The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
To specific remedies for this disease it is scarcely necessary to
allude, after what has been advanced, except by way of warning. In the
simple form of the complaint such medicines are superfluous, or rather
some of them, from their violent properties, most dangerous; in the
complicated forms of the disease they are inadmissible.
The indiscriminate use of purgatives, also, a parent should avoid.
Bowel affections are not an infrequent attendant upon hooping-cough,
and always aggravate the primary disorder.
Of external applications all that need be said is this, that if they
are not violently stimulating they do no harm; if, however, they
contain tartar emetic, in addition to their doing no good to the
disease, they cause unnecessary suffering to the patient, and are
sometimes productive of dangerous and even fatal sores.
Sect. IX.--CROUP.
This disease is one of the most formidable of childhood; sudden
(generally) in its attacks, most active in its progress, and if not
met by a prompt and decided treatment, fatal in its termination. Hence
the paramount importance of parents being acquainted with the signs
which indicate its approach, that medical aid may be secured at the
very onset of the disease. Upon this early application of suitable
remedies every thing depends.
SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either
preceded for two or three days by the symptoms of a common cold,
accompanied with hoarseness and a rough cough; or it may attack with
the most alarming suddenness, during the night for instance, although
the child had been merry and well the previous evening.
Hoarseness, however, is the premonitory and important symptom of
croup; for although it is not every hoarseness that is followed by
this formidable malady, still this symptom rarely attends a common cold
in young children, and therefore always deserves when present the
serious attention of the mother, particularly if accompanied by a rough
cough.
The symptoms or signs of the approach of this disease have been ably
and graphically depicted by the late Dr. Cheyne,
"In the approach of an attack of croup, which almost always takes
place in the evening, probably of a day during which the child has been
exposed to the weather, and often after catarrhal symptoms have existed
for several days, he may be observed to be excited; in variable
spirits; more ready than usual to laugh or to cry; a little flushed;
occasionally coughing, the sound of the cough being rough, like that
which attends the catarrhal stage of the measles. More generally,
however, the patient has been for some time in bed and asleep before
the nature of the disease with which he is threatened is apparent;
then, perhaps without awaking, he gives a very unusual cough, well
known to any one who has witnessed an attack of the croup: it rings as
if the child had coughed through a brazen trumpet; it is truly a tussis
clangosa; it penetrates the walls and floors of the apartment, and
startles the experienced mother--'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; the cough is succeeded by a sonorous
inspiration, not unlike the kink in hooping-cough--a crowing noise, not
so shrill, but similar to the sound emitted by a chicken in the pip
(which in some parts of Scotland is called the roup, hence probably the
word croup); the breathing, hitherto inaudible and natural, now becomes
audible, and a little slower than common, as if the breath were forced
through a narrow tube; and this is more remarkable as the disease
advances," etc. etc.
It is unnecessary for me to add to the foregoing picture.
MATERNAL MANAGEMENT.--Having early obtained medical assistance attend
with the strictest obedience to the directions given. And in this
disease, more than any other, it is particularly important that the
mother should give her personal superintendence; for the activity of
the progress of the disease leaves no time to retrieve errors or atone
for neglect. The practitioner may be prompt and decided in the measures
he prescribes, but they will avail little, unless they are as promptly
and decidedly acted upon.
The parent will have her reward; for, if timely aid has been afforded,
and adequate means used, the event will be almost invariably favourable.
ITS PREVENTION.--Croup, when it has once attacked a child, is very
liable to recur at any period before the thirteenth or fourteenth year
of age. It may even do so several times, and after intervals of various
duration. It is very desirable, therefore, that a parent should be
acquainted with the means of prevention.
They consist simply in the following measures:--The careful protection
of the child from cold or damp weather, particularly the north-east
winds of spring following heavy rains. Croup is most prevalent in those
seasons which are cold and moist, or when the alternations of
temperature are sudden and remarkable. If the residence of the child is
favourable to the production of croup, (for instance, near a large body
of water, or in low damp spots,) he should, if possible, be removed to
a healthier situation. Sponging or the shower-bath, with cold water and
bay-salt, with considerable friction in drying the body, should be
commenced in summer, and employed every morning upon the child's rising
from bed. The clothing should be warm in the winter and spring, the
neck always covered, and flannel worn next the skin throughout the
year; but hot rooms, and much clothing when in bed, must be avoided.
The diet must be light and nourishing; no beer or stimulant given; and
the state of the bowels must be carefully watched.
The above precautions are of course particularly necessary to enforce
immediately after a recovery from an attack, for there is a great
tendency to relapse. If the attack takes place during the winter or
spring months, the invalid must be kept, until milder weather, in the
house, and in a room of an equable and moderately warm temperature. If
in the summer, change of air, as soon as it can be safely effected,
will be found very useful.
Sect. X.--WATER IN THE HEAD.
Water in the head is a formidable disease, and not unfrequent in its
occurrence. It is often destructive to life, and the instances are
numerous in which it has appeared again and again in the same family,
carrying off one child after another, as they have successively arrived
at the same age.
But notwithstanding its frequency and fearful character, a mother may
do much to overcome a constitutional predisposition to this disease,
and thus prevent its appearance; as also she may assist greatly in
promoting its cure, when it does occur. Hence it is most important that
a mother should be acquainted with the measures of prevention; and
also, when it does manifest itself, that clear and accurate information
should be possessed, upon what may be said to constitute the maternal
management of the disorder.
ITS PREVENTION.--Whenever there is found to exist in a family a
predisposition to this malady, one or more children having suffered
from it, a mother must make up her mind, and in the strictest sense of
the word, to be the guardian of the health of any child she may
subsequently give birth to. And not only during the period of infancy,
but during that of childhood also, must she continue the same careful
and vigilant superintendence.
The infant must be brought up on the breast, and if the mother is not
of a decidedly healthy and robust constitution, she must obtain a
wet-nurse possessing such qualifications. The breast-milk, and nothing
beside, must form the nutriment of the child for at least nine months;
and if the infant is delicate or strumous, it will be prudent to
continue it even six months longer. When the period arrives for the
substitution of artificial food, it must be carefully selected; it must
be appropriate to the advancing age of the child; nutritious and
unirritating. Good air and daily exercise, and the bath or sponging,
are of much importance; in short, all those general measures which have
a tendency to promote and maintain the tone and general health of the
system, and thus induce a vigorous and healthy constitution, and to
which reference has been so fully made in the first chapter of this
work, must be strictly regarded and followed out by the parent.
The condition of the digestive organs must be the mother's especial
care. Costiveness must be guarded against; and if at any time the
secretions from the bowels indicate the presence of derangement, the
medical attendant must be applied to, that appropriate remedies may
without delay be exhibited. Their disordered condition is frequently
productive of head-disease. Again and again have I clearly traced the
origin of the complaint, of which I am now writing, as more
immediately resulting from disorder of the digestive apparatus. To a
child thus predisposed to water in the head, the healthy state of these
organs is not only of first consequence, but any deviation from health
to be dreaded, to be immediately attended to, and guarded against in
future; and, as there is a great liability to these attacks at the time
of weaning, the above remarks especially apply to that period, when due
attention must be particularly paid to the plan of diet adopted.
During teething the mother must be especially watchful, for it is at
this time that the disease so commonly appears; the irritation produced
by this process being a frequent exciting cause. Every thing,
therefore, that will tend to allay excitement of the system, must be
strictly enforced, as well as all causes avoided, which would produce
derangement of the stomach and bowels. The head should be kept cool.
For this purpose it must be sponged night and morning throughout the
whole period of teething; a horse-hair pillow used in the cot; and
nothing but a light straw hat should be worn, except in winter, The
diet should be moderate, and carefully regulated after leaving the
breast, and the child should be as much as possible in the open air.
The mouth must be occasionally examined, and if the gums become hot or
distended, they must be scarified or lanced, as may be advised. If the
parent finds at any time an unusual heat about the head, the medical
man must be at once consulted; or if there is watchfulness or
indisposition to sleep at the proper periods, or frequent startings in
the sleep, irritability of temper, and much crying, danger should be
apprehended, and prompt and judicious means employed.
Eruptions about the head, or sores behind the ears, discharging more
or less, will sometimes make their appearance just before the cutting
of a tooth, and disappear after it is cut; or it will sometimes happen
that, if not interfered with, they will continue throughout the whole
period of dentition. Great caution should always be exercised in
reference to these eruptions in all children; and when there is a
predisposition to water in the head, it is dangerous to interfere with
them at all, except they run to such an extent as to become very
troublesome. The sudden healing of these cutaneous affections has again
and again been followed by head-disease. They are unsightly in the
eyes of a parent, but it must be recollected that they render the
situation of such children much more safe; and when teething is
completed they will generally disappear spontaneously; or, if they
should not, they will readily do so by proper medical treatment. I have
no doubt that many a child's life has been saved by the appearance and
continuance of these eruptions; and so sensible are medical men of the
benefit derived from them, that in individuals in whom they do not
appear, and in whose family there exists a predisposition to the
disease now under our consideration, an issue or seton, in the arm or
neck, has sometimes been made, and had a remarkable influence in
warding off this affection. Dr. Cheyne refers to the circumstance of
ten children in one family having died of this disease; the eleventh,
for whom this measure was employed, having been preserved.
Stimulants, throughout the whole period of infancy and childhood, and
of every description, must be prohibited. Children nursed by drunken
parents, and who have indulged in the use of spirituous liquors during
suckling, are never healthy; are the frequent subjects of convulsions,
and many of them die eventually of water in the head. The practice of
administering spirits to the child itself; a habit unfortunately not
very uncommon among the lower classes; produces a similar result.
Narcotics may operate in a like manner: they derange the whole system
when persevered in, particularly affecting the brain; promote disease;
and sometimes give rise to the one in question. This remark should be
borne in mind by the mother, as Godfrey's Cordial and other
preparations of opium are too often kept in the nursery, and secretly
given by unprincipled nurses to quiet a restless and sick child.
All causes of mental excitement should be carefully avoided, and
particularly the too early or excessive exercise of the intellectual
faculties. If the child be endowed with a precocious intellect, the
parent must restrain rather than encourage its exercise. Nothing is
more likely to light up this disease in a constitution predisposed to
it, than a premature exertion of the brain itself.
MATERNAL MANAGEMENT OF THE DISEASE.--The early detection of this
disease is of great importance. The chances that the medical treatment
will terminate successfully much depend upon the early and prompt
application of remedial means. The reason why these cases have so often
terminated fatally has arisen from the physician being consulted when
irremediable mischief had already taken place. It would be difficult,
however, to point out the signs of its approach in all its forms (for
this disease does not always commence in the same way, sometimes with
fever, etc.), still it most frequently occurs preceded by certain
striking and well-marked symptoms; and whenever the following are
noticed by the parent apprehensive of mischief, she should at once send
for her medical adviser:--watchfulness, or starting from sleep with a
cry of alarm; prolonged screaming without any obvious cause; moaning
and drowsiness; rolling the head from side to side on the nurse's
arm, or thrusting it back against the pillow; knitting the brows and
aversion from light, with heat of head, and constant carrying the
little hand up to it; half closing the eyelids, and frequent vomiting.
The chief and principal point in the maternal management (for it
includes every other) is promptly and faithfully to administer the
remedies prescribed by the medical attendant. A vigilant maternal
superintendence is more necessary in this than almost any other
disease; and it is highly desirable, therefore, that the mother should
have a day and night nurse--individuals upon whom she can depend. A
careful notice of symptoms and changes in the patient, in the intervals
of the medical man's visits, and a true and faithful report to him upon
his return, are of essential importance. A sleepy nurse will neglect
the application of the most important remedies, and necessarily give an
unfaithful report of symptoms; hours the most valuable to the child's
well-doing are thus lost, and the chances of saving its life worse than
problematical.
The temperature of the room should be kept rather cool than warm, and
the bed-clothes only sufficient to preserve the natural heat of the
body. Strong light must be excluded. Great quiet should be observed.
Freedom from all excitement of the senses, and irritation of the
temper, should be carefully avoided: this is particularly necessary
where the child is naturally of a quick and sensitive disposition.
All the excretions must be put aside for the inspection of the
physician, but not kept in the sick chamber, which must be well aired,
and perfectly free from closeness. The regimen must be only such as is
ordered, and any departure therefrom will be attended with mischievous
consequences. During the early periods of the disease, all that is
required are cooling diluents, given frequently, and in small
quantities at a time; and upon approaching convalescence great
carefulness must be paid to the amount of nourishment allowed, lest the
disease be rekindled: strict compliance, therefore, to medical
directions must be given.
A very useful and indeed powerful remedy prescribed in this disease,
is sometimes rendered utterly useless from a want of a persevering and
also proper mode of applying it, viz. cold applications to the head.
It is to be effected either by means of cloths kept constantly wet with
cold water, or evaporating lotions; or by means of a bladder containing
pounded ice mixed with water. If the two former are employed they
require frequent renewal, or they become dry, hot, and more injurious
than useful; and whichever is used, it must be kept in constant contact
with the forehead, temples, and upper part of the head. Here is another
error; they are seldom used large enough, and only partially cover
these parts. With the further view of keeping the head cool, and
preventing the accumulation of heat, a flat horse-hair pillow should be
employed, and the head and shoulders somewhat raised.
Perseverance in the measures prescribed, even when the case appears
beyond all hope, must ever be the rule of conduct. Recovery, even in
the most advanced periods of the disease, in cases apparently
desperate, occasionally takes place. There is great reason to fear that
many a child has been lost from a want of proper energy and
perseverance on the part of the attendants in the sick room. They fancy
the case is hopeless, and, to use their own expression, "they will not
torment the child with medicine or remedies any longer."
"Whilst there is life, there is hope," is a sentiment which may with
great truth be applied to all the diseases of infancy and childhood.
Striking, indeed, are the recoveries which occasionally present
themselves to the notice of medical men; and those individuals may with
great justice be charged with unpardonable neglect who do not persevere
in the employment of the remedies prescribed, even up to the last hours
of the child's existence.
INDEX.
Ablution, or sponging, 125.
Abstinence, its good effect, in flatulence and griping in the infant,
50. 226.
Accidents and diseases which may occur to the infant at birth or soon
after, 187.
Acids, injurious to the teeth, 159.
Air and exercise, in infancy, 83.
--, in childhood, 89.
--, its importance to the mother whilst a nurse, 33.
Animal food, in childhood, 55.
--, its injurious effects upon the young and delicate child, 58.
Aperient liniment, 107.
--, medicine, 97.
--, poultice, 104.
Artificial feeding; the causes rendering it necessary, 34.
Artificial food; the proper kind for the child before the sixth
month, 35.
--; the mode of administering it, 39.
--; the quantity to be given at each meal, 42.
--; the frequency of giving it, 43.
--; the posture of the child when fed, 43.
--; the proper kind for the child after the sixth month, to the
completion of first dentition, 44.
--; the kind most suitable under the different complaints to which
infants are liable, 48.
Bath, the cold-water, plunge-bath, 118.
--, the shower, 123.
--, the warm, 128.
--, rules for the use of the warm bath, 131.
Bathing, sea, 120.
--, and cleanliness, during infancy, 72.
--, during childhood, 75.
Bleeding, from leech-bites, how controlled, 113.
--, from the navel string, 201.
--, navel, 203.
Blisters, mode of application, 114.
Bottle, nursing, 40.
Bowels, disorder of, in the infant, 208.
Breasts of the infant, swelling of, 195.
Breathing, how affected by disease, 175.
Calomel, danger in its use, 167.
--, injurious to the teeth, 160.
Carminative, Dalby's, 111.
Carriage, "a good carriage;" how best obtained, 95.
--; the sad results of the mode frequently adopted, 91.
Castor oil, 99.
Choice of a wet-nurse, rules for, 28.
Cleanliness and bathing, 72.
Clothing, in infancy, 78.
--, in childhood, 81.
Clysters, what kind best for children, 105.
--, mode of application, 106.
Cold, infants very susceptible of, 78.
Convulsions, 112, 167.
Cork-nipple teat, 41.
Costiveness, in infancy, 50. 229.
--, in childhood, 231.
Cough, as a sign of disease, 175.
Countenance, in health, 165.
Countenance, in disease, 165.
Croup, 176. 286.
Dalby's Carminative, 111.
Damp, induces disease in the infant, 85.
Dentition, easy, 136.
--, difficult, 139.
Diarrhoea, in the infant, 50. 227.
Dietetics of infancy, 2.
--, of childhood, 54.
--, general directions upon, and of animal food, 55.
--, sugar, 60.
--, salt, 61.
--, fruits, 62.
--, water, 63.
--, wine, beer, spirits, 63.
Diet, under the different complaints to which infants are liable, 48.
--, and regimen of a wet-nurse, 31.
Digestion, in the infant; time requisite for its performance, 42.
Discharge, from the eyes of the infant, 196.
Disease, the importance of its early detection, and hints upon, 162.
Dress, in infancy, 78.
--, in childhood, 81.
Enema. See Clysters.
Eruptions on the skin in infancy; how best prevented, 74.
--, about the head, and sores behind the ears, 295.
--, during teething, 147.
Exercise and air, in infancy, 85.
--, in childhood, 89.
--, horse-exercise; its importance to delicate children, 89.
Eyes, of the infant, discharge from, after birth, 196.
Fever, scarlet, 239.
Flannel clothing, 80.
Flatulence and griping in the infant, 50. 208. 226.
Food, for infants. See Artificial Feeding.
--, for children. See Dietetics of Childhood.
--, and regimen, for nurses, 31.
Fruits, 62.
Gestures, of the infant, in health and disease, 169.
Godfrey's cordial, 111.
Grief, its effects upon the mother's milk, 34.
Gums, of the infant in difficult dentition, the importance of their
being lanced, 140.
Hare-lip, how the infant may be nourished with this defect, 199.
Head, of the infant, swellings upon, when born, 193.
Hereditary transmission of scrofula and consumption; the best antidote
to, 20.
Hooping-cough, 275.
Horse-exercise, its importance to delicate children, 89.
Hunter's, Dr., experiments on the effects of wine upon children, 64.
Jaundice, in the infant after birth, 204.
Ice, how to be applied to the head, 127.
Indigestion, in the infant, 208.
Infant, food for. See Artificial Feeding.
--; when still-born, how to be managed, 187.
--; of injuries received during its birth, 193.
--; retention of its urine after its birth, 194.
--; swelling of the breasts after birth, 195.
--; discharge from the eyes, 196.
--; hare-lip, 199.
--; bleeding from the navel string, 201.
--; ulceration, or imperfect healing of the navel, 202.
Infant; bleeding from the navel, 203.
--, jaundice in, 204.
--, tongue-tied, 205.
--, moles and marks on the skin, 206.
Inflation of the lungs of the infant, the mode, 190.
Lavement, the proper kind for infants and children, 105.
Leech-bites; the mode of controlling the bleeding of, 113
Liniment, aperient, 107.
Looseness, 208.
Lungs of the infant, inflation of, 190.
Magnesia, 102.
Manna, 101.
Maternal nursing, 3.
--, management of the diseases of children, 184.
Measles, 258.
--, how distinguished from scarlet fever and small-pox, 255.
Medicine, aperient, 97.
Mercury, 107.
Milk, the mother's; how to be preserved healthy during suckling, 3.
--; deficiency of, 11.
--; drying up of, 54.
--, cow's; for infant's food, 35.
--, ass's; for infant's food, 37.
--, all kinds of, sometimes disagrees with the infant, 39.
Mind, anxiety of; effects upon the parent's milk, 24.
Moles and marks on the skin, 206.
Mothers, their duty in relation to suckling, 3.
--; those who ought never to suckle their children, 20. 24. 26.
Motions of the infant; what the appearance of, and how frequent, in
health, 99. 172.
--; their deranged condition, a sign of disease, 173.
Napkins, the infant's, 74.
Navel, bleeding from, 203.
--, ulceration or imperfect healing of, 202.
Navel-string, bleeding from, 201.
Naevi, or moles, 206.
Nurses, wet, rules for the choice of, 28.
--, diet and management of, 31.
Nursery medicines, 97.
Nursing, maternal, 3.
--; the plan to be adopted for the first six months, 7.
--; the plan to be followed after the sixth month to the time of
weaning, 9.
--; the injurious effects to the mother of undue and protracted
suckling, 15.
--; the injurious effects of undue and protracted suckling to the
infant, 18.
Opiates, 110. 297.
--, in teething, dangerous, 145.
Passion, its effect upon the breast-milk, 33.
Porter, of its use, by the mother during suckling, 1
--, when mischievous, 4.