The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
If, however, a child is delicate and strumous, and too feeble to take
sufficient exercise on foot,--and to such a constitution the respiration
of a pure air and exercise are indispensable for the improvement of
health, and without them all other efforts will fail,--riding on a
donkey or pony forms the best substitute. This kind of exercise will
always be found of infinite service to delicate children; it amuses the
mind, and exercises the muscles of the whole body, and yet in so
gentle a manner as to induce little fatigue.
The exercises of horseback, however, are most particularly useful
where there is a tendency in the constitution to pulmonary consumption,
either from hereditary or accidental causes. It is here beneficial, as
well through its influence on the general health, as more directly on
the lungs themselves. There can be no doubt that the lungs, like the
muscles of the body, acquire power and health of function by exercise.
Now during a ride this is obtained, and without much fatigue to the
body. The free and equable expansion of the lungs by full inspiration,
necessarily takes place; this maintains their healthy structure, by
keeping all the air-passages open and pervious; it prevents congestion
in the pulmonary circulation, and at the same time provides more
completely for the necessary chemical action on the blood, by changing,
at each act of respiration, a sufficient proportion of the whole air
contained in the lungs,--all objects of great importance, and all
capable of being promoted, more or less, by the means in question.
And be it remembered that these remarks apply with equal force to the
girl as to the boy. She should be allowed, and even encouraged, to take
the same active exercise. Fortunately, this course is followed during
childhood; not so, unfortunately (in the majority of cases, at least),
after this period. Young females are then subjected to those unnatural
restraints, both in exercise and dress, which fashion and vanity
impose, to be followed by effects which, though not immediately
obvious, are capable of laying the foundation of evils that cannot
afterwards be remedied.
A good carriage is the point aimed at (and to which I particularly
refer), and the means adopted for its cultivation fail, after all, in
their end, just in proportion to their rigid employment. For this
purpose the head is kept erect, and the shoulders drawn back, and they
are to be kept in this position not for an hour or so, but continually.
To preserve, however, this unnatural and constrained position, requires
considerable muscular powers, such as no girl can exercise without
long, painful, and injurious training; nor even by this, unless other
measures be resorted to in aid of her direct endeavours. For instead of
the muscles obtaining increased power and strength by these efforts (to
enforce a good carriage), they are enfeebled, and soon become more and
more incapable of performing what is required of them. This fact soon
becomes perceptible; weakness is noticed; but instead of correcting
this by the only rational mode, that of invigorating the weakened
muscles, mechanical aid is called in to support them, and laced
waistcoats are resorted to. These undoubtedly give support--nay, they
may be so used as almost wholly to supersede the muscular efforts, with
the advantage of not tiring, however long or continuously employed.
Improvement of carriage is manifested, the child is sensible of relief
from a painful exertion, the mother is pleased with the success of her
management, and this success appears to superficial observation fully
to confirm the judgment which superintends it. Yet what are the
consequences to which her measures tend, and which such measures are
daily and hourly producing? The muscles of the back and chest,
restrained in their natural and healthful exercise by the waistcoat
called in to aid them, and more signally, in after-life, by the tightly-
laced stays or corsets, become attenuated, and still further enfeebled,
until at length they are wholly dependent on the mechanical aid, being
quite incapable of dispensing with it for any continuance.
By and by a taper waist becomes an object of ambition, and the stays
are laced more closely than ever. This is still done gradually, and, at
first, imperceptibly to the parties. The effect, however, though slow,
is sure; and the powers of endurance thus exercised come in time to
bear, almost unconsciously, what, if suddenly or quickly attempted, no
heroism could possibly sustain. This increased pressure impedes the
motion of the ribs. For perfect respiration these motions should be
free and unrestrained, and perfect respiration is necessary to those
changes in the blood which fit it for nutrition, and the other purposes
of the animal frame. In proportion as respiration is impeded, is the
blood imperfectly vitalised, and in the same ratio are the nutrient and
other functions dependent on the blood inadequately performed. Here,
then, is one source of debility, which affects the whole frame,
reducing every part below the standard of healthful vigour. Quickened
respiration soon ensues, the heart becomes excited, the pulse
accelerated, and palpitation is in time superadded.
There are still further evils produced by tight lacing. For the
pressure being chiefly made on the lower part of the chest, the stomach
and liver are necessarily compressed, to the great disturbance of their
functions; and being pressed downwards too, these trespass on that
space which the other abdominal viscera require, superinducing still
further derangements. Thus almost every function of the body becomes
more or less impeded.
And again, the girl not being able always to have her body cased in
the tight-laced stays, some relaxation must take place. Under it the
muscles of the back, deprived of their accustomed support, and
incapable of themselves to sustain the incumbent weight, yield, and the
column of the spine bends, at first anteriorly, causing round shoulders
and an arched back; but eventually inclines to one or other side,
giving rise to the well-known and too frequently occurring state of
lateral curvature. This last change most frequently commences in the
sitting posture, such females being, through general debility, much
disposed to sedentary habits. Such, though but very slightly sketched,
are a few of the evils attending this baneful practice.
But how, then, is a good carriage to be obtained; which is not only
pleasing to the eye, but is, when natural, absolutely conducive itself
to health? To insure a good carriage, the only rational way is to give
the necessary power, especially to the muscles chiefly concerned; and
this is to be done, not by wearying those muscles by continual and
unrelieved exertion, but by invigorating the frame generally, and more
especially by strengthening the particular muscles through varied
exercise alternated with due repose. Attention to general health,
suitable diet, regular bowels, moderate but regular exercise, not of
particular muscles only, but of the whole frame, cold-bathing or
sponging, and other such measures, will maintain a good carriage, by
giving that power which the more direct means so generally practised
serve but to exhaust.[FN#18]
[FN#18] The above remarks on "good carriage" are almost wholly taken
from a valuable article of Dr. Barlow's, in the "Cyclopaedia of
Practical Medicine."
Chap. II.
ON THE USE AND ABUSE OF CERTAIN REMEDIES.
Sect. I.--APERIENT MEDICINE.
One of the greatest errors of the nursery is the too frequent and
indiscriminate exhibition by the mother or nurse of purgative medicine
to the infant. Various are the forms in which it is given; perhaps the
little powders obtained from the chemist is the most frequent, as it is
certainly the most injurious, form, their chief ingredient being
calomel.
The choice of the aperient, or the dose, or the exact condition of the
health of the infant, or whether it is an aperient at all that is
required, are points entirely overlooked: a little medicine is thought
necessary, because the child appears unwell, and a purgative, or a
little white powder, is forthwith given. The great art of
medicine is the proper application of the proper medicine, in the
proper dose, at the proper time; points never considered in the
nursery. For example, I have known a large dose of magnesia given by a
nurse to an infant, that had been suffering from a diarrhoea of some
days' standing, and very quickly cause death. Now, magnesia is one of
the most useful and harmless medicines that can be given to an infant
when indicated; when prescribed in a dose suited to its age, and when
the proper time is fixed upon for its exhibition; in the foregoing
case, however, every thing forbad its use, but none of these points
were considered.
Aperient medicine, too, is sometimes unwittingly repeated to remove
those symptoms which it has itself produced. Some incidental pain and
uneasiness, some slightly greenish appearance of the motions, leads the
mother to believe that more purging is necessary, when, in fact, both
circumstances have probably been induced by the irritation caused by
the purgatives already too freely administered. How frequently is this
the case, during the first week or ten days of the infant's life, when
the nurse doses the child with tea-spoonful after tea-spoonful of
castor oil, for the relief of pain, which her repeated doses of
medicine have alone created.
The bowels of an infant in health should be relieved two, three, or
four times in the twenty-four hours. The stools should be of the
consistence of thin mustard, and of a lightish yellow colour, having
little smell, free from lumps or white curdy matter, and passed without
pain, or any considerable quantity of wind. And a parent is only
justified in giving aperient medicine, when any deviation from these
conditions exists; and only then, when what may be called healthy
costiveness is present, viz. either the stools less frequent than they
ought to be, or lumpy and partially solid. Then, the only purgative
medicines that can be given with safely to an infant, without medical
sanction, are, castor oil, manna, rhubarb, and magnesia; the
application of the lavement, and the aperient liniment.
CASTOR OIL
This is one of the mildest aperients, prompt in its action, and
effective in clearing out the contents of the bowels; it is a
medicine, therefore, particularly applicable to infants.
During teething there is generally much torpor of the bowels; here,
then, castor oil is a very appropriate and useful artificial means of
increasing the frequency of the alvine discharges.
Then, again, no purgative can be so much relied on for overcoming
habitual costiveness as castor oil; it may for this purpose be given
daily for some weeks, gradually reducing the dose until only a few
drops be taken; after which the bowels generally continue to act
without further artificial assistance. Even its occasional
administration leaves the bowels in a relaxed state; a great advantage
over other purgatives, which generally cause, after their action is
passed off, a confined state.
The proper dose will depend upon the age, and the known effect of
aperient medicine upon the childsome requiring more, others less:
Under one year, one small tea-spoonful.
Under three years, two ditto.
Under six years, three ditto.
Under ten years and upwards, a table spoonful. The quantity being more
or less according to the facility with which the bowels are purged.
It may be given in various ways; poured upon a little mint water, or
blended with a little moist sugar;--or, if the stomach is unusually
delicate, the oil may be made into an emulsion with some aromatic
water, by the intervention of the yolk of an egg and a little syrup of
roses or sugar combined with it. The following proportions make an
elegant and not at all a disagreeable mixture, of which a desert-
spoonful (or more, according to the age,) may be repeated every hour
until it operate:
Castor oil, six drachms;
The yolk of an egg;
Mix well together, and add
Dill water, two ounces,
Syrup of roses, two drachms.
MANNA.
This also may be given with impunity to the youngest infant; it is
sweet to the taste, and mild in its operation. It should be exhibited
in doses of one to two drachms in a little warm milk; or if it cause
flatulence in this form, in some aromatic water, a desert spoonful of
carraway-seed or dill water. For children above two years, it must
always be given with some other aperient: thus, it may be combined with
castor oil by the medium of mucilage or the yolk of an egg; in fact, it
might be substituted for the syrup of roses in the previous
prescription for castor oil.
MAGNESIA AND RHUBARB.
Magnesia, besides being a laxative, allays irritability of the
stomach; it is consequently useful during dentition, at which period
there is both much irritability and a prevailing acescency of the
stomach. The dose is from five grains to ten for an infant, increasing
the quantity to fifteen grains or twenty to children of nine or ten
years of age. When taken alone the best vehicle is hot milk, which
greatly quickens its aperient operation. And whenever the bowels are
distended with wind, the pure magnesia is preferable to the carbonate.
It is well to mention here, that when the infant throws up the nurse's
milk it is generally curdled; a fact which leads the inexperienced
mother to infer that the child is suffering from acidity; and to
counteract the supposed evil magnesia is given again and again. This is
a useless and pernicious practice, for curdling or coagulation of the
milk always takes place in the stomach, and is produced by the gastric
juice, and is so far from being a morbid process, that milk cannot be
properly digested without it.
Rhubarb, it should always be recollected, has an astringent as well as
purgative property, according to the extent of the dose in which it is
administered; the former of which never opposes or interferes with the
energy of the latter, since it only takes effect when the substance is
administered in small doses, or, if given in larger ones, not until it
has ceased to operate as a cathartic. This latter circumstance renders
it particularly eligible in cases of diarrhoea, as it evacuates the
offending matter before it operates as an astringent upon the bowels.
As a purgative it operates mildly, and may be given to the youngest
infant; if from two to twelve months old, from three to six grains; for
children above that age, the dose may range from ten grains to twenty.
Its operation, however, is much quickened by the addition of magnesia;
both of which are more effective when thus united than when given
separately. The following form, in a costive and flatulent state of the
bowels, will be found useful[FN#19]; a tea-spoonful or more may be given
every three or four hours until the desired effect is obtained:--
Powdered rhubarb, half a drachm;
Magnesia, two scruples;
Compound spirits of ammonia, twenty drops;
Dill water, two ounces;
Simple syrup, two drachms.
[FN#19] This may be made up and kept in the nursery for a long time
without spoiling.
Rhubarb, mixed with flour and warm water, may be made into a poultice,
and applied to the abdomen of a child that obstinately refuses to
swallow medicine, and it will be found to produce the same effect as if
the medicine had been taken into the stomach; it will purge briskly.
THE LAVEMENT.
This is an excellent nursery remedy when the bowels are obstinately
costive. It may then be employed as a substitute for medicine, a
protracted and frequent use of which (even of the mildest aperients) is
apt to injure the digestive functions, and to give rise to some degree
of intestinal irritation. Lavements, however, like aperient medicine,
must not be resorted to for a long time together; for whilst the latter
irritate, the former most certainly tend, after a long continued use,
to debilitate the bowels, and thus render them less than ever disposed
to act for themselves. They are an excellent occasional remedy.
The simplest form of an aperient enema, is warm water; but barley-
water, or thin gruel, or even milk and water, are to be preferred at
all times, as they are of a more bland and less irritating nature. If
it be desirable to increase the strength of the injection, castor oil
may be added. The proportions of fluid which are necessary for the
different stages of life, under ordinary circumstances, maybe stated
as follows:--An infant at its birth requires about one fluid ounce; a
child between the age of one and five years, from three to four fluid
ounces; and a youth of ten or fifteen, from six to eight fluid ounces.
The mode of administering an injection to an infant deserves
particular attention, as injury might be caused by its being performed
in a careless or unskilful manner. A gum elastic pipe should be always
used instead of the hard ivory tube. Having smeared this over with
lard, and placed the infant on its left side, with its knees bent up in
the lap of the nurse, it is to be passed a couple of inches into the
bowel, in a direction not parallel to the axis of the body, but rather
inclined to the left. The latter circumstance should never be
neglected, for if not attended to, there will be difficulty in
administering the injection. The fluid must then be propelled very
gradually, or it will be instantly rejected; on the whole being thrown
up (the pipe carefully and slowly withdrawn), the child must be kept
quietly reposing on its nurse's lap, and in the same posture for some
little time.
THE APERIENT LINIMENT.
A liniment to be rubbed on the stomach is another resource in cases of
habitual costiveness, and will frequently be attended with great
success when repeated purgatives have been resisted.
Olive or castor oil may be used for this purpose; they must be warmed
and rubbed over the abdomen night and morning, for five or ten minutes.
Perhaps the best form of liniment that can be made use of is the
following:--
Compound soap liniment, one ounce;
Compound tincture of aloes, half an ounce.
Sect. II.--CALOMEL.
Calomel is one of the most useful medicines we possess; but though
powerful for good, it is by no means powerless for mischief, and pages
might be written upon the evil effects which have resulted from its
indiscriminate use in the nursery; medical men are daily and hourly
witnessing this fact. It is particularly eligible in the diseases of
children; but then it is quite impossible for unprofessional persons to
judge when it may be appropriately exhibited. And it cannot be too
generally known, that the effect of this medicine upon the evacuations
is always to make them appear unnatural. From ignorance of this fact,
calomel is often repeated again and again to relieve that very
condition which it has itself produced, causing, but too frequently, a
degree of irritation in the delicate lining membrane of the bowel,
which it may be very difficult for a medical man to remove, and perhaps
a source of misery to the child as long as it lives.
Its frequent exhibition has also another evil attending it, for "the
immoderate use of mercury in early infancy produces more, perhaps, than
any other similar cause, that universal tendency to decay, which, in
many instances, destroys almost every tooth at an early age."[FN#20]
[FN#20] Bell on the Teeth.
In the diseases of childhood it is often administered by the mother or
nurse with a degree of careless excess which ultimately, if not
immediately, produces severe and irremediable injury. I have met with
such cases; but Mr. Bell details a remarkable instance in point: "A
child, about three years of age, was brought to me, having a most
extensive ulceration in the gum of the lower jaw, by which the alveolar
process (that portion of the jaw which forms the sockets of the teeth)
was partially denuded. The account given by the mother was, that the
child had some time previously been the subject of measles, for which a
chemist, whom she consulted, gave her white powders, one of which was
ordered to be taken every four hours. It appears by the result, that
this must have been calomel; for, after taking it for two or three
days, profuse salivation was produced, with swollen tongue, inflamed
gums, etc., followed by ulceration of the gum, lips, and cheek. On
examining the denuded alveolar process, I found that a considerable
necrosis (death of the bone) had taken place, including the whole
anterior arch of the jaw from the first double tooth on the left side
to the eye-tooth on the right. By degrees the dead portion of bone was
raised, and became loose, when I found that the mischief was not
confined to the alveolar process, but comprised the whole substance of
the bone within the space just mentioned," etc. Surely the knowledge of
such a case as this would induce every prudent mother to exclude
calomel from her list of domestic nursery medicines.
Sect. III.--OPIATES.
This class of medicine is often kept in the nursery, in the forms of
laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's
cordial.
The object with which they are generally given is to allay pain by
producing sleep; they are, therefore, remedies of great convenience to
the nurse; and I am sorry to be obliged to add, that, so exhibited,
they are but too often fatal to the little patient.
The fact is, that in the hands of the physician, there is no medicine
the administration of which requires greater caution and judgment than
opiates, both from the susceptibility of infants to their narcotic
influence, and their varying capability of bearing it; the danger,
therefore, with which their use is fraught in the hands of a nurse
should for ever exclude them from the list of domestic nursery
medicines.
Dalby's carminative and Godfrey's cordial are, perhaps, more
frequently used than any other forms; and some striking cases,
illustrative of the fatal results of exhibiting them indiscriminately,
and without medical sanction, are on record.[FN#21] The late Dr.
Clark, in his "Commentaries," mentions a case which he saw, where
"forty drops of Dolly's carminative destroyed an infant." Dr. Merriman
gives the following in a note in Underwood, "On the Diseases of
Children:"--
[FN#21] Two or three fatal cases, and upon which coroners' inquests
were held, have occurred within the last two years.
"A woman, living near Fitzroy Square, thinking her child not quite
well, gave it a dose of Godfrey's cordial, which she purchased at a
chemist's in the neighbourhood. In a very short time after taking it
the child fell into convulsions, and soon died. In less than a month
the child of another woman in the same house was found to be ill with
disordered bowels. The first woman, not at all suspecting that the
Godfrey's cordial had produced the convulsions in her infant, persuaded
her friend to give the same medicine to her child. A dose from the same
bottle was given, and this child was likewise attacked almost
immediately with convulsions, and also died."
Convulsions and epilepsy, without such fatal results as the foregoing,
are not uncommon as the effect of a single dose of an opiate given
unadvisedly; and by their continued and habitual use (and the form of
syrup of poppies is but too often administered by an indiscreet and
lazy nurse, unknown by the parent), a low, irritative, febrile state is
produced, gradually followed by loss of flesh, the countenance becoming
pallid, sallow, and sunken, the eyes red and swollen, and the
expression stupid and heavy, and the powers of the constitution at last
becoming completely undermined. Such an object is to be seen daily
among the poorer classes,--the miniature of a sickly aged person: death
soon follows here.
Sect. IV.--LEECHING.
Difficulty sometimes arises in putting a stop to the bleeding from
leech-bites; a matter of considerable importance in the case of a
delicate infant. The following measures may be resorted to for this
purpose:--
1. Expose the surface of the part to the external air, so that a
coagulum of blood may form at the orifice: this simple mode will
frequently arrest it.
2. If this fail, make compression upon the part: this is one of the
most effectual means of restraining haemorrhage. It is to be effected
by taking a piece of lint folded three or four thicknesses, and the
size of the finger-nail, to be steadily pressed upon the open orifice
with the point of the finger until the blood has ceased to flow. The
pledget of lint, however, must not be removed for some hours
afterwards, or the bleeding will break out afresh.
3. If the compression fails in stopping the bleeding, or from the
situation of the leech-bites it cannot be adopted, because there is no
firm point of resistance upon which to make pressure, the part may be
dusted with starch or gum arabic powder, or, if this is of no avail,
the wound may be touched with lunar caustic.