The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
THE
MATERNAL MANAGEMENT
OF
CHILDREN,
IN HEALTH AND DISEASE.
By Thomas Bull, M.D.
Physician Accoucheur To The Finsbury Midwifery
Institution, And Lecturer On Midwifery,
And On The Diseases Of Women
And Children;
Author Of "Hints To Mothers On The
Management Of Their Health."
1840.
PREFACE.
This little book has been written for the young and inexperienced
mother. It is intended to furnish her with that information which the
experience and observation of some years convince the author, young
mothers, almost without any exception, do not possess; and yet, from
ignorance of which, the constitution of many an infant has received
irretrievable injury, and life itself but too frequently fallen a
sacrifice.
In the first chapters, devoted to the general management of the child
in health, the author has endeavoured to teach the young mother, that
the prevention of disease is her province, not its cure; that to this
object all her best efforts must be directed; and, moreover, that to
tamper with medicine, when disease has actually commenced, is to hazard
the life of her offspring.
In the fourth chapter it has been attempted to point out, how the
first symptoms of disease may be early detected by the parent. The
subject has been felt to be a difficult one, and to give particular
directions quite out of the question; but it is hoped that the
suggestions thrown out will, in some measure, answer the purpose
intended. On the advantage of an early and prompt application of
remedies in the diseases of childhood, generally so active in their
progress and severe in their character, it is unnecessary to offer any
observation.
The latter part of the work, consisting of the maternal management of
disease, the author regards as a subject of high and serious moment.
Small as is the attention which has been hitherto paid to it, yet, in
the diseases of infancy and childhood, how invaluable is a careful and
judicious maternal superintendence to give effect to the measures
prescribed by the physician.
The author has endeavoured to arrange the contents of the work in a
manner which shall be most easily understood and readily available; and
he now publishes it with the desire to supply, in some degree, a
deficiency in this important department of knowledge.
Finsbury Place, June, 1840.
CONTENTS.
Chapter I.
ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
Sect. - Page
I. On the Dietetics of Infancy - 2
1. Maternal Nursing - 3
Plan of Suckling - 3
Deficiency of Milk - 11
The injurious Effects to Mother and Infant of undue and protracted
Suckling - 15
Mothers who ought never to suckle - 20
2. Wet-nurse Suckling - 27
Choice of a Wet-nurse - 28
Diet and Regimen of a Wet-nurse - 31
3. Artificial Feeding, (bringing up by hand) - 34
The Kind of artificial Food before the sixth Month - 35
The Kind of artificial Food after the sixth Month to the completion of
first Dentition - 44
The Kind of artificial Food most suitable under the different
Complaints to which Infants are liable - 48
II. Weaning - 51
The Time when - 51
The Mode - 52
The drying up of the Mother's Milk - 54
III. On the Dietetics of Childhood - 54
General Directions, and of animal Food - 55
Sugar - 60
Salt - 61
Fruits - 62
Water - 63
Wine, Beer, and Spirits - 63
IV. Sleep - 66
During Infancy - 66
During Childhood - 69
V. Bathing and Cleanliness - 72
During Infancy - 72
During Childhood - 75
VI. Clothing - 78
During Infancy - 78
During Childhood - 81
VII. Air and Exercise - 83
In Infancy - 83
In Childhood - 89
Chap. II.
ON THE USE AND ABUSE OF CERTAIN REMEDIES.
I. Aperient Medicine - 97
Castor Oil - 99
Manna - 101
Magnesia and Rhubarb - 102
The Lavement - 105
The Aperient Liniment - 107
II. Calomel - 107
III. Opiates - 110
IV. Leeching - 113
V. Blisters and Poultices - 114
VI. Baths - 117
The Cold-water Plunge Bath - 118
Sea Bathing - 120
The Shower Bath - 123
Ablution, or Sponging - 125
The Warm Bath - 188
Chap. III.
ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.
I. On Teething. - 134
The Manner in which the temporary or milk Teeth appear - 134
The Management of the Infant when Teething is without difficulty - 136
The Management of the Infant in difficult Teething - 139
II. Hints on the permanent or adult Teeth - 148
The Manner in which they appear - 248
Their Value and Importance - 152
Their Management and Preservation - 154
Chap. IV.
HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.
I. Signs of Health - 163
II. Signs of Disease - 164
Of the Countenance - 165
Of the Gestures - 169
Of the Sleep - 171
Of the Stools - 172
Of the Breathing and Cough - 175
III. Other Circumstances which will assist in the early Detection of
Disease - 178
The Influence of the Seasons in producing particular Forms of Disorder
- 178
The Influence of an hereditary Predisposition to certain Diseases - 179
Chap. V.
ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
I. Accidents and Diseases which may occur to the Infant at Birth, or
soon after - 187
1. Still-born - 187
2. Injuries received during Birth - 193
3. Retention of Urine - 194
4. Swelling of the Breasts - 195
5. Inflammation of the Eyes - 196
6. Hare-lip - 199
7. Bleeding from the Navel-string - 201
8. Ulceration or imperfect Healing of the Navel - 20l
9. Bleeding from the Navel - 203
10. Jaundice - 204
11. Tongue-tied - 205
12. Moles and Marks on the Skin, etc. - 206
II. Disorders of the Stomach and Bowels; viz., Indigestion -
Flatulence - Vomiting - Griping and Looseness - 208
1. In the Infant at the Breast - 21O
2. At the period of Weaning - 217
3. In the child brought up by Hand - 221
Maternal Treatment - 222
III. Costiveness - 229
In Infancy - 229
In Childhood - 231
IV. Worms - 234
Not so frequent as popularly supposed; an error productive of mischief
- 234
How produced and how best prevented - 237
V. Scarlet Fever - 239
Mild Form - 239
With Sore Throat - 242
Scarlet Fever compared with Measles - 245
Maternal Management - 246
VI. Measles - 253
Description - 253
Compared with Scarlet Fever and Small Pox - 255
Maternal Management - 256
VII. Small-Pox - 262
Natural Small-Pox - 263
Small-Pox in the Vaccinated - 266
Maternal Management - 268
VIII. Hooping Cough - 275
Description - 276
Maternal Management - 279
IX. Croup - 286
Signs of its Approach - 286
Maternal Management - 289
Its prevention - 289
X. Water in the Head - 291
Its Prevention - 292
Maternal Management - 298
THE MATERNAL MANAGEMENT OF CHILDREN.
Chapter I.
ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
The line of demarcation made between infancy and childhood, both by
ancient and modern writers, has always been arbitrary. I would draw the
line between the two, at a period of time which appears to me to be the
most natural, the most simple, and least likely to lead the reader into
the danger of misapplying any part of the practical directions of this,
or any future chapter of the work. We will consider, then, that--
Infancy, commencing with birth, extends to about the end of the second
year, when the first dentition is completed.
Childhood extends from about the second, to the seventh or eighth
year, when the second dentition is commenced.
Sect. I. DIETETICS OF INFANCY.
In the early months of infancy the organs of digestion are unsuited to
any other food than that derived from the breast of the mother. So
little capable are they, indeed, to digest any other, even of the
blandest and most digestible kind, that probably not more than one
infant in six or seven ever arrives at the more advanced periods of
life when deprived of the kind of nourishment nature intended for this
epoch.
It is not every parent, however, who is able to become a nurse; and
with many this office would not only be highly injurious to their own
health, but materially so to that of their offspring. This may arise
from various causes, hereafter to be noticed, but whenever they exist a
wet-nurse is demanded.
Again, the latter resource is not always attainable, so that the
hazardous experiment of an artificial diet, or bringing up by hand, as
it is then termed, is obliged to be resorted to.
Thus, infantile dietetics naturally divides itself into Maternal
Nursing, Wet-Nurse Suckling, And Artificial Feeding.
1. MATERNAL NURSING.
PLAN OF SUCKLING.
From the first moment the infant is applied to the breast, it must be
nursed upon a certain plan. This is necessary to the well-doing of the
child, and will contribute essentially to preserve the health of the
parent, who will thus be rendered a good nurse, and her duty at the
same time will become a pleasure.
This implies, however, a careful attention on the part of the mother
to her own health; for that of her child is essentially dependent upon
it. Healthy, nourishing, and digestible milk can be procured only from
a healthy parent; and it is against common sense to expect that, if a
mother impairs her health and digestion by improper diet, neglect
of exercise, and impure air, she can, nevertheless, provide as
wholesome and uncontaminated a fluid for her child, as if she were
diligently attentive to these important points. Every instance of
indisposition in the nurse is liable to affect the infant.
And this leads me to observe, that it is a common mistake to suppose
that, because a woman is nursing, she ought therefore to live very
fully, and to add an allowance of wine, porter, or other fermented
liquor, to her usual diet. The only result of this plan is, to cause an
unnatural degree of fulness in the system, which places the nurse on
the brink of disease, and which of itself frequently puts a stop to the
secretion of the milk, instead of increasing it. The right plan of
proceeding is plain enough; only let attention be paid to the ordinary
laws of health, and the mother, if she have a sound constitution, will
make a better nurse than by any foolish deviation founded on ignorance
and caprice.
The following case proves the correctness of this statement:--
A young married lady, confined with her first child, left the lying-in-
room at the expiration of the third week, a good nurse, and in perfect
health. She had had some slight trouble with her nipples, but this was
soon overcome.
The porter system was now commenced, and from a pint to a pint and a
half of this beverage was taken in the four and twenty hours. This was
resorted to, not because there was any deficiency in the supply of
milk, for it was ample, and the infant thriving upon it; but because,
having become a nurse, she was told that it was usual and necessary,
and that without it her milk and strength would ere long fail.
After this plan had been followed for a few days, the mother became
drowsy and disposed to sleep in the daytime; and headach, thirst, a hot
skin, in fact, fever supervened; the milk diminished in quantity, and,
for the first time, the stomach and bowels of the infant became
disordered. The porter was ordered to be left off; remedial measures
were prescribed; and all symptoms, both in parent and child, were after
a while removed, and health restored.
Having been accustomed, prior to becoming a mother, to take a glass or
two of wine, and occasionally a tumbler of table beer, she was advised
to follow precisely her former dietetic plan, but with the addition of
half a pint of barley-milk morning and night. Both parent and child
continued in excellent health during the remaining period of suckling,
and the latter did not taste artificial food until the ninth month, the
parent's milk being all-sufficient for its wants.
No one can doubt that the porter was in this case the source of the
mischief. The patient had gone into the lying-in-room in full health,
had had a good time, and came out from her chamber (comparatively) as
strong as she entered it. Her constitution had not been previously worn
down by repeated child-bearing and nursing, she had an ample supply of
milk, and was fully capable, therefore, of performing the duties which
now devolved upon her, without resorting to any unusual stimulant or
support. Her previous habits were totally at variance with the plan
which was adopted; her system became too full, disease was produced,
and the result experienced was nothing more than what might be expected.
The plan to be followed for the first six months.-Until the breast-
milk is fully established, which may not be until the second or third
day subsequent to delivery (almost invariably so in a first
confinement), the infant must be fed upon a little thin gruel, or upon
one third water and two thirds milk, sweetened with loaf sugar.
After this time it must obtain its nourishment from the breast alone,
and for a week or ten days the appetite of the infant must be the
mother's guide, as to the frequency in offering the breast. The stomach
at birth is feeble, and as yet unaccustomed to food; its wants,
therefore, are easily satisfied, but they are frequently renewed. An
interval, however, sufficient for digesting the little swallowed, is
obtained before the appetite again revives, and a fresh supply is
demanded.
At the expiration of a week or so it is essentially necessary, and
with some children this may be done with safety from the first day of
suckling, to nurse the infant at regular intervals of three or four
hours, day and night. This allows sufficient time for each meal to be
digested, and tends to keep the bowels of the child in order. Such
regularity, moreover, will do much to obviate fretfulness, and that
constant cry, which seems as if it could be allayed only by constantly
putting the child to the breast. A young mother very frequently runs
into a serious error in this particular, considering every expression
of uneasiness as an indication of appetite, and whenever the infant
cries offering it the breast, although ten minutes may not have elapsed
since its last meal. This is an injurious and even dangerous practice,
for, by overloading the stomach, the food remains undigested, the
child's bowels are always out of order, it soon becomes restless and
feverish, and is, perhaps, eventually lost; when, by simply attending
to the above rules of nursing, the infant might have become healthy and
vigorous.
For the same reason, the infant that sleeps with its parent must not
be allowed to have the nipple remaining in its mouth all night. If
nursed as suggested, it will be found to awaken, as the hour for its
meal approaches, with great regularity. In reference to night-nursing,
I would suggest suckling the babe as late as ten o'clock p. m., and not
putting it to the breast again until five o'clock the next morning.
Many mothers have adopted this hint, with great advantage to their own
health, and without the slightest detriment to that of the child. With
the latter it soon becomes a habit; to induce it, however, it must be
taught early.
The foregoing plan, and without variation, must be pursued to the
sixth month.
AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a
large supply of good and nourishing milk, and her child is healthy and
evidently flourishing upon it, no change in its diet ought to be made.
If otherwise, however, (and this will but too frequently be the case,
even before the sixth month[FN#1],) the child may be fed twice in the
course of the day, and that kind of food chosen which, after a little
trial, is found to agree best.
[FN#1] See Deficiency of Milk, p. 11.
Leman's tops and bottoms, steeped in hot water, with the addition of a
little fresh milk, and sweetened or not with loaf sugar, is one of the
best description.
If the stomach reject this, farinaceous food boiled in water, and
mixed with a small quantity of milk, may be employed. Or weak mutton or
veal broth, or beef tea, clear and free from fat, and mixed with an
equal quantity of farinaceous food.
If this artificial diet is used before the sixth month, it must be
given through the sucking-bottle; after this period with a spoon: in
either case it must be previously passed through a sieve.
When the large or grinding teeth have appeared, the same food is still
to be continued, but need not any longer be expressed through the sieve.
Such is the plan of nursing to be followed by the mother until she
wean her infant altogether from the breast. The period when this ought
to take place, as also the manner of accomplishing it, are detailed
in the section on "Weaning."[FN#2]
[FN#2] See page 51.
The diet from weaning to the termination of infancy is pointed out
under "Artificial Feeding."[FN#3]
[FN#3] See page 34.
DEFICIENCY OF MILK.
If this deficiency exist from the earliest weeks after delivery, and
it is not quickly remedied by the means presently to be pointed out, a
wet-nurse must be obtained. It will be of no avail partially to nurse,
and partially to feed the infant at this period and under such
circumstances, for if it is not soon lost, it will only live for a few
months, or a year at most, and be an object of the greatest anxiety and
grief to its parent. This condition arises from the unwholesomeness of
the mother's milk, united with the artificial food; for when the milk
is deficient from the first, and continues so notwithstanding the means
used for its increase, it is invariably unhealthy in its quality.
This deficiency, however, may exist, and even at a very early period
after delivery, and yet be removed. This, however, is not to be
accomplished by the means too frequently resorted to; for it is the
custom with many, two or three weeks after their confinement, if the
supply of nourishment for the infant is scanty, to partake largely of
malt liquor for its increase. Sooner or later this will be found
injurious to the constitution of the mother: but how, then, is this
deficiency to be obviated? Let the nurse keep but in good health, and
this point gained, the milk, both as to quantity and quality, will be
as ample, nutritious, and good, as can be produced by the individual.
I would recommend a plain, generous, and nutritious diet; not one
description of food exclusively, but, as is natural, a wholesome,
mixed, animal, and vegetable diet, with or without wine or malt liquor,
according to former habit; and, occasionally, where malt liquor has
never been previously taken, a pint of good sound ale may be taken
daily with advantage, if it agree with the stomach. Regular exercise in
the open air is of the greatest importance, as it has an extraordinary
influence in promoting the secretion of healthy milk. Early after
leaving the lying-in room, carriage exercise, where it can be
obtained, is to be preferred, to be exchanged, in a week or so, for
horse exercise, or the daily walk. The tepid, or cold salt-water shower
bath, should be used every morning; but if it cannot be borne, sponging
the body withsalt-water must be substituted.
By adopting with perseverance the foregoing plan, a breast of milk
will be obtained as ample in quantity, and good in quality, as the
constitution of the parent can produce, as the following case proves:
On the 17th September, 1839, I attended a lady twenty-four years of
age, a delicate, but healthy woman, in her first confinement. The
labour was good. Every thing went on well for the first week, except
that, although the breasts became enlarged, and promised a good supply
of nourishment for the infant, at its close there was merely a little
oozing from the nipple. During the next fortnight a slight, but very
gradual increase in quantity took place, so that a dessert spoonful
only was obtained about the middle of this period, and perhaps double
this quantity at its expiration. In the mean time the child was
necessarily fed upon an artificial diet, and as a consequence its
bowels became deranged, and a severe diarrhoea followed. A wet-nurse
was advised for the child as the only means of saving its life, and
change of air for the mother as the most likely expedient (in
connection with the general treatment pointed out above) for obtaining
a good breast of milk. Accordingly, on the 5th October, the patient,
taking with her the infant and a wet-nurse, went a few miles from town.
For three or four days it was a question whether the little one would
live, for so greatly had it been reduced by the looseness of the bowels
that it had not strength to grasp the nipple of its nurse; the milk,
therefore, was obliged to be drawn, and the child fed with it from a
spoon. After the lapse of a few days, however, it could obtain the
breast-milk for itself; and, to make short of the case, on the 25th of
the same month, the mother and child returned home, the former having a
very fair proportion of healthy milk in her bosom, and the child
perfectly recovered and evidently thriving fast upon it.
Where, however, there has been an early deficiency in the supply of
nourishment, it will most frequently happen that, before the sixth or
seventh month, the infant's demands will be greater than the mother can
meet. The deficiency must be made up by artificial food, which must be
of a kind generally employed before the sixth month, and given through
the bottle. If, however, this plan of dieting should disagree, the
child must, even at this period, have a wet-nurse.
Women who marry comparatively late in life, and bear children,
generally have a deficiency of milk after the second or third month:
artificial feeding must in part be here resorted to.
THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED
SUCKLING.
UPON THE MOTHER.--The period of suckling is generally one of the most
healthy of a woman's life. But there are exceptions to this as a
general rule; and nursing, instead of being accompanied by health, may
be the cause of its being materially, and even fatally, impaired. This
may arise out of one of two causes, either, a parent continuing to
suckle too long; or, from the original powers or strength not being
equal to the continued drain on the system.
Examples of the first class I am meeting with daily. I refer to poor
married women, who, having nursed their infants eighteen months, two
years, or even longer than this, from the belief that by so doing they
will prevent pregnancy, call to consult me with an exhausted frame and
disordered general health, arising solely from protracted nursing,
pursued from the above mistaken notion.
I most frequently meet with examples of the second class in the
delicate woman, who, having had two or three children in quick
succession, her health has given way, so that she has all the symptoms
arising from undue suckling, when perhaps the infant at her breast is
not more than two or three months old.
Since the health of the mother, then, will suffer materially from this
circumstance, she ought not to be ignorant of the fact; so that, when
the first symptoms manifest themselves, she may be able to recognise
their insidious approach; and tracing them to their real cause, obtain
medical advice before her health be seriously impaired.
SYMPTOMS.--The earliest symptom is a dragging sensation in the back
when the child is in the act of sucking, and an exhausted feeling of
sinking and emptiness at the pit of the stomach afterwards. This is
soon followed by loss of appetite, costive bowels, and pain on the left
side; then, the head will be more or less affected, sometimes with much
throbbing, singing in the ears, and always some degree of giddiness,
with great depression of spirits.
Soon the chest becomes affected, and the breathing is short,
accompanied by a dry cough and palpitation of the heart upon the
slightest exertion. As the disease advances, the countenance becomes
very pale, and the flesh wastes, and profuse night perspirations, great
debility, swelling of the ankles, and nervousness ensue. It is
unnecessary, however, to enter into a more full detail of symptoms.
TREATMENT.--All that it will be useful to say in reference to
treatment, is this; that, although much may be done in the first
instance by medicine, change of air, cold and sea bathing, yet the
quickest and most effectual remedy is to wean the child, and thus
remove the cause.
THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful
reason why the child should be weaned, or rather, have a young and
healthy wet-nurse, if practicable. The effects upon the infant, suckled
under such circumstances, will be most serious. Born in perfect health,
it will now begin to fall off in its appearance, for the mother's milk
will be no longer competent to afford it due nourishment; it will be
inadequate in quantity and quality. Its countenance, therefore, will
become pale; its look sickly and aged; the flesh soft and flabby; the
limbs emaciated; the belly, in some cases, large, in others, shrunk;
and the evacuations fetid and unnatural; and in a very few weeks, the
blooming healthy child will be changed into the pale, sickly, peevish,
wasted creature, whose life appears hardly desirable.