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.
If the lips are drawn apart, so as to show the teeth or gums, the seat of the pain is in the belly. This sign, however, will only be present during the actual existence of suffering; if, therefore, there be any doubt whether it exist, press upon the stomach, and watch the eifect on the expression of the countenance.
If the pain arise simply from irritation of the bowels excited from indigestion, it will be temporary, and the sign will go and come just as the spasm may occur, and slight remedial measures will give relief.
If, however, the disease be more serious, and inflammation ensue, this sign will be more constantly present, and soon the countenance will become pale, or sallow and sunken,—the child will dread motion, and lie upon its back with the knees bent up to the belly,—the tongue will be loaded,—and in breathing, while the chest will be seen to heave with more than usual effort, the muscles of the belly will remain perfectly quiescent.
If the nostrils are drawn upwards and in quick motion, pain exists in the chest. This sign, however, will generally be the accompaniment of inflammation of the chest, in which case the countenance will be discoloured,—the eyes more or less staring, and the breathing will be difficult and hurried; and if the child's mode of respiring be watched, the chest will be observed to be unmoved, while the belly quickly heaves with every inspiration.
Convulsions are generally preceded by some changes in the countenance. The upper lip will be drawn up, and is occasionally bluish or livid. Then there may be slight squinting, or a singular rotation of the eye upon its own axis; alternate flushing or paleness of the face; and sudden animation followed by languor.
These signs will sometimes manifest themselves many hours, nay days, before the attack occurs; may be looked upon as premonitory; and if timely noticed, and suitable medical aid resorted to, the occurrence of a fit may be altogether prevented.
The state of the eyes should always be attended to. In health they are clear and bright, but in disease they become dull, and give a heavy appearance to the countenance; though after long continued irritation they will assume a degree of quickness which is very remarkable, and a sort of pearly brightness which is better known from observation than it can be from description.
The direction of the eyes, too, should be regarded, for from this we may learn something. When the infant is first brought to the light, both eyes are scarcely ever directed to the same object: this occurs without any tendency to disease, and merely proves, that regarding one object with both eyes is only an acquired habit. But when the child has come to that age when the eyes are by habit directed to the same object, and afterwards it loses that power, this circumstance alone may be looked upon as a frequent prelude to disease affecting the head.
OF THE GESTURES.
The gestures of a healthy child are all easy and natural; but in sickness those deviations occur, which alone will often denote the nature of the disease.
Suppose an infant to have acquired the power to support itself, to hold its head erect; let sickness come, its head will droop immediately, and this power will be lost, only to be regained with the return of health; and during the interval every posture and movement will be that of languor.
The little one that has just taught itself to run alone from chair to chair, having two or three teeth pressing upon and irritating the gums, will for a time be completely taken off its feet, and perhaps lie languidly in its cot, or on its nurse's arm.
The legs being drawn up to the belly, and accompanied by crying, are proofs of disorder and pain in the bowels. Press upon this part, and your pressure will increase the pain. Look to the secretions from the bowels themselves, and by their unhealthy character your suspicions, in reference to the seat of the disorder, are at once confirmed.
The hands of a child in health are rarely carried above its mouth; but let there be any thing wrong about the head and pain present, and the little one's hands will be constantly raised to the head and face.
Sudden starting when awake, as also during sleep, though it occur from trifling causes, should never be disregarded. It is frequently connected with approaching disorder of the brain. It may forebode a convulsive fit, and such suspicion is confirmed, if you find the thumb of the child drawn in and firmly pressed upon the palm, with the fingers so compressed upon it, that the hand cannot be forced open without difficulty. The same condition will exist in the toes, but not to so great a degree; there may also be a puffy state of the back of the hands and feet, and both foot and wrist bent downwards.
There are other and milder signs threatening convulsions and connected with gesture, which should be regarded:—the head being drawn rigidly backwards,—an arm fixed firmly to the side, or near to it,—as also one of the legs drawn stifly upwards. These signs, as also those enumerated above, are confirmed beyond all doubt, if there be present certain alterations in the usual habits of the child:—if the sleep is disturbed,—if there be frequent fits of crying,—great peevishness of temper,—the countenance alternately flushed and pale,—sudden animation followed by as sudden a fit of languor,—catchings of the breath followed by a long and deep inspiration,—all so many premonitory symptoms of an approaching attack.
OF THE SLEEP.
The sleep of the infant in health is quiet, composed, and refreshing. In very early infancy, when not at the breast, it is for the most part asleep in its cot; and although as the months advance it sleeps less, yet when the hour for repose arrives, the child is no sooner laid down to rest, than it drops off into a quiet, peaceful slumber.
Not so, if ill. Frequently it will be unwilling to be put into its cot at all, and the nurse will be obliged to take the infant in her arms; it will then sleep but for a short time, and in a restless and disturbed manner.
If it suffer pain, however slight, the countenance will indicate it; and, as when awake, so now, if there is any thing wrong about the head, the contraction of the eye-brow and grinding of the teeth will appear; if any thing wrong about the belly, the lips will be drawn apart, showing the teeth or gums,—and in both instances there will be great restlessness and frequent startings.
OF THE STOOLS.
In the new-born infant the motions are dark coloured, very much like pitch both in consistence and appearance. The first milk, however, secreted in the mother's breast, acts as an aperient upon the infant's bowels, and thus in about four-and-twenty hours it is cleansed away; or if it should not, a tea-spoonful of castor oil accomplishes this purpose.
From this time, and through the whole of infancy, the stools will be of a lightish yellow colour, the consistence of thin mustard, having little smell, smooth in appearance, and therefore free from lumps or white curded matter, and passed without pain or any considerable quantity of wind. And as long as the child is in health, it will have daily two or three, or even four, of these evacuations. But as it grows older, they will not be quite so frequent; they will become darker in colour, and more solid, though not so much so as in the adult.
Any deviation, then, from the above characters, is of course a sign of something wrong; and as a deranged condition of the bowels is frequently the first indication we have of coming disease, the nurse should daily be directed to watch the evacuations. Their appearance, colour, and the manner in which discharged, are the points principally to be looked to. If the stools have a very curdy appearance, or are too liquid, or green, or dark-coloured, or smell badly, they are unnatural. And in reference to the manner in which they are discharged, it should be borne in mind, that, in a healthy child, the motion is passed with but little wind, and as if squeezed out, but in disease, it will be thrown out with considerable force, which is a sign of great irritation. The number, too, of stools passed within the four-and- twenty hours it is important to note, so that if the child does not have its accustomed relief, (and it must not be forgotten that children, although in perfect health, differ as to the precise number,) a little castor oil may be at once exhibited, and thus mischief be prevented.
This, however, is not the place to discuss the question of disordered bowels, but simply to point out how this circumstance may be known.[FN#27]
[FN#27] See section on Disorders of the Stomach and Bowels, p. 208.
OF THE BREATHING AND COUGH.
The breathing of a child in health is formed of equal inspirations and expirations, and it breathes quietly, regularly, inaudibly, and without effort. But let inflammation of the air-tubes or lungs take place, and the inspiration will become in a few hours so quickened and hurried, and perhaps audible, that the attention has only to be directed to the circumstance to be at once perceived.
Now all changes which occur in the breathing from its healthy standard, however slight the shades of difference may be, it is most important should be noticed early. For many of the complaints in the chest, although very formidable in their character, if only seen early by the medical man, may be arrested in their progress; but otherwise, may be beyond the control of art. A parent, therefore, should make herself familiar with the breathing of her child in health, and she will readily mark any change which may arise.
Of cough I should not have said any thing in this chapter, as it can never fail to be noticed, except that it is highly necessary to throw out one caution. Whenever a child has the symptoms of a common cold, attended by hoarseness and a rough cough, always look upon it with suspicion, and never neglect seeking a medical opinion. Hoarseness does not usually attend a common cold in the child, and these symptoms may be premonitory of an attack of "croup;" a disease excessively rapid in its progress, and which, from the importance of the parts affected, carrying on, as they do, a function indispensably necessary to life, requires the most prompt and decided treatment.
The following observations of Dr. Cheyne are so strikingly illustrative, and so pertinent to my present purpose, that I cannot refrain inserting them:—"In the approach of an attack of croup, which almost always takes place in the evening, probably of a day during which the child has been exposed to the weather, and often after catarrhal symptoms have existed for several days, he may be observed to be excited, in variable spirits, more ready than usual to laugh than to cry, a little flushed, occasionally coughing, the sound of the cough being rough, like that which attends the catarrhal stage of the measles. More generally, however, the patient has been for some time in bed and asleep, before the nature of the disease with which he is threatened is apparent; then, perhaps, without waking, he gives a very unusual cough, well known to any one who has witnessed an attack of the croup; it rings as if the child had coughed through a brazen trumpet; it is truly a tussis clangosa; it penetrates the walls and floor of the apartment, and startles the experienced mother,—'Oh! I am afraid our child is taking the croup!' She runs to the nursery, finds her child sleeping softly, and hopes she may be mistaken. But remaining to tend him, before long the ringing cough, a single cough, is repeated again and again; the patient is roused, and then a new symptom is remarked; the sound of his voice is changed; puling, and as if the throat were swelled, it corresponds with the cough," etc.
How important that a mother should be acquainted with the above signs of one of the most terrific complaints to which childhood is subject; for, if she only send for medical assistance during its first stage, the treatment will be almost invariably successful; whereas, if this "golden opportunity" is lost, this disease will seldom yield to the influence of measures, however wisely chosen or perseveringly employed.
SECT. III.—OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION OF DISEASE.
1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF DISORDER.—The recollection of the fact, that at the different seasons of the year some diseases are more prevalent than at other periods, will greatly aid a judicious parent in the early detection of the presence of disorder, and its kind, in her child.
Thus, in the early part of the winter, what is called catarrh, viz. an increased secretion of mucus from the membranes of the nose, fauces, and air-tubes, with fever, and attended with sneezing and cough, thirst, lassitude, and want of appetite, is generally prevalent.
As the winter advances, the air-tubes of the lungs, and the lungs themselves, are liable to become the seat of disorder; and those signs will present themselves, which have been pointed out in the previous section as characteristic of such attacks.
In the spring, we have still the same diseases prevalent, and in addition, measles, scarlet fever, small-pox, and chicken pox, which increase in liability towards the close of this season, and with the first weeks of summer.
In the summer, disease is less prevalent than at any other period of the year; but towards its middle and close, and through the whole of the autumnal months, bowel complaints may be expected, in the forms of diarrhoea, cholera, and dysentery.
2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.— Without entering into this subject at large, still it may be useful to remark, that in some families there is a predisposition to some diseases, which, occurring in the first child, will, as each succeeding child is born, attack at the same age. Amongst other diseases of this class are, croup, hooping-cough, and water in the head.
This observation should not only lead a mother to be alive to the possibility of the successional occurrence of these diseases in her family, and so early note their appearance, and seek medical advice, but should at the same time make her most anxious, on the one hand, to shield her child from all their exciting causes, and on the other, to adopt those measures which may contribute indirectly to overcome the constitutional predisposition to them.
Of the scrofulous constitution, I will merely mention here, that it is of the greatest importance, where a predisposition to this disease exists in a family, that a mother should immediately attend to any alteration in the gait or contour of her child, and give prompt attention also to any complaint made of swelling about a joint, although it may be unattended with pain. The importance of this remark will be seen by contrasting the result of the following cases which occurred in children of the same family.
Case I.
A. B., a female child, having blue eyes, light hair, and a fair complexion, in the early part of the year 1838, being then two years of age, had an enlargement of the left knee joint. For some weeks previous to this time, there had been a degree of heat about the part; but as no pain apparently existed, it was not regarded as of any consequence, and nothing was done. The child, living in the neighbourhood of London, was afterwards placed under medical treatment. Two or three months having elapsed, it was brought to town, and shown to me, in consequence of a slight tumefaction over the lower part of the spine. This soon disappeared under the measures employed, and eventually the disease of the knee (evidently scrofulous) was arrested, so that now the case promises to be cured; but the joint will for ever be stiff, and the limb thus affected shorter than the other.
Case II.
G. B., the brother of the above, a handsome boy, with light hair, fine blue eyes,—indeed, very much like his little sister,—in the year 1836, had enlargements of the glands in his neck, which were relieved by the treatment resorted to.
In April, 1839, being then eight years old, he was observed by his mother to limp slightly in walking, but complained of little or no pain. From the caution, however, which had been given to the parent at the time I was consulted about the previous case, to notice at an early period any symptom of this nature in her children, the fact was immediately attended to. The affection was evidently in the hip; there was imperfection in the gait, and pain upon pressing over the joint. A blister was applied, perfect rest to the limb enjoined, and steel medicines ordered; and in a fortnight the motions of the joint were restrained more effectually by the application of strips of soap plaster and a bandage. In three months the child was ordered to the sea- side, and eventually was able to walk without the slightest limp or pain, and may be said to be quite well.
I would not say that in the first case, if the disease had been discovered early, and at that time met by judicious medical treatment, a stiff knee and shortened limb would have been prevented, although this is my belief; but in reference to the latter case, I have no hesitation in saying, that without the disease had been early detected by the mother, and as promptly attended to by her, the remedial measures might have failed,—certainly the result would not have been so highly satisfactory as it was.
Chap. V.
ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
The especial province of the mother is the prevention of disease, not its cure. To the establishment and carrying out of this principle, every word contained in the preceding pages has directly or indirectly tended.
This, however, is not all. When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.
Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to; and will most assuredly fail altogether, if counteracted by the erroneous prejudices of ignorant attendants. But to the affections of infancy and childhood, this remark applies with great force; since, at this period, disease is generally so sudden in its assaults, and rapid in its progress, that unless the measures prescribed are rigidly and promptly administered, their exhibition is soon rendered altogether fruitless.