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The Maternal Management of Children, in Health and Disease.
by Thomas Bull, M.D.
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IN CHILDHOOD.—The clothing of the child should possess the same properties as that of infancy. It should afford due warmth, be of such materials as do not irritate the skin, and so made as to occasion no unnatural constriction.

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

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

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

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



Sect. VII. AIR AND EXERCISE.



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

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



[FN#17] Sir James Clark on Consumption.



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

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

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

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

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

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

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

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

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

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

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

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

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



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



Chap. II.



ON THE USE AND ABUSE OF CERTAIN REMEDIES.

Sect. I.—APERIENT MEDICINE.



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

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

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

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



CASTOR OIL

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

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

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

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

Under one year, one small tea-spoonful.

Under three years, two ditto.

Under six years, three ditto.

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

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

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



MANNA.

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



MAGNESIA AND RHUBARB.

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

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

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

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

Powdered rhubarb, half a drachm;

Magnesia, two scruples;

Compound spirits of ammonia, twenty drops;

Dill water, two ounces;

Simple syrup, two drachms.



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



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



THE LAVEMENT.

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

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

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



THE APERIENT LINIMENT.

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

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

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



Sect. II.—CALOMEL.



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

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



[FN#20] Bell on the Teeth.



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



Sect. III.—OPIATES.



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

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

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

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



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



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

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



Sect. IV.—LEECHING.



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

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

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

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

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

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



Sect. V.—BLISTERS AND POULTICES.



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

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

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

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

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

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

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



Sect. VI.—BATHS.



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



THE COLD WATER PLUNGE BATH.



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

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

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



SEA BATHING.



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



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



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

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

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



THE SHOWER BATH.



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

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

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



ABLUTION, OR SPONGING.



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

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

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

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

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

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

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



THE WARM BATH.



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

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

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

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

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



RULES FOR THE USE OF THE WARM BATH.



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

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

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

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

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

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

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



Chap. III.

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



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



Sect. I.—ON TEETHING.



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

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

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



MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.



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

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

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

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



THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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



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



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



THE MANNER IN WHICH THEY APPEAR.



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

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

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

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

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



THEIR VALUE AND IMPORTANCE.



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

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

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



THEIR MANAGEMENT AND PRESERVATION.



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

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

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



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



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



[FN#25] Bell on the Teeth.



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

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

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

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

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

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

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

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



[FN#26] Bell on the Teeth.



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

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

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



CHAP. IV.

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



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

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



Sect. I.—SIGNS OF HEALTH.



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

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

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

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



Sect. II. SIGNS OF DISEASE.



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

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



OF THE COUNTENANCE.



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

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

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

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