The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
Again; the return of the monthly periods whilst the mother is a nurse
always affects the properties of the milk, more or less, deranging the
stomach and bowels of the infant. It will thus frequently happen, that
a few days before the mother is going to be unwell, the infant will
become fretful and uneasy; its stomach will throw up the milk, and its
motions will be frequent, watery, and greenish. And then, when the
period is fully over, the milk will cease to purge. It is principally
in the early months, however, that the infant seems to be affected by
this circumstance; for it will be generally found that although the
milk is certainly impaired by it, being less abundant and nutritious,
still, after the third or fourth month it ceases to affect the infant.
Is then a mother, because her monthly periods return after her
delivery, to give up nursing? Certainly not, unless the infant's health
is seriously affected by it; for she will generally find that, as the
periods come round, by keeping the infant pretty much from the breast,
during its continuance, and feeding him upon artificial food, she will
prevent disorder of the child's health, and be able in the intervals to
nurse her infant with advantage. It must be added, however, that a wet-
nurse is to be resorted to rather than any risk incurred of injuring
the child's health; and that, in every case, partial feeding will be
necessary at a much earlier period than when a mother is not thus
affected.
The milk may also be rendered less nutritive, and diminished in
quantity, by the mother again becoming pregnant. In this case,
however, the parent's health will chiefly suffer, if she persevere in
nursing; this, however, will again act prejudicially to the child. It
will be wise, therefore, if pregnancy should occur, and the milk
disagree with the infant, to resign the duties of a nurse, and to put
the child upon a suitable artificial diet;--if, however, pregnancy
should take place before the infant is six month's old, a wet-nurse
ought to be procured.
FROM IRREGULAR NURSING.--This is one of the most frequent sources of
derangement of the stomach and bowels of the child. The infant that is
constantly at the breast will always be suffering, more or less, from
flatulence, griping, looseness of the bowels, and vomiting. This is
caused by a sufficient interval not being allowed between the meals for
digestion. The milk, therefore, passes on from the stomach into the
bowels undigested, and the effects just alluded to follow. Time must
not only be given for the proper digestion of the milk, but the stomach
itself must be allowed a season of repose. This evil, then, must be
avoided most carefully by the mother strictly adhering to those rules
for nursing which have been already laid down.[FN#34]
[FN#34] See page 5.
FROM TEETHING.--The bowels of the infant at the breast, as well as
after it is weaned, are generally affected by teething. And it is
fortunate that this is the case, for it prevents more serious
affections. Indeed, the diarrhoea that occurs during dentition, except
it be violent, must not be subdued; if, however, this is the case,
attention must be paid to it. It will generally be found to be
accompanied by a swollen gum; the freely lancing of which will
sometimes alone put a stop to the looseness: further medical aid may,
however, be necessary.
FROM COLD AND DAMP, ETC.--Of course there are other causes besides
these already alluded to, giving rise to bowel complaints, during this
epoch,--causes not cognisable by the mother, however, and not mentioned
therefore here. It is right, however, that she should be aware that
these affections are sometimes the result simply of impressions of cold
or damp, particularly at certain seasons of the year; in the autumn,
for instance, when, as is well known, bowel complaints are very
frequent. When thus produced, it is important early to seek medical
aid, as inflammation is generally the result.
2. AT THE PERIOD OF WEANING.
There is great susceptibility to derangements of the stomach and
bowels of the child at the period when weaning ordinarily takes place,
so that great care and judgment must be exercised in effecting this
object. Usually, however, the bowels are deranged during this process
from one of these causes; from weaning too early, from effecting it too
suddenly and abruptly, or from over-feeding and the use of improper and
unsuitable food. There is another cause which also may give rise to
diarrhoea at this time, independently of weaning, viz. the irritation
of difficult teething.
WEANING TOO EARLY.--The substitution of artificial food for the breast-
milk of the mother, at a period when the digestive organs of the infant
are too delicate for this change, is a frequent source of the
affections now under consideration.
The attempt to wean a delicate child, for instance, when only six
months old, will inevitably be followed by disorder of the stomach and
bowels. Unless, therefore, a mother is obliged to resort to this
measure, from becoming pregnant, or any other unavoidable cause, if she
consult the welfare of her child, she will not give up nursing at this
early period. But if she should be no longer competent to suckle, and
her infant be delicate, a wet-nurse must be obtained; for, the infant's
bowels becoming disordered, medicine or remedies will avail little
without healthy breast milk.
The age at which weaning ought to take place must ever depend upon
circumstances; the ninth month would not be too early for some, the
twelfth would be for others.[FN#35]
[FN#35] See page 51.
FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once
of the breast, and substituting artificial food, however proper under
due regulations such food may be, will invariably cause bowel
complaints. Certain rules and regulations must be adopted to effect
weaning safely, the details of which are given elsewhere.[FN#36]
[FN#36] See page 52.
OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These
causes are more productive of disorder of the stomach and bowels at the
time of weaning than any yet referred to.
If too large a quantity of food is given at each meal, or the meals
are too frequently repeated, in both instances the stomach will become
oppressed, wearied, and deranged; part of the food, perhaps, thrown up
by vomiting, whilst the remainder, not having undergone the digestive
process, will pass on into the bowels, irritate its delicate lining
membrane, and produce flatulence, with griping, purging, and perhaps
convulsions.
Then, again, improper and unsuitable food will be followed by
precisely the same effects; and unless a judicious alteration be
quickly made, remedies will not only have no influence over the
disease, but the cause being continued, the disease will become most
seriously aggravated.
It is, therefore, of the first importance to the well-doing of the
child, that at this period, when the mother is about to substitute an
artificial food for that of her own breast, she should first ascertain
what kind of food suits the child best, and then the precise quantity
which nature demands. Many cases might be cited, where children have
never had a prescription written for them, simply because, these points
having been attended to, their diet has been managed with judgment and
care; whilst, on the other hand, others might be referred to, whose
life has been hazarded, and all but lost, simply from injudicious
dietetic management. Over-feeding, and improper articles of food, are
more frequently productive, in their result, of anxious hours and
distressing scenes to the parent, and of danger and loss of life to the
child, than almost any other causes.
TEETHING.--The irritation caused by difficult teething may give rise to
diarrhoea at the period when the infant is weaned, independently
of the weaning itself. Such disorder of the bowels, if it manifestly
occur from this cause, is a favourable circumstance, and should not be
interfered with, unless indeed the attack be severe and aggravated,
when medical aid becomes necessary. Slight diarrhoea then, during
weaning, when it is fairly traceable to the cutting of a tooth (the
heated and inflamed state of the gum will at once point to this as the
source of the derangement), is of no consequence, but it must not be
mistaken for disorder arising from other causes. Lancing the gum will
at once, then, remove the cause, and generally cure the bowel complaint.
3. TO THE CHILD BROUGHT UP BY HAND.
Children brought up on an artificial diet are very liable to
indigestion and bowel complaints; indeed none more so: and it is from
these affections that so many of these infants perish. When, then, it
is absolutely necessary from untoward circumstances to have recourse to
this mode of nourishing the child, the rules and regulations laid down
in the section on "Artificial Feeding" must be most strictly followed
out, if the parent would hope to avoid disease and rear her
child.[FN#37] And if these affections should at any time unfortunately
manifest themselves, the mother ought carefully and diligently to
examine whether the plan of feeding pursued is in every particular
correct, particularly bearing in mind that the two causes most
frequently productive of disorder in the child are overfeeding and the
exhibition of unsuitable food--the two grand errors of the nursery.
These results, however, have already been sufficiently dwelt upon as
likely to take place at weaning, and they may of course occur to a
child who is brought up on an artificial diet at any period.
[FN#37] See page 34.
MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.
As must have been already seen, the maternal treatment chiefly
consists in the removal of the cause of the disorder; medicine may
occasionally be exhibited by the mother, but its use in her hands must
be very limited indeed.
Unfortunately the general resource and only remedy of most mothers in
affections of the stomach and bowels is an aperient, and a combination
containing calomel is the one too frequently selected. The primary
cause of the disorder is undetected, and consequently no measures taken
for its removal, but purgative powder after purgative powder is given,
the evil being supposed to rest in the bowels alone, and that such
means must eventually get rid of it. The mother is not aware all this
time that the real source of the derangement is probably in the diet
itself; that there is some error here, and that unless this is
corrected, the remedies must be worse than useless. The consequence of
such a plan of proceeding is usually very sad; a confirmed and
obstinate diarrhoea but too commonly ensues, and the infant is
sometimes reduced to the last extremity.
The removal of the cause of the disorder, then, in a large number of
instances of derangement of the stomach and bowels, if effected early,
will cure the disease, and without further remedy. But it will be
asked, by what method is this cause to be detected? In this way. In all
human probability the primary cause of the disorder is connected with
the diet; this is the case in ninety-nine instances out of a hundred.
Well, then, is the sick child at the breast? If so, ascertain whether
the breast-milk is healthy and wholesome, or whether any circumstances
exist which have rendered it otherwise? If nothing faulty is found
here, the next question would naturally be, whether the rules and
regulations laid down for suckling have been strictly adhered to? Or,
whether the infant is sufficiently old to render it at all probable
that a tooth may be irritating the gum?
Perhaps the child is being weaned; well, is there any error here? Is
the change being attempted too early? or too suddenly and abruptly? If
this is not the case, then, has the child been overfed, or is the food
given of the proper description?
Is the child being brought up by hand? Then, there is every reason to
suspect, either that the quality of the food given is not the most
suitable, or, that the quantity exhibited is too great; in fact, that
the rules laid down for "artificial feeding" have not been strictly
acted upon.
By a mode of investigation like this, any defect or error in the
dietetic management of the infant producing the disorder will be easily
detected by a careful mother; and its correction alone will, in very
many instances, be all that is necessary to remove the symptoms.
For example, if flatulence and griping, followed by diarrhoea, occur
to an infant at the breast; if at the same time it becomes pale, its
flesh flabby, its disposition fretful, always crying until it is put to
the breast, the nipple of which it grasps eagerly, sucking eagerly, yet
never satisfied, for its hunger continues, it is not nourished; if,
too, the more it sucks, the more the stomach and bowels are deranged,
the more it vomits and is purged; depend upon it the cause of all the
evil will be found to be unwholesome milk. No medicine will avail any
thing here; the cause must be removed; the best medicine, and the only
remedy, is a breast of healthy milk. And if this is not procured
early, there will be great danger of a diarrhoea setting in, which may
probably prove fatal to the child.
Again; if there is simply vomiting of the breast-milk almost
immediately after the child has been suckled, the milk coming up pure
and unchanged, and discharged without any apparent effort, and the
moment after the child is cheerful and happy, this will be found to
depend upon repletion, and not upon unwholesome milk; in fact, the
stomach has received too much. This must be prevented in future, not by
giving medicine, but simply by removing the infant from the nipple
immediately it ceases to draw strongly, the moment it begins to dally
with the breast.
Again; if flatulence and griping occur to the child brought up by
handy this derangement will generally be found to result from
overfeeding: abstinence and diminution of the quantity of the food will
generally be all that is necessary here. It will be well, however, for
the mother in this case, and she may do it with the utmost safety, to
unload the bowels of their indigestible contents by the exhibition of a
tea-spoonful of castor oil. A dose or two of this medicine will
effectually clear them out, without increasing the irritation, or
weakening the child, whilst it will in most instances altogether remove
the symptoms. If the flatulence, however, should continue, four or five
grains of magnesia may be mixed with the last meal at night, and a
little warm water thrown up into the bowel as an injection the next
morning.
Diarrhoea occurring in a child brought up by hand, if it be not the
result of overfeeding, will very frequently be found to arise from
unsuitable diet, the food given not being of a kind suited to the
infant's stomach; for what will agree with one child often disagrees
with another. Alteration of diet will sometimes alone suffice in these
cases to cure, if this alteration is only made early enough, before any
considerable irritation of the stomach and bowels has been induced.
Thin arrow-root made with water (prepared very carefully, or the child
will refuse it,) should be given for five or six days; the warm bath
used every night for the same period, a new flannel bandage rolled
round the body, and the child cautiously protected from a damp
atmosphere. The arrow-root, upon the cessation of the diarrhoea, may
have cows' milk added to it, if milk is not found to disagree: when
this is the case, chicken or weak mutton broth, free from fat, or beef-
tea, thickened with farinaceous food, with a little salt added, are the
best substitutes. Should not the diarrhoea yield to the foregoing
measures, and that readily, medical aid ought to be sought. Diarrhoea
is very frequent from the time of weaning to the third year of age, and
certainly in its effects forms so important a disease, that, unless in
the slight form noticed above, a mother is not justified in attempting
its relief.
In conclusion, I would observe, that I do not think a mother justified
in attempting more than what has been laid down here for her guidance.
It is believed that the few and plain common-sense directions given, if
followed, will do much to prevent disease, and even to relieve it in
its milder forms; they will not, however, cure disease itself when
really established: and again I would repeat, let the mother recollect
that to prevent disease is her province--to cure it, is the physician's.
Sect. III.--COSTIVENESS.
1. IN INFANCY.
The principle to act upon in the management of the infant's bowels is
this,--that they should be kept free, and by the mildest and least
irritating means.
If therefore they become accidentally confined (less than two stools
in the four-and-twenty hours), and the infant is suckled, the mother
may ascertain whether an aperient taken by herself will render her milk
of a sufficiently purgative quality to act upon the bowels of her
child. This is the mildest mode of all.
If, however, this does not answer, or is not practicable from the
child being fed artificially, then the mildest aperient medicines must
be chosen to accomplish this purpose. The kind of medicine to be
selected, and the doses in which to be adminstered, will be found in
the section on "Aperient Medicine."[FN#39]
[FN#39] See page 97.
If, however, the bowels of the infant are disposed to be habitually
confined, it should be ascertained whether this may not be dependent
upon its diet. The same food that agrees perfectly well with one child
will frequently cause costiveness in another. An intelligent and
observing mother will soon discover whether this is the source of the
mischief, or not. Boiled milk, for instance, will invariably cause
confined bowels in some children; the same result will follow sago
boiled in beef tea, with others; whilst, on the other hand, the bowels
may frequently be brought into regular order, and their confined state
overcome, by changing the food to Leman's tops and bottoms steeped in
hot water, and a small quantity of unboiled milk added; or prepared
barley, mixed in warm water and unboiled milk, will have the same
effect.
Sometimes children are constitutionally costive, that is, the bowels
are relieved every third or fourth day, not oftener, and yet perfect
health is enjoyed. This occasionally will happen in large families, all
the children, though perfectly healthy and robust, being similarly
affected. When such is found by a mother to be really the habit of her
child, it would be very unwise, because injurious to its health, to
attempt by purgatives to obtain more frequent relief. At the same time
it will be prudent and necessary for her to watch that the regular time
is not exceeded. This condition seldom occurs to the very young infant.
2. IN CHILDHOOD.
Children of sound health, who are judiciously fed, and have sufficient
exercise, very seldom need aperient medicine. Errors in diet, a want of
proper attention to the state of the skin, insufficiency of air and
exercise, in fine, a neglect of those general principles which have
been laid down for the management of health, and upon the observance of
which the due and healthy performance of every function of the body
depends, are the sources of bowel derangements, and particularly, at
this age, of costiveness.
I feel assured, however, that some children are more troubled with
costiveness than others, from the simple but important circumstance of
their not being early taught the habit of relieving the bowels daily,
and at a certain hour. There is a natural tendency to this periodical
relief of the system, and it exists at the earliest age. And if the
mother only cause this habit to be fairly established in infancy, she
will do much towards promoting regularity of her child's bowels
throughout life. The recollection of this fact, and the mother's acting
upon it, is of the greatest importance to the future health and comfort
of her children.
If the bowels are accidentally confined at this age, castor oil is
certainly the best aperient that can be given: it acts mildly but
efficiently, clearing out the bowels without irritating them. The dose
must be regulated by the age, as also by the effect that aperients
generally have upon the individual. Great care must in future be taken
to avoid the cause or accidental circumstance which produced the
irregularity.
When the bowels are habitually costive, much care and judgment is
necessary for their relief and future management. Fortunately this
condition is very rare in youth. The activity and exposure to the air,
usual at this period of life, render purgatives unnecessary, unless,
indeed (as just mentioned), some error in diet, or some unusual
circumstance, render them accidentally confined. Should, however, the
foregoing state exist, medicine alone will avail little; there are
certain general measures which must also be acted up to, and most
strictly, if the end is to be accomplished. They consist, principally,
in an observance of great regularity with respect to the time of taking
food, its quality, quantity, and due mastication; regular and
sufficient exercise, horse exercise being particularly serviceable; the
shower-bath, or daily ablution; early rising (the indulgence in the
habit of lying in bed always predisposing to constipation); and,
lastly, the patient habituating himself to evacuate the bowels at a
certain hour of the day. After breakfast appears to be the time when
the bowels are more disposed to act than at any other part of the day;
this is the time, then, that should be chosen.
All these points must be sedulously observed, and upon the principles
laid down in the various chapters upon these subjects, if habitual
costiveness is expected to be overcome.
SECT. IV.--WORMS.
NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF
MISCHIEF.--Almost all diseases have been, at one time or other,
attributed to the generation of worms in the intestines. And at the
present day it is not at all an uncommon occurrence for medical men to
be called in to prescribe for children, to whom the strongest purgative
quack medicines have been previously exhibited by parents, for the
removal of symptoms which, upon investigation, are found in no way
connected with or produced by worms. The results of such errors are
always, more or less, mischievous, and sometimes of so serious a nature
as to lay the foundation of disease which ultimately proves fatal. This
observation, moreover, it behoves a mother carefully to regard, since
the symptoms, popularly supposed to indicate the existence of worms,
are so deceptive, (and none more so than that which is usually so much
depended upon--the picking of the nose,) that it may be positively
asserted to be impossible for an unprofessional person to form a
correct and sound opinion in any of these cases.
It was at one time imagined, and the idea is still popularly current,
that worms were the occasion of a troublesome and lingering species of
fever, which was therefore designated worm-fever. This notion is now
entirely exploded; for if worms be present under such circumstances, it
is a mere accidental complication; the fever referred to being
generally of a remitting character, and neither caused by or causing
the generation of worms. The symptoms of this fever, however, have led
and continue to lead very many astray. This is not surprising, since
they so closely resemble those which characterise the presence of
worms, that an unprofessional person is almost sure to be misled by
them. Amongst other symptoms, there is the picking of the nose and
lips, offensive breath, occasional vomiting, deranged bowels, pain in
the head and belly, with a tumid and swollen condition of the latter, a
short dry cough, wasting of the flesh, etc.; symptoms continually
attendant upon the disorder now under consideration. These cases have
hitherto been perpetually looked upon by mothers as worm-cases, and
after having been treated by them as such, by the use of the popular
worm-powders of the day, have, as perpetually, presented themselves to
the physician greatly and grievously aggravated by such injudicious
treatment. It is folly, at any time, for an unprofessional person to
prescribe for a case where worms are actually known to exist: surely
where there is any doubt upon the latter point it must be greater folly
still.
The infant at the breast is seldom, if ever, the subject of this
disorder, whilst an artificial diet, or bringing up by hand,
predisposes to it. Worms most frequently occur, however, during
childhood; much more so at this epoch than in adult age. They do not
invariably occasion indisposition, for they are now and then passed
without pain or distress by children who are in the enjoyment of
perfect health, and in whom previously there was not the slightest
suspicion of their existence. The idea, formerly so prevalent, of their
being attended with danger, is without foundation; for unless the case
be mismanaged, they rarely give rise to serious consequences.