaries of this kind; and yet will indulge their children with scarcely any restraint in the use of these pernicious luxuries. The sicklier and weaker a child is, the more apt in general is it to be allowed these destruc- tive gratifications. The pale, feeble, and sickly child, whose stomach is hardly able to digest the most simple and appropriate aliment, is sought to be appeased and delighted by the luscious and scarcely digestible articles of the confectioner. Indigestion, intestinal irritation, terminating often in ulceration and incurable diarrhoea, are the frequent conse- quences of such conduct; and at best, such indul- gences must inevitably prolong the feeble and sickly condition of the child, and not unfrequently even- tuate in permanent constitutional infirmity." My own observation and experience confirms most fully the truth of this statement. In families where there is much dinner company, as a general rule, there is always more disorder of the digestive organs of the children than where this is not the case. The dried grape or raisin should be given to chil- dren with caution, and, indeed, they are better al- together without them. If eaten freely, they are apt to disorder the digestive organs and cause flatu- lence; but more than this, the skins, which are not digestible even by the stomach of the adult, are liable FRUITS AND SWEETMEATS. 103 to remain in the bowels, and cause very serious ill- ness. Dr. Eberle speaks of three instances occur- ring to him, in which convulsions and speedy death were unequivocally the consequence of overcharging the stomach with this fruit; and he relates another case of the child of a medical friend of a most alarming character produced by the same cause. "The infant appeared to be well when put to bed. On attending it about midnight, it was found cold, pulseless, with a death-like expression of the counte- nance, and apparently dying. In a short time spon- taneous vomiting came on, by which a large quan- tity of raisins was thrown from the stomach, after which all the alarming symptoms speedily disap- peared. The raisins had been given to the child by a servant of the family without the knowledge of its parents." SECT. VI.--WATER, WINE, BEER, AND SPIRITS. Water 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 pre- paration, however, must be at a boiling tempera- ture, and it ought to be drunk as soon as it has suffi- ciently cooled; for by being kept it acquires a mawk- ish and unpleasant flavour. The practice of giving wine, beer, or, indeed, any stimulant, to a healthy child, is highly reprehen- sible ; it ought never to be given except medicinally. 104 DIET OF CHILDHOOD. 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, or some functional derangement. 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 at this tender age. To one of the children he gave, every day after dinner, a full glass of sherry: the child was five years of age, and unaccustomed to the use of wine. To the other child, of nearly the same age, and equally unused to wine, he gave an orange. In the course of a week, a very marked difference was perceptible in the pulse, urine, and evacuations from the bowels of the two children. The pulse of the first was raised, the urine high-coloured, and the evacuations destitute of their usual quantity of bile. In the other child, no change whatever was produced. He then reversed the experiment, giving to the first the orange, and to the second the wine, and the results corresponded: the child who had the orange continued well, and the system of the other got straightway into disorder, as in the first experiment. Marcellin relates an instance of seven children in a family whose bowels became infested with worms, BEVERAGE. 105 from the use of stimulants. They were cured by substituting water for the pernicious beverage. In this city, spirits, particularly gin, are given to infants and children to a frightful extent. I once saw an old Irish woman give diluted spirits to an infant just born. A short time since one of these dram-drinking children, about eight years of age, was brought into one of our hospitals. The attend- ants, from its emaciated appearance, considered the child was dying from mere starvation; which was true enough in a certain sense. Food was accord- ingly 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; a quantity of which must have destroyed life, if dram-drinking had not been the habit of the boy. 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 as- pect of the countenance being most fearful. They are continually suffering from bowel complaints and convulsive disorders; which, under these circum- stances, terminate invariably in an early death. There is a circumstance connected with the diet- ing of children with which parents ought to be ac- quainted ; certain articles of food, most wholesome in themselves and taken with advantage by others, 106 DIET OF CHILDHOOD. disagreeing with an individual child. We cannot conceive why, but presume it depends upon a hidden peculiarity of constitution, which we call idiosyn- crasy, and which generally remains through life. Eggs, milk, sugar, cheese, mutton, and other kinds of food, will thus have an almost poisonous effect, even when taken in the smallest quantity, and how- ever disguised by the most ingenious cookery. Dr. Prout mentions the case of an individual who could not eat mutton in any form. The peculiarity was supposed to be owing to caprice, and the mut- ton was repeatedly disguised, and given unknown to the individual; but uniformly with the same re- sult of producing vomiting and diarrhoea. And from the severity of the effects, which were in fact those of a virulent poison, there can be little doubt, that if the use of mutton had been persisted in, it would soon have destroyed the life of the indivi- dual. But whilst we admit this rare peculiarity, we must be careful not to indulge the dainty dislikes of a child to substances which when eaten produce no ill effects. For the mind's sake, as well as the body, such a disposition cannot be too early and vigorously opposed. GENERAL MANAGEMENT. 107 CHAPTER V. GENERAL MANAGEMENT OF INFANTS UP TO THE SECOND YEAR, AND OF CHILDREN UP TO THE EIGHTH. SECT. 1.--OF CHILDREN'S APARTMENTS AND SERVANTS. A large portion of the early years of children being spent in the nursery, and under the immediate care of dependants, the apartments they inhabit, and the persons who have the charge of them, ought to be of no small moment to parents, for the health and future welfare of their children will greatly de- pend on these two points. Apartments.—The proper ventilation of the apartments of children has not hitherto received that share of attention which its serious influence upon health deserves. Provision is rarely made for a-regular supply of fresh, or removal of vitiated air, beyond what is afforded by windows, doors, and open chimneys. The fact is that the public gene- rally are not yet alive to the vast evils consequent upon breathing impure air. If, however, any one wants to be convinced, and to see them in their most unmitigated form, it is only necessary to visit 108 THE CHILDREN'S APARTMENTS. the dwellings of the poor in a crowded city; the atmosphere they will have to breathe, and the ap- pearance of the inmates, will amply suffice to con- vince the most skeptical. In Mr. Farr's calculations, founded on the returns made to the Registrar Gene- ral, it is stated in the third Annual Report, that in cities, as contrasted with rural districts, the deaths from consumption are increased 24 per cent.-, those from typhus fever, 55 per cent.; those from child- birth, 59 per cent.; and so of several other disorders. The diseases chiefly incidental to childhood are twice as fatal in the town districts as they are in the coun- try. The mean duration of life in the two classes of districts differs nearly 17 years; being in the pro- portion of 55 in the country, to 38 years in the towns. These differences can only be explained by attributing them to the weakening influence of im- pure air, and the want of sufficient exercise; and there is one circumstance which shows that impure air is the more noxious agent of the two, namely, the great comparative mortality in towns of children under two years of age, even although they get as much exercise as their time of life would allow of any where. Many authorities might be appealed to in confirmation of this conclusion. I will only cite one; Sir James Clark regards "the respiration of a deteriorated atmosphere as one of the most powerful causes of tuberculous cachexia," (viz. the constitu- tional affection which precedes the appearance of consumption.) He says: "If an infant born in per- THE CHILDREN'S APARTMENTS. 109 feet health, and of the healthiest parents, be kept in close rooms, in which free ventilation and cleanli- ness are neglected, a few months will often suffice to induce tuberculous cachexia." "There can be no doubt," he adds, " that the habitual respiration of the air of ill-ventilated and gloomy alleys in large towns is a powerful means of augmenting the heredi- tary disposition to scrofula, and even of inducing such a disposition de novo. Children reared in the work-houses of this country, and in similar estab- lishments abroad, almost all become scrofulous, and this more, I believe, from the confined impure air in which they live, and the want of active exercise, than from defective nourishment." A striking in- stance of the ill effects of deficient ventilation in schools strongly confirmatory of this view is men- tioned in the second volume of the Poor Law Re- ports. The school referred to consisted of 600 pu- pils, amongst whom scrofula broke out extensive- ly, and great mortality occurred, which was ascribed to bad and insufficient food. The case was investi- gated; the food was proved to be most abundant and good; and defective ventilation and consequent at- mospheric impurity was assigned as the cause. Ven- tilation was applied, the scrofula soon after disap- peared, and 1100 children are now maintained in good health, where the 600, before ventilation, were scrofulous and sickly. Enough has been said, I think, to prove the ex- treme importance of thorough ventilation in the 10 110 GENERAL MANAGEMENT. apartments of the young, and to induce the reader to adopt the principle, where at present it is in any de- gree neglected. For it may be regarded as a well ascertained fact, that where systematic ventilation does not exist, it is almost impossible to keep an apartment shut up for any length of time, without a condition of atmosphere being produced that must be injurious. How often, where rooms are ill-ven- tilated, must a mother, on entering her nursery in the course of the day, but more particularly the bed- room of her children in the early morning, be sen- sible of the impurity of the atmosphere, while the occupants are altogether unconscious of it. Com- paratively fresh at the commencement of the day or night, the air deteriorates so slowly and equally, that unless it is contrasted with the external atmosphere its impure state is not perceived. Now the result of breathing this, day after day and night after night, however slightly it may be vitiated, is inevitably deteriorative of health, and although its injurious in- fluence be not so immediate or serious as in the ag- gravated case of the poor child, it is slowly going on, and is like in kind, for scrofula (the sure result of a fixed law) in one or other of its forms, or deli- cate health, will manifest itself. The lassitude and weariness of children after a night's repose, when they ought to be refreshed and sprightly, is often attributed to indisposition, when it frequently arises simply from breathing through the night the atmo- sphere of a close bed-room. THE CHILDREN'S APARTMENTS. Ill To explain the manner in which the atmosphere becomes deteriorated by respiration seems desirable, and 1 cannot do better than quote Dr. Arnott's words: " Ventilation is the changing any where, air which has been rendered impure. The chief cause of impurity is the respiration of persons in the place. In respiration or breathing, a man draws into his chest at one time about 20 cubic inches of air, and of that air a fifth part is oxygen, of which again there is converted into carbonic acid nearly one-half. The carbonic acid, if afterwards inhaled, would be nox- ious to the individual. About 15 inspirations are made in the minute, vitiating therefore 300 cubic inches, or nearly one-sixth of a cubic foot of atmo- spheric air, but which, mixing as it escapes with se- veral times as much, renders unfit for respiration at least two cubic feet under common circumstances. The removal of this impure air, and the supply in its stead of fresh air, is perfectly accomplished by an uninterrupted natural agency. The air which issues from the chest being heated to near the tempera- ture of the body, or 98°, and therefore dilated, is specifically lighter than the surrounding air at any ordinary temperature, and therefore ascends in the atmosphere, to be diffused there, as oil set free under water rises in it to spread above: in both cases, a heavier fluid, in fact, pushing up and taking the place of a lighter. This beautiful provision of nature, without trouble to the party, or even his being aware of it, is relieving him at every instant from 112 GENERAL MANAGEMENT. the presence of a deadly, though invisible poison? and replacing it with pure, vital sustenance; and the process continues while he sleeps as while he wakes, and is as perfect for the unconscious babe, or even brute creature, as for the wisest philosopher. The process may be called natural ventilation, and in the open atmosphere, while the wind blows, and air is as uninterruptedly passing the person, as the water of a mountain stream is passing its finny inhabitants, the process is perfect. When men, however, con- struct apartments which shut up or confine air, the action is disturbed. But even then, some degree of the same change always takes place by the escape through the crevices and joinings about windows, * doors, &c, of a portion of the warm air, to be replaced by fresh air entering below. And it is this natural ventilation of rooms, which, by effecting the purpose to a certain degree, has prevented the mass of man- kind from discovering the want of any other. Such accidental ventilation, however, is very irregular and imperfect."* It will be observed that the breath of the inmates of the apartment does not tend towards the chimney,but directly to the ceiling, and to escape must again descend to come below the level of the mantel-piece ere it reach the chimney, and thus the same air may be breathed again and again.t * Dr. Arnott on Ventilating and Warming. t It is known that a canary bird, suspended at the top of a cur- tained bedstead in which people have slept, will generally, owing to the impurity of the air, be found dead in the morning. THE CHILDREN'S APARTMENTS. 113 Provided there be a proper draught up the chim- ney Dr. Arnott's valve* secures the most perfect * " The ventilating valve is a contrivance placed in an opening made from the room into the chimney flue, near the ceiling, by which all the noxious air above referred to, is allowed at once, in obedience to the chimney draught, to pass away, but through which no air or smoke can return. The valve is in principle a small weigh-beam or steel-yard, carrying on one arm a metallic flap to close the opening, and on the other a weight to balance the flap. The weight may be screwed on its arm to such a dis- tance from the axis, or centre of motion, that it shall exactly counterpoise the flap, but when in use it is left a little farther off, so as just to preponderate, and to lift the flap very softly to the closing position. Although the valve, therefore, be heavy and durable, a breath of air suffices to move it; which, if from the room, opens it, and if from the chimney, closes it; and when no such force interferes, it settles in its closed position. " It is to be observed, that if the opening or throat of the chim- ney flue at the fire-place be so wide, that more air can easily enter there than can escape at the chimney pot above, the chim- ney will not draw air in also at the ventilating valve; it is essen- tial, therefore, that the register door, which is part of ordinary good stoves, be so far closed, after the fire is lighted, as to allow only the smoky air to enter, and not also, as is common, much of the pure air of the room escaping to waste. Where such a door does not exist, it may be obtained for a few shillings. It is farther essential, that the chimney pot above be.of sufficient size, and that no known cause of unsteady draught be allowed to remain. Usually the crevices unavoidably left around the doors and windows of.rooms, admit air enough to feed the fire and to ventilate sufficiently, but, occasionally, it is well to widen the chink above or below the door. In summer, when there is no fire, the bottom of the chimney should be closed by the register door, or by the common chimney board."—Dr. Arnott on Ven tilation and Warming. 10* 114 GENERAL MANAGEMENT. ventilation, and must be considered one of the most valuable of that disinterested philosopher's contri- butions to human welfare and comfort. But owing to the unscientific construction of most fire-places and chimney flues, this contrivance is often rendered futile by the downward draught in certain states of the atmosphere. There is, however, a chimney-pot exhibited at Edwards', Poland Street, which (it is said) under all circumstances secures this upward draught, and besides preventing the possibility of the chimney smoking, furnishes to Dr. Arnott's ventilating valve the conditions under which it per- fectly realizes the expectations of its inventor. For the admission of fresh air into the apartment, if the crevices usually and unavoidably left around the doors and windows of rooms, do not admit enough to feed the fire and to ventilate sufficiently, and they seldom do, it will be well either to widen the chink above the door, or in some cases to intro- duce a plate of zinc finely perforated (220 holes to an inch) into one of the window frames,—the size of which plate must vary, according to the size and construction of the room. These fine orifices pre- vent the air coming in with a rush, which would occasion discomfort, and tend to diffuse the air equally and gently through the apartment. There are other modes proposed, which under certain cir- cumstances may be more desirable. But whatever This valve, and full particulars, may be obtained at Edwards's, 20, Poland Street, Oxford Street. THE CHILDREN'S APARTMENTS. 115 plan is adopted it is imperatively necessary to secure a pure external atmosphere by effective drainage, cleansing, and prevention of nuisances, for without such measures no system of ventilation can be suc- cessful, and with it one-half of the remedy may be said to be already secured. In addition to these means, the windows of the nursery should be thrown wide open before the children come into it in the morning, and those of the bed room after they have left it; and, of course, in summer weather both may be frequently left open during the day, when judiciously managed, with great advantage. No cooking, or washing of linen, nothing, in fact, that would pollute the atmosphere, must be permitted in the nursery. Its temperature must be carefully regulated, and never allowed to rise above 65°. Heated rooms make children very susceptible of disease, particularly during the period of teething; and such as are accustomed to immode- rately warmed rooms will always, when taken into the cold external air, be much more liable to suffer than others, and during cold and humid weather will seldom be free from coughs and colds. The best mode of warming is a good coal fire. In the winter months, in the case of young children, there should also be a fire in the bed-room, so as to'secure a temperature of 60°. Many an attack of inflamma- tion of the lungs has arisen from a delicate child being undressed and put to bed at this period of the year in a room where this precaution has been dis- regarded. 116 GENERAL MANAGEMENT. If possible, the nursery should have a southerly or westerly aspect, command a pleasant prospect with- out, and be light and cheerful within. The light of the sun has a powerful influence upon the growth and healthy development of the body; and if chil- dren are immured in cheerless rooms, looking into dark shrubberies, or on the back yards and chimneys of a town, their health must inevitably suffer. The influence of light on the vegetable kingdom is known to every one who has observed the bleached appear- ance of a plant growing in the dark, or corn growing under the shade of a tree, which is always paler and later in ripening than that growing in an open part of the field. Some ingenious experiments were made by Dr. Edwards, showing the influence of light upon the development of animals, in which it was found that those which naturally change their form, as tadpoles, were prevented doing so by its withdrawal. By analogy we are warranted in infer- ring that light must materially influence develop- ment and health in man; and it is positively found that children deprived of its wholesome and gentle stimulus grow up pale, sickly, and deformed, of which numerous examples may be seen in the dark courts and cellars of all great cities. Then, again, a dull and confined prospect is a source of gloom to the naturally cheerful and active mind of a child; it should look out upon that which would gladden and refresh it. For the same reason the walls of its nursery should be surrounded with THE CHILDREN'S APARTMENTS. 117 pleasant and instructive pictures (easily attainable in the present day;) all which would tend constantly, although imperceptibly, to produce a beneficial and happy influence upon health and character. The fire should be guarded by a high and firmly fixed fender; the lower half of the windows with iron bars,—a precaution which has saved many a life. The floor also should be well carpeted, which best prevents those serious effects which sometimes fol- low severe falls in early childhood. Never have any unnecessary furniture in this apartment, that there may be ample space for the children to exer- cise and amuse themselves in. Leave as few things as possible within their reach, which they are not to touch; and never allow painted toys to very young children: they carry them to their mouths (particularly if teething,) and sucking off the paint, there is great danger of their health suffering from the lead which is thus swallowed. Nurse-maid.—I would remind the mother that although she is the guardian of the physical and moral health of her children, she must recollect that the nurse-maid must necessarily have a considerable influence over the culture of both. The most watch- ful parent cannot be every moment in her nursery, but her nurse-maid lives there. Day and night she has the care of and is the companion of the little ones. She looks after their persons, food, clothing, and apartments,—their amusements, exercise, and m 118 GENERAL management. rest,—and she must necessarily, more or less, have to do with the formation of their moral character. Not only their present health and well-doing, but their conduct and happiness in future life, will, to a great degree, be influenced by the manner in which the nurse-maid's duty is performed. There is there- fore every reason for using the utmost care in the selection of the individual to whom such a trust is confided. A nurse should be of a happy, cheerful disposi- tion; this has a most beneficial influence on the character and health of children. The youngest child is sensibly affected by the feelings apparent in the faces of those around him. How beautifully is this circumstance illustrated in the following quo- tation from the diary of a titled and amiable woman of former times, which, although a fiction, the para- graph I quote is so true to nature that I cannot re- frain from inserting it. Speaking of her first and infant boy, she writes:—"Yesterday it happened, as I nursed him, that, being vexed by some trifling matters that were not done as I desired, the disturbed expression of my countenance so distressed him that he uttered a complaining cry; made happy by a smile and by the more serene aspect that affec- tion called forth, he nestled his little face again in my bosom and did soon fall asleep. It doth seem a trifling thing to note, but it teacheth the necessity of watchfulness."* An active, cheerful, good-hu- * Diary of Lady Willoughby, p. 11. NURSE-MAID. 119 moured nurse, by regular affectionate attendance, by endeavouring to prevent all unnecessary suffering, and by quickly comprehending the language of signs in her little charge, will make a child good-hu- moured. Yet, on the other hand, the best-humoured woman in the world, if she is stupid, is not fit to have the care of a child, for it will not be able to make her understand any thing less than vocifera- tion. A careless, negligent, and passionate woman will not only injure the temper of the child, but its health too. If possible, avoid placing children un- der the charge of an individual suffering from any great natural defect—a person who squints, for in- stance, or who may have lost an eye,—or who is lame, or particularly ugly,—or even one who has a bad expression of countenance. Any one who stutters, or has any kind of impediment in her speech,—nay, any one whose voice is particularly harsh and loud,—or whose manners are rough and clumsy,— is not a fit person to have charge of chil- dren. Cleanliness is essential in a nurse. Without thorough cleanliness the health and comfort of chil- dren must greatly suffer. Thei* persons, clothes, bed-clothes, and beds must ever be kept clean, pure, and sweet; and depend upon it this will never be the case, if the nurse who has the charge of them is not in herself in all respects cleanly. Never be satisfied with a nurse merely washing her face and hands upon rising in the morning, and the latter 120 GENERAL MANAGEMENT. during the day as occasion may oblige her; but re- quire a thorough ablution of the whole body, every or every other morning. This will not be thought by any means a work of supererogation, when it is remembered that one or other of the little ones is in the nurse's arms the greater part of the day, and, perhaps, during the night one has to sleep with her. A nurse should be an early riser. She will thus betimes have her nursery well ventilated and cleaned, and ready for the children, who are gene- rally early risers, or ought to be. In order for this to be habitually carried out, arrangements must al- ways allow the nurse-maid to retire to rest early. A nurse-maid should be fully impressed with the importance of promptly informing the parents of any circumstances connected with the health of the children that from time to time may demand atten- tion. An observant nurse will often, by thus timely drawing attention to slight indisposition, prevent serious disease.—And she should, on no account, conceal any injury the child may have sustained. SECT. II.—SLEEP. During Infancy.—For three or four weeks af- ter birth the infant sleeps, more or less, day and night, only waking to satisfy the demands of hun- ger. 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 SLEEP. 121 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 will be ne- cessary to induce regularity in the hours of rest, 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, say from eleven to one o'clock, and again for half an hour or an hour about three o'clock, not later, or it will inevitably cause a bad night. He should not now be put to sleep immediately after a meal, as the process of digestion would cause the sleep to be uneasy, and therefore unrefreshing. The amount of sleep re- quired will necessarily differ somewhat in different children, but an observant parenfrwill soon deter- mine for herself what is required, and the regula- tions laid down above will be found generally ap- plicable. The chamber should always be darkened and kept as free from noise as possible. During the lying-in month 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 im- mediately be removed to the bed and care of ano- ther 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 11 122 GENERAL MANAGEMENT. course be soon deranged, and the infant would also suffer from the influence this 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, certainly not under 60°,—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 frequently the case that inflamma- tion of some internal organ will occur under such circumstances, without the true source of the disease ever being suspected. Here, however, the error must be guarded against, 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 both in the bed-room and nursery, and the light must be excluded by closing the win- dow-curtains or shutters. SLEEP. 123 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 horse-hair; for at this time teeth- ing commences, and it is highly important that the head should be kept cool. Great care must be taken to keep the bed and bed-clothes of the infant per- fectly sweet and clean. They should frequently be taken out and exposed to the air. A very excellent means to prevent their being soiled is the use of Macintosh sheeting. During Childhood.—From the second year and up to the third or fourth, the child should be per- mitted 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 fol- lowing 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. The amount of sleep necessary to pre- serve health varies according to the state of the body, and the habits of the individual. As already ob- served, infants pass much the greater portion of their time in sleep. Children sleep twelve or fourteen hours. The school-boy generally ten. In youth a 124 GENERAL MANAGEMENT. 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. Regularity as to the time of going to rest is the chief point to attend to; permit nothing to interfere with this, 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. 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 re- tiring 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, he should not be permitted to lie longer in bed, but he 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, pro- motes 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. BATHING and cleanliness. 125 The bed on which the child now sleeps should be a mattress: at this age a feather bed is always in- jurious 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 im- pressions of cold. Instead of the bed being made up in the morning as soon as vacated (a very com- mon practice,) and while still saturated with the nocturnal exhalations from the body, the night and 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. Never allow a child to sleep with persons in bad health, or who 3re far advanced in life; if possible he should sleep alone. Those who possess the means should avoid placing several children in the same bed-room. v SECT. III.--BATHING AND CLEANLINESS. During Infancy.—Too much attention cannot be paid to cleanliness: it is essential to the infant's health. There is constantly exhaling from the in- numerable pores of the skin a large amount of fluid and solid matter designated in common terms the perspiration. The fluid part of this passes off, and mixes with the atmosphere, but a great portion of the solid part is left adhering to the skin. The latter, if not removed, after a time so accumulates 11* 126 GENERAL MANAGEMENT. as to obstruct the pores, and necessarily impedes any further exhalation. The result is disordered health, or perhaps an obstinate and troublesome eruption on the skin itself. Persons generally have no idea of the value and importance of the functions of the perspiratory system, and its influence on the health and comfort of the individual. This subject is pre- sented in a very interesting and striking manner in the following observations of Mr. Erasmus Wilson. " I counted the perspiratory pores in the palm of the hand, and found 3528 in a square inch. Now, each of these pores being the aperture of a little tube of about a quarter of an inch long, it follows that in a square inch of skin on the palm of the hand there exists a length of tube equal to 882 inches, or 73^- feet. Surely*such an amount of drainage as 73 feet in every square inch of skin, assuming this to be the average of the whole body, is something wonderful, and the thought naturally intrudes itself,—what if this drainage was obstructed?"*—"The number of square inches of surface in a man of ordinary height and bulk is 2500; the number of pores, therefore, is 700,000, and the number of inches of perspiratory tube 1,750,000, that is 145,833 feet, or 48,600 yards, or nearly 28 miles." From this ex- planation the necessity and value of cleanliness to the * Perhaps the importance of attending to the skin will receive additional weight by my stating that the amount of the drainage which daily passes from its pores approximates very nearly to that which flows from the kidneys. BATHING AND CLEANLINESS. 127 health must be self-evident. Besides these impor- tant considerations, Dr. Eberle very justly observes: "The agreeable feeling which entire cleanliness is calculated to produce, as well as the excellent moral influence which it is capable of exerting on the mind, are in themselves of sufficient moment to claim for it the most solicitous attention. Children who are early accustomed to the comfortable and healthful impressions of washing and bathing, will rarely in after-life neglect the observance of per- sonal cleanliness; and those, on the contrary, who are neglected in this respect during childhood, will seldom manifest a proper regard for this physical virtue in the subsequent stages of their lives." The principal points to which especial attention must be paid by the parent are the following:— Temperature of the Water.—In the early weeks of the infant's life, it should as soon as taken from its bed in the morning be washed in warm water from 96° to 98°, and be put into a bath of the same tem- perature for a few minutes every evening before it is put to rest. To bathe a delicate infant of a few days or even weeks old in colder water with a view " to harden " the constitution (as it is called,) is the most effectual way to undermine its health and en- tail 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 128 GENERAL MANAGEMENT. 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 de- presses the vital energies, and prevents that healthy glow on the surface which usually follows the mo- mentary and brief action of cold, and upon which its usefulness depends. With some children, in- deed, 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 flannnel,—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 contained in a muslin bag: 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. BATHING AND CLEANLINESS. 129 I cannot refrain from quoting a passage here, which I recommend to the consideration of every parent, as no less philosophical than practically true. " During this daily process of washing, which should not be done languidly, but briskly and expeditiously, the mind of the little infant should be amused and excited. In this manner dressing, instead of being dreaded, as a period of daily suffering,—instead of being painful, and one continued fit of crying, will become a recreation and amusement. In this, treat your infant, even your little infant, as a sensitive and intelligent creature. Let every thing which must be done, be made not a source of pain, but of pleasure, and it will then become a source of health, and that both of body and mind; a source of exer- cise to the one, and of early discipline to the other. Even at this tender age, the little creature may be taught to be patient, and even gay, under suffering. Let it be remembered that every act of the nurse towards the little infant is productive of good or evil upon its character as well as health. Even the act of washing and clothing may be made to disci- pline and improve the temper, or to try and impair it, and may therefore be very influential on its happiness in future life. For thus it may be taught to endure affliction with patience and even cheer- fulness, instead of fretfulness and repining. And every infliction upon the temper is also an inflic- tion upon the body and health of the little child. The parent and the nurse should, therefore, endea- 130 GENERAL MANAGEMENT. vour to throw her own mind into her duties towards her offspring. And in her intention of controlling her infant's temper, let her not forget that the first step is to control her own. How often have I ob- served an unhappy mother the parent of unhappy children!"* 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 these discharges are about to take place, that she may not only anticipate them, but teach the child, at a very early age, to give in- telligent warning of its necessities. Thus a habit of regularity with regard to these 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; the hair must be regularly brushed and combed, and the ears, the eyes, the nose, and the openings of the passages from the in- terior of the body, as well as the surface of the skin generally, must be kept perfectly clean. The care- ful adoption of these means will be found the best preservative against those eruptive disorders which are so frequent and troublesome during the period of infancy. During Childhood.—When the second period, or that of childhood arrives, bathing is but too fre- * Letters to a Mother, on the Watchful Care of her Infant, p. 89. BATHING AND CLEANLINESS. 131 quently 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 cleanli- ness, 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 unneces- sary 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 sea-bathing should be substituted. The best time is two or three hours after breakfast; but he must not be fatigued before- hand, for if so, the cold bath cannot be used without danger. Care must be taken that he does not re- main in too long, as the animal heat will be lowered below the proper degree, which would be most in- jurious. In boys of a feeble constitution, great mis- chief is often produced in this way. It is a, matter 132 GENERAL MANAGEMENT. 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 stru- mous.—If a child is of a delicate and strumous con- stitution, 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 in- creased 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 salt- water 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 CLOTHING. 133 weather cold,—tepid vinegar and water, or tepid salt water, must be substituted. SECT. IV.--CLOTHING. In Infancy.— Infants are very susceptible of the impressions of cold; a proper regard, therefore, to a suitable clothing of the body is essential to their enjoyment of health. Unfortunately an opinion is prevalent 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 re- sults. This opinion has been much strengthened by the insidious manner in which cold operates on the frame, the injurious effects not being always ma- nifest 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. It cannot be too generally known that the power of generating heat in warm- blooded animals is at its minimum at birth, and in- creases successively to adult age—that young ani- mals, therefore, instead of being warmer than adults, are generally a degree or two colder, and moreover part with their heat more readily. These facts show how absurd must be the folly of that system of "hardening" the constitution, which induces some parents to plunge the tender and delicate child into a cold bath at all seasons of the year, and freely expose him to the cold, cutting currents of an 12 134 GENERAL MANAGEMENT. easterly wind, in the lightest clothing;—cruel as absurd. 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 the pa- rent must avoid the too common, but frequently fa- tal, practice of leaving bare, at all seasons of the year, the neck and upper part of the chest and arms of her little one; such exposure in damp and cold weather being a fruitful source of croup, inflamma- tion of the lungs, and other serious complaints. At the same time a prevalent error in the opposite ex- treme must be guarded against—that of enveloping the child in innumerable folds of warm clothing, and keeping it constantly confined to very hot and close rooms ; since nothing tends so much to enfee- ble the constitution, to induce disease, and render the skin highly susceptible of the impressions of cold, and thus produce those very ailments which it is the chief intention to prevent. The infant's clothing should possess lightness as well as warmth, and therefore flannel and calico are the best mate- rials to use. The skin, however, in the early months is so delicate, that a shirt of fine linen must at first be worn under the flannel; but as the child grows older the flannel is desirable next the skin, giving CLOTHING. 135 by its roughness a gentle stimulus to it, and thus promoting health. When a child is at all disposed to bowel complaints, flannel is indispensable. They should be so made as to put no restrictions to the free movements of all parts of the child's body—so loose and easy as to permit the insensible perspiration to have a free exit, instead of being confined and absorbed by the clothes, and held in contact with the skin till it gives rise to irritation. Full room too should be allowed for growth, which is continually and rapidly going on; and particularly should this be the case round the throat, arm-holes, chest and wrists, so that they may be easily let out. The construction of the dress should be so simple as to permit of being quickly put off and on, since dressing is irksome to an infant, causing it to cr}r, and exciting as much mental irritation as it is capa- ble of feeling. Pins should be wholly dispensed with, their use being hazardous through the care- lessness of nurses, and even through the ordinary movements of the infant itself. This leads me to make one general remark applicable not only to the clothing but also to other circumstances in the eco- nomy of an infant—the babe can itself give no ex- planation of the inconveniencies it suffers. "Bear- ing this in mind, and remembering how continually adults are annoyed by trifles which they have the perception to discover, and the ability to remove, it will readily be acknowledged that nothing is too insignificant for the constant and regular attention 136 GENERAL MANAGEMENT. of a mother." For example, "articles of dress contract, or otherwise lose their shape; a ruck forms, a hook bends, or a button turns and presses upon the flesh: any one of these accidents occasions pain, and frets the temper of an infant." The clothing should be changed daily ; this is eminently conducive to health. There should al- ways too be an immediate change of wet and soiled linen, for that which is fresh and dry. Unless these directions are attended to, washing will, in a great measure, fail in its object, especially in ensuring freedom from skin diseases. The wardrobe, there- fore, must be sufficiently large to admit of this; and where pecuniary means are not abundant, the mother, in making her baby linen, should remem- ber that quantity is more important than quality. With regard to caps, they should be made of thin material, with no under-cap. The head is to be kept cool, not warm. As soon as the hair begins to grow, provided it is not very cold weather, caps may with advantage be left off altogether, night as well as day. During thefirst seven or eight months, the child's clothes extend considerably beyond the legs and feet, and up to this period, therefore, they are complete- ly protected from cold and the variations of tempe- rature. But from this time, when short-coating, as it is styled, is commenced, cotton or fine flannel socks should be put on in warm weather, and fine Angola stockings during cold weather. Shoes also must now CLOTHING. 137 be worn,made of light and pliable materials,and large enough to prevent all constraint to the feet; neither too roomy, nor too tight. Some persons object to the use of shoes, believing that they interfere with the child's learning to walk; if, however, they are large, and of pliant materials, this cannot be; whilst it must be remembered, on the other hand, that they are useful not only in protecting the feet from cold, but from injury also, for accidents from pins and needles running into the feet are not at all uncom- mon where children are allowed to walk without them. The change to short-clothing should always be avoided in cold weather. In Childhood.—The clothing of c/^Yo^ooa? should possess the same properties as that of infancy. It should afford due warmth, and yet be light, and so made as to occasion no unnatural constriction. In reference to due warmth, it may be well again to re- peat, that too little clothing (that state of semi-nudi- ty which the vanity of some parents encourages) is frequently productive of the most sudden attacks of active disease; and that children who are thus ex- posed, 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. It has been said, and I believe with great truth, that the foundation of pulmonary consumption is often thus laid, during the first few- years of life. On the other hand, do not forget that 12* 138 GENERAL MANAGEMENT. too warm clothing is also a source of disease, some- times even of the same diseases which originate in ex; posure to cold, and often renders the frame more sus- ceptible of the impressions of cold, especially of cold air taken into the lungs. Regulate the cloth- ing, then, according to the season; resume the win- ter dress early, and put it aside late; for it is in spring and autumn that the vicissitudes in our cli- mate are greatest, and congestive and inflammatory complaints most common. With regard to material (as was before observed,) the skin will generally long before this period bear flannel or fleecy hosiery next to it; and it is not on- ly proper that it should be continued, but necessary. It may be put off with advantage during the night, and cotton may be substituted during the summer,the flannel being resumed early in the autumn. If, in any given case, flannel 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 restraint shall be put on the movements of the body or limbs, nor injurious pressure made on his waist or chest. All his mus- cles ought to have full liberty to act, as their free exercise promotes both their growth and activity, and thus ensures the regularity and efficiency of the several functions to which these muscles are subser- vient. For this reason long drawers and socks should be worn, which avoids the necessity of gar- ters. CLOTHING. 139 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 but too frequently adopted which has the most pernicious effects upon her health, and the develop- ment of the body,—the employment of tight stays, which impede the free and full action of the respira- tory organs, being only one of the many restrictions and injurious practices fromwhich in later years she is thus doomed to suffer so severely. But the course pursued, and its terrible consequences, will be dwelt upon in the next section, on Exercise. SECT. V. — AIR AND EXERCISE. During Infancy. — The importance of pure air in the apartments of children was pointed out in the early part of this chapter. I have here only to speak of open air exercise. Daily experience proves how invigorating and vivifying is its influence upon the system of the young. We must, however, act pru- dently in this matter. A delicate infant, born late in the autumn, will scarcely be able to be taken out, in a changeable climate like ours, before the suc- ceeding spring, and provided its apartments are large, often changed, and well ventilated, he will not suffer from the confinement. No opportunity, however, should be lost, if the child be strong and healthy, of taking him into the open air at stated periods. At all 140 GENERAL MANAGEMENT. seasons, however, regard must be had to the state of the weather. To a damp condition of the atmo- sphere the infant should never be exposed; it is one of the most powerful exciting causes of consumptive disease: and the same caution is necessary in refer- ence to an easterly wind, being more productive, I believe, of inflammation of the lungs, (so frequent in childhood,) than any other cause. The nurse should always have strict orders not to loiter and linger about, exposing the infant; the source frequently of a two-fold evil, a moral one to herself, and a physi- cal one to her charge. 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: and here I would ob- serve, that the mode of carrying an infant must be carefully attended to. Upon this subject I cannot do better than quote the words of Dr. Eberle; he remarks, "The spine and its muscles seldom acquire sufficient strength and firmness before the end of the third month, to enable the child to support its body in an upright position, without inconvenience or risk of injury. Until this power is manifestly acquired, the infant should not be carried or suffered to sit with its body erect, without supporting it in such a manner as to lighten the pressure made on the spine, and aid it in maintaining the upright posture of its head and trunk." He accordingly advises that "at first (a few days after birth) the infant should he taken from its cradle or bed two or three times daily. AIR AND EXERCISE. 141 and laid on its back, upon a pillow, and carried gently about the chamber." . . . "After the third or fourth week, the child maybe carried in a reclining posture on the arm of a careful nurse, in such a way as to afford entire support to the body and .head. This may be done by reclining the infant upon the fore-arm, the hand embracing the upper and poste- rior part of the thighs, whilst its body and head are supported by resting against the breast and arm of the nurse. When held in this way, it may be gently moved from side to side, or up and down, while it is carefully carried through a well-ventilated room." This plan of passive exercise must be fol- lowed until the completion of the third month, when the child will have acquired a sufficient degree of muscular power to maintain itself in a sitting pos- ture. In this position it may be carried about for a short time twice or thrice daily, provided the spine and head be supported by the nurse—"an aid which can seldom be prudently dispensed with before the child is six or seven months old."* In the mean time, when two or three months old, and it begins to sleep less during the day, the infant will greatly enjoy being occasionally placed upon a soft mattress or sofa, and allowed to roll and kick about at its pleasure. Such exercise will tend much to develop the powers of its muscular system ; it will also learn to use its limbs and walk earlier than if deprived of this freedom of action. * Eberle on the Diseases and Physical Education of Children, p. 45. 142 GENERAL MANAGEMENT. It is a very common practice for a nurse to sup- port a young infant upright on her knee, and vio- lently to jolt it up and down—-violently, indeed, considering the delicate structure of the infant's frame. This is done thoughtlessly, and in the be- lief that it is a source of enjoyment, instead mani- festly of inflicting pain on the child. Gentle and cautious tossing, or rather dandling to and fro, is really agreeable to a child, and can never, therefore, be objectionable: but the rough treatment alluded to, a mother must carefully prevent. The same pre- caution it is necessary to observe in regard to the rocking an infant in a cradle. I believe that gentle and cautious rocking is a soothing and useful exer- cise to a child; but it is quite otherwise when rough, and long continued. By and by, the child will make its first attempts to walk. Now, it is important that none of the many plans which have been advised to teach a child to walk should be adopted—the go-cart, leading- strings, and contrivances of this sort; 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 prema- turely 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 con- sequence become curved and distorted. It is highly AIR AND EXERCISE. 143 necessary that the young and inexperienced mother should recollect this fact, for the early efforts of the child 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 pa- rent has had to mourn over the deformity which she has herself created. It may be as well here to re- mark, 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 ori- ginal cause of the distortion—never allowing the child to get upon his feet. The only way to ac- complish the latter intention, is to put both the legs into a large stocking; this will effectually answer the purpose, while, at the same time, it does not prevent the free and full exercise of the muscles of the legs. After pursuing this plan for some months, 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 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 learn to crawl: this exercises every 144 GENERAL MANAGEMENT. muscle in the body, does not fatigue the child, throws no weight upon the bones, but imparts vi- gour and strength, and is thus highly useful. After awhile, 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 accom- plish 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 any thing 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 exul- tation; when, after numerous trials, he will feel con- fident 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. Of late an American invention, called the Infant Gymnasium, or Baby Jumper, has come into use. It is an apparatus for the self-exercising of young children, invented by Mr. Rogers of New York. It would seem to afford a harmless and healthful mode of exercise, and from all accounts, an exceed- ingly grateful one. AIR AND EXERCISE. 145 During Childhood.—When the child has ac- quired 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, the 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 improve- ment 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 consump- tion, 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, 13 146 GENERAL MANAGEMENT. 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 of 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 con- gestion 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 im- portance, 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 unnatu- ral 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 after- wards 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 employ- ment. For this purpose the head is kept erect, and AIR AND EXERCISE. 147 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 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 perform- ing what is required of them. "This fact soon be- comes 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 mea- sures tend, and which such measures are daily and hourly producing? The muscles of the back and chest, restrained in their natural and healthful exer- cise by the waistcoat called-in to aid them, and 148 GENERAL MANAGEMENT. more signally, in after-life, by the tightly-laced stays or corset, become attenuated, and still further enfeebled, until 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, im- perceptibly to the parties. The effect, however, though slow, is sure; and the powers of endurance thus exercised, come in time to bear, almost uncon- sciously, what, if suddenly or quickly attempted, no heroism could possibly sustain. This increased pres- sure impedes the motion of the ribs. " For perfect respiration these motions should be free and unre- strained, 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 vitalized, 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." Quick- ened respiration soon ensues, the heart becomes ex- cited, 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 AIR AND EXERCISE. 149 necessarily compressed, to the great disturbance of their functions; and being pressed downwards too, these trespass on that space which the other abdomi- nal viscera require, superinducing still further de- rangements. 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, de- prived 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 debili- ty, 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 ensure a good carriage, the only rational way is to give the necessary power, especially to the mus- cles chiefly concerned; and this is to be done, not by wearing those muscles by continual and unre- lieved exertion, but by invigorating the frame ge- nerally, and more especially by strengthening the 13* 150 GENERAL MANAGEMENT. particular muscles through varied exercise alter- nated 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." In these few remarks on " a good carriage," I have drawn freely from a valuable article of Dr. Barlow's, in the Cyclopaedia of Practical Medicine. medicines: their use and abuse. 151 CHAPTER VI. of medicines: their use and abuse. In almost every nursery some medicines are kept, which are given to the children more or less fre- quently as their trifling ailments occur. And there is no objection to this, provided due care and judg- ment are exercised by those who administer them, and only those medicines are kept and given, which may be resorted to with safety. Unfortunately this is not the case in all families; and then what misery and destruction to health does the nursery medi- cine-chest produce! slowly, perhaps,—but not the less surely. If, however, it be granted, that a young mother is not to send for the physician for every trifling ailment of her little one, and surely no one would insist on this, then it is also very plain that there is a certain amount of information in the way of caution as well as instruction about medicine and remedies of which she ought not to be ignorant. For example, it is not required of her to seek her medical attendant every time her infant needs a dose of castor oil,—but then she surely ought to know something about the quantity of this drug that it is proper to exhibit, as well as the best and least disa- 152 OF MEDICINES. greeable form in which it may be given. Then again, in reference to the making of so simple a matter as a bread and water poultice, this is either one of the most comforting and useful of local reme- dies, or most irritating and useless, according as it is well or ill-made: no mother, therefore, ought to be ignorant how to make it; and yet few possess this knowledge. But more than this, in time of real illness, to carry out the prescriptions of the medi- cal adviser himself, requires a certain amount of in- formation bearing upon the preparation and appli- cation of remedial agents,—such, for instance, as leeches, blisters, and baths,—which it is most im- portant and necessary the parent should be furnished with. It would therefore appear desirable to say a few words even upon medicine and remedies, with which a mother should make herself familiar, that she may not only administer to the trifling ailments of her children with safety, but that she may be enabled efficiently to comply with the prescriptions of the medical attendant, when disease of a serious character attacks them. Here perhaps is the best and most appropriate place to remark upon the mode of administering medicine to children. There is great difficulty sometimes in getting a child to take its medicine. I believe this in most instances to be the fault of the parent. If you are only firm in your manner, as well as kind, you will always succeed, unless with a very obstinate child indeed. With such there is medicines: their use and abuse. 153 only one resource, and that is the employment of the medicine spoon, the invention of Dr. A. T. Thomson, by whom it is thus described: " It con- sists of a spoon with a hollow handle opening at the top, and also into the bowl of the spoon, which is covered with a hinged lid, but is open at the apex. The spoon is made in the form of a wedge, in order to force the teeth apart when resistance is made to its introduction into the mouth; and it is rounded at the corner in order to avoid injuring the tongue and gums. When any fluid is poured into the spoon, and the lid shut down, the pressure of the atmo- sphere upon the fluid, at the opening near the apex, prevents it from running out of the spoon, as long as the orifice at the upper end of the handle is firmly compressed by the thumb of any person; but as soon as the thumb is removed, the fluid is projected with considerable force from the spoon. When the spoon is to be used, the head of the child must be steadied by an attendant, who should also compress the nostrils, which obliges the mouth to be opened for the facility of breathing. The spoon is then to be introduced into the mouth of the child by ano- ther person holding it with one hand, and at the same time keeping down the arms of the child with his other hand. The back of the spoon is then to be gently pressed upon the tongue, and the thumb being removed from the opening of the handle, the air rushes in, and projects the medicine into the gullet, whence it is instantly conveyed into the sto- mach." 154 OF MEDICINES. 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. Various are the forms in which it is given; perhaps, among a certain class, the " little powder" obtained from the chemist is the most frequent, as it is certainly the most injurious, from its chief ingredient being calomel. With such persons the choice of the ape- rient, or the dose, or the exact condition of the health, or whether it is an aperient at all that is re- quired, are considerations that never for one moment enter their minds: a little medicine is thought neces- sary, because it is evident the child is not well, and a purgative or a little white powder is forthwith given. For instance, I have known a nurse thoughtlessly give a large dose of magnesia to an infant that had been suffering from a diarrhoea of some days' stand- ing, and cause death. Now this medicine is one of the most useful and harmless that can be given to a child when it is really indicated, and in a dose suited to the age, and when the proper time is fixed upon for its exhibition; in the foregoing case every thing forbade its use: but none of these points were con- sidered. Again, a mother frequently falls into the common error of repeating aperient medicine to re- move those very symptoms which its previous ex- hibition has produced. Some incidental pain and APERIENT MEDICINE. 155 uneasiness, some slightly greenish appearance of the motions, leads to the belief that more purging is ne- cessary, when in fact both circumstances have pro- bably been induced by the irritation caused by the purgatives already too freely administered. How often 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. It would be well if all who have the management of children were to remember whenever they open the medicine-chest, that " the great art of medicine is the proper appli- cation of the proper medicine in the proper dose, at the proper time." For the information of a young mother it is im- portant to mention that the bowels of an infant in health should be relieved two, three, or four times in the twenty-four hours; that the stools should be of the consistence of thin mustard, of a lightish yel- low colour, free from any fetid or acid smell, desti- tute of lumps or white curdy matter, and passed without pain or any considerable quantity of wind; and that as the child grows older, while the stools diminish in number, they become darker in colour. The following purgatives are the only ones that ought to be found in the nursery; and they may be given with perfect safety by the parent, either alone or in the combinations prescribed, provided always the directions laid down are attended to. 156 OF MEDICINES. Castor Oil.—A mild aperient, prompt in its ac- tion and effective; it is a medicine, therefore, parti- cularly applicable to infants. It has this great ad- vantage, too, over other purgatives; that while they generally cause, after their action is passed off, a con- fined state of bowels, this leaves them relaxed. The dose will depend upon the age and the known effects of aperient medicine upon the child; some requiring more, others less. As a general rule, one or two tea-spoonfuls. To cover its unpleasant flavour it maybe given in various ways;—either mixed in warm milk; or floating on peppermint, mint, or some other aromatic water. Or, if the stomach is unusually delicate, it may be made into the follow- ing emulsion, of which give a dessert-spoonful or more according to the age, every hour until it ope- rates :—Take of castor oil, six drachms; the yolk of an egg; dill water, two ounces; loaf sugar, two drachms; mix intimately. For overcoming habitual costiveness no medi- cine can be so much relied upon 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 will generally con- tinue to act without further artificial assistance. During teething, when there is a sluggish state of the bowels, castor oil is a very useful remedy. I am in the habit, however, in this case, of pre- scribing it in combination with magnesia, in a form which I owe to Dr. Eberle, and which is so certain APERIENT MEDICINE. 157 and mild in its operation, while it is really pleasant to the taste, that I find children take it with little or no reluctance. The following is the form, of which give one or two tea-spoonfuls for a dose, and repeat it if necessary:—Take of castor oil, one ounce; calcined magnesia, two drachms; loaf sugar, three drachms; oil of anise, two drops; mix inti- mately. Manna.—This also may be given with impunity to the youngest infant; it is sweet to the taste, and mild in its operation. The dose is from one to three drachms. It may be given in a little warm milk; or, if it cause flatulence in this form, in some aromatic water, as a dessert-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 me- dium of mucilage or the yolk of an egg; in fact, it might be substituted for the white sugar in the pre- vious 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 prevail- ing acescency of the stomach. The dose is from five grains to ten for an infant, increasing the quan- tity 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 ape- 14 158 OF MEDICINES. rient operation. And whenever the bowels are dis- tended 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 inexperi- enced mother to infer that the child i3 suffering from acidity; and to counteract the supposed evil, mag- nesia 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 mild cases of diar- rhoea, 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 ad- dition of magnesia; both of which are more effective APERIENT MEDICINE. 159 when thus united than when given separately. The following form, in a costive and flatulent state of the bowels, will be found useful; a tea-spoonful or more may be given every three or four hours until the de- sired effect is obtained:—Take of powdered rhubarb, half a drachm; magnesia, two scruples; compound spirits of ammonia, twenty drops; dill water, two ounces; simple syrup, two drachms. Purgative Biscuits.—For years, in some fami- lies, aperient medicine, when occasionally required, has been exhibited in this form. There can be no objection to this, if it lessen the child's misery in physic taking; but these biscuits must be carefully made and carefully used. The Montpellier Hospital has the following formula, which, as its purgative quality is jalap, should not be given to very young children:— "Take an ounce of flour, and an ounce of sugar, two eggs, and one drachm of powder of jalap; let three biscuits be made, a quarter of one of which will contain five grains of jalap; and may be taken once or twice a day, according to the effect." The following form for castor oil biscuits may also be occasionally resorted to:— Take a quarter of a pound of flour, two ounces of moist sugar, a small quantity of mixed spice finely powdered, and with an ounce and a half of castor oil, make the whole into the consistency of pie-crust; to which may be added a few currants. After rolling out the paste, divide into ten cakes, and bake over a quick oven. Each cake will contain rather 160 OF MEDICINES. more than a tea-spoonful of oil, and one or more may be given according to the age of the child. The same may be made into gingerbread nuts by adding proper proportions of treacle and ground ginger. The Lavement.—This is an excellent nursery remedy when the bowels are obstinately costive. It may then be employed as a substitute for medi- cine, a protracted and frequent use of which (even of the mildest aperients) is apt to injure the diges- tive functions, and to give rise to some degree of intestinal irritation. Lavements, however, like ape- rient medicine, must not be resorted to for a long time together; for whilst the latter irritate, the former must 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, may be stated as fol- lows:—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 often or fifteen, from six to eight fluid ounces. The mode of administering an injection to an APERIENT MEDICINE. 161 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 attend- ed 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: one ounce of compound soap liniment mixed with half an ounce of compound tincture of aloes. 14* 162 OF MEDICINES. 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 ex- hibited. 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 immo- derate use of mercury in early infancy produces more, perhaps, than any other similar cause, that universal tendency to decay, which, in many in- stances, destroys almost every tooth at an early age." In the diseases of childhood it is often adminis- tered by the mother or nurse with a degree of care- less excess which ultimately, if not immediately, produces severe and irremediable injury. I have CALOMEL. 163 met with such cases; but Mr. Bell details a remark- able 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, &c, followed by ulceration of the gum, lips, and cheek. On exa- mining a 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 por- tion of bone was raised and became loose, when I found that the mischief was not confined to the al- veolar process, but comprised the whole substance of the bone within the space just mentioned," &c. Surely the knowledge of such a case as this would induce every prudent mother to exclude calomel from her list of nursery medicines. 164 OF MEDICINES. SECT. III.--OPIATES. This class of medicine is often kept in the nursery, in the forms of laudanum, syrup of white poppies, paregoric elixir, Dover's powder, Dalby's carmina- tive, and Godfrey's cordial. The object with which they are generally given is to allay pain by pro- ducing sleep, or perhaps, much more frequently to allay the crying of a fretful child. They are, there- fore, remedies of great convenience to the nurse; and so exhibited, they are too often fatal. In the hands of the physician, there is no medi- cine 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 nursery medicines. It is calculated that three-fourths of all the deaths that take place from opium, occur in children under five years of age. The amount which will some- times cause death is very small; a fact most import- ant to remember, and of itself a powerful argument against its use in any form by unprofessional per- sons. Dr. Kelso met with an instance, where a child nine months old was killed in nine hours by four drops of laudanum. A case is mentioned in a late number of the Medical Gazette, in which two drops killed an infant; and another is reported in OPIATES. 165 the Lancet for February, 1842, of a child two days old, killed by a dose of a mixture containing only one drop and a half of laudanum, the child dying in fourteen hours. Syrup of poppies is nothing more than a sweetened decoction of poppy heads, and many cases of poison- ing have occurred from its injudicious use. " There is great reason, however, to believe, that what is sold by many druggists for syrup of poppies, as a soothing medicine for children, is a mixture of tinc- ture or infusion of opium with simple syrup; it is, therefore, a preparation of very variable strength. This will account for what appears to many persons inexplicable, namely, that an infant will be destroyed by a very small dose." In 1837-8, seven children (whose cases are on record) lost their lives from this medicine; in one of them a tea-spoonful and a half was given; stupor came on in half an hour, and the child died the following day. And in January, 1841, a child, six months old, is said to have died from the effects of less than half a tea-spoonful of this syrup, bought at a druggist's. Paregoric elixir has been occasionally given with fatal effects. A child, between five and six years old, had some cough medicine prescribed for it at a chemist's, the principal ingredient of which was paregoric, and it died, poisoned. Another authen- ticated case is reported, where a child of seven months old was killed by the exhibition of a tea- spoonful. 166 OF MEDICINES. In reference to Dover's powder, Dr. Ramisch of Prague met with an instance of a child, four months old, which was nearly killed by the administration of one grain only; and in June, 1832, a case occurred, in which four grains were given to a child four years and a half old, which became comatose, and died in seven hours. Ten grains of this preparation contain one grain of solid opium. Dalby's carminative, with the exception of God- frey's cordial, is perhaps the most popular quack medicine of its class in use, and one of the most fatally destructive from the indiscriminate and care- less manner in which it is employed. The late Dr. Clark, in his Commentaries, mentions a case which he saw, where forty drops of this preparation destroyed an infant. Godfrey's cordial has been abundantly destruc- tive. In 1837-38, twelve children were killed by it; in one of these cases, the infant was four months old, and half a tea-spoonful was the dose given: an inquest was held on the body. Dr. Merriman relates the following instructive cases:—"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 cor- OPIATES. 167 dial 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 imme- diately 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 a lazy unprincipled nurse, unknown to the parent, will very often resort to these medicines, in some one or other form) a low, irritated, febrile state is produced, gradually followed by the loss of flesh; the counte- nance becoming pallid, sallow, and sunken; the eyes red and swollen; 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. The habit of administering opiates to young chil- dren has become prevalent to an alarming degree in the manufacturing counties, and to a considerable extent in rural districts. It is not confined to in- fants suffering from disease, but also extends to those in a state of health, in order to ensure their more easy management when the mother is absent from home. A respectable druggist in Manchester states, "I sell in retail alone five gallons per week ofl quietness,' and half a gallon of' Godfrey,' "* the * Second Report of the Commissioners on the state of Large Towns, &c, p. 454. 168 OF MEDICINES. former preparation being so strong as to contain 100 drops of laudanum in an ounce; a single tea-spoon- ful is the prescribed dose, so that allowing one ounce weekly to each family, this one druggist sup- plies 700 families every week. It behoves parents residing in these districts to be more than usually careful to whom they intrust their children. But surely enough has been said to prevent the parent, directly or indirectly, allowing the unprofessional use of opiates to her children. Remember their great susceptibility to their narcotic influence, their different capability of bearing it, and the facts which have been adduced to prove the fatal effects which so frequently follow their unguarded employment. SECT. IV.—LEECHES. Leeches should never be employed unless ordered by the medical attendant; and when used, never let the young child see them: it can be easily prevent- ed ; and, as the sight of them generally gives alarm, it should be avoided. When applied to the chest for an}' inflammatory attack, expose as lit- tle of the surface during the time the leeches are drawing as possible, lest fresh cold should be given. The mode of applying them.—First wash the part, and dry it thoroughly. Then the readiest mode of applying the leeches is to take off the lid of the chip box in which they are sent, placing the mouth of the box on the part to which they are to be applied. Keep it steadily there for ten minutes, LEECHES. 169 and then lift up the edge, and you will generally find that the leeches have taken. Next separate their tails from the bottom of the box, and so re- move it. If the leeches take well, at the expiration of twenty minutes or half an hour they will drop off, filled, having done their duty, with the exception, perhaps, of a solitary one still adhering, but idle. This should be at once separated, not by forcibly detaching it, but by means of a little salt put on its head. It is a great mistake to allow a single leech to remain on for an hour or more after the others have dropped off, doing nothing, while it wearies and exhausts the child. The leech-bites are now to be sponged with warm water, or a bread and wa- ter poultice, applied, as may have been directed by the medical attendant. In children, however, a poul- tice is seldom ordered; and so having been sponged for ten minutes, a pledget of lint is to be placed over the part, and steady pressure made upon it, and kept up by the ends of the fingers for five or ten minutes, and subsequently by means of a ban- dage or otherwise—being always most careful not in any degree to disturb the lint. In general this quickly puts a stop to the bleeding. The mode of arresting the bleeding.—Difficulty sometimes arises in putting a stop to the bleeding from leech-bites; a matter of considerable import- ance in the case of a delicate infant. And in order to prevent the serious consequences that sometimes happen from this source to children, the bleeding 15 170 OF MEDICINES. should always be stopped before the patient is left for the night. Again, it is always prudent to ap- ply them only over some bone, so that pressure may be effectually applied. The following mea- sures may be resorted to for arresting the bleeding when necessary:— 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 hemorrhage. It is to be effected by placing a small portion of scraped lint over each leech-bite, and pressing on them with the points of the fingers (previously greased with cold cream, that they may not, when taken away, disturb the lint) for five or ten minutes. Or, if this fail, twine a very small piece of lint into a hard knot, so as to be less than a pea, and wiping the orifice quite clean of blood, place this little pad upon the bleeding point, then, taking ad- vantage of the elasticity of the integument, draw a strip of adhesive plaster tight over it. The point to be observed particularly in this application is, that the strip of plaster may be long enough to en- sure a steady pressure of the pad by drawing up the integuments from a distance, by which the elastic quality of this structure gives a permanent pressure; but even this pressure should be confined as much as possible to the bleeding orifice. 3. If the compression fails in stopping' the bleed- BLISTERS. 171 ing, or from the situation of the leech-bites, it can- not 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, which should be scraped previ- ously to a fine point, for this purpose. If none of these measures are successful, the as- sistance of the medical attendant must be obtained; and if firm pressure be made upon the part, no se- rious 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. A blister should never be resorted to for any in- fantile disease, except when ordered by a medical man, as its injudicious use might greatly aggravate the complaint. It should never be applied to any part where the skin is excoriated or broken. In applying it, it should be ascertained that it is really in contact with the skin; and to secure this, the finger should be passed rather firmly over it, after it is put on, particularly round its edge. It should never be allowed to remain on longer than from two to four hours, at the expiration of which time, the skin will generall3r be found red and inflamed, and if the plaster is removed, and the part dressed with spermaceti ointment or a bread and water 172 OF MEDICINES. poultice, a full blister will usually be found to rise in an hour or so after. This precaution is necessary, because from the great irritability of the skin of the child, there is danger that not only the scarf-skin (as it is called) will be raised as a blister, but the true skin beneath will be destroyed. This would occasion great suffering, and cause a very trouble- some sore, seriously affecting the health and strength of the child, and perhaps, even put its life in jeo- pardy. This danger, however, may at all times be avoided, first, by interposing between the blister and the child's skin a piece of tissue paper, to be previously moistened with almond oil,—or if the oil is not at hand, by rubbing the surface of the paper with the point of a warm finger on that of the blis- tering ointment, and it will quickly become satu- rated with the grease it contains;—and, secondly, whether the previous precaution is adopted or not, by carefully raising the edge of the blister when it has been on two hours, and if the part looks red and inflamed, by at once removing it, particularly if there be already little points of vesication visible. In dressing the blister great care should be taken in letting out the fluid not to tear the bladder. Having spread a piece of lint the size of the blis- tered part with spermaceti ointment, take a sponge previously softened by rinsing in warm water, and holding it just beneath the most depending part of the fluid bladder. Make a snip at this part with the points of a sharp pair of scissors, and the fluid POULTICES. 173 running out will be received by the sponge. If not entirely emptied, what is left may be carefully pressed out, and if this cannot be accomplished with- out another snip of the scissors, it must be made, but spare the skin as much as you can. The object of all this care of the scarf-skin is simply this : it pro- tects the true skin beneath from the external air, which would dry its surface, render it very sore, and interfere with the ready healing of the blister. In four hours the blistered surface should be again looked to, and if any further accumulation of fluid has taken place, it must be let out as previously, and the sore must be again dressed. For the next twenty-four hours the dressing must be renewed every four hours, after which time the inflammation having subsided, morning and evening will be often enough. SECT. VI.--POULTICES. Bread and water poultice.—Although this is one of the commonest applications in use, it is rarely well made or properly applied. It thus becomes injurious rather than useful; adding to the inflam- mation or irritation of the part, instead of soothing and allaying it. Nothing, however, is more simple than the mode of its preparation. Scald a basin, and then pour boiling water into it. Cut the hard out- sides from a sufficient quantity of stale bread and crumble it into the water. Most of it will sink to the bottom. Those pieces which float are lumpy 174 OF MEDICINES. and can be skimmed off with a spoon. Pour off the water and empty out the poultice on to a piece of linen which is to contain it, having previously laid this on a folded towel. This will -drain the poultice of its superfluous moisture. Fold the edges of the linen a little over the edges of the poultice, and apply it just warm enough to be borne; then cover it with oil silk. A poultice thus made will form an exquisitely bland and soothing application to an inflamed surface; and the oiled silk prevent- ing evaporation, it will be found, when taken off, as moist as the first moment that it was put on. Linseed-meal poultice.—This is seldom made properly; the late Mr. Abernethy thus described how it ought to be made: "Scald your basin," he says, "by pouring a little hot water into it, then put a small quantity of finely ground linseed meal into the basin, pour a little hot water on it, and stir it round briskly until you have well incorporated them; add a little more meal and a little more water, then stir it again. Do not let any lumps remain in .he basin, but stir the poultice well, and do not be sparing of your trouble. If properly made, it is so well worked together that you might throw it up to the ceiling, and it would come down again without falling in pieces; it is, in fact, like a pancake. What you do next, is to take as much of it out of the basin as you may require, lay it on a piece of soft linen, let it be about a quarter of an inch thick, and so wide that it may cover the whole of the inflamed part." BATHS. 175 Mustard poultice.—This is an invaluable appli- cation in some of the diseases of infancy and child- hood, and therefore frequently ordered. It is made as follows:—First mix two-thirds of mustard flour and one-third of wheaten flour, as much as you will require for your poultice. Then scald out a basin with boiling water,—into this put your mixture of mustard and wheaten flour, pour a little hot water on it, stir it round, and add water sufficient to make it the consistence of thick paste. Then spread on soft linen about a quarter of an inch thick, the size ordered, and apply next the skin. The time it is to be kept on will depend upon the individual sensi- bility of the skin of the child; but in general, from fifteen to twenty minutes will be found amply suffi- cient This application must at all times be care- fully watched; for if it remain on too long, ulcera- tion and even death of the part might ensue; there- fore, directly the skin is found tolerably red, the poultice should be removed. After its removal, a soft piece of linen is to be put over the part, and if very painful it may be dressed with spermaceti ointment SECT. VII.—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 hygiena (this has been briefly alluded to under the section "Bathing,") and in the latter, a valuable 176 OF MEDICINES. 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. Cold water plunge-bath.—It consists of water in its natural degree of heat; its temperature vary- ing, according to the season of the year or other circumstances, from 30° to 60°. The phenomena produced upon a strong and healthy boy plunging into this bath, will be as fol- lows:—He will first experience a sensation of cold, followed by slight shuddering, and, if the immer- sion has been sudden, a peculiar impression on the nervous system, called a shock. Almost immedi- ately 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 fol- lowed 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 reac- tion will ensue, and he will become chilly, which will gradually increase to a strong and general shi- vering;—his feet and legs will become benumbed, BATHS. 177 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 immer- sion, the shivering and consequent train of sensations occur. This arises from the infant at birth having less power of producing heat than when further ad- vanced 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 cold 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 ob- tained, 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 178 OF MEDICINES. earlier hour must be chosen. Exercise is always useful previously to the bath; but 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. It is a matter of importance, however, in bathing children? that they should not be terrified by the immersion, and every precaution should be taken to prevent this. The length of time of remaining in will de- pend upon circumstances. One dip only is enough at the first bath. Subsequently the time of remain- ing 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. Ex- ercise 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 ensures con- siderable friction of the surface of the skin. If the boy is in sound health, he may bathe daily. As a remedy, sea bathing is highly serviceable. Its employment, however, requires much caution, and great mischief is sometimes committed by its indiscriminate use. 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 BATHS. 179 improper, but dangerous. Instead of being strength- ened, 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 per- spirations in bed, capricious appetite, confined or relaxed bowels, indisposition to exertion, and wea- riness from the slightest effort. 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 in- crease 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 180 OF MEDICINES. 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 of bay salt, and by vigorous rubbing. As the child gets older the com- mon form of shower bath may be used, and through- out 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. A warm sheet to throw round the person of the child directly he comes out of the bath is always desirable in the winter months. 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, porduces a glow and invi- goration of frame almost equal to the former. It is also the surest preventive to 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 WARM BATH. 181 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 appli- cation 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, small-pox, 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 neces- sity 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 conve- niently applied in a well cleaned pig's bladder, which 16 182 OF MEDICINES. 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 clothes 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 treat- ment, 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. Warm Bath.—The warm bath judiciously pre- scribed is one of the most valuable remedial agents we possess, and the means for promptly administer- ing it should always be at hand; but although pow- erful for good, when misapplied, it is equally pow- WARM BATH. 183 erful for mischief. For instance, in active inflam- matory affections, before the loss of blood, the use of the warm bath would greatly aggravate the dis- ease; 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 pecu- liarities of individual cases. For in plethoric and gross children, the local abstraction of blood from the head, and the complete unloading of the alimen- tary 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 threat- ened: only put the child into a warm bath, and, with 184 OF MEDICINES. the common domestic remedies, a very serious at- tack may be warded off. Again, in the commence- ment of a diarrhoea, a warm bath, and discontinuing the cause of the attack, will alone suffice to cure; and, moreover, 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, reco- very has been brought about by the simple use of the warm bath. 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. There are certain rules for the use of the warm bath, which should invariably be acted up to. Their neglect might be followed by serious consequences. 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 be- tween 92° and 989, which appears to be most agree- able to the child; but on no account must 98° be exceeded. When ordered as a remedial measure, the temperature will of course be fixed by the me- dical attendant. The same degree of temperature must be kept up during the whole period of immer- sion. For this purpose the thermometer must be kept in the bath, and additions of warm water made WARM BATH. 185 as the temperature is found to decrease. These ad- ditions 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. It must be varied ac- cording to the age of the child. For the first four or five weeks, the infant should not be kept in be- yond three or four minutes; and the duration must afterwards be gradually prolonged as the child ad- vances 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. If the bath is em- ployed 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. And the instant 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. If, however, the object is not to excite per- 16* 186 OF MEDICINES. spiration, the child may be dressed in his ordinary clothing, but should not be allowed to expose him- self 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. For any complaint of long standing, or as a general rule, it should be taken be- tween breakfast and dinner, about two hours after the former, or an hour and a half before the latter. This implies that an 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. Foot-Bath.—A partial warm bath, such as the foot-bath, is one of the safest and most frequently employed in the nursery. It 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 dis- ease have been complained of, the disorder may sometimes be cut short by the use of the foot-bath, continued till free perspiration occurs. It is frequently ordered during teething, and in affections of the head. In these cases the intention is not merely to produce a gentle and general per- spiration, but it is more particularly used to draw the blood from the head and body to the feet The FOOT BATH. 187 temperature of the water should be raised as high as can be borne, and it must be kept up by the oc- casional addition of fresh hot water. The vessel employed should be deep enough to permit the wa- ter to reach the knees, and a blanket must be thrown around the little patient and the bath. After the child has remained in from ten minutes to a quarter of an hour, the feet and legs must be rubbed per- fectly dry, woollen stockings drawn on, and the child put into a warm bed. A mustard foot-bath is made by the addition of a table-spoonful of mustard flour to every gallon of water. In convulsions excited by difficult teething, this bath is most useful, and may always be resorted to without fear by the mother. Its good effects will be much enhanced if, at the same time, a piece of flannel wet with cold water is applied over the head and temples, or cold water may be sprinkled on the face. 188 OF VACCINATION. CHAPTER VII. OF VACCINATION. There are several circumstances connected with vaccination, namely, the age and condition of the child upon whom it is to be performed,—the pro- gress in appearance of the vaccine vesicle,—and the maternal management of the child during the pro- cess, with which a parent ought to be more or less acquainted. The application of this remedy ever requires care and judgment, and for want of these it has frequently failed to confer its inestimable benefits, particularly in the hands of those charitable, but unprofessional individuals who are in the habit of gratuitously vaccinating the poor in remote dis- tricts in which they live, and where medical aid can only with difficulty be obtained. A desire to remedy this evil, in however slight degree, induces me to give a few hints upon the subject; and if these observations do no more than excite a greater atten- tion to the subject, they will do some good.* * The following extract from the Report of the National Vaccine Establishment (dated 1839,) points out the causes of failure, and at the same time shows that there is no real ground for any loss of confidence in the protective power of cow-pox. It OF VACCINATION. 1S9 The age and condition of the child.—The most favourable time for vaccinating an infant is between the age of six weeks and four months; a period that is prior to the irritation of teething, and also subse- quent to the extreme irritability of first infancy- Should, however, small-pox be very prevalent, and in the near neighbourhood, rather than expose the infant to its contagious influence, it should be vac- cinated at once. There will be but little risk in this measure, even if resorted to immediately after its birth. The child, when operated upon, should be as far as possible in perfect health. If disease be present in the system, if it be the period of dentition, if the bowels are at all disordered, or if there be any erup- tion on the surface of the body, vaccination should be postponed, unless from the pressure of some extreme necessity. And again, if it be positively necessary from circumstances to vaccinate during is signed by four of the medical officers. " We are convinced that the indiscriminate vaccination which has been practised in this country by ignorant and unqualified persons, with but little or no regard to the condition of the body of the person to be vac- cinated, to the selection of the vaccine lymph, or to the progress and character of the vesicle to be formed, are to be regarded amongst the main causes of the occasional failure of vaccination. We have the opportunity of bearing our most ample testimony to the continuance of the efficiency of the original vaccine lymph introduced by Dr. Jenner, through nearly a million of subjects successively, of whom many thousands have been exposed with entire impunity to small-pox in its most malignant form." 190 OF VACCINATION. the presence of a chronic eruption, there is no ob- jection to this, for it is not unlikely that it will be benefited by the introduction of the vaccine disease; but on some future occasion the vaccination ought to be repeated in order to test the efficiency of the former trial. The vaccine matter to be employed.—It must be what is called active virus, or it will be of no use, that is to say, it must be taken from a vesicle before a certain date after vaccination, or it will be unfit for reproduction. Now, lymph may be taken with every prospect of success from the fifth to the eighth day; after this it is not to be depended upon; —the eighth is the day almost universally fixed upon for this purpose. Having selected a vesicle, three or four slight punctures are to be made in its elevated margin with the point of a very sharp lancet, from which minute points of transparent lymph will soon be found to exude. With the lancet so charged the infant is to be vaccinated im- mediately, or before many hours have elapsed, otherwise the lymph will become inert, and rust the instrument. If the lymph is to be collected and preserved for future use, great care is required, as it is very liable to spontaneous decomposition and other changes which impair its efficacy. The following are the modes generally adopted. The lymph may be received upon a piece of glass about an inch square, allowed to dry, and then covered with a similar OF VACCINATION. 191 piece of glass, and folded up in tinfoil or goldbeater's skin. Or it may be preserved on ivory points, shaped like the tooth of a comb. These must be dipped twice or thrice in the fluid of the vesicle, allowed to dry between each charging, and then wrapped up in goldbeater's skin. Again, it may be kept fluid in small capillary tubes, having a bulb at one end. The virus is to be allowed to ascend from the punctured vesicle, the air in the bulb having been rarefied by the application of heat, and the tube is to be hermetically sealed immediately on its being charged. The dry crust or scab of a mature cow- ^pock is also made use of, and it has been ascertained is the most certain mode of transmitting the cow- pox to hot countries. It must be kept dry in a well-stopped phial. The health and constitution of the child from whence the lymph is taken should always be care- fully regarded. A child in perfect health, with no cutaneous affection or vicious constitutional taint, is the only subject from whom it ought ever to be propagated. Great carefulness upon this point is demanded, and incalculable injury has too often resulted from its unwarrantable neglect. Obstinate and alarming cutaneous disorders have from time to lime been communicated to children by vacci- nating with virus from an unhealthy infant. The mode of vaccinating.—The best place for the operation is about one-third down the upper arm, and rather to its outer side. The instrument 192 OF VACCINATION. to be employed is the lancet; it should have a broad shoulder, a fine point, and should be clean and per- fectly sharp. Failure often arises from a peculiar toughness of the child's skin, which a blunt lancet penetrates with difficulty; the lymph is consequently pushed back upon the shoulder of the instrument, and none of it enters the wound. The arm of the infant is to be firmly grasped by the left hand of the operator, and the skin at that part of the arm where the punctures are to be made, is to be kept perfectly tense with the forefinger and thumb. The lancet being held in a slanting position between the thumb and forefinger of the right hand, its point (previous-, ly charged with fresh lymph) is to be introduced just under the skin; it is to be kept in the wound a few seconds, and then wiped repeatedly over the puncture. Not fewer than five punctures are thus to be made in the same arm, and at such distances from each other as not to run together in their advance to maturation. It is desirable to vaccinate in one arm only, and that the left, that the nurse, in handling the child, may have less difficulty in preserving the vesicles from injury. The places will bleed more or less, and freely if the child is full of blood, or cry much; if, however, the lymph be good, and has once come in contact with the absorb- ing surface below the cuticle (scarf-skin,) whether there be much or little blood is of no moment. If the ivory points are employed, and they are more convenient and equally successful with the former mode, the puncture in the arm must be OF VACCINATION. 193 made with a sharp and clean lancet as already di- rected, and into it a point be inserted (previously breathed upon once or twice to moisten the dried lymph,) allowed to remain a minute or two, and, when withdrawn, wiped once or twice over the puncture. The lymph must then be inserted in five different punctures. Some persons prefer to vaccinate by scratch, rather than by puncture. Here a blunt but clean lancet is to be chosen:—to be charged with virus (as directed above,) and its edge drawn again and again, but very lightly, over the skin, so as to make five or six scratches, each about the eighth of an inch in length. The lancet is then to be rubbed over these till the lymph is wiped off its point. Blood ought not to be drawn, the scratches should merely become red, like the accidental scratch from the point of a pin. Nothing further is necessary, except exposing the arm for a few minutes to the air, that the small quantity of fluid that will exude from the operation may become dry. If the lymph used has been preserved between glass, a minute drop of cold water is to be taken on the point of the lancet, and the dry lymph is to be rubbed down with this until dissolved, and then used exactly as fresh virus. If the capillary tube is used, the matter must be expelled from the broken tube by heat, as by put- ting the bulb into the mouth, and then employed in the same manner as if it were fresh. 17 194 VACCINATION. The crusts or scabs are prepared for use by rub- bing them to powder, and moistening them with a little cold water to the consistence of thin mucilage. It is advisable with the vaccine thus obtained to make more than the usual number of punctures. The appearance and progress of a genuine vac- cine vesicle.—If the vaccination has been success- fully performed upon a healthy infant, the puncture on the second day may be felt elevated; on the third or fourth a small red pimple is to be seen, and if examined with a magnifying glass, surrounded by a slight efflorescence; on the fifth day a distinct vesicle becomes apparent to the eye, circular in form, having an elevated edge and depressed cen- tre ; on the eighth day it appears distended with a clear lymph, is either pearl-coloured or slightly yellow, and is at its greatest perfection. On the evening of this day an inflamed ring begins to form around the base of the vesicle, which con- tinues to increase during the two following days; it is circular in form, and its diameter extends from one to three inches. It is at its height on the tenth day, when there is considerable hardness and swell- ing of the subjacent parts; on the eleventh day it begins to fade, generally from the centre to the cir- cumference,sometimes forming two or three concen- tric rings of a bluish tinge. After the tenth day the vesicle itself begins to decline, the centre first turns brown, and the whole is gradually converted into a hard round scab of a dark mahogany colour. About the twenty-first day this crust falls off, leaving VACCINATION. 195 a permanent circular cicatrix, somewhat depressed, and marked with six or eight minute pits. Such is the course of a true vaccine vesicle; and if there be a shadow of a doubt that the vaccination is defective in any one of the above points, especially if the in- flamed ring do not appear, the operation should be performed again. Always suffer one or two of the vesicles, at least, to pursue their entire course untouched: if there be more than two, then lymph may be taken from the supernumerary one, if required for vaccinating others. Constitutional symptoms and management.— Some children pass through the disorder without the slightest indication of constitutional disturbance, which is not to be looked upon as by any means essen- tial to the success of the vaccine process. If the constitutional symptoms manifest themselves, it will be about the seventh or eighth day; the infant will be restless and hot, and the bowels more or less disordered. It is not an uncommon circum- stance to find about the tenth day an eruption, show- ing itself on the extremities of the child, sometimes extending to the trunk of the body. It continues for three or four days ; occasionally until after the vaccine scab has fallen off. This eruption is chiefly met with in children of full habits,in whom numerous vesicles have been raised, which discharge freely. Internal treatment is rarely required during vac- cination, except now and then a mild aperient, such as a tea-spoonful of castor oil. Febrile symptoms, 196 VACCINATION. however, sometimes manifest themselves, when it becomes necessary. The chief thing to be attended to in the management is to protect the vesicles, as they enlarge, from injury, particularly from the sixth or seventh day. If, unfortunately, from friction or any other cause, the inflammation and swelling around the pustule should become severe, cold water, or a weak solution of Goulard's extract, or a bread and water poultice must be applied. Constitutional inaptitude.—Every effort to communicate the vaccine disease will now and then fail; the child will not take the vaccination. When a case of this kind is met with, after a fair number of trials with fresh and active virus, the little patient should be left for a few months in the hope that some change may take place in the system, and then an- other trial be instituted. Experience has long proved that the predisposition to receive cow-pox is not equally great in all persons, nor at all times; and that in some individuals there exists through life an insusceptibility to the vaccine disease. The child of a weak and unhealthy constitution will not unfrequently be found indisposed to take the vac- cination, but in this case the inaptitude is temporary; whilst, on the other hand, when this indisposition is met with in a healthy and robust condition of body, it will most probably last through life. Happily, however, experience has further shown that in most of these instances the individual is equally insuscep- tible of the small-pox disease. management during teething. 197 CHAPTER VIII. management during teething, and of the per- manent 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 make their appearance are called the temporary or milk teeth; the second, the perma- nent or adult teeth, and these come up as the for- mer fall out, and so gradually replace them. SECT. I.--MANAGEMENT OF THE INFANT DURING TEETHING. 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 denti- tion may be estimated at from a year and a half to two years. The process varies, however, in differ- 198 OF TEETHING. ent 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 development 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 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 den- tition is frequently a period of great danger to the infant. It therefore becomes very important for the mother to know how the dangers and difficulties of teething can in any degree be diminished, or, if possible, altogether prevented. 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. 1. The management of the infant when teeth- ing is without difficulty.—In the child of a healthy constitution, which has been properly, that is, natu- rally 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 MANAGEMENT DURING TEETHING. 199 and easy. There will be 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 symp- toms disappear in a few days, to recur again when the tooth approaches the gum. The treatment 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 should be 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 use- ful. 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, 200 OF TEETHING. 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 ob- jectionable. 2. 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 heredi- tary taint, the process of dentition will be attended with more or less difficulty, and not unfrequently with danger. MANAGEMENT DURING TEETHING. 201 The symptoms of difficult dentition are of much more aggravated description than those which at- tend 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. There will be 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 de- termination 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 symp- toms of difficult teething, and which will be present to a greater or less degree. In reference to the 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 ope- ration. They think it gives great pain, and if the tooth is not very near, makes it come through the gum subsequently the more difficult. With regard 202 OF TEETHING. 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 subse- quent progress of the tooth, it is quite groundless; for cicatrices, like all other new-formed parts, are much more easily absorbed than the original struc- ture. Of the practical utility and perfect safety of this operation we have ample proof in its daily per- formance 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, there- fore, 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 espe- cial attention; and, by so doing, she will save her child much suffering. The condition of the mouth MANAGEMENT DURING TEETHING. 203 should be carefully inspected from time to time; and should a swollen gum be discovered, it should immediately be attended to, not waiting till consti- tutional 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 condi- tion 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 aggra- vated 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 diffi- cult 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, 204 OF TEETHING. 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 freely sponged with cold water night and morn- ing; this measure may be resorted to in every case without fear, and will invariably be attended with great benefit. Whether the child's body is to be sponged with cold or tepid water, must depend upon the season of the year and constitution of the child, as well as upon other circumstances; now and then, for instance, the warm hip-bath will be ordered by the medical attendant to be employed for several consecutive days, which, by acting upon the skin, diminishes the determination of the blood to the head, and thus forms an important source of relief. No other covering than that which nature has pro- vided should be put upon the head 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. 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 MANAGEMENT DURING TEETHING. 205 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 imme- diately after this operation. Indeed, if the mother be far away from immediate medical aid, and con- vulsions are threatened, I see no reason why she should not herself at once lance the inflamed gum, but every reason why she should. Mr. Cline used to relate the case of a family in which, child after child, when they arrived at a certain age, died in convulsions from teething, until he taught the mother how to lance the gums, which she resorted to in future immediately a convulsive fit was threatened: and Cline adds, "she never lost another, at least from this cause; for as soon as the symptoms of teething appeared, she looked for an inflamed gum, lanced it, and they ceased." Place the forefinger and thumb of the left hand on each side of the inflamed gum, then draw the edge of the gum lancet vertically along the top of it, making slight pressure, until the edge of the instrument is felt to grate upon the tooth,—or, if this is not felt, until the upper part of the gum is freely lanced. If it be a double tooth, a crucial incision must be made, that is to say, two incisions, one to cross the other. 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 18 206 OF TEETHING. 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 rest- less 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; and if sleeplessness should still continue, sponge its face and hands, and refreshing sleep will often follow. From these few hints, it must have been seen how much the sufferings from teething may be mitigated by judicious management- If the parent is able to support her infant upon the breast alone, teething will be found comparatively an easy pro- cess, and unattended with danger; the mother thus reaping a delightful reward for all the anxieties and privations which nursing necessarily involves. 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 suffer- ing and inconvenience will arise than when less attention has been paid to it. When teething is difficult, the importance of calling in proper aid at an early period, of fully carrying out the directions of the medical attendant, must be apparent, and no foolish prejudices must be allowed to interfere with his prescriptions and management. If I stood in " See page 164. MANAGEMENT DURING TEETHING. 207 need of any argument to impress upon the mind of a parent the importance of this last injunction, I would simply state, that its neglect is 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. 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, and may occur too when there is an absence of all strumous taint. It is only necessary to make one further remark, that 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 ON THE PERMANENT TEETH. Parents are not sufficiently alive to the import- ance of attending to the condition of the mouth of 208 MANAGEMENT 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 chil- dren 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 beau- tiful; 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 thfty fail to do so; they are not sufficiently numerous,—in their structure they are not strong or durable,—nor is their power of mas- tication sufficiently great THE PERMANENT TEETH. 209 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 dimen- sions 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 18* 210 MANAGEMENT OF in this situation their full development, 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 development 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 THE PERMANENT TEETH. 211 almost unnecessary to say a word upon so self-evi- dent 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 per- fect the general features, if the teeth are irregular or deficient, an unpleasing expression, proportionate to the extent of the displacement, is inevitably pro- duced. 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 be- comes 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 supernume- rary 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 re- 812 MANAGEMENT OF lation to the part they sustain in connexion with di- gestion, 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 be- comes of a uniform pulpy consistence, fit for being easily swallowed, and acted upon by the gastric juice on its arrival in the stomach. That due mas- tication of the food is essential to healthy digestion, which will be promoted or retarded in exact pro- portion 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 intro- duced 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 vomit- ing, or pass on into the intestine, to give rise to colic, bowel complaints, or flatulence, and very frequently in children to a serious attack of convulsions. Their management whilst coming.—During the advance of the permanent teeth, every parent ought to have the mouih of her child inspected occasion- ally, that any irregularity in their position or ar- rangement 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 un- frequently made in this matter, and which them- selves 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 THE PERMANENT TEETH. 213 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 un- necessary, 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 per- manent 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 ac- cordance 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 peculi- arities of each individual case, the dentist will de- cide 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 com- fort and appearance of your child. Means to be used for their preservation.—The preservation of the teeth requires attention to several 214 MANAGEMENT OF 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 his dinner 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 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. If there is a tendency to the formation of tar- tar, 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. Mr. Bell says, " 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 irre- mediable injury to the teeth; for they often contain a quantity of tartaric or other acid, which effects a gradual decomposition of the enamel." One of the commonest tooth-powders of the present day, and which is a very good form, is the following:—Pre- pared 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. But the best of all dentifrices is the plain camphorated tooth-powder; for while THE PERMANENT TEETH. 215 the camphor does no injury to the teeth, it instantly destroys those minute creatures which produce the tartar and green incrustation on the enamel. "To promote a general cleanliness of the teeth, the fact cannot be too often repeated, that a microscopic ob- server, M. Mandl, has discovered that not only the foul mucous covering of the tongue, but the tartar of the teeth consists of the dead remains of millions of infusorial animalculse. Leuwenhoek discovered long ago, that the mucous secretion of the human mouth abounded in living specimens of these minute beings; but it remained for M. Mandl to make known that the tartar of the teeth consists of their dead bodies compactly united together in one mass, by chemical decomposition. When a portion of this tartar of the teeth is softened in clear water, and placed under a powerful microscope, it is found to consist of their delicate skeletons." 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 and water, and also that he rinses out the mouth after the dinner meal. And if tartar should be disposed to form, then he must in addition use tooth-powder. If the gums should be lender, 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 216 THE PERMANET TEETH. same quantity of spirits of camphor; or the follow- ing form may be used:—Borax, two drachms; tinc- ture of myrrh, four drachms; and distilled water, eleven ounces. The use of acids to the teeth cannot be too strongly deprecated: they decompose their substance and lead to their rapid decay. Hence the white- ness produced by acid tooth powders and washes is not less deceitful than ruinous in its consequences. As has just been observed, they perform all that their vendors promise, causing the teeth, for a lit- tle 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 or- dered 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 young lady (and there are many such instances) who once had a sound and fine set of teeth, 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 consi- derable time (with other medicines) sulphuric acid: but the glass tube was not thought of, and the conse- quences followed which have been described. Calomel as it is frequently given alone, or in the little while powders, in infancy and childhood, by THE PERMANENT TEETH. 217 mothers and nurses, is productive of serious and irre- mediable injury to the teeth. Mr. Bell says, " The immoderate use of mercury in early infancy pro- duces, more perhaps than any other similar cause, that universal tendency to decay, which, in many in- stances, 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 reme- dy, this panacea, as many appear to consider it, in infantile diseases." The teeth are exceedingly apt to suffer from sud- den 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. There are many other causes which might be men- tioned as tending to induce decay of the teeth, but their consideration here is purposely avoided. It is hoped 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. 19 PART II. MANAGEMENT OF CHILDREN IN DISEASE. CHAPTER IX. GENERAL REMARKS ON ILLNESS. In the previous part of this work devoted to the general management of the child in health, I have endeavoured to teach the mother that her especial province is the prevention of disease, not its cure. To establish and carry out this principle, every word contained in the preceding pages has directly or indirectly tended. It must be remembered, however, that this is not all. The mother has a most important part to perform in the diseases of infancy and early childhood. I refer to those duties which constitute the domestic management of illness, and which embrace the period from the first moment of indisposition to its close. In the different chap- ters which follow, I have pointed out in what these duties consist; it will be well, however, to give some hints on illness in general, which it is believed, if acted upon, will tend to abridge the duration and GENERAL REMARKS ON DISEASE. 219 abate the violence of disease when present, and consequently the danger and sufferings of the child. Many mothers are continually giving medicine to their children. Some trivial derangement is supposed to exist, but whatever may be the matter, physic is the sovereign and only remedy, and dose follows dose until illness is really produced, and the medical man summoned to treat a disorder occa- sioned entirely by the love of drug-giving. Medi- cine thus unadvisedly exhibited, is a fruitful source of mischief and suffering, and the children of such mothers stand a very poor chance of struggling through childhood, and certainly are very unlikely to see a healthy and vigorous maturity. Temporary indisposition from disorder of any of the natural functions, is generally to be put to rights by domestic remedies and a spare diet for four and twenty hours; but, if these measures should not succeed, and symptoms of disorder rather increase than diminish, it is as much the wisdom as the duty of the mother to send for medical aid at once, before the health is permitted to suffer, and disease of a serious nature is established. Whenever a child becomes suddenly indisposed, with or without any apparent cause, there ought to be no temporizing with symptoms in the hope that nursery medicines will give relief, and that before evening or in the morning the invalid will be better; much valuable time is thus frequently lost, and the delay in sending for the medical attendant is occa- sionally fatal to the child. 220 GENERAL REMARKS The medical man being in attendance, his advice ought to be strictly and conscientiously followed out. His right to entire confidence and implicit obedience is implied in calling him in at all. Entering the sick chamber upon these terms, and taking upon himself, as he does from the moment he prescribes for his patient, the responsi- bility of the case, the measures he directs ought, in common fairness, to be faithfully acted on. This, however, is not always done. Now and then, in an unguarded moment, a parent allows herself to be persuaded by some friend who may call, to adopt a remedy which has been so successful " in just such a case as this," and the medical man's prescription gives place. There can be no harm in her submit- ting it to his judgment, but much harm may be done by not doing so. And in cases of severe illness it too frequently happens that well-meaning friends, without intending it perhaps, shake the confidence of parents in their professional adviser, in whom before they had, and most deservedly, implicit faith; cruelly harassing the parent's feelings, and acting thoughtlessly and unjustifiably towards the medical man. Serious disease sometimes advances, simply because the measures prescribed are not folloived out. The medicine perhaps is not given from the carelessness of the nurse, or it may be from the difficulty of getting the child to take it. There cannot be a more unjustifiable and unwise way of ON DISEASE. 221 overcoming the last, than to threaten the child with " what the doctor will do," if he does not comply; thus making the doctor a bugbear instead of a friend. Deceit is not the way to bring the child to sub- mission, surely, and here it does direct and manifest injury; for it not only makes the child look upon the medical man as an object of dread, but also necessarily so excites him in his presence, as to disguise or even aggravate the symptoms of the disease, and thus may make a wrong impression on his mind, and deceive his judgment. Tha^nischief, however, does not stop here, for ill-health or tem- porary sickness thus proves a source of moral evil to the child. " A sick child is but too often per- suaded or deceived into taking medicine, when he should be directed by the calm, honest steadfastness of a parent's authority. If he once obtains the victory, or has reason to think himself imposed upon, he will become unmanageable, or meet deceit with deceit. The observance of the duties of obe- dience during illness is no source of pain, but pro- duces that calm reliance upon the sense, affection, and power of the parent, most favourable to recovery." But to return to our point. In serious and active disease the efficacy of medicine often depends on keeping the system under its influence. If this is suspended for a time, the disorder may be making destructive progress. Medical treatment, to be successful, must be seconded by a careful, pains- taking, and judicious maternal superintendence. 19* 222 GENERAL REMARKS No medical treatment can avail at any time, if directions be only partially carried out, or be negli- gently attended to, and will most assuredly fail altogether, if counteracted by the erroneous preju- dices of ignorant attendants. To the affections of infancy and childhood, this remark applies with great force, since at this period, disease (if it be at all serious) is generally so sudden in its assaults, and rapid in its progress, that unless the measures pre- scribed are promptly and rigidly administered, their exhibiting 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 affection- ate attentions; and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct, carefully provided against. And not only is a firm and strict compliance with medical directions necessary; but it is of the utmost importance that whenever the physician visits his patient, the report of the symptoms and progress of the case should be unbiassed, faithful, and full. An ignorant servant or nurse, unless great caution be exercised by the medical attendant, may, by an unin- tentional, but erroneous report of symptoms, produce a very wrong impression upon his mind, as to the actual state of the disease. He cannot sit hour after hour watching symptoms; hence the great import- ON DISEASE. 223 ance of their being faithfully reported. Now if this cannot be done by the mother, it must be by some person equally competent. Hence the necessity, more especially evident in sickness, of having at- tendants about your children upon whose judgment as well as kindness and affection you can most fully rely. I know there is a great difficulty in meeting with suitable persons for this office, but I think British mothers seek them in the wrong class of society. If they would only go a step higher, to that class who spend their days and almost nights in plying the needle, exhausting their strength and ruining their health, they would be much more suc- cessful in meeting with what they want. For my own part, I think great good would result from the establishment of an Institution for the instruction of such young women in the offices and duties of the nursery, and from my own observation, I have no doubt it would meet with ample success. Serious mischief now and then ensues during an illness from the mismanagement of the diet. Its regulation is important not only in the removal of disease, but in the progress to recovery. A child, for instance, shall be convalescent, and from some indiscretion in this particular, the most serious re- lapse shall be induced. There is no greater obstacle to recovery, than-dietetic negligence. Strict direc- tions upon this particular should ever be rigidly acted up to. It is a great mistake to suppose that medicine is to do every thing. When active disease 224 GENERAL REMARKS is present (as has just been pointed out) it may be the child's salvation,—but nine-tenths of the dis- orders of children are to be removed by general mea- sures aiding the restorative efforts of nature. Do not, however, make a great mistake here, and suppose you can dispense with medical aid. The judgment and counsel of the physician is as necessary in the one case as the other, to point out and watch over the course to be pursued to restore health. Quiet is of great moment in the sick room. Whenever illness threatens, it is always well, where it is possible, to remove the patient to a bed-room as far away from the noise of the nursery as practica- ble; and this has another advantage, it may prevent infection spreading to the other children, should the disorder prove of this character. Purity of atmosphere is essential. In sickness the system becomes more keenly susceptible than ever to the mischief of breathing vitiated air. Pre- suming the means of ventilation proposed in the fifth chapter (p. 107,) are enforced, it is only neces- sary to recommend the quick removal from time to time from the sick-chamber of any thing, linen or otherwise, likely to corrupt the atmosphere. This remark applies particularly to the secretions from the bowels, which should be instantly taken away, and kept in some distant and convenient place for the inspection of the medical attendant. The visits of friends should not be allowed. Their presence cannot fail to deteriorate the atmo- ON DISEASE. 225 sphere, and their conversation is always mischievous by exciting the child. There are other weighty considerations which might be adduced here, proving how much depends upon efficient domestic manage- ment in the time of sickness; but they will be se- verally dwelt upon, when the disease with which they are more particularly connected is spoken of. To aid the mother in the early recognition of dis- ease, the next chapter has been written. The means of detecting it, as far at least as it was found pos- sible to convey such instruction to an unprofessional person, has been pointed out, and it is hoped with some measure of success to those who will take the pains to get clear notions of its details. 226 HINTS FOR DETECTION OF DISEASE. CHAPTER X. HINTS FOR THE MOTHER'S EARLY DETECTION OF DISEASE IN THE CHILD. 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 ap- proach. Its first signs are not always visible to an unpractised eye: it may have made dangerous ad- vances before the mother's mind is awakened to its presence; and medical aid maybe 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 de- tect disease at its first appearance, and thus ensure for her child timely medical assistance, and spare herself those painful, but unavailing regrets which a suspicion of neglect would infallibty awaken. This knowledge it will not be difficult for her to obtain. She has only to become familiar with those indica- tions which constitute health, and she will for the most part be able to detect the first appearances of disease. SIGNS OF DISEASE. 227 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 nor deficiency; and a similar regu- larity in its excretions both in quantity and appear- ance. If the figure of the healthy infant is observed, something may be learnt from this. There will be perceived such a 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 por- tion of a circle. The limbs will feel firm and solid, and unless they are bent, the joints cannot be dis- covered. 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 in- fant will be cheerful and sprightly, ready to laugh, and loving to be played with. When asleep, it will appear calm, every feature composed, its coun- tenance displaying an expression the reverse of un- happiness. SECT. II.—SIGNS OF DISEASE. Just in proportion as the above appearances are 228 HINTS FOR DETECTION OF DISEASE. 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, how- ever, 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,—in the cry,—and by the breathing and cough. The Countenance.—In health, the countenance of a child 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, there- fore, remarked at an early period, and proper reme- dies used, its notice may prevent one of the most fearful of infantile complaints—" water in the head." But if this sign is passed by unheeded, and the dis- ease 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,— SIGNS OF DISEASE. 229 its bowTels obstinately costive, or its motions scanty, dark-coloured, and foul. If the lips are drawn apart, so as to show the teeth or gums, the seat of the pain is in the belly. This sign, however, will only be present during the actual existence of suffering; if, therefore, there be any doubt whether it exist, press upon the stomach, and watch the effect on the expression of the coun- tenance. If the pain arise simply from irritation of the bowels excited by undigested matter, 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 mus- cles of the belly will remain perfectly quiescent. If the nostrils are drawn upwards and in quick motion, pain exists in the chest. This sign, how- ever, will generally be the accompaniment of inflam- mation 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. 20 230 HINTS FOR DETECTION OF DISEASE. 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 premonitory signs will some- times manifest themselves many hours, nay days, before the attack occurs; and if noticed in time, 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 dis- ease 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 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 re- garding one object with both eyes is only an ac- quired 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 cir- cumstance alone may be looked upon as a frequent prelude to disease affecting the head. SIGNS OF DISEASE. 231 The Gestures.—The gestures of a healthy child are all easy and natural; but in sickness those de- viations 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 re- turn of health; and during the interval every pos- ture and movement will be that of.languor. The child that has just taught itself to run 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 lan- guidly in its cot, or on its nurse's arm. The legs being drawn up to the belly, and ac- companied 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 secre- tions from the bowels themselves, and by their un- healthy character your suspicions, in reference to the seat of the disorder, are at once confirmed. The hands of a cWld 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. Suddenly starting when awake, as also during sleep, though it occur from trifling causes, should never be disregarded. It is frequently connected with ap- proaching disorder of the brain. It may forebode 232 HINTS FOR DETECTION OF DISEASE. 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 com- pressed 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 con- vulsions and connected with gesture, which should be regarded:—the head drawn rigidly backwards,— an arm fixed firmly to the side, or near to it,—as also one of the legs drawn stiffly upwards. If in addi- tion there are certain alterations in the usual habits of the child:—the sleep disturbed,—frequent fits of crying,— great peevishness of temper,— the coun- tenance alternately flushed and pale,—sudden ani- mation followed by as sudden a fit of languor,— catchings of the breath followed by a long and deep inspiration,—the expectation of an attack of convul- sions is confirmed beyond doubt. The Sleep.— The sleep of ^ie infant in health is quiet, composed, and refreshing. In very early in- fancy, when not at the breast, it is for the most part asleep in its cot; and although as the months ad- vance 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 SIGNS OF DISEASE. 233 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 man- ner. If it suffer pain, however slight, the counte- nance will indicate it; and, as when awake, so now, if there is any thing wrong about the head, the con- traction of the eyebrow, 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 restless- ness and frequent startings. The Stools.—In the new-born infant the motions are dark-coloured, very much like pitch both in con- sistence 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 20* 234 HINTS FOR DETECTION OF DISEASE. 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 evacua- tions. Their appearance, colour, and the manner in which they are discharged, are the points princi- pally to be looked to. If the stools have a very curdy appearance, or are too liquid, or green, or dark-coloured, or smell badly, they are unnatural. And 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 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.* The Cry.—.By crying, the infant, for the most part, manifests its sensations and wants. A parent, therefore, should learn to distinguish with accuracy * See the chapter on Disorders of the Stomach and Bowels, p. 280. SIGNS OF DISEASE. 235 that cry which denotes hunger, and that which proceeds from pain and other causes. It is import- ant a young mother's attention should be directed to this subject, if it were only to guard her from falling into the common and most injurious error of looking upon every cry of her offspring as an indi- cation of hunger,—a mistake often fraught with fatal results. The cry of hunger may be easily recognised by a little observation. An infant awakening, and needing the breast, will generally show certain signs of hunger before it cries for food. It will put out its tongue, move its head about as if in search of the breast, and if at this moment the mother comes in sight, thoroughly arousing himself, he will manifest his joy at seeing her, and eagerly take his meal; but if, on the other hand, she is not present, and these signs are not heeded, the cry will begin, and con- tinue, much in the same tone, until the supply is obtained. Now these signs are not present when the cry is occasioned by some other cause. The child, it is true, will take the breast when offered, but it does not ask for it; and it will become quiet as soon as put there; but this composure will be of short duration, for as soon as it is taken from it, its lamentations will be resumed with redoubled vio- lence. The cry of discomfort will with some children be frequent enough, the most trifling causes pro- ducing it. Thus, some temporary inconvenience 236 HINTS FOR DETECTION OF DISEASE. from posture:—the child has been lying long in one position, and has grown tired of it; some slight pain or uneasiness caused by a rucking or pressure in some portion of its dress; or perhaps positive pain, though slight enough, from the pricking of a pin:— these and many other causes of a slight and passing kind will be continually occurring, and no mother will have difficulty in detecting, and at once re- moving them. The cry of pain and suffering is variously ex- pressed. If a child, usually placid and cheerful, gets fretful, fractious, and crying, with its fingers continually going to its mouth, this denotes pain caused by a coming tooth pressing against a tender and inflamed gum. If a child, not accustomed to cry much, on some occasion is perpetually crying, this denotes some continued, recurring, painful sen- sation somewhere, and demands medical attention to detect and remove the cause. If a child cry vio- lently, this denotes the presence of severe pain, unless it be the effect of passion. If it be from pain, and you find at the same time the child incessantly drawing up its legs towards its body, it is a sign that it is suffering from disorder and pain in its bowels. This may either be trifling in degree, caused by spasm, the result of slight irritation, possibly the effect of over-feeding (the most frequent cry of infancy,) to be relieved perhaps by the gentle friction of a warm hand before the fire (and not by putting to the breast,) or, it may have a much more SIGNS OF DISEASE. 237 serious origin, and is not thus to be removed, pointing out the necessity for prompt professional attention. If the violent fit of crying be simply the effect of temper (and a discerning mother will rea- dily perceive the difference,) the child will some- times hold its breath, until the recovery of it seems doubtful, and it will get black in the face. To remedy this, plunge the hand or both into cold water; this will induce gasping or sighing, and so the breath is again fully drawn. The flow of tears seems only to attend the mental feelings, or emotions, as they are called, and to be one of the chief signs of their activity. It therefore becomes possible to distinguish the cry of temper and self-will from that of simple bodily suffering, which has no tears. This must be in- quired into; the other ought to be neglected. Even young children are gratified by the attention paid to their fits of naughtiness, and are less likely to repeat them if experience teaches them that they are not attended to. Moaning, or the plaintive cry which characte- rizes some diseases, needs no description: it will not escape the observation of a kind mother. These varieties then of infantile cry are all more or less important, and are easily detected. The breast must be given only when it is the result of hunger; if excited by some temporary inconve- nience, the cause of it should be sought for and be removed; if caused by pain excited by disease, the 23S HINTS FOR DETECTION OF DISEASE. mother by detecting it will directly seek medical aid, and will thus very frequently prevent serious indisposition to her child, greatly abridge the du- ration and violence of the attack if it take place, or if she have to endure the grief of a bereavement, will at least be spared the pain of self-reproach. The Breathing.—The breathing of a child in health is formed of equal inspirations and expira- tions, and it breathes quietly, regularly, inaudibly, and without effort. But let inflammation of the air- tubes or lungs take place, and the respiration 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 per- ceived. 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 of the chest, although very formidable in their character, if only seen early by the medical man, may be ar- rested in their progress; but otherwise they may get 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.—Of this symptom I should not have said any thing in this chapter, as it can never fail signs of disease. 239 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 sus- picion, narrowly watch the child, and never neglect seeking a medical opinion. Hoarseness does not usually attend a common cold in a very young child, and these symptoms may be premonitory of an at- tack 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 pre- sent purpose, that although they will be again re- ferred to, I cannot refrain inserting them here:— " In the approach of an attack of croup, which al- most 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, occasion- ally 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 240 HINTS FOR DETECTION OF DISEASE. 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 expe- rienced 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 mis- taken. 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 symp- tom is remarked; the sound of his voice is changed; puling, and as if the throat were swelled, it corre- sponds with the cough," &c. How important that a mother should be acquaint- ed 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, if vigorous and judicious, will be al- most 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 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 HINTS FOR DETECTION OF DISEASE. 241 diseases are more prevalent than at other periods, will greatly aid a judicious parent in the early de- tection 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 ge- nerally 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 an 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 21 242 HINTS FOR DETECTION OF DISEASE. 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, so as to recognise them promptly, and lose no time in seeking advice, but should at the same time make her most anxious to shield her child from all their exciting causes, and to adopt those measures which may contribute indirectly to" overcome the constitutional predispo- sition. 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 re- mark will be seen by contrasting the result of the following cases which occurred in children of the same family. 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 HINTS FOR DETECTION OF DISEASE. 243 existed, it was not regarded as of any consequence, and nothing was done. The child was afterwards placed under medical treatment. Two or three months having elapsed, it was 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, which was scrofulous, was arrested, so that now the case promises to be cured; but the joint will for ever be stiff, and the limb shorter than the other. Q. B., the brother of the above, a handsome boy, with light hair, fine blue eyes, 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 com- plained 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 ivas immediately attended to. The affection was evidently in the hip; there was imperfection in the gait, and pain upon pressing over the hip 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 244 HINTS FOR DETECTION OF DISEASE. 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 short- ened limb would have been prevented, although this is my belief;—but as to the latter case, I have no hesitation in saying that, if the disease had not been detected as soon as it was, the remedial mea- sures might have failed,—certainly the result would not have been so highly satisfactory as it was. ACCIDENTS AND DISEASES. 245 CHAPTER XI. ACCIDENTS AND DISEASES WHICH MAY OCCUR AT BIRTH OR SOON AFTER. • There are many circumstances of more or less frequent occurrence, involving the happiness of the parents, and the present and future welfare of the child, immediately connected with its birth or arising soon after, of which the attendants in the lying- in room should not be ignorant. Thus the child may be born apparently dead (still-born as it is termed,) and unless the most active exertions are made, will be 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 to be pursued, that they might be carried into effect with more promptitude and suc- cess than they now frequently are. It must be re- membered that in a rapid labour the child is not unfrequently born before it is possible for medical assistance to be procured, and it may happen in such a case that it is still-born. Again, deformities occur, happily not very often; still, when the event does arise, it is most important that it should not be dis- covered to the mother immediately upon the birth of the child by a sudden exclamation of surprise on 21* 246 ACCIDENTS AND DISEASES. the part of the attendants, which undoubtedly will be the case, unless a hint of this kind is given, and they are put upon their guard ; but a fit and proper opportunity must be chosen, when the communica- tion may be made tenderly and cautiously, and with the least danger of causing distress or producing ex- citement. % It may be a defect in the bowel or uri- nary passage, which the nurse only discovers, after a few hours, by the fact of nothing passing through these passages. Now, she is not at once to make the circumstance known to her mistress, but should do so quietly to the medical man, who, having given what professional aid the case demands, will exer- cise his own judgment in revealing it or not to the parent at this time or hereafter. And so at a later period, about the second or third day after the child's birth, an inflammation sometimes attacks the eye, which is of considerable consequence, and the more so from its commencing in a way not calculated to excite alarm. The child cannot express its sensa- tions, and the swelling of the eye conceals the pro- gress of the disease, so that serious mischief is fre- quently done before the medical man sees the patient. The inflammation is not immediately noticed; and the measures employed are frequently insufficient to check its progress. This causes more blindness (I refer to the lower classes of society more par- ticularly) than any other inflammatory disorder that happens to the eye; and the number of children is very considerable whose sight is partially or com- STILL-BORN. 247 pletely 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 men- tioned take place, in many cases, before they are aware of the danger, and before the medical man is resorted to for assistance. These, then, and many other morbid conditions connected with the infant will occasionally be met with in the lying-in room, and although one and all will demand the profes- sional attendant's care and management, enough has been said, I think, to prove, that the unprofessional attendants ought to be aware of their existence and possible occurrence, that they may act discreetly as circumstances arise, early call his attention to them, and subsequently carry out his directions with promptitude and exactness. SECT. I.--STILL-BORN. This condition may exist in a greater or less de- gree: the infant may be completely still-born, with no indication of life, except, perhaps, the pulsation of the chord, 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 respi- ration. Under all these circumstances, a good deal can often be effected by art. In every instance, therefore, in which we have not positive evidence 248 ACCIDENTS AND DISEASES. of the child being dead, in the existence of putrefac- tion, 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 circum- stances 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 forrrfer ligature, and then di- viding 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., in- flation 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 pre- viously 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 respira- tion is not fully established, it must not be di- vided ; and as long as pulsation continues, and the STILL-BORN. 249 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. Then at short in- tervals suddenly and forcibly blow on its face and chest. Every one knows the convulsive gasping which the shock of sudden cold produces. And rub the chest by the hand, and give a gentle shock to the body by slapping the back. A little perse- verance in the employment of these means will often establish respiration, and save the necessity of fur- ther measures. If, however, they 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.—The above means not having been successful, and the pulsation in the cord having ceased, the infant must be separated, and in- flation of the lungs resorted to. This is to be effect- ed 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 250 ACCIDENTS AND DISEASES. 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, per severing, 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 circum- stance the operator should be fully alive—that when the child begins to manifest symptoms of returning animation, its tongue will be drawn backwards and STILL-BORN. 251 upwards against the roof of the mouth, filling up the passage to the throat, and preventing further infla- tion 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 infla- tion is going on, the bath may be got ready, then resorted to, and if unsuccessful, inflation may and ought again to be followed up. If the bath is use- ful 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°; 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 esta- blished, laid in a warm bed, or, what is still better, in its mother's bosom; letting it, however, have plenty of air. We should not relinquish our endeavours at re- suscitation 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. 252 ACCIDENTS AND DISEASES. SECT. II.—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 al- ways 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 re- quired, 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. SECT. III.--RETENTION OF URINE AND MOTIONS. Occasionally an infant will not pass any urine for many hours after its birth. This most frequently SWELLING OF THE BREASTS. 253 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 sub- ject, if any thing 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. SECT. IV.--SWELLING OF THE BREASTS. At birth, or two or three days subsequently, the breasts of the infant will frequently be found swol- len, hard, and painful, containing a fluid much resembling milk. Some nurses 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 22 254 ACCIDENTS AND DISEASES. 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. SECT. V.—INFLAMMATION OF THE EYES. 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. 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 eye- lids 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, HARE-LIP. 255 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 import- ance of the disease, and the signs by which it may be recognised at its first approach. Keeping the eye free from discharge, by the constant removal of the matter secreted, is what the medical attendant will chiefly insist upon; and unless 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. SECT. VI.--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, pro- vided 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 spoken of at page 80. 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. If, however, the defect exists in a still greater 256 ACCIDENTS AND DISEASES. 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. For instruction upon these points, see " Artificial Feeding," page 73. Caution in reference to the operation.—With regard to the operation for the removal of this deformity, I would strongly warn parents against desiring it too early. Various considerations con- tribute to make the distressed parents anxious for this. But very seldom indeed—except the defor- mity 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 deformi- ty by operation is from that of two years and a half to four years. SECT. VII.--BLEEDING FROM THE NAVEL-STRING. Bleeding from the navel-string will sometimes 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 unusu- ally 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 BLEEDING FROM THE NAVEL. 257 that the attendants in the lying-in room should un- derstand how to manage this accident when it oc- curs, 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 un- wrapped; and then a second ligature be applied be- low 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 can- not be relied on for this purpose. SECT. VIII.--ULCERATION, AND BLEEDING FROM THE NAVEL. Ulceration, or imperfect healing of the navel.— The cord separates from the navel generally some time between the fifth and fifteenth day from deli- very, and the part usually heals without giving the slightest trouble. This, however, is not always the case, for some- times 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 lit- 22* 258 ACCIDENTS AND DISEASES. tie powdered alum, or, if this fail, it should be once or twice slightly touched with blue-stone, and af- terwards 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 atten- tion of the medical man is called to it early, it will always do well: until his directions are given, ap- ply a nicely made bread and water poultice. Bleeding from the navel.—A day or two after the cord separates, or at'the time of separation, bleed- ing may take place from the navel; fortunately,this rarely occurs; 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 nar- row 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 TONGUE-TIED. 259 the disease, which subsequently falling off, a com- plete cure is accomplished. SECT. IX.—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 disappearingspontaneously,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 jaun- dice 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 unfrequent occurrence,) it is not likely to arise; and therefore jaundice during the first and second week after delivery need not create alarm. SECT. X.--TONGUE-TIED. 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, 260 ACCIDENTS AND DISEASES. 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 labour- ing 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 alto- gether 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. SECT. XI.—MOLES AND MARKS ON THE SKIN. 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," and as this part of the subject is foreign to the present inquiry, which chiefly has reference to the probable effect of their presence upon the health of the child, it is unnecessar}'- again to refer to it here. These appearances may be divided into two classes: the brownish mole, and claret-stain, and small but somewhat elevated tumours, either of a MOLES AND MARKS ON THE SKIN. 261 dark blue, livid colour, or of a bright vermilion hue. Moles and stains.—They are of no importance, as far as the health of the infant is concerned. If situated in the face, however, they frequently cause great disfigurement, as the claret-stain, which may be seen sometimes to occupy nearly half the face. But they happily do not increase in size, remaining stationary through life; and as any operation that might be proposed for their removal, would only cause an equal, if not greater, deformity, they ought to be left alone. Coloured spots or tumours.—These vary in their number, size, and situation. The same child is sometimes born with many of them. They may be as small as a pea, or as large as a crown piece. They are not only found on the skin, but on the lips, in the mouth, &c. 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 applica- tion of remedial measures, the less severe will they be, and the greater is the probability of a speedy and successful result,—so is it always important for the mother at once to obtain a medical opinion, that the measure of interference or non-interference may be decided. 262 ACCIDENTS AND DISEASES. CHAPTER XII. OTHER ACCIDENTS OF INFANCY AND CHILDHOOD. Accidents more or less serious are daily occur- ring to children. Of course they take place sud- denly,—in a moment; and, in nine cases out often, the parents and attendants, greatly alarmed, know not what to do, or perhaps ignorantly do the very thing they ought not. The sudden rousing the pa- rental feelings incapacitates the mind for action, un- less, indeed, it be in some degree prepared by pre- vious instruction. This knowledge, however, is seldom possessed, unless circumstances at some former period have arisen to give it. A few hints, then, for immediate guidance and direction in case of need, may not be unwelcome or useless. The principal information, however, which it is pro- posed to communicate, is just that which may be advantageously used before surgical aid can be ob- tained. If the mind of the mother or attendant is fully impressed with the necessity of doing one thing, and that the best that can be done, no time is lost, hurry and excitement are avoided, and the mischief is not increased. A few words under the separate heads will amply suffice to convey all that need be said. SCALDS OR BURNS. 263 SECT. I. — SCALDS OR BURNS. The danger to be apprehended from a scald or burn must always be mainly in proportion to the extent of surface scalded, or the length of time the burning body continues in contact with the skin. Scalds.—Immediately remove the child from the source of the injury. Undress him, but in doing this be very careful that the blistered part is no way rubbed, so as to endanger the breaking of the blis- ter or the tearing of the cuticle; this would increase the danger of the accident. The outer garments may generally be taken off without fear, but the body-linen requires great caution, lest any portion of it adhere to the wounded part; if this is found to be the case, the linen or flannel shirt must, if neces- sary, be cut away piecemeal, leaving that portion untouched which adheres to and covers the sore. Having put the child to bed, cover the injured part with three or four thicknesses of cotton wadding, and so apply it as completely to exclude the exter- nal air; a bandage or something of the kind will best accomplish this object by keeping the cotton in close contact with the part. If the scald has been severe, or if not, and the extremities are dis- posed to be cold or the child to shiver (and delicate children are very prone to be thus affected, even when but very slightly scalded, from the shock which is given to the system,) apply warm water 264 ACCIDENTS AND DI3EASES. bottles to the feet, and give a small quantity of wine and water. And now wait until the medical man arrives. Burns.—Should the clothing of a child take fire, let it be remembered that the upright posture is ob- viously not only favourable to the spreading of the flames, but to their reaching the more important parts of the body, the neck and head. Any motion of the body to and fro gives great advantage to the flames by bringing fresh currents of air in contact with the burning materials, and it is, therefore, ut- terly absurd to allow the child to run screaming about. Throw him down upon the floor; keep rolling him over and over upon the carpet; if pos- sible seize the hearth-rug, or table-cover, or strip yourself of your shawl and envelop the child in it as closely and completely as possible. In this way you will most readily put out the fire. With regard to treatment, the same plan must be pursued as in scalds. Undress the child, attending to the precautions given above. Put him to bed. Cover the burnt parts with cotton wadding, most carefully excluding the external air. Keep the child warm, and, therefore, if necessary, apply the warm water bottles to the feet, and give wine and water to the stomach. And now wait the arrival of the medical attendant. It might so happen that cotton wadding is not at hand, in which case you may use in its stead linen well soaked either in spirits of tur- pentine, brandy, or even milk. SWALLOWING BOILING WATER. 265 Two further remarks only are necessary, and which have reference to both accidents. On their first occurrence, or during the progress of the case, the attendants not unfrequently give laudanum to quiet the restlessness of the child;—this remedy may be required, and if so the medical man will give it; but never allow an unprofessional person to administer it, as serious results might ensue. Again, it cannot be too widely known by parents and friends that when a scald or burn is extensive, or if it is not so, but situated on certain parts of the body, that it may give rise to the most serious deformity, and that no efforts whatever of the surgeon can possibly prevent this. It is just to all parties to bear this fact in mind. SECT. II.--SWALLOWING BOILING WATER. Death from the accidental swallowing of boiling water, from the mouth of a tea-kettle or tea-pot, is by no means uncommon among young children. In the Registrar General's Report for 1838-39, twenty- four deaths are stated to have occurred among young children from this cause alone. Fortunately, how- ever, in the majority of instances the child is too quickly alarmed by the pain to complete the degluti- tion of the boiling water, and it is no sooner in the mouth than it is immediately got rid of. But yet the tongue, mouth, and the parts at the back of the throat are scalded, and they become swollen so that the pa- 23 266 ACCIDENTS AND DISEASES. tient seems to be threatened with suffocation, and even the mildest cases are of a fearful character. Upon the immediate emergency you may apply a strong mustard poultice to the outside and front of the throat; and if you cannot directly obtain medical help, the application of a leech or two, according to the age, will sometimes be followed by the best ef- fects, causing the breathing to become free imme- diately after. SECT. III.—BRUISES. A simple, uncomplicated bruise (the appearance of which every body is familiar with) requires very simple treatment. If more severe, the medical man must be sent for. However, until his arrival, both may be treated alike. Apply then cold water to the part, and you may put some nitre into the water, if you have any in the house, to make it colder. Dip into the water a piece of linen rag folded once or twice, and proportioned to the size of the bruise, and lay it upon it, and renew this application suffi- ciently often to maintain its coldness. Or you may substitute for this, if you can procure it, ice, which must be broken into small pieces, put into a blad- der, and applied. It is important to give this caution: in case the blow occur to the head of a young child, do not think too lightly of the circumstance. Its health should be watched for some time afterwards, and WOUNDS. 267 the medical man consulted as to its management; for want of such care, 1 have again and again seen serious results. One of the worst cases of convul- sions that I was ever called to, was clearly traceable to a blow on the back of the head, received from a fall out of the nurse's arms, two or three weeks previously, which had been all but forgotten, and thought of no consequence. If the fall or blow is followed by paleness and vomiting, never delay to place the child under medical vigilance. SECT. IV.—WOUNDS. These will either be clean, as when made by some sharp, cutting instrument, as by a knife,—or torn, as by a broken plate, or such as would be produced by a fall on the ground and occasioned by rough gravel. In either case, if the accident be severe, medical aid must be sought; a few plain directions, however, for the management of the lesser forms of accident may be useful. And first, of what you are not to do. Do not apply the favourite and very popular remedies, Tincture of Benjamin or Friar's Balsam ; they do no good, but positive harm, by hindering the sub- sequent healing of the wound. Applications of this description have, in delicate children, caused a trifling cut to become a dangerous sore. Take then a soft sponge and some cold water, and bathe the wound so as to arrest the slight bleeding 26S ACCIDENTS AND DISEASES. which may be going on;—or if you have reason to believe from the way in which the accident hap- pened that any foreign substances are lodged in the wound, such as gravel, dirt, or glass, take tepid water and freely sponge the part until the wound is clean; but if you find that the foreign matters cannot be easily extracted, apply a bread and water poultice; suppuration will ensue, and the particles readily dis- charge themselves. Such a case, however, demands the surgeon's care, and ought to have it, if possible. Having then cleaned the wound, bring the edges together, and keep them in opposition by means of strips of adhesive plaster laid across the wound. The plaster must, of course, be cut of convenient length and width to the size of the wound: long and wide, or short and narrow, as the wound may be large or small. So dressed, it may remain for three, four, or more days, in fact so long as the dressing continues firmly attached and gives no pain; but it will generally become loose about the fourth or fifth day, and if removed, the chances are, that the wound will be found healed, or at all events the greater part of it, and to the remainder fresh dressing may be applied. The most important point of all is to know what to do in a case of severe bleeding before the arrival of the surgeon. Pressure well applied is the remedy. For this purpose, if the wound is in the trunk, take a piece of lint or rag, double it three or four times, and keep it pressed firmly upon the BROKEN LIMBS. 269 part until professional assistance is obtained. In the case where the finger or any part of either extremity is wounded, a bandage should be applied over the lint, and tied tightly round the limb, so as to keep up firm and continued pressure. This advice is frequently misapplied;—rag after rag is heaped upon the part, and pressure is no longer made. SECT. V.--BROKEN LIMBS. When a child meets with an accident, and it is suspected that a bone is broken from the nature of the complaint he makes and the deformity of the limb, such as its being bent, shortened, or twisted, much immediate additional suffering to the patient, and increased mischief to the injured part may often be saved by a little care and management. In lift- ing the child from the place where the accident happens, and carrying him to a couch or bed, let it be one person's business to take charge of the broken limb, and instead of allowing it to dangle loosely, carefully support it in a natural position, and as much as possible, steady it from all jar or shock. Then do not attempt to undress him, but place the limb upon a soft pillow in the most easy position, and thus let things remain until the arrival of the surgeon. 23* 270 ACCIDENTS AND DISEASES. SECT. VI.--SPRAINS. If a severe sprain should occur, it ought not to be trifled with, but the surgeon consulted, for the consequences are sometimes more lasting than of a broken bone. This observation particularly applies to the sprains of the knee or ankle-joint. Even slight sprains, neglected, occasionally terminate in the establishment of serious disease, a result which a little care and prudence would have altogether prevented. Again, the cure of these accidents de- mand not only much care, but much patience also, for their consequences, as a stiff wrist, for instance, will require perhaps many weeks before perfect freedom of motion and use are regained. If the knee or ankle-joint is sprained, put the child to bed; if an upper extremity, this is not ne- cessary; but in either case, it is rest, freedom from all motion of the injured part, that you are to aim at; place the limb therefore in that position which secures this object most completely. For some hours foment the part with flannels wrung out in warm water, and at bed-time put on a large and well-applied bread and water poultice. Entire rest, and a poultice renewed about three times a day, are the means to be employed for the next three or four days. Then, if the sprain has been slight, the poul- tice may be left off, and a bandage applied to give support to the joint; and if it be the knee or ankle, the limb must be used very sparingly and cautiously for some time. FOREIGN BODIES IN THE EAR AND NOSE. 271 In reference to the poultice, a better and more cleanly remedy is the water dressing, which con- sists in passing a piece of lint or rag twice or thrice round the injured part, and saturating it with tepid water, and then carefully covering the whole with oiled silk; this prevents evaporation, and thus the whole part is kept in a continual soothing vapour bath. This application is a much less troublesome one than the poultice, and answers equally well. Although the accident in the first instance may have been thought slight, yet if after an hour or two's application of the fomentations the child com- plain of much pain, it is always wise to send for medical aid; leeches or other treatment may now be necessary, and delay in the use of such measures might be mischievous. SECT. VII.—FOREIGN BODIES IN THE EAR AND NOSE. A foreign body occasionally gets into the ear or up the nostril of the child. If it be a hard sub- stance, such as a glass bead or a shell, its remaining in a few days will not be of much consequence, and it may probably drop out, unless indeed it has been forced in; but if it be a pea, or bean, or seed, indeed any thing of a kind that can imbibe the moisture of the part, and so become swollen, the sooner it is re- moved the better, for the longer it remains, the firmer, from its increasing size, will it be fixed, the greater suffering will it give, and the more difficult will be its removal. 272 ACCIDENTS AND DISEASES. " If the pea or shell be in the nostril," says Mr. South, "the child should be made to draw his breath in deeply, and then closing the other nostril with the finger, and closing the mouth firmly, to snort forcibly through that side of the nose in which the substance is lodged. If this be done soon after the accident, two or three efforts usually shoot the un- welcome lodger out. But if this do not succeed, the nose must be tightly nipped with the finger and thumb above the pea or shell, so as to prevent it getting further in, and then the eyed end of a bod- kin or probe, having been a little bent, must be gently insinuated between the bottom of the nose and the substance, and when introduced sufficiently far, must be gently used as a hook to bring it down. Pushing it back into the throat should not be tried, as not unfrequently so doing only fixes it the more firmly. If a doctor be within reach, it is better at once, if the substance cannot be snorted out, to take the child to him, as he will be able to manage the matter better and more readily the earlier he is ap- plied to. " It is of much greater consequence when any thing has been pushed into the ear, as, though the passage is short, its nearly circular form and smooth surface more readily permits its being quickly thrust almost to, or even quite down to the drum of the ear. The passage is also so narrow, that it is difficult to get in either the end of a bodkin or eyed probe between the substance and the ear-passage, CHOKING. 273 and not unfrequently, indeed, it is pushed farther in. If it were advisable to attempt the early re- moval of any swellable body from the nose, it is ten times more so when such is lodged in the ear-tube, nearly the whole of which being very unyielding, the agony which the swelling body produces by its enlargement is extreme. The doctor, therefore, should be immediately sought for. No syringing with water or any other fluid should be resorted to, as it will excite the pea to swell, and increase the mischief; and dry heat alone must be employed. " If, however, a hard body, as a shell or button, or bead, be pushed into the ear, syringing with water may be used with advantage, as, if the water pass in any way between the hard body and the ear-drum, it will not unfrequently force it out. The head should be laid down, so that the ear in which the hard body is, should be undermost, and in this position the water should be thrown up with the syringe, the nozzle of which, however, must be held at some little distance, and not put into the pipe of the ear, or it will prevent the hard body dropping out. Whilst the head is thus laid on its side, I have known the offender ousted by a smart-box on the other ear."* SECT. VIII.--CHOKING. Some children eat much too fast; they bolt their food rather than eat it; and now and then a large * Hints on Emergencies, p. 299. 274 ACCIDENTS AND DISEASES. portion sticks by the way; sometimes a fish-bone or other bone is swallowed, and is similarly placed; —sometimes a metallic body, as money. Now any one of these substances may stick at the back of the throat,—in the gullet itself, higher or lower,—or may at once pass down into the stomach. If the first take place whilst the child is eating, and he appears choking, it is always advisable im- mediately to thrust the finger and thumb as far back into the throat as possible, and if there be any thing there, to attempt to pull it out at once; whilst you are doing this sometimes a violent fit of coughing will take place and expel it. If the second occur, a child for instance eating hastily and carelessly, and bolting a large piece of meat, it sticks in the gullet, make the child take large draughts of water, and at the same time make powerful efforts to swallow; the water will fre- quently dislodge the food, and both pass down into the stomach together; but if this happy result does not take place, medical aid must be obtained forth- with. If it be a piece of bone or a pin that is swal- lowed, and it lodges by the way, there need be no alarm, but instead of water, first give the child a crust of bread, see that he chews it coarsely, and then make him swallow it, taking at the same time a gulp or two of water, and the chances are in favour of the bone or pin being carried down into the stomach. Of the treatment of things that pass down at once STINGS OF INSECTS. 275 into the stomach, such as pieces of money, buttons and many articles of a like kind, which children, playing with, frequently put into the mouth and sometimes swallow, little need be said, for they are seldom followed by any serious consequences. Sooner or later the foreign body passes through the alimentary canal with the food, and is thus got rid of. I may add, however, that in this case it is a very common practice to give repeated doses of aperient medicine; now, unless the bowels should become confined, such a measure is rather injurious than useful. Of substances getting into the windpipe it would be useless to say any thing to the unprofessional reader. SECT. IX.—STINGS OF INSECTS. Children are perhaps more frequently stung by bees and wasps than adults. The first thing to be done is to examine the wound with a lens, and if the sting is still in, to extract it with a pair of fine forceps or tweezers. If only part is left, this will be attended with difficulty, but by gently squeezing the sides of the wound, it may sometimes be pressed out. Then the best remedies to apply to the part are, either turpentine, hot vinegar, spirits of wine, eau-de-cologne, or olive oil. If none of these are at hand, cold water simply will give great relief, if used continuously. If the wound should look very 276 ACCIDENTS AND DISEASES. angry, or become very painful, a bread and water poultice or the water dressing, will be the best ap- plication. Subsequently if any oedematous swelling remains, a piece of soft linen soaked in soap liniment may be used. For the bites of bugs, fleas, or gnats, the best remedy is eau-de-cologne, so as to convert the itch- ing into slight smarting; or the part may be smeared over with olive oil. sect. x.—POISONS. I have known in more than one instance the at- tendants upon a sick child give a lotion containing poison instead of the medicine, and cases have also again and again occurred where children, finding bottles in a closet or elsewhere, have out of curiosity swallowed laudanum, oil of vitriol, and the like. The alarm and distress suffered by the parents, having no immediate guidance or help, may be easily imagined. To know what to do on the spur of the moment is not only in all instances a source of the greatest relief, but in some cases, from the rapidly fatal operation of some poisons, a matter of life or death. Just a few directions therefore suited to such emergencies will not be out of place, the more particularly as every one must feel that the more universally such information is diffused the better. Presuming then that the medical man will be sent for without delay, the following means may be employed until his arrival:— POISONS. 277 Poisons. Treatment. Laudanum, in any form. Sulphuric acid (oil of vitriol.) Nitric acid (aqua fortis.) Oxalic acid. Arsenic. The great object is to remove the poi- son from the stomach. Give an emetic, sulphate of zinc (white vitriol) is best, (ten grains;)—or if you have it not, ipe- cacuanha (ten grains;)—or tartarized an- timony (one grain every quarter of an hour.) Repeat the dose until copious vomiting is excited. Keep the patient constantly roused; walk him up and down the room, drag him along, and do not listen to his entreaties to be left to re- pose. Dash cold water over the head and face occasionally, and also put the feet in warm water. When the opium has been completely removed, coffee may be given. Administer without delay chalk or magnesia, if you have it by you (a full table spoon to every tumbler of water,) but if not, scrape off the plaster from the wall of the apartment, and mix it with water; give freely one of the foregoing. Whilst this antidote is being prepared, if vomiting is not already free, give an emetic. After the antidote has been freely given, use diluents, such as milk, so as to render the vomiting more easy. Empty the stomach by an emetic of ten grains of sulphate of zinc. Give milk both before and after the vomiting has begun, never allowing the strength to be exhausted by the retching, the stomach 24 278 ACCIDENTS AND DISEASES* Poisons. Treatment. having nothing to act upon. If you have not milk, flour and water will form a good substitute. Corrosive sub- Give the white of eggs beaten up in limate. water, and if eggs cannot be immediately obtained, flour and water, or milk. Goulard water. If the child is not sick, give an emetic; sulphate of zinc (white vitriol) is best. Lotions and If in doubt about the kind of poison Liniments. contained in the lotion or liniment, give an emetic immediately, which ridding the stomach of it, will of itself generally be all that is necessary, since these pre- parations most frequently do not contain much poisonous matter. DISORDERS OF THE STOMACH, ETC. 279 CHAPTER XIII. DISORDERS OF THE STOMACH AND BOWELS OF INFANTS. Disorder of the stomach and bowels, as shown by indigestion, flatulence, vomiting, griping, and looseness, is one of the most fruitful sources of the diseases of infancy. Only prevent their derange- ment, and in nine instances out of ten the infant will be healthy, and flourish. Experience daily proves, that a large proportion of the children who die in in- fancy are lost from derangement of these organs as the primary cause. There are many causes which may give rise to these affections; some of them ap- pertain to the mother's system, others to that of the infant. All are capable, to a great extent, of being prevented or remedied. It is, therefore, most im- portant that a parent should not be ignorant or mis- informed 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 re- ference, these disorders will be spoken of as they 280 DISORDERS OF THE STOMACH occur:—in the infant at the breast—at the period of weaning—and in the infant brought up by hand. SECT. I.--IN THE INFANT AT THE BREAST. The most frequent causes giving rise to derange- ments of the stomach and bowels in the infant at the breast, are unwholesome breast-milk, irregular nursing, the irritation of teething, and cold or damp. 1. Unhealthy breast-milk.—This mayr 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 (p. 54,) and the effects both upon mother and child fully dwelt upon. To cure derangement of the bowels from this cause, a wet-nurse is the only remedy. 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. A fit of passion in the nurse will frequently be followed by a fit of bowel complaint in the child. These causes of course are temporary, and when removed the milk becomes as healthy and sufficient for the child AND BOWELS OF INFANTS. 281 as before. Sudden and great mental disturbance, however, will occasionally drive away the milk al- together, and in a few hours. Unwholesome articles of diet will affect the mo- ther's milk, and derange the infant's bowels. Malt liquor that is not sound; salads, pickles, sour fruit, cucumbers, melons, acids, and the like. Too full and luxurious a mode of living, by causing the milk to become too rich, will injuriously affect the child. Cases illustrating these facts have already been given in the first chapter. 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 ol 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 hap- pen, that a few days before the mother is going to be unwell, the infant will become fretful and un- easy; its stomach will throw up the milk, and its 24* 282 DISORDERS OF THE STOMACH 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 affect- ed 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 in- fant. Is then a mother, because her monthly pe- riods 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 as much as possible from the breast, during its continuance, and feeding him upon artificial food, she will pre- vent 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 in- juring 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 be- coming pregnant. In this case, however, the pa- rent'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 AND BOWELS OF INFANTS. 283 upon a suitable artificial diet;—if, however, preg- nancy should take place before the infant is six months old, a wet-nurse ought to be procured. 2. 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 inter- val not being allowed between the meals for diges- tion. The milk, therefore, passes on from the sto- mach 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 laid down in the earlier part of this work. 3. 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, how- ever, 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 some- times alone put a stop to the looseness; further me- dical aid may, however, be necessary. 284 DISORDERS OF THE STOMACH 4. Cold and damp.—Ql course there are other causes besides those already alluded to, giving rise to bowel complaints during this period,—causes not cognizable by the mother, however, and therefore not mentioned 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 inflam- mation is generally the result. SECT. II.--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 de- ranged during this process from one of these causes —from weaning too early, from effecting it too sud- denly 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. 1. From 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 AND BOWELS OF INFANTS. 285 are too delicate for this change, is a frequent source of the affections now under consideration. The at- tempt to wean a delicate child, for instance, when only six months old, will inevitably be followed by disorder of the stomach and bowels. Unless, there- fore, 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, medi- cine 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 be too early for some, the twelfth would be for others. This, however, is spoken of elsewhere, (p. 57.) 2. From sudden and abrupt alteration of diet. —Depriving the child at once of the breast, and sub- stituting 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 in the article on weaning. 3. From over-feeding, 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 286 DISORDERS OF THE STOMACH too large a quantity of food is given at each meal, or the meals are too frequently repeated, in both in- stances the stomach will become oppressed, wearied, and deranged; part of the food will be 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 in- fluence over the disease, but the cause being con- tinued, the disease will become most seriously ag- gravated. 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 as- certain 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 the want of judicious dietetic regula- tion. Over-feeding, and improper articles of food, are more frequently productive, in their result, of anxious hours and distressing scenes to the parent, AND BOWELS OF INFANTS. 287 and of danger and loss of life to the child, than al- most any other causes. 4. Teething.—The irritation occasioned by dif- ficult teething may give rise to diarrhoea at the pe- riod 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, un- less indeed the attack be severe and aggravated, when medical aid becomes necessary. Slight diar- rhoea, then, during weaning, when it is fairly tracea- ble 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 re- move the cause, and generally cure the bowel com- plaint. SECT. III.—IN THE INFANT 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, therefore, it is absolutely necessary from untoward circumstances to have recourse to this mode of nourishing the child, the rules laid down in the section on "Arti- ficial Feeding" (p. 73,) must be most strictly fol- lowed out, if the parent would hope to avoid disease 288 DISORDERS OF THE STOMACH and rear her child. And if, unfortunately, these affections should at any time manifest themselves, the mother ought carefully and diligently to examine whether the plan of feeding pursued is in every particular correct, especially bearing in mind that the two causes most frequently productive of dis- order in the child are over-feeding and the exhi- bition 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. SECT. IV.—MATERNAL MANAGEMENT OF THESE DISORDERS. As must have been already seen, the maternal treatment of disorders of the stomach and bowels 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 re- source and only remedy of most mothers in affec- tions of the stomach and bowels is an aperient, and a combination containing calomel is the one too fre- quently 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 eventu- ally get rid of it. The mother is not aware all this AND BOWELS OF INFANTS. 289 time that the real source of the derangement is pro- bably 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 con- firmed 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 de- tected? 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. If the child is sick at the breast, ascertain whether the breast-milk is healthy and wholesome, or whether any circumstances exist which may have rendered it otherwise? If nothing faulty is found here, the next question would natu- rally be, whether the regulations laid down for suck- ling 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. Is the change being at- tempted too early? or too suddenly and abruptly? If this is not the case, has the child been over-fed, or is the food given of the proper description? Is the child being brought up by hand ? Then, there is 25 290 DISORDERS OF THE STOMACH every reason to suspect, either that the food is not properly prepared, or 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 observed. 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 re- move the symptoms. For example, if flatulence and griping, followed by diarrhoea, occur to an in- fant 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 anything here; the cause must be re- moved ; the best medicine, and the only remedy, is a breast of healthy milk. And if this is not pro- cured 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 un- changed, and discharged without any apparent effort, AND BOWELS OF INFANTS. 291 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 sto- mach has received too much. This must be pre- vented 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. If flatulence and griping occur to the child brought up by hand, this derangement will gene- rally be found to result from over-feeding: absti- nence 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 exhibi- tion 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 injec- tion the next morning. Again, if diarrhoea occurs in a child brought up by hand, if it be not the result of over-feeding, it will very frequently be found to arise from unsuitable diet, or at least unsuitable to that particular child; for what will agree with one child often disagrees with another. Alteration of diet will sometimes be quite sufficient for the cure, 292 DISORDERS OF THE STOMACH, ETC. 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 atmo- sphere. The arrow-root, upon the cessation of the diarrhoea, may have cow's 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 the diarrhoea not yield to the foregoing measures, and that readily, medical aid ought to be sought. Diarrhoea very frequently occurs 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 mentioned 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 pre- vent 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. COLDS AND COUGHS. 293 CHAPTER XIV. THE DISEASES OF CHILDREN. SECT. I.—COLDS AND COUGHS. A neglected cold or cough not unfrequently leads to consequences of the most serious kind. Because it is one of the commonest of all disorders of the nursery, it is too often disregarded, and thus the seeds of future disease are sown, which the adoption at the time of the most simple measures might have prevented. Perhaps, even now, the reader is smiling at the importance given to this subject; experience, however, teaches a graver lesson, and shows that the path of wisdom is never to neglect the most trifling symptoms which are in any way connected with organs vital to life. A cold in the head may gradually creep down into the lungs, and cause in- flammation of the air tubes and substance of that organ,—two of the most fatal diseases to which the human frame, particularly that of the child, is liable. A cold, when properly managed, is usually a trivial disorder, running its course in a few days. Put the child's feet in a mustard foot-bath,—keep him in bed,—let him live upon slops,—give at the 25* 294 DISEASES OF CHILDREN. outset a gentle aperient, and afterwards every four or six hours a little camphor julep with a few grains of nitre and a few drops of antimonial wine,—and the chances are, in eight and forty hours he is well. Some children are always taking colds. The best means of prevention in these cases is the use of the cold shower-bath, as directed in the section on that subject It will inure the surface of the child's body to a lower temperature than it is likely to be subjected to when out in the air, in the course of the day. If the child be too much alarmed at the shower-bath, sponging must be substituted. A cough in infancy is usually connected with teething, and immediately the gum is lanced and the pressure caused by the tooth relieved, it ceases. An ordinary cold, if the mucous lining of the upper and back parts of the throat is affected, will give rise to a cough, which the means already pointed out will, ordinarily, arrest. Should the parent, however, observe the breathing become quickened and hurried, the cough frequent and short, the skin hot, and the face flushed, she ought no longer to trust to domestic remedies, as it is now evident the disorder has travelled down into the lungs. If a child has the symptoms of a common cold, but attended by hoarseness and a rough cough, always look upon it with suspicion, and never ne- glect seeking medical advice without loss of time. These symptoms are indicative of the possible occurrence of a very formidable affection—croup. COSTIVENESS. 295 It may be useful to repeat what has already been alluded to in the article on clothing, that the prac- tice of leaving in the early years of the child's life, in our changeable climate, the neck, shoulders, and arms quite naked, whilst the rest of the body is warmly clad, is a fruitful source of those inflamma- tory affections of the lungs so common and fatal to children. There can be no doubt also that the foundation of future disease of these organs is often laid in this way. The tables of the Registrar General prove not only that the amount of death from diseases of the respiratory organs is very great, and much greater than was supposed, but that chil- dren furnish the majority of the cases. SECT. II.—COSTIVENESS. 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 prac- ticable from the child being fed artificially, then the 296 DISEASES OF CHILDREN. mildest aperient medicines must be chosen to accom- plish this purpose. The kind of medicine to be selected, and the doses in which to be administered, will be found in the section on " Aperient Medi- cine," p. 154. 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 dis- cover 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 boiling water, and a small quantity of unboiled milk added; or Densham's farinaceous food, prepared in the manner directed above (p. 88,) 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 COSTIVENESS. 297 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 ex- ceeded. This condition seldom occurs to the very young infant. In childhood, if sound health is enjoyed, the diet judiciously managed and sufficient exercise taken, aperient medicine will seldom be required. Errors in diet, a want of proper attention to the state of the skin, insufficiency of air and exercise, in fine, a ne- glect of those general principles which have been laid down for the management of health, and upon the observance of which the due and healthy per- formance of every function of the body depends, are the sources of bowel derangements, and particu- larly, 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 regu- larity 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. 298 DISEASES OF 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, how- ever, 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, princi- pally, in an observance of great regularity with re- spect 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 pre- disposing to constipation;) and, lastly, the patient habituating himself to evacuate the bowels at a cer- tain hour of the day. After breakfast appears to PROTRUSION OF THE BOWEL. 299 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 princi- ples laid down in the various chapters upon these subjects, if habitual costiveness is expected to be overcome. SECT. III.—PROTRUSION OF THE BOWEL. This complaint naturally gives rise to a good deal of alarm, and the accident is referred to here more for the sake of relieving unnecessary anxiety, than to offer curative suggestions. The fact is, it will be always wise, when it takes place for the first time, to consult your medical adviser; for although the accident is not a serious one, still under such cir- cumstances medical advice is demanded. There are cases, however, in which it occurs again and again in the same child, where this is hardly necessary. For instance, some children never have an attack of diarrhoea, however slight, but the bowel comes down; and in others, who are very subject to cos- tiveness, whenever the bowels are allowed to become at all confined, the same result takes place whenever they go to stool; in the latter, the complaint owes its origin frequently to a careless nurse allowing such a child to remain for ten minutes or more straining violently on the commode. The means of prevention are, due regulation of 300 DISEASES OF CHILDREN. the bowels by the mildest measures, and the avoid- ance in the general management of the child's health of all causes likely to excite diarrhoea or costive- ness. Such children, while young, should be watched by the nurse when at stool, that all straining may be prevented. The child should also, besides its morning bath, have the hips dipped for a minute or two in a cold bath every night upon going to bed. The mode of returning the bowel.—It must never be allowed to remain down, and the sooner the at- tempt be made to return it, the easier it will be to effect. Lay the child on its back,—place a pillow under its buttocks so as to raise them, and having tenderly washed the protruded part with a soft sponge and tepid water, embrace it with the points of your fingers, and steadily press it upwards, con- tinuing such pressure until the bowel slips in. If at any time you fail after using a reasonable amount of gentle and persevering effort, send for medical assistance; for, as has before been stated, the bowel must not be allowed to remain down. SECT. IV.—RUPTURE. This generally, in the child, occurs in the navel, or near the groin. Curative measures are commonly attended with success, if they are unremittingly employed. It is of vast importance that a cure should be effected during childhood, or the indivi- dual will, in after years, suffer a constant discom- RUPTURE. 301 fort,—be disqualified for many kinds of exertion, and may any day be in danger of losing his life. Now the cure mainly depends on the persevering care of those who have charge of the child, and the subject is noticed here, to press this point on the attention of those on whom the responsibility de- volves. Rupture of the navel is by far the most frequent form. It is generally first observed about two months after birth. The navel should have closed, but it has not, and a portion of bowel protrudes through the opening, and, covered by the skin and integuments, forms the hernia or swelling, which will vary in size from a hazelnut to a walnut, al- ways, however, increasing in size when the child strains either by coughing or otherwise. The object in the cure is to keep the bowel permanently within the abdomen, so as to give nature an opportunity of closing the opening. The mechanical means se- lected for this purpose by the surgeon will differ according to his own experience; but, whatever means are adopted, the treatment will have in view this one simple but all-important object, and will utterly fail unless continued vigilance is exercised by the nurse to carry out this intention. Not only must she be certain that the mechanical means are always in place, but when removed for the purposes of bathing and cleansing the child, that during this process the bowel is not allowed to come through the opening,—to guard against which she must place 26 302 DISEASES OF CHILDREN. her own finger over it, until the bandages are re- applied. All this requires the exercise of constant watchfulness; but perseverance will be successful. Of rupture near the groin no mechanical means can be commenced with any expectation of success, so far as my experience goes, until after the first twelve months have expired. To do any good, a truss must be worn, and it is impossible to accom- plish this satisfactorily at this early period. Take what pains you may, the instrument will become displaced, the straps be constantly soiled, irritating and chafing the skin of the child, and with all your care and perseverance, you will at last be obliged to relinquish its use until a later period. Moreover, the very fretfulness caused by wearing the instru- ment at this time, and under these circumstances, tends to increase the size of the rupture: you must be content to bathe the parts with cold water night and morning, and keep the child as tranquil as pos- sible to avoid crying. Sometimes you will succeed by these means alone in effecting a cure before the time arrives when the truss can be usefully re- sorted to. In either form of rupture, should the child, at any time before its cure, be evidently suffering from pain traceable to the complaint, it is important to recollect that the surgeon should always be sent for, to see and examine the child. WORMS. 303 SECT. V.--WORMS. 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 pre- viously 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, mis- chievous, and sometimes of so serious a nature as to lay the foundation of disease which ultimately proves fatal. This observation, moreover, it be- hooves a mother carefully to regard, since the symp- toms, 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 as- serted 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 304 DISEASES OF CHILDREN. 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 characterize 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, de- ranged bowels, pain in the head and belly, with a tumid and swollen condition of the latter, a short dry cough, and wasting of the flesh; symptoms con- tinually attendant upon the disorder now under con- sideration. These cases have hitherto been perpe- tually 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 physi- cian grievously aggravated by such injudicious treat- ment. It is folly, at any time, for an unprofessional person to prescribe for a case where worms are ac- tually 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. WORMS. 305 They do not invariably occasion indisposition, for they are now and then passed without pain or dis- tress by children who are in the enjoyment of per- fect 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 ge- neral 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 neces- sary stimulant to the digestive organs,) or other condiments, predisposes to worms. This observa- tion 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 in- fested with worms, and quickly died. Sugar, too, whilst a necessary condiment for the food of chil- dren, 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 26* 306 DISEASES OF CHILDREN. injudicious means occasionally employed to effect the removal of these animals, by the debility pro- duced in the intestinal canal, favours not only their re-appearance but their increase. These, then, are so many causes which may occa- sion worms in the child. A mother, therefore, should at all times be careful in the regulation of the diet and general management of her child's ha- bits and health, even if no stronger obligations ex- isted 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 mani- fested. Again; she must not forget that the symp- toms 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 medi- cine 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 tend to produce them. SECT. VI.--THRUSH. This is one of the most common diseases of infancy. It is an eruption of minute pustules, usually appearing first on the inner surface of the angle of the lips, and about the tip of the tongue, in the form of white specks, spreading more or less rapidly, until, in some instances, a continuous white THRUSH. 307 crust is formed over the whole surface of the tongue, mouth, and back parts of the throat. In general, however, the eruption is not so extensively diffused, and is seen only on the tongue and central parts of the inside of the cheeks. If the case be mild, no particular uneasiness will arise from the eruption; but when it is extensive, there will be more or less suffering and disorder of the system. It is popularly believed that the eruption passes through the whole alimentary canal, and the excoriation which some- times exists about the extremity of the bowel is taken for proof of this. But this arises solely from the acrid nature of the discharges. The eruption seldom extends beyond the throat. The duration of the disease is uncertain. If the case be slight, the eruption will disappear in a few days, and there will be no material indisposition;—if severe, it will continue many weeks, and then seldom fails to seri- ously affect the health. There are many causes which tend to induce this disorder, particularly in delicate and feeble children, who scarcely ever escape it. Any thing that occa- sions disorder of the stomach and bowels;—unwhole- some nourishment, whether the breast-milk or arti- ficial food;—over-feeding;—breathing impure air in crowded and ill-ventilated apartments, and hence its frequent occurrence formerly in foundling hospitals; —these and various other causes will give rise to it. In those mild cases where the assistance of the medical man is not sought, a tea-spoonful two or 308 DISEASES OF CHILDREN. three times a day of the rhubarb and magnesia mixture (p. 157,) until the bowels are freely opened but not purged, is advisable. Of local applications to the mouth, borax is most useful. It may be applied in the form of a dry powder and dusted upon the sores every three or four hours (two grains mixed with four or five grains of very finely pul- verized loaf-sugar,) or in solution, dissolving thirty grains of the borax in an ounce and a half of water, and applying it by means of a soft sponge or rag tied to a piece of stick. The precipitated chalk powder may also be resorted to for the foregoing purpose; it affords great comfort by neutralizing the acid secretions in the mouth. It may be applied in the same manner as the dried borax;—and if swal- lowed it will be rather useful than otherwise. Care should always be taken not to rub off the crusts that form; which is sometimes done by a clumsy nurse; it gives much pain to the child, and causes mischief. If the anus become much inflamed and excoriated by the discharges, the parts must be kept most vigilantly clean, and frequently washed with tepid milk and water, and then carefully dried and anointed freely with fresh lard, which will guard them in some measure from the cause of irritation. If at any time the inflammation and soreness become very severe, a soft and well-made bread and water poultice may be applied, and the parts previously bathed with Goulard water (one drachm of Goulard's extract to half a pint of water.) INVOLUNTARY DISCHARGE OF URINE. 309 SECT. VII.--INVOLUNTARY DISCHARGE OF URINE IN THE NIGHT. « This is a very troublesome affection of childhood, but is frequently prolonged month after month for want of due vigilance, and perhaps knowledge, on the part of those who have the charge of the child. It generally commences during teething. In the first instance it depends, for the most part, upon an unhealthy state of urine, irritating in its qualities, and not unfrequently depositing a red sand or gravel;—but afterwards, the original cause being removed, it is kept up by the mere force of habit, particularly the custom of lying on the back, which has considerable effect in. exciting this affection. In some children, in whom the original cause has been long removed, the incontinence seems occa- sionally to recur from this circumstance alone. When this complaint first shows itself, accom- panied or not by an unhealthy state of the urine, of which fact, except gravel be present, parents cannot judge, the medical man ought to be consulted. In all cases, however, medicine will be of little avail without a very strict attention to general mea- sures. The diet must be as simple and wholesome as possible, suited to the age; all indigestible arti- cles, and sours, or sweets in the form of pastry, must be prohibited,—the beverage of course, at this age, will be water, and this must be of the softest. 310 DISEASES OF CHILDREN. No fluid must be allowed for three hours before bed-time, at which period the bladder must be emptied, and the child must be aroused three hours after for the sam^ purpose,—or, as the habit of dis- charging the urine with some is periodical, returning always at the same hour, he must be taken up an hour before that arrives at which he has been accus- tomed to wet the bed. Sleeping on the back must be prevented as much as possible, and some contri- vance adopted to secure this object. The cold hip- bath for a minute in winter, and for several minutes in summer, just before going to bed;—and the cold salt water shower-bath upon rising in the mornino-, if the child is old enough to bear it, will be found most useful. Sea-bathing will be better still, if it can be obtained. The child should sleep on a piece of Macintosh sheeting, or on a piece of leather, either one or the other, covered with calico or flannel, to prevent the bed from becoming soiled. SECT. VIII.--ERUPTIONS. Red-gum.—This seldom occurs after the sixth week of infancy, and can be hardly called a disease. It consists of pimples of a vivid red colour, appear- ing most commonly on the cheeks, fore-arms, and back of the hands, and interspersed with diffused red patches. It is brighter, but not unlike the rash of measles. It is generally connected with some acidity of the stomach and disorder of the bowels, TOOTH-RASH. 311 but it is seldom attended with general indisposition. Medical interference is scarcely ever thought neces- sary; at the same time if the eruption be suddenly driven in, as by exposure to cold, serious results might follow. The management of the child consists in the daily use of the warm-bath, which will promote theiiealthy action of the skin, and tend to allay the irritation of the stomach and bowels; and the exhibition for a few days every night, or every night and morning, of a tea-spoonful of the rhubarb and magnesia mix- ture, (p. 157.) Tooth-rash.—This occurs to infants at the breast, and is evidently connected with teething. When it appears as early as the fourth or fifth month, it consists of an eruption of pimples seated chiefly on the cheeks and forehead, small, crowded together, and less vivid in their colour than the red-gum;— but a few months later it will be found in large ir- regular patches on the outside of the hands, arms, and shoulders, and sometimes even on the legs. It usually continues twelve or fourteen days, when it begins to fade and gradually disappears. In the majority of instances no constitutional disturbance or particular inconvenience attends this affection, if we except the irritation caused by the eruption, which is sometimes very troublesome, particularly at night. Every thing, therefore, capable of adding to it, such as the wearing of flannel or muslin next 312 diseases of children. the skin is to be avoided. The parts may also be frequently washed with tepid milk and water, or the decoction of poppy heads, and afterwards dusted with fine starch powder. The bowels should be gently acted upon with the rhubarb and magnesia mixture, and if the gums are swollen and inflamed from the pressure of a tooth, they should be freely lanced. Sore Ears.—Every mother is acquainted with the sore ears of teething, and she is told that it is dangerous to heal them. In this way not unfre- quently a slight excoriation, from fear of interference or mismanagement, becomes a deep and troublesome ulcer, very difficult of cure. A copious and most offensive discharge will ensue, of such irritating quality as to excoriate the parts it comes in contact with. A deep ulcerous fissure may form in the cleft or groove behind the ear;—the whole ear be- come inflamed or swollen, and dreadfully painful to the child. It is most true that to dry up or sud- denly heal these sores during active dentition might be productive of most serious consequences, and no prudent physician would advise such a course; but they are not, therefore, to be neglected and allowed to degenerate into the condition above described. Always keep the excoriated surface as clean as possible, by washing it frequently with tepid milk and water; this will prevent the discharge becoming acrid and offensive, which would not only increase THE MILKY-SCALE. 313 the pain but irritate and inflame the ear and cause the excoriation to ulcerate. If at any time this con- dition arise, or indeed if this is not the case, but much irritation and itching are present, fomentations of the warm decoction of poppy heads every four or five hours, followed by large and soft bread and wa- ter poultice, should be resorted to, and be continued till these symptoms are relieved. Then, however, it must be at once left off, or it will itself occasion little pustules around the margin of the sores, and thus increase their size. The bowels must be gently acted upon, and the diet carefully regulated. If the child wear a cap, it must be left off, as it increases the heat of the parts, and is also liable to stick to them. If necessary, the hands must be muffled to prevent the scratching of the sores; and when put to sleep at night, the child should be kept from lying upon, and thus heating the sore ear, as much as possible. The same condition of ear will some- times take place before the teeth can possibly be the cause; this is most likely to occur in fat and lusty children. The Milky-scale.—This eruption usually oc- curs during teething. A number of small yellow- ish pustules appear on the scalp, forehead, temples, and cheeks, more or less crowded together upon an irritated and bright red surface. They soon break and discharge a viscid fluid, which concretes into thin, yellowish green scabs. These crusts gra- 27 314 DISEASES OF CHILDREN. dually increase in thickness and extent, and if pressed, a thin viscid fluid will ooze from beneath them, of an offensive character. Very frequently, after a short time, the whole face, with the excep- tion of the nose and eyelids, will be covered with an almost continuous crust, the child appearing as if it wore a mask. The glands at the back of the neck become more or less swollen; and sometimes the eruption extends to the body and limbs. The du- ration of this disease is very variable. In some in- stances it disappears in four or five weeks; more frequently, however, it continues for three or four months, and often much longer. It is not conta- gious. The unsightliness of this affection causes much uneasiness, and if it spread to and down the face, even alarm. Parents should be earnestly cautioned against the adoption of means intended to "dry up" and cure this eruption. Water on the head, and fatal diarrhoea, have again and again been the result. The disease may be removed without the slightest ill consequences; but then the cure must be effected gradually, and in conjunction with those precau- tionary and remedial measures which your medical attendant will advise. There is no reason for alarm, if the measures thus prescribed are patiently and attentively followed out In fact, this eruption will frequently operate as a salutary check upon diseases really dangerous, with which the system may have been threatened, or even effect the cure of those NETTLE-RASH. 315 which it may be labouring under. It is a comfort also to know, that although it disfigures very greatly while it lasts, this eruption never leaves any perma- nent mark; the skin of the affected part always re- gaining its natural smoothness and colour in the course of five or six weeks after the disease has dis- appeared. Although it is not intended to enter on the treat- ment, it may be useful to add, that the excessive ir- ritation and itching of so large and sore a surface, which causes great distress, and sometimes is very exhausting to the strength, may be greatly relieved by repeatedly fomenting the parts with warm de- coction of poppy-heads, and afterwards powdering the surface freely (if medical directions do not for- bid) with starch powder; A fretful, mournful cry, which has lasted for hours, will frequently be sub- dued in a few minutes by these means, and tran- quil sleep induced. Sometimes the application of fresh cream will give great relief; and at all times, washing away the acrid secretion with milk and water will contribute greatly to the child's comfort. When the weather will permit, the more the child is taken into the fresh air the better. Nettle-rash.—This affection is not unfrequent in young children, particularly during teething; and although very unimportant, it sometimes appears so suddenly and extensively as to occasion considerable alarm to the mother. The child is put to sleep per- 316 DISEASES OF CHILDREN. fectly well, and after a time awakes very restless and perhaps screaming. Upon examination its body and limbs are found covered with raised patches or wheals of irregular shape and pale colour, resembling those caused by the stinging of nettles, and accom- panied with excessive itching. This is most likely to occur in very hot weather, and as it is easily re- cognised as nettle-rash, all anxiety may at once cease. It is generally connected with acidity of stomach and derangement of the bowels. This is to be cor- rected by exhibiting the rhubarb and magnesia mix- ture two or three times a day, in a dose suitable to the age of the child,—and to relieve the excessive itching and heat, a tepid bath should be resorted to at once, and daily so long as the eruption lasts, and from time to time the parts be gently but well rubbed with a handful of flour or fine starch powder. In four and twenty or eight and forty hours after the full operation of the medicine, the rash in most cases will have disappeared. Dandruff.—Scurf on the head,—dandriff, as it is called, but properly dandruff,—is well known in the nursery, and frequently very troublesome. It is characterized by the production of minute white scales in great abundance, attended sometimes with heat and considerable itching and tingling; the scales being thrown off as soon as formed, and repro- duced with great rapidity. It is most common in children possessing a delicate skin and fair com- RING-WORM. 317 plexion. If properly attended to when first per- ceived, it is not difficult of removal. Close atten- tion to cleanliness;—thoroughly washing the head night and morning with distilled vinegar,—a care- fully regulated diet, and a little aperient medicine two or three times repeated, will frequently be suf- ficient for its cure. And if from time to time there should be a disposition to its return, the same means will generally suffice, but the parent should then see whether there is not some neglect in the general management of the child's health, particularly in reference to the regulation of the bowels and diet, and cleanliness of the head. In severe cases the hair must be removed and medical advice sought. Another method of getting rid of dandruff in its mild form is adopted by some, and it is a very good one. An egg is beaten up,—well rubbed into the hair and at its roots,—and afterwards thoroughly washed out with plenty of tepid water;—the head is then dried, and a little almond oil applied. Ape- rient medicine and careful diet is to be also observed. Ring-worm.—The scalp may be the seat of various diseased actions, and they are only alluded to here for the purpose of cautioning parents not to rely on their own powers of discrimination and attempt a cure by domestic remedies, or, worse still, by a re- sort to quack medicines, lest they aggravate the complaint and prevent the vigorous growth of the hair for the future by injuring the bulbs from which 27* 318 DISEASES OF CHILDREN. it springs. It requires a practised eye to detect those scalp affections which require precautions against contagion, and to distinguish those kinds which local applications are likely to remove, and then to select such as are both effectual and safe. Some popular remedies are harmless enough, and only produce disappointment. Some, as tobacco water, are so dangerous that their employment in human diseases may be said to be discontinued. In many of these scalp diseases more may be done by a treatment addressed to the constitutional state of the patient than by any applications whatever. Patient adherence to medical counsels, and very chiefly to that of extreme cleanliness, will be re- warded. It is a good general rule, to keep sepa- rate hair-brushes, combs, towels, and caps for the child who is the subject of any suspicious eruption about the head. SECT. IX.—INFLAMMATION AND ABSCESS IN THE EAR. Children are very subject to this, either with or without eruptions about the head and face. It is a most painful affection, and yet often remains undiscovered for some time. The child becomes fretful, extremely restless, looks distressed, is con- stantly crying in a mournful and most piteous tone, with occasional fits of a more violent character. It leans its head on one side, or moves it from side to side. It will sleep for a few hours, and then awake ABSCESS IN THE EAR. 319 crying most violently, until, worn out, it again sinks off exhausted, to awake again in the same state. If the tube of the ear is pressed upon, the child will shrink and shriek with the pain, leaving no doubt of the nature of the case, if the previous indications left the matter at all uncertain. It is important that these symptoms should be remembered, as indica- tive of this complaint. The child may be saved from a great deal of unnecessary suffering, and often consequences of a serious character, such as deafness, may be prevented, if proper measures are resorted to. A small blister behind the ear kept on for four or five hours,—fomentations over the ear and in front of it, with a few drops of laudanum on lint pressed gently into the tube itself, repeated from time to time,—acting briskly on the bowels with a mild purgative,—will, if promptly employed, generally arrest the inflammation, prevent the formation of matter, and entirely remove the complaint. If, however, time has been lost from the nature of the case not having been understood, and then only temporizing applications resorted to, the inflamma- tion will go on and abscess form. Indeed, this will sometimes occur where every thing has been done to prevent it. In this case no decided relief to suf- fering will be experienced until the abscess burst and matter is discharged, when all pain will suddenly subside, and the child be perfectly easy. The ear must now be carefully and with very gentle efforts syringed out three or four times a day 320 DISEASES OF CHILDREN. with tepid milk and water. This will be very grate- ful to the child, and the youngest will generally allow it to be done with the greatest quietness. It is of much importance to keep the ear-tube as free from the discharge as possible, and to encourage the healing of the abscess; which may be further pro- moted, after a day or two, by substituting for milk and water an infusion of cinchona bark (one ounce of bark, upon which pour a pint of boiling water, and macerate for six hours in a vessel lightly co- vered, and strain.) If the discharge should continue after a few days, and become offensive in character, an extension of the disease is to be feared, and pos- sibly deafness. Throughout the progress of the case medical aid will be sought by those who are able to obtain it; and, at this juncture, those who have it not, ought most certainly to seek it. SECT. X.—DEFORMITIES. Deformed Feet.—Almost the first question which the mother asks after delivery is whether the infant is perfect, and great is the distress if any deformity is found to exist. It cannot, therefore, be too extensively known that one of the most com- mon forms in which deformity presents itself at birth, that of the feet, is not incurable. Modern science has proved, that even in the worst cases, much may be effected by art; whilst in the milder cases a cure so nearly perfect may be obtained as to DEFORMITIES. 321 give the limb its ordinary symmetry, arid almost natural usefulness. The curative means, however, must be employed early in infancy, and, if effi- ciently carried out, will prevent the necessity for the employment of those more severe measures which, at an after period, are not unfrequently de- manded. The remote cause of these deformities has been referred to an original defect in the nerves supply- ing the limb, in consequence of which there is a want of balance in the development and action of the antagonist muscles. The immediate cause was formerly supposed to be deficiency and alteration of the ankle bones, whereas it consists in this relative disproportion of muscular action, which holds the foot so constantly in one attitude that it becomes its permanent position. Deformity of the Chest.—It may be useful to make a remark or two in reference to a deformity of the chest which I believe is sometimes uninten- tionally much aggravated by those who have the charge of children so affected. It is true that this complaint is not often met with in the children of the wealthy and higher classes, unless indeed one or both parents are persons of enfeebled health; but among the poor it is not unfrequent. It consists in both sides of the chest being much flattened or de- pressed, while the front of the chest and the spine are correspondingly prominent and thrown out. It oc- 322 DISEASES OF CHILDREN. curs only in the weakly and delicate child; is some- times hardly evident at birth, but during, or even before the period of teething, becomes manifest enough. If the child be born with this affection, and the mother be a delicate and strumous woman, a healthy wet-nurse ought to be obtained, and the wet-nurse suckling in such a case should be continued for twelve or even eighteen months. If, however, this condition of the chest is not marked at birth, but rather observed to develop itself after a few months, if the parent is a healthy woman, I would not have her give up nursing; but in this, as in the-former case, more than usual vigilance must be shown in the general management of the child's health. Much may be done to prevent an increase of the mischief, and much for its entire removal. The chief point, however, to which I wish to draw the parent's notice, is the mode of handling such a child, for without care the deformity will be much increased. Ordinarily, in taking up a child, the palm of the hands press upon the sides of the chest directly under the arm-pits; now, if this is done to such a child, it will tend inevitably to in- crease the mischief; to avoid this, therefore, must be in the constant recollection of the nurse. On the other hand, much good will result from the frequent application for a moment or so of pressure on the front of the chest and spine; this should only be done, however, during expiration, so as not to in- bleeding from the nose. 323 terfere with the free dilatation of the walls of the chest which takes place during inspiration. To be useful, this suggestion must be steadily followed up day by day, and month after month. And as the child grows older, the same intention is still to be carried out by a regular and carefully regulated ex- ercise of the muscles of the arms and trunk of the body. It has been proposed, as the best mode of accomplishing this, to cause the child to raise weights by means of ropes and pulleys placed at a considerable height over its head, so that by taking hold of the rope by both hands raised above the head, and pulling it downwards, the muscles may be brought into action, and the walls of the chest thereby dilated. There will be no difficulty in ar- ranging such an apparatus in the nursery; and the weights must be increased as power in the child's arms increase. During infancy, warm or tepid salt- water bathing will be advisable,—the purest air,— and in fact the employment of every means that will tend to strengthen the frame. sect. xi.—bleeding from the nose. This is a very frequent occurrence in children, and occasionally very salutary, and may be left to work its own cure. If, however, it is at any time profuse, and attended by headache, consult your me- dical adviser, and in the meanwhile, in order to arrest the bleeding, place the child in the upright 324 diseases of children. posture, apply cold water to the head, or dash cold iced-water over the face, or apply ice itself in a cloth over the forehead and nose, and place a piece of cold metal (a large key for example) down the back,—give a draught of cold waterf—and you may even, if the bleeding still continue, compress the nostril between your fingers; but then this must be kept up for some time to do any good. A gentle aperient may also be given with advantage. SECT. XII.—CHILBLAINS. None are more tormented with chilblains than children; it is one of the nursery plagues, and if you can do any thing for their relief, thankful indeed will be the sufferer. The best way of preventing them, is to clothe the child's feet and legs (in cold weather) in worsted or angola stockings, and see that he has thick-soled shoes, or what is better, boots. Chilblains depend upon a languid circulation, and, therefore, particularly trouble the delicate and weak, and the strong too if the extremities are not properly clothed and due exercise taken. But the chilblains have come; then rub them morning and evening with laudanum, and after- wards rub the limb itself well with a dry and warm flannel to excite and encourage the circulation. Perhaps the chilblains have broken, and are very tender and inflamed, then put on a bread and wa- SCARLET FEVER. 325 ter poultice, and when the inflammation has sub- sided, dress them with resin or calamine cerate. SECT. XIII.—SCARLET FEVER. There are several varieties of this disease: it will be more perspicuous, however, for our purpose to speak of it under two forms,—mild scarlet fever, and scarlet fever with sore throat. But I fancy I hear a parent say, then what is scarlatina? Simply the Latin and scientific name for scarlet fever; and when you have supposed your child has not had the scarlet fever, but only scarlatina, you have been la- bouring under a mistake, for they are one and the same thing. This is a very absurd error, and every one ought to know that it is such; for the mystifi- cation which prevails among the public upon this point produces nothing but confusion, and sometimes a disregard of necessary precautions. In the mild form of this disease there is the rash with fever, with little or no affection of the throat. The first sympto?ns are those of fever; they precede the eruption. The degree of fever, however, is variable; for the symptoms are sometimes so mode- rate as scarcely to attract attention—slight and irregular shivering, nausea, perhaps vomiting, thirst, and heat of skin; whilst, at others, there is conside- rable constitutional disturbance,indicated bypungent heat of skin, flushing of the face, suffusion of the eyes, pain in the head, great anxiety and restlessness, 28 326 DISEASES OF CHILDREN. and occasionally slight delirium. These symptoms are followed on the second day (in the majority of instances) by the rash. This first appears in nume- rous 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 occa- sionally tinges the inside of the lips, cheeks, palate, throat, nostrils, and even the internal surface of the eye-lids. 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 neigh- bouring parts, at the flexure of the joints, and upon those parts of the body which are subjected to pres- sure. 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 inter- stices 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 efflo- rescence; but the tongue still remains morbidly red SCARLET FEVER. 327 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. In scarlet fever ivith sore throat, as the title implies, the fever and rash are accompanied with inflammation of the throat. The symptoms are more severe than in the mild form of the 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 ap- pear 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 ineffec- tual efforts made to expel it. If the inflammatory action be more severe, exudations of lymph will also 328 DISEASES OF CHILDREN. 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,assumes 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 headache, 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 more pun- gently 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. SCARLET FEVER. 329 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 symp- toms 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 direc- tions 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 distin- guish this disease from other acute eruptive disor- ders. The one to which it bears the greatest resem- blance is the measles; but from this it is readily dis- tinguished 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 at- tend on scarlet fever—^at least, in any high degree In measles, also, there is an absence of that restless- ness, anxiety, and depression of spirits, by which scarlet fever is peculiarly distinguished.—The rash* too, in measles, does not appear till two or three 28* * 330 DISEASES OF CHILDREN. 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, dif- fused 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-lu- nar 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, irre- spective 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 mild- est cases, the child must be kept in bed from the first accession of the fever. He must not be load- ed, 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 pa- tient. 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 hav y most de- SCARLET FEVER. 331 cided 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 practi- cable. However mild the symptoms of this disease may be at the commencement, a careful and vigilant watchfulness is necessary, lest inflammation of some internal organ suddenly arise (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 pungent- ly 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 abstract- ed, and the child refreshed; and this may again and again be resorted to, as the heat again returns. Dr. Bateman observes, that by this application alone, " the pulse has been diminished in frequency, the thirst has abated, the tongue has become moist, a general free perspiration has broken forth, the skin has become soft and cool, and the eyes have bright- ened; 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 332 DISEASES OF CHILDREN. return, and with it the distressing symptoms; but a repetition of the remedy is followed by the same beneficial effects as at first." 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 per- mitted it. Under these circumstances, the inhala- tion 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 me- dical 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. Oranges, grapes, or lemons sweetened with sugar, may also be allowed, particu- larly 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 SCARLET FEVER. 333 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. The discharges from the bowels should always be kept for the me- dical man's inspection, that he may be satisfied as to the effects of his prescriptions. Convalescence.—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 inflamma- tory 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 atten- tion must still be paid to the state of the bowels, and, indeed, to all the secretions and excretions. Even when scarlet fever has been of the mildest form, a parent cannot observe too much care and caution during the period of convalescence. One of the most common and serious of the after-disorders 334 DISEASES OF CHILDREN. of this fever is dropsy; a disease much more frequent, as far as my experience goes, after a mild than after a severe attack of scarlet fever. This, in all proba- bility, is owing to neglect at this period; for I have generally been able to trace the source of the dropsy ? in the cases which I have seen, to some accidental or heedless exposure of the child to a cold or damp atmosphere. 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, &?c.—The contagious character of this disease requires the separation of the invalid from the rest of the family, and when it is practicable, the other children should be removed from home. This measure is always advisable, whether the dis- ease is severe in its character or not; for if it become rife in a family, it will frequently affect the indivi- SCARLET FEVER. 335 duals composing it very differently. Some escape altogether; others have the mild form of the com- plaint; 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; so that the fact of the first case being mild, is no guarantee that those that follow will be so. Great caution must also be exercised, after the convalescence of the patient, that the other children are not brought into contact with him too soon: for infection may be thus produced, though several weeks may have elapsed from the period of the peeling off the skin. It is right also that it should be known that the contagion lurks about the apart- ment, and clings to the furniture and clothes of the invalid, for a very long time, it may be after great care has been taken to purify them. For this reason, during the illness all bed hangings, carpets, or fur- niture in the room that can be dispensed with, should; and the soiled linen, from time to time, as it is removed from the patient or his bed, should be immediately put into boiling water. It is always a necessary precaution after the illness, to have the bed upon which the patient has been lying taken to pieces, and the feathers baked; and the bed-room may be whitewashed, and even fresh papered with advantage. If there are cesspools connected with the water-closets, they must be emptied. When a child has recently had scarlet fever, the 336 DISEASES OF CHILDREN. parents ought to be very cautious that he is not sent back to school too soon. Thoughtlessly to do this would be unpardonable, and knowingly to run any risk of carrying infection amongst a large number of children a direct violation of what is right and just to others. If a child is threatened with this disease at school, he ought immediately to be re- moved to an airy lodging in the neighbourhood. It is impossible to calculate the amount of evil which this measure, acted upon promptly, may prevent. The period at which the disease shows itself, after the exposure of an individual to sources of con- tagion, 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 ex- posure and the manifestation of the disease. It is believed by many that belladonna exerts a preventive and protecting influence upon the body against the contagion of scarlet fever, or, if it should not prevent the disease, it will render it mild. This may or may not be so; but there can be no harm done in giving it, provided the dose ordinarily ex- hibited by those who have faith in its efficacy is not exceeded, and provided also that its employment does not lead to the neglect of other precautions. Dissolve three grains of the extract of belladonna in an ounce of distilled water, and give three dropsof this solution twice daily, to a child under twelve months old, and one drop more for every year above that age. measles. 337 In conclusion: this disease is a complaint of in- fancy and childhood, rather than of adult age; ge- nerally 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. XIV.--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 de- pends upon a specific contagion;—occurs most fre- quently 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, as is 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, how- ever, been delayed until the sixteenth. Description of the disease.—The child infected will be observed not to be as well as usual, less ac- tive, 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. Ilis voice will be hoarse; there will be frequent cough, headache, sneezing, running from the nose and eyes 29 338 DISEASES OF CHILDREN. —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 erup- tion will be first 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 semi-lunar 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 in- crease. 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, espe- cially 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 dis- appeared on the tenth day from the commencement MEASLES. 339 of the fever, or the sixth from its own first appear- ance. As the fading proceeds, the spots drop off in the form of little branny scales, which are some- times, from their minuteness, scarcely perceptible. They leave a slight discoloration 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, which characterize measles. Again, in measles, the eruption is more pointed, of a crim- son 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 headache 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 or- dinary and simple form, is a mild, and by no means dangerous, disease: it is sometimes, however, ac- 340 DISEASES OF CHILDREN. companied 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 re- quired at this time to ensure a careful attention to the medical directions, as also to those general points of management upon which the well-doing of her child much depends, of which the following are the most important:— Ventilation of the bed-room, 8,-c.—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 ex- posure to cold. To these points the parent's atten- tion 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 conco- mitant 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 accom- panying 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 MEASLES. 341 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 ac- count of the tenderness of the eyes; all noise ex- cluded, 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, mayT be given liberally; as barley-water, or thin gruel, &c. Sponging, fyc.—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 pa- tient; 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 mani- fests symptoms of cold in the head and fever, it 29* 342 DISEASES OF CHILDREN. should at once be a reason for carefulness on the part of the parent. The diet should be light, cool- ing, 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 unaccom- panied with danger, but that the mildest form may be speedily converted into the most dangerous. That is to say, a sudden change may take place in the symptoms, arising out of circumstances which could not have been foreseen, and therefore una- voidable; or may be produced by improper manage- ment 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 refer- ence to the first, if the child should complain at any period of the disease of severe headache, with piercing pain through the temples, and if this is ac- companied 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 close of the eruption, that is, from the seventh to the ninth day, the breathing should again become hurried, (this symptom is very ge- nerally 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, &c, (all MEASLES. 343 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 re- ference to it, to observe, that it sometimes happens that the rash comes out imperfectly, or, having ap- peared 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 spirits, 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 ge- nerally the disappearance of the rash will be depen- dent upon the existence of some internal inflamma- tion, 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 eircumstances the child should be instantly, and without hesita- tion, put into the warm bath. Measles are frequently followed by cough, and deranged bowels; and there is always great suscep- tibility 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. 344 DISEASES OF CHILDREN. In conclusion, it may be remarked, that very frequently during infancy and childhood, and par- ticularly during the period of teething, eruptions very similar in appearance to this disease occur; unless, however, they are accompanied by the spe- cific fever, and run the regular course, they may at once be decided upon as not being the measles. SECT. XV.—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 occasion- ally 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. In natural smallpox, the infection having been received into the system of a child that has not been vaccinated, about fourteen days 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 SMALL-POX. 345 or in the stomach; with sickness, giddiness, or headache; as also great drowsiness. And if an in- fant 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 frequent- ly 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 opake; and they will consequently appear white, or of a light straw colour. Each pimple or pocM 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, gra- dually swell; and the eye-lids are often so much 346 DISEASES OF CHILDREN. distended as to close the eyes and produce tempo- rary blindness. There will always at this time be some degree of fever present, and its amount will vary with the circumstances of each individual case. The skin, too, will be very tender, so much so some- times as greatly to harass and distress the child. On the eleventh day the swelling and inflammation of the skin of the body and face subside; the pim- ples 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 course 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 distur- bance, 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. In small-pox in the vaccinated, the disease, in almost every instance, is much altered or modified SMALL-POX. 347 in its character. Indeed in children, in whom of course vaccination has been but 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 pre- cursory rigor, &c.; 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 modi- fied by vaccination is as follows. The first stage is the same usually as in the natural form of the dis- ease. As soon, however, as the eruption appears, the modifying power of the vaccination becomes ap- parent. 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 con- trolling power of the vaccination will immediately show itself after its appearance—first, in the com- plete 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, 348 DISEASES OF CHILDREN. and the remainder will by the fifth day be filled with the opake yellowish fluid, then dry up, be- coming 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 men- tion that small-pox has occurred even to the vacci- nated 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 enter- tained, from the abundance of facts now before the world, that such modification is the law of the ani- mal economy, and that the regular or natural pro- gress is the exception. Maternal Management.—The grand princi- ple 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 par- ticular points to accomplish this purpose, they uni- formly make this principle their chief aim and ob- ject. 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 SMALL-POX. 349 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 in- stances 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 gene- rally about the third or fourth day he will gladly re- sort 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 venti- lated; fresh air frequently admitted; and if the sea- son of the y~ear permit, and there is no dampness of atmosphere, a window should be constantly open during the day: it is also desirable to keep the cham- ber darkened in all cases, as there is always a tenden- cy to inflammation of the eyes. If these directions are not regarded, and 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 erro- 30 350 DISEASES OF CHILDREN. neons notion of bringing out the erruption,) the mild- est 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 en- dangering life. Regimen.—This must be most sparing. Cold water may be given when asked for. 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 un- til the disease is going off must any change be made in the diet. This period having arrived, mildly nu- tritious 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 careful- ly 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, re- quiring no treatment. In the more aggravated cases however, in which the pustules are very numerous, running one into the other, and, bursting, discharge SMALL-POX. 351 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 nume- rous here than elsewhere. It is a popular error to suppose that by wearing masks of fine linen or cam- bric illined with particular ointments, these scars or pits may be prevented: it is impossible to pre- vent 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 continu- ance. This will contribute very much to the com- fort 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 352 DISEASES OF CHILDREN. 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, 8?c.—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 conjunc- tion 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 ac- complished by steeping in the solution pieces of linen, and hanging them about the rooms, as also frequently and freely sprinkling the walls them- selves; and as soon as the invalid is removed, the chamber should be white-washed, the various arti- cles 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. And again, as the contagious property of small-pox CHICKEN-POX. 353 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 care- ful that the invalid is not too soon brought in con- tact with the healthy members of the family. An observance of these precautions is imperatively de- manded; they not only protect the healthy, but aid the infected. SECT. XVI.--CHICKEN POX. This disorder is almost confined to infancy and early childhood. The eruption is seldom preceded by any constitutional symptoms, but commences on the shoulders, neck, and breast; affecting almost always the scalp, but not the face, which in small- pox, it will be remembered, never escapes. It is composed from the very first of perfectly transpa- rent vesicles surrounded by a very slight degree of superficial redness; and when very copious, to em- ploy Dr. Gregory's characteristic simile, "the body has the appearance of having been exposed to a shower of boiling water, each drop of which had occasioned a minute blister." Crops of vesicles ap- pear in succession for two or three days; and while new ones are forming, the first are beginning to shrivel. The fluid in the vesicles after the second or third day becomes slightly opake, and the vesi- cles therefore pearl-like. They form small scabs or scales, drying very quickly and as quickly falling 30* 354 DISEASES OF CHILDREN. off, leaving here and there superficial marks, which however are rarely permanent in after life. The whole course of the disease seldom exceeds a week, and during its progress there is no constitutional disturbance of any consequence: the tongue con- tinues clean, the pulse of natural frequency, the ap- petite good, and the rest undisturbed. The maternal management will be the same as in the mildest case of modified small-pox. It is only necessary to add one or two points, which have been clearly established, and which it will be well for parents to bear in mind. Chicken- pox is a contagious disease, readily communicated from one child to another. It occurs equally in those who have, and those who have not been vaccinated. It is a distinct disease from small-pox, springing from a specific poison, and occurs but once in the child's life. It affords no protection against small- pox, while, on the other hand, small-pox affords no protection against it. It will therefore be as much the wisdom as the duty of the parent, whenever any eruption occurs in the nursery which is at all equi- vocal in its character, to use the same precautionary measures for preventing the extension of the disease, as if she was sure it was modified small-pox itself. SECT. XVII.--HOOPING-COUGH. My chief inducement to notice this disorder arises out of the well-known fact, that there is no complaint HOOPING-COUGH. 355 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 circum- stance 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 danger- ous 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 misma- naged, 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 356 DISEASES OF CHILDREN. 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, and full of tears. The child, with a forewarning of the attack, which it dreads, falls on his knees, or clings closely to any thing near him. The paroxysm ter- minates 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, perfect health is restored. Sometimes, however, particularly in the autumn, and at other seasons on the occurrence of easterly winds, the HOOPING-COUGH. 357 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 apparent perfect 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 sel- dom 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 preva- lent, 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 358 DISEASES OF CHILDREN. 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 chil- dren 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 mater- nal management consists in assisting, by watchful- ness and care, the fulfilment of this design. In these slighter cases little more is required of the mother during the first 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 di- rected. 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, but at first it is injurious, and at- tended 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. HOOPING-COUGH. 359 Purgatives and other medicines will be required, and ordered by the medical attendant; the chief at- tention, however, of the parent must be directed to any change she may observe in the symptoms, breathing, &c; she must be all on the alert to notice the first sign of local inflammation. Of this, how- ever, 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 gene- rally runs its course without any untoward event, and the child recovers perfectly. Sometimes, how- ever, although the patient is quite well, and the dis- ease 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 cer- tainly and rapidly remedial. Crying, mental irrita- tion 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 360 DISEASES OF CHILDREN. soon as the fit is threatened. These hints the mo- ther should bear in mind. So much for the simple form of the disease, and that in which it most fre- quently 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 insidi- ously come on, and advance to an irremediable de- gree, 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 com- mencement or first symptoms of those diseases which so frequently occur at this time, and the successful treatment of which will mainly depend upon the 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 superadded to the hooping-cough. The pro- gress of hooping-cough, then, must be closely at- tended 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 HOOPING-COUGH. 361 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 ap- proach of mischief, when she observes the fits of coughing become more frequent and more distress- ing 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 abun- dant, 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 inflam- mation, 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, the brain is more liable to suffer than any other organ, and convulsions and water on the head to occur, particularly if the latter disease prevails in the fa- mily. Whenever the paroxysm of cough is in- creased in violence, the characteristic hoop disap- pearing, the face becoming very livid; the hands clenched, and the thumbs drawn into the palms; the head hot, and marked fits of drowsiness and languor; 31 362 DISEASES OF CHILDREN. and the child, during sleep, screaming out, or grind- ing its teeth—mischief in the head ought to be feared. Of this treatment we have nothing to say here, except that the gums must be carefully ex- amined, and scarified if they require it, and the tem- perature 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 hooping-cough 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 com- plicated forms of the disease they are inadmissible. The indiscriminate use of purgatives, also, a parent should avoid. Bowel affections are not an infre- quent attendant upon hooping-cough, and always aggravate the primary disorder. Of external ap- plications 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 un- necessary suffering to the patient, and are sometimes productive of dangerous and even fatal sores. croup. 363 SECT. XVIII.—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 ap- proach, 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, accom- panied 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 im- portant 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 de- serves, 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: this has been before referred 364 DISEASES OF CHILDREN. to, but it will bear repetition. He says: "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 dis- ease 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 —'0, 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 re- maining 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 re- marked: 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 sono- rous inspiration, not unlike the kink in hooping- cough—a crowing noise, not so shrill, but similar croup. 365 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 re- markable as the disease advances," &c, &c. It is unnecessary for me to add to the foregoing picture. Maternal Management.—Having early ob- tained 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. But I can suppose this book in the hands of a mother, at a distance from medical aid, whose child has had an attack of croup previously, and in whom she again recognises its approach: is she to allow an hour or two to elapse whilst the medical man is sent for, without resorting to any measures for the child's relief? I should say certainly not, and that 31* 366 DISEASES OF CHILDREN. there are three remedies which she may at once adopt, without the fear of doing harm, and with the almost certain expectation of giving decided relief: an emetic—a warm-bath—and the application of leeches. First: dissolve a grain of tartarized antimony in an ounce of boiling water, and when cold, give a tea-spoonful to a child in its first year, and an addi- tional tea-spoonful for every additional year, and repeat the dose every quarter of an hour until vomit- ing is produced. Second: immediately after vomiting is excited, use the warm-bath at a temperature of 98° Fahren- heit, and let the child remain in from a quarter of an hour to twenty minutes. Have a hot sheet ready, with which quickly dry the child's body, and then put him into bed again. The relief to the distress- ing symptoms from this measure alone is sometimes very great indeed. Third: if the child be not a delicate and weakly one, now apply leeches. The number must again depend upon the age: two to an infant in its first year, and an additional leech may be employed for every additional year, so that six would be put on a child five years old. They must not be applied to the throat itself, because upon this part the child could not bear the amount of pressure that might be necessary to put a stop to the bleeding when the leeches were taken off: but it must be immediately on the upper part of the sternum, that is, the bone croup. 367 at the lowest part of the throat. In putting them on, as little of the child's person should be exposed to the surrounding atmosphere as possible, lest fresh cold should given. One caution should be added here. Blisters, but more frequently mustard poultices, are applied in this disease, by parents in their alarm, and in the expectation that they will afford relief. In the on- set they are decidedly injurious,— and they are often unadvisable even at a later period of the com- plaint. Its Prevention.—Croup seldom occurs during the first year of infantile life; most frequently in the second year, and between this and puberty (the fourteenth year,) its attacks are occasionally to be apprehended. When it has once attacked a child, it 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 pa- rent should be acquainted with the means of pre- vention. They consist 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; for croup is most pre- valent 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 in a low, damp situation, or near the sea or any large 368 DISEASES OF CHILDREN. body of water, he should, if possible, be removed to a healthier spot, for croup appears to be almost en- demic in such places. Five times, in its most se- vere form, have I been called to treat this disease in children of the same family, who live in the im- mediate neighbourhood of London, but inhabiting a house in a low marshy spot, and near a large body of water; and when I have met this complaint, it has ge- nerally been in similar places; seldom in the city it- self. Dr. Alison, however, notices a curious circum- stance, and which it may be useful to remember: he says, " That it seems to be often produced by the child's sitting in a room newly washed; and that he has noticed its frequent occurrence on a Saturday night, the only day in the week on which it is cus- tomary for the lower orders of Edinburgh to wash their houses." This is a valuable hint, more par- ticularly where there is a predisposition to this dis- ease in a family. Then the child, every morning upon rising, should be sponged all over, or have the shower-bath; the latter is best if it can be borne; — in either case the water must be cold and have bay- salt in it; and considerable friction with a hard or coarse cloth should be made in drying the person. 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. The state of the bowels must be WATER IN THE HEAD. 369 carefully watched, and immediate recourse had to medicine, upon the appearance of catarrhal or croupal symptoms. It is of course particularly necessary to enforce these precautions immediately after a recovery from an attack, for there is a great tendency to re- lapse. If the attack takes place during the winter or spring months, the invalid must be kept, until milder weather, in the house, and in apartments 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. Croup is not contagious; although, like sore throat, and for the same reasons, it is found sometimes ex- isting at the same time, or in quick succession, in more than one child of the same family. Thus two twin children of Dr. Gregory's of Edinburgh were seized with croup on the same night. They had been walking in the evening on the sea-shore during a cold wind. SECT. XIX.--WATER IN THE HEAD. Water in the head is a formidable disease, and not unfrequent in its occurrence. It is often destruc- tive 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 notwith- standing its frequency and fearful character, a mo- 370 DISEASES OF CHILDREN. ther may do much to overcome a constitutional pre- disposition to this disease, and thus prevent its ap- pearance; as also she may assist greatly in promoting its cure, when it does occur. Hence it is most im- portant that a mother should be acquainted with the measures of prevention; and also, when it does mani- fest 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 ro- bust constitution, she must obtain a wet-nurse pos- sessing 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 care- fully selected; it must be appropriate to the ad- vancing age of the child; nutritious and unirritating. WATER IN THE HEAD. 371 Good air and daily exercise, and the bath or spong- ing, 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 sys- tem, and thus induce a vigorous and healthy consti- tution, and to which reference has been so fully made in the second 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 appropri- ate 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 dis- order 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 im- mediately 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 372 DISEASES OF CHILDREN. 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 derange- ment 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, ex- cept 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 pa- rent 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 con- tinue throughout the whole period of dentition. Great caution should always be exercised in refer- ence to these eruptions in all children; and when WATER IN THE HEAD. 373 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 trouble- some. The sudden healing of these cutaneous affec- tions 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 situ- ation 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 de- rived 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 con- sideration, an issue or seton, in the arm or neck, has sometimes been made, and had a remarkable influ- ence in warding off this affection. Dr. Cheyne re- fers 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 in- fancy 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 32 374 DISEASES OF CHILDREN. 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 care- fully avoided, and particularly the too early or ex- cessive exercise of the intellectual faculties. If the child be endowed with a precocious intellect, the parent must restrain rather than encourage its exer- cise. 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 im- portance. 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 irremedial 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 water in the head. 375 not always commence in the same way, sometimes with fevers, &c.,) still it most frequently occurs pre- ceded by certain striking and well-marked symp- toms; 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 6leep 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 hand up to it; half-closing the eyelids, and frequent vo- miting. 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 su- perintendence is more necessary in this than almost any other disease; and it is highly desirable, there- fore, 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 re- medies, 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. 376 DISEASES OF CHILDREN. The temperature of the room should be kept rather cool than warm, and the bed-clothes only sufficient to preserve the natural heat of 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 care- fully avoided: this is particularly necessary where the child is naturally of a quick and sensitive dispo- sition. All the excretions must be put aside for the in- spection 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 conva- lescence great carefulness must be paid to the amount of nourishment allowed, lest the disease be re- kindled : strict compliance, therefore, to medical di- rections must be given. A very useful and indeed powerful remedy pre- scribed 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 em- WATER IN THE HEAD. 377 ployed, they require frequent renewal, or they be- come dry, hot, and more injurious than useful; and whichever is used, it must be kept in constant con- tact with the fore-head, 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 expres- sion, "they will not torment the child with medi- cine 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 re- medies prescribed, even up to the last, hours of the child's existence. 32* 37S DISEASES OF CHILDREN. SECT. XX.--CONVULSIONS. At no period of life are convulsions so liable to take place as in infancy and childhood. The ner- vous system of the child is peculiarly sensitive, and the sources of its derangement are numerous at this period. It is hardly necessary to allude to those causes which most usually excite convulsions, except by way of warning. Errors in diet are by far the most common source of convulsive affections, and it has been justly remarked, that so long as nurses and mothers believe that children thrive in proportion to the quantity they eat, so long will convulsive diseases be frequent and severe. If the quantity and quality of the food is but carefully regarded, there will be no fear of this affection from this source. During teething, convulsions are perhaps more frequent than at any other period; not that they so commonly arise from the irritation caused by the cutting of a tooth as is generally thought, for it is more often the result, even at this time, of irrita- tion of bowels from some error in diet. Eruptions about the head, which have been dis- charging, being suddenly suppressed—falls on the head—violent mental emotions on the part of the nurse, affecting her milk, and in this way the child; —these, and a variety of other causes, will occasion this formidable affection. Most of these may in a CONVULSIONS. 379 great measure be avoided, if the child be properly managed, and ought not therefore ever to occur in a well-regulated nursery; some, however, are un- avoidable, and the question comes, what course is the mother to take at the moment of the occurrence of a fit? Instantly put the child up to the hips in a warm- bath, and apply cold water to the head; the child's head should be raised, and the water poured on it, in a gentle and continuous stream, out of a jug, from a small height. If it is the period of teething, exa- mine the mouth, and if the gums are swollen and inflamed, having the irritated appearance of teething, the mother will be fully justified in lancing the gums, provided medical aid is not near. If you have reason to believe the attack is induced by an overloaded stomach, and the food has not been long taken, administer an emetic of ipecacuanha, and then a purgative enema, and none will answer better than a tea-spoonful of the spirits of turpentine in half a tumbler of warm gruel. The latter application may be beneficially employed in all cases, from whatever cause the convulsions may arise. These means will ordinarily afford relief, and by this time the medical attendant will be present to advise what further steps ought to be taken. 380 ON THE PREVENTION OF CHAPTER XV. ON THE PREVENTION OF SCROFULA AND CONSUMPTION. On some subjects connected with health a degree of ignorance prevails that cannot be too much lamented, for the prevalence of correct notions would be followed by the richest harvest of good. Scrofula is, perhaps, more than any other evil to which humanity is liable, beset with dangerous misconceptions. It engages a great deal of atten- tion, and its cure, when it forces itself into notice, is diligently attempted. But its prevention would be far more certain than its cure ever can be, were the popular mind fully informed of its real nature. Then, we should not only see the development of this malady in individuals arrested, but the diffusion of the scrofulous constitution itself in a great mea- sure prevented. The term scrofula is popularly applied and limited to enlargements of the glands of the neck, formerly designated " the King's Evil." Now it ought to be known that this enlargement is the result of a peculiar condition of the system, which may manifest itself in this or any other part, for none is exempt from the liability. If in the lungs, SCROFULA AND CONSUMPTION. 381 it constitutes consumption or scrofula of the lungs; —if in the bowels, mesenteric disease;—if in the joints, white-swelling, and so on. It may safely be defined as a disease of debility, which besets the functions intended to maintain the whole frame in constant repair, the result being the presence in the blood of a material which does not belong to the natural and healthy condition of the frame, which becomes deposited in one part or other, obstructing its functions, destroying its structure, and leading to processes which may result in the removal of these diseased deposits, but more frequently destroys life. Thus,—to take the examples to which we have just referred,—if this morbid matter is deposited in the glands of the neck, they become hard and enlarged, and may remain so for years; but if in- flammation is excited, and there is pain, heat, and redness, what was hard becomes soft, the skin covering it gets thin and breaks, matter is dis- charged, and with it perhaps a hard concretion of scrofulous deposit; after which all swelling, heat, and pain will subside, and the parts return to their former state in a measure uninjured, an unsightly scar being the only mark of past disease. In this case, then, the disease is deposited and removed without destroying life, because the part in which it was located, and from which it had to be removed, was not a vital organ. Let the same deposit be formed in the lungs, 382 ON THE PREVENTION OF and follow the same course; the consequences will be far different. The portion of the lung occupied by the disease will inevitably be destroyed. Al- though the tuberculous matter may be expectorated, the damage to the lung cannot be repaired. If one portion passes through the process safely, the chances are that the same deposit has taken place in other parts of the organ, which will have to go through the same course, till death arise from the destruction of the organs of breathing. As a last example, take another form of scrofula, very common and very fatal among children, where this deposit prevents the nourishment of the body. I refer to mesenteric disease. In close connexion with the bowels there are a large number of little glands called mesenteric, through which the nutri- ment is conveyed from the alimentary canal to the large blood vessels. If this diseased deposit invade these glands, and they become charged with it, the nutriment cannot pass through them, and although the child's appetite become ravenous, and the amount of food taken be ever so large, it cannot pass into the blood, and the child dies, starved. The popular notion, then, that this disease is chiefly confined to the neck, is not correct. It may, as I have endeavoured in a familiar manner to ex- plain, pervade any part of the system, producing consequences more or less serious according to the situation and organs involved. The system obtains it in one of two ways: it is SCROFULA AND CONSUMPTION. 383 either inherited, or produced after birth. In the vast majority of individuals it has been transmitted from parents to offspring. This is its chief source. Marriage at too early an age, before the system is developed,—or where there is great disparity of years,—or of persons who are too nearly allied in blood,—and more especially of those who are con- scious that scrofula in any of its shapes exists in their families, and perhaps in their own frame,— must be avoided. It will be difficult to get people to recognise and conform to this cautious and un- selfish policy, opposed as it often will be to the strongest predilections. But much is to be hoped from the spread of information. When the public are fully aware of the misery and suffering which want of foresight and self-control must entail on their offspring, this liability will be taken into the account of prudence, as much as that of insanity al- ready is. It may be originated in the healthy offspring of healthy parents by the influence of unfavourable cir- cumstances; as, insufficient nutriment, habitual ex- posure to wet and cold,—the privation of pure air and light,—want of natural exercise,—and mental disquietude. The predisposition may exist in various degrees of force. In the same family its features may be more or less prominent: in one child scarcely mani- fest,—in another strongly marked. If it be pos- sessed by either parent, the children must be consi- 384 ON THE PREVENTION OF dered as liable to be partakers of the same predis- position; and where both parents are strumous the children will in all probability be doubly so. The predisposition, as noticed in consumption, will now and then seem as it were to pass over one generation altogether, and visit the next with terrible havoc. Various causes tend doubtless to give rise to these different results. Much will depend upon the state of both parents' health at the time of the conception of the child,—much upon the management of the mother's own health during the pregnancy,—and, above all, upon the physical and moral management of the child after its birth, and the circumstances by which it is surrounded. The mode of prevention is certainly the most im- portant part of this inquiry, and seems to me pecu- liarly appropriate in a work addressed to mothers. The fact is, it is to the mother's judicious care and watchful perseverance through the whole of child- hood and youth that we must chiefly look for a suc- cessful issue to any means that may be suggested to ward off this destructive disease. Most happily, if we cannot eradicate the tendency, we do possess the means of so invigorating and amending the consti- tution, as to justify the expectation of a freedom from the peculiar disorders in which it is prone to manifest itself. And it assuredly becomes all pa- rents to obtain clear notions upon this matter. If the future happiness and domestic welfare of families are alone considered, the inquiry is a deeply im- SCROFULA AND CONSUMPTION. 385 portant one; but when it is remembered that for the most part this sad condition of health is the parent's gift, the obligation devolving upon the latter, in as far as it lies in their power to counteract its baneful effects, must appear in a strong and painfully con- vincing light. Not that in the system of manage- ment to be adopted there is any wide difference from that which in the first part of this work has been proposed for all children. For the most part it is nearly the same. But in carrying out, it de- mands a more rigid and scrupulous attention to its details, conjoined with a careful protection of the child from those sources of injury which upon other constitutions might fall harmlessly. It embraces attention to diet, clothing, cleanliness, and bathing, the regulations of the stomach and bowels,—and where it is practicable, to climate and residence, and also to education. Of the food. If the infant inherit the strumous predisposition from the father only, the mother be- ing entirely free and of sound health, it may be nursed by her;—but if the mother is strumous, wet- nurse suckling must be resorted to. Artificial feed- ing is quite out of the question; it alone would be sufficient to develop the disease, as such a child would be imperfectly nourished; this is a fruitful source of scrofula in England. Great care and cau- tion must be exercised in selecting the wet-nurse; she must be of sound and vigorous health; and the choice should always be left to the medical attend- 33 386 ON THE PREVENTION OF ant The child should be nursed until it is twelve or fifteen months old, by which time it will have passed through some of the dangers at least inci- dental to the period of teething. And for the last six months of this time, it will be advisable to have a fresh wet-nurse (in most cases) to secure the per- fect nourishment of the system. If artificial food is given at all at this time, it must be of the lightest quality, and form but a small proportion of the nu- triment. When the child has got teeth to masticate solid animal food, it must be commenced with caution. At first small in quantity, of the lightest quality, and only on alternate days. Its effects must be watched. If not found to heat and flush the cheeks, and the secretions of the bowels continue healthy and re- gular, and the child grows and looks well—these are sure indications that the new diet agrees with him. For the future, the food should always be nourishing, but unstimulating. Of the clothing.—The regulations given at page 133, must be strictly followed out; great care being observed that it is suited to the season of the year, and amply sufficient to protect the child from every sensation of cold or chill; at the same time light in quality, so as not to overheat and oppress. The neck, arms, and legs must be covered. Their ex- posure is a frequent source of acute disease, and will invariably be found in a scrofulous child to cause the glandular enlargements so much dreaded. Flan- SCROFULA AND CONSUMPTION. 387 tiel should always be worn next the skin; of thinner texture in summer, and always taken off at night. The inspiration of a pure air is indispensable. One authority, indeed, considers vitiated atmosphere alone sufficient to generate scrofula. Whether this be so or not, there can be no doubt that impure air favours the development of it in those who already possess the predisposition. The full and particular directions for the ventilation of the apartments, al- ready given at p. 110, must in this case be particu- larly regarded as well as those upon light, the want of which would be equally injurious. If the child is born late in the year, he had better not be taken out of doors until the following spring, and if the apartments inhabited are well ventilated, the con- finement will not be injurious. For the future, when the weather will permit, the more the child is in the open air the better. The excellent effect of an out-door life in the country, in the warm sea- sons of the year, upon those who already suffer from glandular enlargements, has often been noticed. If practicable, the exercise of riding on a donkey or pony should be taken daily; this will be particu- larly serviceable where there is too great delicacy to take sufficient exercise on foot;—for exercise should at all times be moderate, and stop short of fatigue. Early hours must be observed, and a care- ful avoidance of vicious and exhausting indulgences. A wisely ordered moral oversight is of infinite im- portance. 388 ON THE PREVENTION OF Such constitutions are peculiarly susceptible to cold and damp. The moist, cold, and variable cli- mate of this country is particularly favourable to its development. Every thing, therefore, should be done to fortify and strengthen the system, and di- minish the liability to the impression of cold. Bath- ing, properly conducted, will aid us greatly in this matter. Cleanliness is imperative, but more than this is required. The infant at first should be washed in warm water in the morning, and a bath, of a warmth grateful to the child's feelings, should be used every night. After a few weeks, and by degrees, the temperature of the water with which the child is sponged in the morning should be low- ered, until it can be borne cold. As he grows older, the cold salt-water (artificial or otherwise) plunge- bath may be employed in summer, or the showrer- bath, if the system is able to bear the shock,—or what is better still, if the child resides on the coast, he may bathe during the summer months.* The situation of a residence is of great moment, and frequently a matter of much practical difficulty. A few months spent in a damp locality by a child predisposed to scrofula is quite sufficient to develop it in one or other of its forms. Again and again have I witnessed the death of one or more members of a family clearly traceable to the removal to a re- sidence in a damp locality, developing disease, which I feel assured would have remained dormant, had * See the precautions.on sea-bathing, p. 177. SCROFULA AND CONSUMPTION. 389 such an unfortunate change of residence not been made; for, a drier climate being sought, similar dis- ease was arrested in other members of the same family. There is a village in the neighbourhood of London, surrounded by hills, itself situated in a low valley, a river making many windings through it, which in winter is always enveloped in a damp mist, in which I have witnessed the foregoing result more than once. If possible, then, avoid for a scrofulous child a dwelling built near water (particularly if stagnant,) or near marshes; or one immediately surrounded by or overhung by large trees, which interfere with the free circulation of the air, and cause a state of » constant humidity of the atmosphere, except in the driest weather. Sir James Clark, in his admirable work on Scrofula and Consumption, says: "It is not generally known how limited may be the range of a damp unhealthy atmosphere; a low situation surrounded by trees may be capable of inducing tuberculous disease in an infant, whereas a rising ground a hundred yards distant may afford a healthy site for his residence." If any derangement of the digestive functions arises, this must be brought under the notice of the medical attendant. In these children costiveness is apt to prevail; but it will be found generally to arise from a mismanaged diet, from over-feeding. The fact that defective nourishment will develop scrofula, sometimes leads into the opposite extreme, 33* 390 ON THE PREVENTION OF and the system as a consequence becomes loaded, the digestive organs deranged, and costiveness ensues. The due regulation of the bowels, there- fore, is of great consequence; and they should always be watched with great care. If purgative medicine at any time becomes necessary, it should be of the mildest kind, so as to expend as little strength as possible. Great caution will be necessary in the education. These children are generally precocious in intellect, which too often leads to an injudicious, and, as it too frequently proves, fatal mental discipline. The long confinement in a badly ventilated school-room, day after day, and the mental exhaustion which hard study induces, are fraught with peculiar danger to strumous children. Sir James Clark, in the work already quoted, remarks: "At no period of youth should education be pushed beyond its proper limits, or the mind be worked above its powers; the wel- fare of the pupil demands the observance of this rule on the part of the master as well as the parents, more especially when the child belongs to that class of strumous children whose intellects are preterna- turally acute. Unfortunately, however, these are generally the pupils selected by the master to do credit to his establishment; every means are taken to encourage the premature manifestation of mind, and to stimulate the child to renewed exertions; and thus health, and even life, is often sacrificed at a period of brilliant promise, when the hopes of SCROFULA AND CONSUMPTION. 391 friends are buoyed up by the fallacious expectation of a harvest which a more rational system of educa- tion might have realized." The evils arising from this erroneous system of education are more prevalent in female than in boys' schools; in the latter the mischief is in some measure counterbalanced by the natural activity of the boy, and the greater amount of open air exercise which he enjoys than the girl. To quote Sir J. C. again: he says: " The prevailing system of female education is indeed fraught with most pernicious consequences; at a period of life when the development of the physical constitution demands the most judicious management, young girls are sent to school in which no other object appears to claim consideration than the amount of mental improvement, or rather the variety of accomplishments with which they can be stored. At an early hour in the morning the pupil is set down at the piano or the drawing table, where she remains in a constrained position, and often in a cold room, till the whole frame, and more especially the lower extremities, become chilled: the brief relaxation during the short space allowed for meals and the formal walk, are insuffi- cient to restore the natural warmth of the system; and it often happens that girls are allowed to retire to their room at bed-time with their feet so chilled as frequently to prevent sleep for hours. . . . While school-boys have the advantage of a play-ground, or enjoy their recreation at pleasure in the open 392 ON THE PREVENTION OF fields, the unfortunate inmates of a female boarding- school are only permitted to walk along the foot- paths in pairs in stiff and monotonous formality, resembling, as Beddoes justly remarks, a funeral procession, and wanting nothing to funereal melan- choly but sables and the hearse. The consequence is, that the muscles of the upper extremities, and those which are chiefly concerned in the support of the trunk, are rarely called into active play; they do not acquire strength as the body increases in stature; they remain weak and unequal to the task of supporting the trunk in the erect posture. A curved state of the spine is generally the conse- quence; and this, by altering the position and form of the thorax, renders the respiratory movements imperfect; the capacity of the chest is diminished, and the lungs are consequently more liable to con- gestion, and the diseases which are its consequences. While the natural form of the body is thus destroyed, the derangement of the general health is manifested by the paleness of the countenance, the dry and coarse appearance of the skin, costive bowels, and cold extremities. In short, all the requisites for the production of struma may be found in a large proportion of female boarding-schools, where the system we have described is pursued." Every physician practising in a large city can most fully confirm these important statements; and although there are many exceptions to this system, still it is always desirable that the female children of a scro- SCROFULA AND CONSUMPTION. 393 fulous family should be educated at home, where a judicious mental as well as physical training can be more completely followed out. Such are the principal points comprehended in the management of the child of scrofulous consti- tution. Experience has fully proved its efficacy. Its more extensive employment would lead to an incalculable amount of benefit to mankind. Ter- rible as are the ravages of this malady, sweeping off as it sometimes does, and in the space of a few short years, every member of a large family, by that most destructive of all its developments, con- sumption,—it cannot be doubted that as just views of its nature become more widely propagated, and the means of prevention more generally adopted, its prevalence will be largely diminished, and this scourge be less familiar to us. The present state of science, however, seems to show that this happy result must be expected from prevention rather than cure. \ INDEX. Ablution or sponging, 69,120, 127, 180. Abstinence, its good effect in flatulence and griping; in the infant, 88,291. Accidents and diseases which may occur to the infant at birth or soon after, 245. --------of a subsequent period, 262. Acids, injurious to the teeth, 216. Air and exercise, 139, 145. -------------, its importance to the mother whilst a nurse, 46. -------------, its importance to the wet-nurse, 68. Ammon, Von, quoted, 49. Animal food, given too early, highly injurious, 85. ---------, in childhood, 93. ---------, its injurious effects upon the young and delicate child, 94. Anxiety of mind, its effects upon breast-milk, 47. Aperient biscuits, 159. --------enema, 160. --------liniment, 161. --------medicine, 154. Aqua fortis, 277. Arnott, Dr., quoted, 111. Arrow-root, how prepared for an infant, 84. Arsenic, antidote to, 277. Artificial feeding, causes rendering it necessary, 73. Artificial food, the milk of animals the best kind until the first teeth appear, 74. -----------, the manner of preparing it, 75, 76. -----------, the mode of giving it, 79. ------.------, the quantity, and frequency of giving it, 81. -----------, the posture of the infant when fed, 82. -----------, the proper kind after the first teeth have appeared, 87. -----------, the various kinds, when milk disagrees, 78. -----------, Hard's farinaceous food, how prepared, 83. --------•----, tops and bottoms, how prepared, 83. 396 INDEX. Artificial food, arrow-root, how prepared, 84. -----------, Densham's farinaceous food, how prepared, 88. -----------, sago, how made, 83. -----------? beef-tea, how made, 85. -----------, chicken-tea, how made, 85. -----------, mutton-tea, how made, 85. -----------, veal-tea, how made, 85. -----------, the kind most suitable under the different com- plaints to which infants are liable, 87. Ass's milk, how prepared, 75. ---------, best mode of supplying it, 75, 76. Asparagus for children, 97. Attendants upon children in health, 119; in sickness, 222. Atmosphere of the nursery, 21, 107, 139; of the bed-rooms, 110, 122, 330. ---------, a damp and humid state of, injurious, 140. ---------, a very cold condition of, dangerous, 122, 133. Barlow, Dr., quoted, 148. Bath, the cold-water plunge, 176. ----, the shower, 179. ----, the warm, 182. ----, rules for the use of the warm, 184. ----, foot, 186. Bathing and cleanliness during infancy and childhood, 125, 130. ------, sea, 177. Bed, the infant's, 122; the child's, 125. Bed-room, ventilation and temperature of, 107, 115, 122. Beef tea, how prepared for an infant, 85. Beer, 103. Bees, the stings of, how treated, 275. Bell, Mr., quoted, 163, 212, 214. Bleeding from the nose, 323. --------from leech-bites, how controlled, 169. -------from the navel, 258. --------from the navel-string, 256. -------from wounds, 268. Blisters, mode of applying and dressing, 171, 172. Boiling water, the swallowing of, 265. Bottle, the nursing, 78. Bowel, protrusion of, 299. Bowels, of their mismanagement immediately after birth, 155; condition of the stools when healthy, 155. ------, training of, 130. ------, confined, 88, 295. ------, relaxed, 87, 279. ------, flatulence and griping of, 88, 279. INDEX. 397 Bread and water poultice, how made, 173. Breasts of the infant, swelling of, 252. Breathing of the infant, how affected by disease, 237. Brocoli, for children, 97. Broken limbs, what to do, 269. Broths, how .made, 84, 85. Bruises, their management, 266. Bugs, the bites of, how treated, 277. Burns and scalds, their treatment, 263. Calomel, danger of, 162; injurious to the teeth, 216. Caps, the use of, for infants and children, 136, Carminative, Dalby's, its danger, 16a Carriage, "a good carriage," how best obtained, 149; and the sad results of the mode frequently adopted, 146. Carrots, as an article of diet for children, 97. Carrying of the infant, the mode of, 140. Castor oil, its use, 156. Castor oil biscuits, how made, 159. Cauliflower, for children, 97. Chest, deformity of, 321. Cheyne, Dr., quoted, 239, 368. Chicken-broth, how made, 85. Chicken-pox, 353. Chilblains, 324. Choice of a nurse-maid, importance of, 117, Choice of a wet nurse, rules for, 63. Clark, Sir James, quoted, 86, 108, 389. Cleanliness and bathing of children, 125. —-------its necessity in a nurse-maid, 119. ---------of importance to the wet nurse, 69. Cline, Mr., quoted, 205. Clothing, 133, 136. Clysters, what kind best for children, 160. -------, mode of applying, 160. Colds and coughs, 293. Cold and damp, children very susceptible of, 122,127, 133, 13!». 284. Colostrum, 35. Combe, Dr., quoted, 29. Consumption, 15, 380. Convulsions, 47, 92, 103, 204, 230, 37a Cooper, Sir A., quoted, 27. Cork-nipple teat, 80. Corrosive sublimate, 278. Corsets, 139. Costiveness, 88, 156, 295, 297. 34 398 INDEX. Cough as a sign of disease, 238. Coughs and colds, 293. Countenance, in health, 228. -----------, in disease, 228. Cow's milk, how prepared for the infant, 76. ----------, substitutes for, when it disagrees, 78,. Croup, 239, 363. Cry, (the,) of hunger, 235. ----of discomfort, 235. ----of pain, 236. ----of temper, 237. Cuts and wounds, how managed, 267. Dalby's Carminative, its dangerous effects, 166", Damp induces disease in the infant, 140. Dandling, 82,142. Dandruff, 318. Deformities, 245, 256, 320. Densham's farinaceous food, how prepared, 88. Dentition, easy; management of the infant, 198. --------, difficult; management of the infant, 200. Diarrhoea in the infant, 87, 289. Diet, of infancy, 25; of childhood, 90; general directions upon, 90; animal food, 93; vegetables, 96; sugar and salt, 98; fresh and dried fruits and sweetmeats, 100 ; water, wine, beer, and spirits, 103: for infants, under the different complaints to which they are liable, 87. ----proper for a nursing mother, 44. ----and regimen for a wet-nurse, 66. ----, unwholesome articles of, their bad effect upon the breast- milk, 45, 51. ----in illness, 223. Digestion, in the infant; time requisite for its performance, 38, 81. Discharge from the eyes of the infant, 255. Disease, the importance of its early detection, 226. ------, hints for its early detection, 227. Donne, Dr., quoted, 36, 41, 73. Dover's powder, 166. Draughts of air, 122. Dress, the infant's, 133, the child's, 137. Drying up the breast-milk, directly after delivery, 59. -----------------------, at the time of weaning, 61.. Early rising, its importance, 120, 124. Ear, foreign bodies getting into, 271. INDEX. 399 Ear, inflammation and abscess in, 318. Easterly winds, hazard of exposure to, 140. Eberle, Dr., quoted, 93, 101, 127, 140, 156. Enemas for children, 160. Eruptions, 125, 207, 372. Evacuations, 155,233. Ewe's milk, 74. Exercise and air, in infancy, 139; in childhood, 145. -------essential to a nursing woman, 46, 68. -------(horse,) its importance to delicate children, 145, 387. Eyes of the infant, discharge from, after birth, 255. Farr, Mr., quoted, 108. Fear, effects of, upon the breast-milk, 47. Feather-bed, 123. Feet, deformities of, 320. Fever, scarlet, 325. Fire-places, 113. Fish, as an article of food for children, 396. Flannel, 135, 138. Flatulence and griping in the infant, 88, 290. Fleas, bites of, 276. Food, for infants. See Artificial Feeding. ----for children. See Diet of Childhood. Food and regimen for wet-nurses, 66. ----, peculiarity of constitution in reference to, 105. Foot-bath, 186. Foreign bodies getting into the ear and nose, 271. Friar's balsam, 267. Friction of the skin, 128. Friends, their visits in the sick-room, 224. Fruits, fresh, 100. -----, dried, and sweetmeats, 101. Gestures of the infant in health and disease, 231. Gnats, bites of, how treated, 276. Goat's milk, 74. Godfrey's cordial, 166. Goulard water, antidote to, 278. Greens, as an article of diet for children, 97. Grief, its effects upon the breast-milk, 50. Griping of the bowels, 290. Gums of the infant in difficult dentition, the importance of lancing, 201. ----, mode of lancing, 202. 400 INDEX. Hardening the constitution of the child, 127,133. Hard's farinaceous food, how prepared, 83. Hare-lip, how the infant is to be nourished, 245. Head, coverings of, 136, 204. Head of the infant, swellings upon, at birth, 252. Health of infant, signs of, 227. Hereditary predisposition to certain diseases, the influence of, 15, 241, 385. ---------transmission of scrofula and consumption, the best antidote, 30, 386. Hooping-cough, 354. Horse-exercise, its importance to delicate children, 145, 386. Hunter, Dr., quoted, 104. Ice, how to be applied to the head, 181. Idiotcy, 207. Illness, general remarks upon, 218. ------, sudden, 219. Indigestion, 279. Indisposition, temporary, 219. Infant, injuriously affected by protracted suckling, 56. -----, food for. See Artificial Feeding. -----,when still-born, how to be managed, 247. -----, of injuries received during its birth, 252. -----, retention of its urine, after its birth, 252. -----, swelling of the breasts, 252. -----, discharge from the eyes, 253. -----, hare-lip, how managed, 255. -----, bleeding from the navel-string, 256. -----, ulceration or imperfect healing of the navel, 257. -----, bleeding from the navel, 258. -----, jaundice of, 259. -----, tongue-tied, 259. -----, moles and marks on the skin of, 260. Inflammation,of the eyes, 253. Inflation of the lungs of the infant, the mode of, 249. Injuries, 252, 262. Involuntary discharge of urine, 309. Jalap-biscuits, recipe for, 159. Jaundice in the infant after birth, 259. Jolting, violent, painful to an infant, 82, 142. Knee-joint, sprain of, 270. Lancing the gums, when useful, 201. --------■-------, how performed, 2f5. INDEX. 401 Laudanum, antidote to, 277. Lavement, 160. Leading strings, 142. Leeches, mode of applying, 168. —---, the mode of controlling the bleeding of, 169. Lifting of infants, a caution, 140. Light, its influence, 116. Limbs, broken, what to do, 269. Liniment, aperient, for infant, 161. --------, for dispersing the breast-milk, 61. Linseed-meal poultice, how made, 174. Liverpool, 21. Looseness of the bowels, 88. Lungs of the infant, inflation of, 249. Magnesia, 157. Manna, 157. Marriage, 22, 383. Maternal nursing, the duty and advantages of, 25. --------management of the child in disease, 218. Measles, 337; how distinguished from scarlet fever and small- pox, 339. Meconium, 35. Medical attendant, 220. Medicine, aperient, for children, 154. -----—, aperient, when taken by the mother, its effects upon the breast-milk, 46. Medicines, nursery, 151. Medicine-spoon, how used, 153. Medicine unadvisedly given, 219. Mental emotion, 31, 47. ------health, 18. Mercury, cautions about, 1G2. Merriman, Dr., quoted, 166. Milk, its composition, 75. ----, breast, how preserved healthy, 44. ----------, deficiency of, 52. ----------, drying up of, 59. ----, ass's, 75. ----, cow's, 76. ----, all kinds sometimes disagree, 78. Milky scale, 313. Mind, anxiety of, effects upon the breast milk, 47. Moaning in the child as a sign of disease, 237. Moles and marks on the skin, 260. Monthly periods, the return of, their effect upon the breast-milk, 50, 65, 70. 34* 402 INDEX. Mortality of children, 13,198. Mothers' duties, 13. ----.---, their duty in relation to suckling, 25, 33. -------, those who ought not to nurse, 29. -------, their health injuriously affected by protracted suck- ling, 54. Motions of the infant, appearance of, and frequency in health, 155,233. --------------------, their deranged condition a sign of dis- ease, 234. Mustard foot-bath, 187. -------poultice, how made, 175. Mutton-tea, how prepared, 85. Napkins, the infant's, 130. Navel, bleeding from, 258. -----, ulceration or imperfect healing of, 257. Navel-string, bleeding from, 258. Nam, or moles, 260. Nettle-rash, 315. Night-nursing, 39. Nose, bleeding from, 323. ----, foreign bodies getting into, 271. Nurse-maid, qualifications for, 117. ----------, her influence, 118. Nursery, its requisites, 107. -------medicines, 151. Nursing, maternal, 25. -------■, rules for, 34. -------, rules for the health of the mother, 44, -------, protracted, injurious, 54. -------, beneficial to the healthy, 26. Opiates, 71, 164. -------, in teething, 205. Oxalic acid, antidote to, 277. Paregoric elixir, 165. Parent's influence, 117. Passion, its effects on breast-milk, 50. Peas-meal, 97. Pereira, Dr., quoted, 98. Permanent or adult teeth, 207. Pillow, 123. Pins, in the clothing, 135. Poisons, 276. Pork, unsuitable for children, 96. INDEX. 403 Porter, of its use by the nursing mother, 45, 51. ------, of its use by the wet-nurse, 67. Potato, as an article of diet for children, 96. Poultice, bread and water, how made, 173. --------, linseed meal, how made, 174. --------, mustard, how made and applied, 175. Pregnancy, how it affects the breast-milk, 52. --------, physical health of the mother during, 16. --------, mental health, 18. Protrusion of the bowel, 299. Erout, Dr., quoted, 26, 106. Purgative biscuits, 159. --------, medicine, 154. Quack medicines, 303. Quietness, 167. Quiet in illness, its importance, 224. Raisins, their occasional ill effects, 102. Red-gum, 310. Respiration, 111. Restlessness, 206. Retention of urine in the infant, 252. Rhubarb, 158. Rice, 97. Ringworm, 317. Rocking, caution about, 142. Rules for suckling, until the first teeth appear, 38. ---------------after the first teeth have appeared, 42. -----for the health of the nursing mother, 44. -----for the use of the warm bath, 184. Rupture, 300. Sago, how prepared for the infant, 83. Salt, as a condiment, 98. Scalds and burns, their immediate management, 263. Scarlet fever, 325; how distinguished from measles, 329. Scarlatina, 325. Scrofulous constitution, 15, 29, 132, 242, 384. Scrofula, its prevention, 384. Sea-bathing, 177. . . Seasons, (the) their influence in producing particular forms of disorder, 240. Shoes, 136. Short-coating, 136. Shower bath, 179. 404 INDEX. Sick-room, 218. Signs of health in the infant, what, 227; signs of disease, what, 227. Skin of the infant, importance of its perfect cleanliness, 125. ----------------, friction and sponging of, beneficial, 128. ----, the importance of its being attended to by a nursing wo- man, 46, 69 ; by the nurse-maid, 120. Sleep, during infancy, 120; during childhood, 123. -----, how affected when the child is ill, 233. Small-pox, 344; maternal management of, 348. Socks and stockings for children, 136. South, Mr., quoted, 272. Spirituous liquors, 103, 373. Sponging, 46, 69, 120, 128, 181. Spoon-feeding, 38, 79. Sprains, 270. Squinting, 54. Still-born, 247. Stings of insects, 275. Stomach and bowels, their derangement a fruitful source of dis- ease, 279. ------------------, disorder of, in the infant at the breast, 280; at weaning, 284; in the infant brought up by hand, 287; their treatment, 288. Stools of the infant, what the appearance of, and how frequent, in health, 155, 233. -----, their deranged condition a sign of disease, 234. Strumous disease, 15, 380. Suckling, plan of; maternal, 34; wet nurse, 63. Sugar, as a condiment, 98. Sweetmeats, injurious to children, 101, 305. Swelling of the breasts of the infant, 252. Swallowing boiling water, 265. Symptoms, faithful report of, 222. Syringe, enema, 160. Syrup of poppies, 165. Tartar on the teeth, how prevented, 214. Tears, the flow of, 237. Teat, of the cow—the artificial—the cork, 80. Teeth, of the permanent or adult teeth, 208; the manner in which they appear, 208; their value and importance, 211; their management whilst coming, 212; the means to be used for their preservation, 213. Teething, management of the child when easy, 198. --------, management of the child when difficult, 200. --------> how it sometimes affects the bowels, 283. INDEX. 405 Temper, in the nursing woman, 47, 50, 66. -------, in the nurse-maid, 118. Temperature of the apartments, 115. Thompson, Dr., quoted, 153. Throat, foreign bodies getting into, 273. Thrush, 306. Tight lacing, evils of, 146. Tincture of Benjamin, 2G7. Tongue-tied, 259. Tooth-powders, 214. Tooth-rash, 311. Tops and bottoms, 83. Tous les mois, 83. Toys, painted, injury from, 117. Turnips, as an article of diet, 97. Ulceration or imperfect healing of the navel, 257. Unhealthy breast-milk, cause of disorder in the infant, 280. Urine, retention of, in the infant after birth, 252. -----, involuntary discharge of, 309. Vaccination, 188; the most favourable time for, 189; the pro- gress in appearance of the vaccine vesicle, 194; the mater- nal management of the child, 195. Veal-broth, how prepared for an infant, 85. Veal, in its solid form, onfit for children, 96;. Vegetables, 96. Ventilation, 21, 107, 224. Ventilating valve, 113. Vitriol, antidote to, 277. Vomiting, 234. Walking, the mode of teaching a child, 142. Wardrobe, the child's, 136. Warm bath, 182; rules for the use of, 184. ----------, directions for the use of when the infant is still- born, 251. Wasps, stings of, how treated, 275. Water, the temperature for bathing an infant, 127; a child, 131. -----, as a beverage for children, 103. Water in the head, 191, 369. Water-dressing, 271. Weaning, the time when to take place, 58; mode of effecting it, 58. -------, drying up the breast-milk, 59. Wet-nurse suckling, 63. ________, rules for the choice of, 63 ; diet and management of, 66,69. 406 INDEX. Wilson, Mr. E., quoted, 126. Wine, its pernicious effects on children, 103. Woman's milk sometimes bitter, 52. Workhouses, 19. Worms, 104, 303. Wounds, their immediate management, 267. THE END. NLM041400895