The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
The only measure that can save the life, and recover an infant from
this state, is that which would previously have prevented it a healthy
wet-nurse.
If the effects upon the infant should not be so aggravated as those
just described, and it subsequently live and thrive, there will be a
tendency in such a constitution to scrofula and consumption, to
manifest itself at some future period of life, undoubtedly acquired
from the parent, and dependent upon the impaired state of her health at
the time of its suckling. A wet-nurse early resorted to, will prevent
this.
It will be naturally asked, for how long a period a mother ought to
perform the office of a nurse? No specific time can be mentioned, and
the only way in which the question can be met is this: no woman, with
advantage to her own health, can suckle her infant beyond twelve or
eighteen months; and at various periods between the third and twelfth
month, many women will be obliged partially or entirely to resign the
office.[FN#4]
[FN#4] See "Weaning," p. 51.
The monthly periods generally reappear from the twelfth to the
fourteenth month from delivery; and when established, as the milk is
found invariably to diminish in quantity, and also to deteriorate in
quality, and the child is but imperfectly nourished, it is positively
necessary in such instances at once to wean it.
OF MOTHERS WHO OUGHT NEVER TO SUCKLE.
There are some females who ought never to undertake the office of
suckling, both on account of their own health, and also that of their
offspring.
THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the
infant born of such a parent there will be a constitutional
predisposition to the same disease; and, if it is nourished from her
system, this hereditary predisposition will be confirmed.
"No fact in medicine is better established than that which proves the
hereditary transmission from parents to children of a constitutional
liability to pulmonary disease, and especially to consumption; yet no
condition is less attended to in forming matrimonial engagements. The
children of scrofulous and consumptive parents are generally
precocious, and their minds being early matured, they engage early in
the business of life, and often enter the married state before their
bodily frame has had time to consolidate. For a few years every thing
seems to go on prosperously, and a numerous family gathers around them.
All at once, however, even while youth remains, their physical powers
begin to give way, and they drop prematurely into the grave, exhausted
by consumption, and leaving children behind them, destined, in all
probability, either to be cut off as they approach maturity, or to run
through the same delusive but fatal career as that of the parents from
whom they derived their existence."[FN#5] There is scarcely an
individual who reads these facts, to whom memory will not furnish some
sad and mournful example of their truth; though they perhaps may have
hitherto been in ignorance of the exciting cause.
[FN#5] Combe's Principles of Physiology applied to the Preservation of
Health, etc.
It is, however, with the mother as a nurse that I have now to do, and
I would earnestly advise every one of a consumptive or strumous habit
(and if there is any doubt upon this point, the opinion of a medical
adviser will at once decide it) never to suckle her offspring; her
constitution renders her unfit for the task. And, however painful it
may be to her mind at every confinement to debar herself this
delightful duty, she must recollect that it will be far better for her
own health, and infinitely more so for that of the child, that she
should not even attempt it; that her own health would be injured, and
her infant's, sooner or later, destroyed by it.
The infant of a consumptive parent, however, must not be brought up by
hand. It must have a young, healthy, and vigorous wet-nurse; and in
selecting a woman for this important duty very great care must be
observed.[FN#6] The child should be nursed until it is twelve or fifteen
months old. In some cases it will be right to continue it until the
first set of teeth have appeared, when it will be desirable that a
fresh wet-nurse should be obtained for the last six months.[FN#7] If
the child is partially fed during the latter months (from
necessity or any other cause), the food should be of the lightest
quality, and constitute but a small proportion of its nutriment.
[FN#6] See "Choice of a Wet-nurse," p. 28.
[FN#7] One that has been confined about six weeks or two months.
But not only must the nourishment of such a child be regarded, but the
air it breathes, and the exercise that is given to it; as also, the
careful removal of all functional derangements as they occur, by a
timely application to the medical attendant, and maintaining,
especially, a healthy condition of the digestive organs. All these
points must be strictly followed out, if any good is to be effected.
By a rigid attention to these measures the mother adopts the surest
antidote, indirectly, to overcome the constitutional predisposition to
that disease, the seeds of which, if not inherited from the parent,
are but too frequently developed in the infant during the period of
nursing; and, at the same time, she takes the best means to engender a
sound and healthy constitution in her child. This, surely, is worth any
sacrifice.
If the infant derives the disposition to a strumous constitution
entirely from the father, and the mother's health be unexceptionable,
then I would strongly advise her to suckle her own child.
THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There
are other women who ought never to become nurses. The mother of a
highly nervous temperament, who is alarmed at any accidental change she
may happen to notice in her infant's countenance, who is excited and
agitated by the ordinary occurrences of the day; such a parent will do
her offspring more harm than good by attempting to suckle it. Her milk
will be totally unfit for its nourishment: at one time it will be
deficient in quantity, at another, so depraved in its quality, that
serious disturbance to the infant's health, will ensue. The young and
inexperienced mother, who is a parent for the first time, and
altogether ignorant of the duties of her office, and at the same time
most anxious to fulfil them faithfully, is but too frequently an
instance in point; although at a future period she will generally make
a good nurse. The following is an illustration:--
In December, 1838, I attended a young married lady in her first
confinement, and in excellent health. She gave birth to a fine, plump,
healthy boy. Every thing went on well for three weeks, the mother
having an abundant supply of milk, and the infant evidently thriving
upon it. About this time, however, the child had frequent fits of
crying; the bowels became obstinately costive;--the motions being
lumpy, of a mixed colour, quite dry, and passed with great pain. It
became rapidly thin, and after a while its flesh so wasted, and became
so flabby, that it might be said literally to hang on the bones. The
fits of crying now increased in frequency and violence, coming on every
time after the little one left the breast, when it would commence
screaming violently, beat the air with its hands and feet, and nothing
that was done could appease it. Having lasted for half an hour or more,
it would fall asleep quite exhausted; the fit recurring again, when
again it had been to the breast.
It was very evident that the infant's hunger was not satisfied, as it
was also but too evident its body was not nourished by the parent's
milk, which, although abundant in quantity (the breast being large and
full of milk), was at this time seriously deteriorated in its nutritive
quality. This was caused, I believe, from great anxiety of mind. Her
nurse became suddenly deranged, and the whole responsibility and care
of the child thus devolved upon the mother, of the duties connected
with which she was entirely ignorant.
A wet-nurse was obtained. In a very few hours after this change was
effected, the screaming ceased, the child had quiet and refreshing
sleep, and in twelve hours a healthy motion was passed. The child
gained flesh almost as quickly as it had previously lost it, and is now
as fine and healthy an infant as it promised to be when born.
Whenever there has existed previously any nervous or mental affection
in the parent, wet-nurse suckling is always advisable; this, with
judicious management of childhood, will do much to counteract the
hereditary predisposition.
THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE
OUGHT NOT.--The mother who cannot make up her mind exclusively to
devote herself to the duties of a nurse, and give up all engagements
that would interfere with her health, and so with the formation of
healthy milk, and with the regular and stated periods of nursing her
infant, ought never to suckle. It is unnecessary to say why; but I
think it right, for the child's sake, to add, that if it does not
sicken, pine, and die, disease will be generated in its constitution,
to manifest itself at some future period.
The child, then, under all the foregoing circumstances, must be
provided with its support from another source, and a wet-nurse is the
best.
2. WET-NURSE SUCKLING.
Ill health and many other circumstances may prevent a parent from
suckling her child, and render a wet-nurse necessary. Now, although she
will do wisely to leave the choice of one to her medical attendant,
still, as some difficulty may attend this, and as most certainly the
mother herself ought to be acquainted with the principal points to
which his attention is directed in the selection of a good nurse, it
will be well to point out in what they consist.
CHOICE OF A WET-NURSE.
The first thing to which a medical man looks, is the general health of
the woman; next, the condition of her breast, the quality of her milk
its age and her own; whether she is ever unwell while nursing; and,
last of all, the condition and health of the child.
IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the
marks of a sound constitution, and ought to be free from all suspicion
of a strumous character; her tongue clean, and digestion good; her
teeth and gums sound and perfect; her skin free from eruption, and her
breath sweet.
WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and
well formed; its size not dependent upon a large quantity of fat, which
will generally take away from its firmness, giving it a flabby
appearance, but upon its glandular structure, which conveys to the
touch a knotted, irregular, and hard feel; and the nipple must be
perfect, of moderate size, but well developed.
WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish-
white colour; sweet to the taste; and when allowed to stand, should
throw up a considerable quantity of cream.
WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely
expired, the wet-nurse to be hired ought certainly not to have reached
her second month. At this time, the nearer the birth of the child, and
the delivery of its foster-parent, the better: the reason for which
is, that during the first few weeks the milk is thinner and more watery
than it afterwards becomes. If, consequently, a new-born infant be
provided with a nurse, who has been delivered three or four months, the
natural relation between its stomach and the quality of the milk is
destroyed, and the infant suffers from the oppression of food too heavy
for its digestive power.
On the other hand, if you are seeking a wet-nurse for an infant of
four or five months old, it would be very prejudicial to transfer the
child to a woman recently delivered; the milk would be too watery for
its support, and its health in consequence would give way.
THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from
twenty-one to thirty admits of no question. And the woman who has had
one or two children before is always to be preferred, as she will be
likely to have more milk, and may also be supposed to have acquired
some experience in the management of infants.
INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her
at once. You will have no difficulty in ascertaining this point; for
this class of persons have an idea that their milk is renewed, as they
term it, by this circumstance, monthly; and, therefore, that it is a
recommendation, rendering their milk fitter for younger children than
it would otherwise have been. It produces, however, quite a contrary
effect; it much impairs the milk, which will be found to disagree with
the child, rendering it at first fretful,--after a time being vomited
up, and productive of frequent watery dark green motions.
Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the
sprightly appearance of health, to bear the marks of being well
nourished, its flesh firm, its skin clean and free from eruptions. It
should be examined in this respect, particularly about the head, neck,
and gums.
If a medical man finds that both mother and child answer to the above
description, he has no hesitation in recommending the former as likely
to prove a good wet-nurse.
DIET AND REGIMEN OF A WET-NURSE.
The regimen of a wet-nurse should not differ much from that to which
she has been accustomed; and any change which it may be necessary to
make in it should be gradual. It is erroneous to suppose that women
when nursing require to be much more highly fed than at other times: a
good nurse does not need this, and a bad one will not be the better for
it. The quantity which many nurses eat and drink, and the indolent life
which they too often lead, have the effect of deranging their digestive
organs, and frequently induce a state of febrile excitement, which
always diminishes, and even sometimes altogether disperses, the milk.
It will be necessary then to guard against the nurse overloading her
stomach with a mass of indigestible food and drink. She should live as
much as possible in the manner to which she has been accustomed; she
should have a wholesome, mixed, animal and vegetable diet, and a
moderate and somewhat extra quantity of malt liquor, provided it agree
with her system.
A very prevailing notion exists that porter tends to produce a great
flow of milk, and in consequence the wet-nurse is allowed as much as
she likes; a large quantity is in this way taken, and after a short
time so much febrile action excited in the system, that instead of
increasing the flow of milk, it diminishes it greatly. Some parents,
however, aware of this fact, will go into an opposite extreme, and
refuse the nurse even that which is necessary. Either excess is of
course wrong. It is difficult in general terms to say what ought to be
considered a proper daily allowance, but some is in general necessary;
and whenever a woman has been used to drink malt-liquor, she will
rarely make a good wet-nurse if she is denied a reasonable quantity of
that beverage. Good sound ale sometimes agrees better than porter. It
may be well here to remark, that in London, I frequently meet with
severe cases of diarrhoea in infants at the breast, fairly traceable to
bad porter, which vitiating the quality of the milk, no medical
treatment cures the disease, until this beverage is left off or
changed, when it at once disappears.
The nurse should take exercise daily in the open air. Nothing tends
more directly to maintain a good supply of healthy milk, than air and
exercise; and the best wet-nurse would soon lose her milk, if
constantly kept within doors. Sponging the whole body also with cold
water with bay-salt in it every morning, should be insisted upon, if
possible: it preserves cleanliness, and greatly invigorates the health.
United with this, the nurse should rise early, and also be regularly
employed during the day in some little portion of duty in the family, an
attendance upon the wants of the child not being alone sufficient.
An amiable disposition and good temper are very desirable. A violent
fit of passion may exert so peculiar an influence in changing the
natural properties of the milk, that a child has been known to be
attacked with a fit of convulsions after being suckled by a nurse while
labouring under the effects of a fit of anger. The depressing passions
frequently drive the milk away altogether. It is hence of no small
moment, that a wet-nurse be of a quiet and even temper, and not
disposed to mental disturbance.
3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.
Extreme delicacy of constitution, diseased condition of the frame,
defective secretion of milk, and other causes, may forbid the mother
suckling her child; and unless she can perform this office with safety
to herself, and benefit to her infant, she ought not to attempt it. In
this case a young and healthy wet-nurse is the best substitute; but
even this resource is not always attainable. Under these circumstances,
the child must be brought up on an artificial diet "by hand,"--as it is
popularly called.
To accomplish this with success requires the most careful attention on
the part of the parent, and at all times is attended with risk to the
life of the child; for although some children, thus reared, live and
have sound health, these are exceptions to the general rule, artificial
feeding being in most instances unsuccessful.
THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.
It should be as like the breast-milk as possible. This is obtained by
a mixture of cow's milk, water, and sugar, in the following
proportions:--
Fresh cow's milk, two thirds;
Boiling water, or thin barley water, one third;
Loaf sugar, a sufficient quantity to sweeten.
This is the best diet that can be used for the first six months, after
which some farinaceous food may be combined.
In early infancy, mothers are too much in the habit of giving thick
gruel, panada, biscuit-powder, and such matters, thinking that a diet
of a lighter kind will not nourish. This is a mistake; for these
preparations are much too solid; they overload the stomach, and cause
indigestion, flatulence, and griping. These create a necessity for
purgative medicines and carminatives, which again weaken digestion,
and, by unnatural irritation, perpetuate the evils which render them
necessary. Thus many infants are kept in a continual round of
repletion, indigestion, and purging, with the administration of
cordials and narcotics, who, if their diet were in quantity and quality
suited to their digestive powers, would need no aid from physic or
physicians.
In preparing this diet, it is highly important to obtain pure milk,
not previously skimmed, or mixed with water; and in warm weather just
taken from the cow. It should not be mixed with the water or sugar
until wanted, and not more made than will be taken by the child at the
time, for it must be prepared fresh at every meal. It is best not to
heat the milk over the fire, but let the water be in a boiling state
when mixed with it, and thus given to the infant tepid or lukewarm.
As the infant advances in age, the proportion of milk may be gradually
increased; this is necessary after the second month, when three parts
of milk to one of water may be allowed. But there must be no change in
the kind of diet if the health of the child is good, and its appearance
perceptibly improving. Nothing is more absurd than the notion, that in
early life children require a variety of food; only one kind of food is
prepared by nature, and it is impossible to transgress this law without
marked injury.
If cow's milk disagree with an infant--and this is sometimes
unfortunately the case, even from its birth ass's milk,--diluted with
one third its quantity of water, may be given as a substitute. I am now
attending a lady in her fourth confinement, who is unable, from defect
in her nipples, to suckle her children. The first child had a healthy
wet-nurse, and has grown a fine healthy lad. The second, a girl, was
unfortunate in her nurse, she being of a strumous and unhealthy
constitution, although to a casual observer bearing the appearance of
health. The child lived only three months, and the nurse died of a
rapid consumption shortly after. This discouraged the mother from
adopting wet-nurse suckling for the third child (a great error); and an
artificial diet of cow's milk was resorted to. The third day from
commencing this plan, flatulence, griping, purging, and vomiting came
on, one symptom quickly following the other; the child wasted, and on
the sixth day had several convulsive fits. The diet was immediately
changed for ass's milk, and in less than twelve hours the sickness and
purging ceased; the flatulence was relieved; the motions, from being
green, watery, and passed with great violence and pain, became of a
healthy consistence and colour, and the screaming ceased. The symptoms
did not return, the child thrived, very soon consuming regularly one
quart of the ass's milk daily, and is now a fine healthy girl two years
old. A fortnight since the parent was confined with a fourth child.
Cow's milk was given to it for two or three days (from the difficulty
of obtaining that of the ass), the same train of symptoms, precisely,
came on with which the third child had been affected, which again gave
way upon following up the same plan of diet--the substitution of the
ass's milk for that of the cow. The evident conclusion from this is,
that the breast-milk of a healthy woman is incomparably the most
suitable diet for the infant; but that, if she be not of a healthy
constitution, it may be destructive to the child; and that where this
cannot be obtained, and cow's milk is found to disagree, ass's milk may
sometimes be resorted to with the happiest results.[FN#8]
[FN#8] An infant will generally consume a quart, or a little more, of
ass's milk in the four and twenty hours; and as this quantity is
nearly as much as the animal will give, it is best to purchase an ass
for the express purpose. The foal must be separated from the mother,
and the forage of the latter carefully attended to, or the milk will
disagree with the child.
Sometimes the mother's breast, and every description of milk, is
rejected by the child; in which case recourse must be had to veal or
weak mutton broth, or beef tea, clear and free from fat, mixed with a
very small quantity of farinaceous food, carefully passed through a
sieve before it is poured into the sucking-bottle.
THE MODE OF ADMINISTERING IT.--There are two ways--by the spoon, and by
the nursing-bottle. The first ought never to be employed at this
period, inasmuch as the power of digestion in infants is very weak,
and their food is designed by nature to be taken very slowly into the
stomach, being procured from the breast by the act of sucking, in which
act a great quantity of saliva is secreted, and being poured into the
mouth, mixes with the milk, and is swallowed with it. This process of
nature, then, should be emulated as far as possible; and food (for this
purpose) should be imbibed by suction from a nursing-bottle: it is thus
obtained slowly, and the suction employed secures the mixture of a due
quantity of saliva, which has a highly important influence on digestion.
Too much care cannot be taken to keep the bottle perfectly sweet. For
this purpose there should always be two in the nursery, to be used
alternately; and, if any food remain after a meal, it must be emptied
out. The bottle must always be scalded out after use. The flat glass
nursing-bottle itself is too well known to need description; it may be
well, however, to say a word about the teat that covers its narrow
neck, and through which the infant sucks the food. If the artificial
or prepared cow's teat is made use of, it should be so attached to the
bottle that its extremity does not extend beyond its apex more than
half or three quarters of an inch; for if it projects more than this,
the child will get the sides of the teat so firmly pressed together
between its gums, that there will be no channel for the milk to flow
through. This remark applies equally to the teat made of soft wash-
leather, which many ladies prefer to that of the cow, and it is a good
substitute; but then a fresh piece of leather must be made use of
daily, otherwise the food will be tainted, and the child's bowels
deranged. It is also necessary that both of these, when used, should
have a small conical piece of sponge inclosed.
The most cleanly and convenient apparatus is a cork nipple, upon the
plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork,
being of a particularly fine texture, is supple and elastic, yielding
to the infant's lips while sucking, and is much more durable than the
teats ordinarily used.
[FN#9] Sold by Weiss et Son, 62. Strand,
Whatever kind of bottle or teat is used, however, it must never be
forgotten that cleanliness is absolutely essential to the success of
this plan of rearing children.