The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
If none of these measures are successful, the assistance of the
medical attendant must be obtained; and if firm pressure be made upon
the part, no serious loss of blood can ensue before his arrival.
Leeches should never be resorted to by a parent for any of the
diseases of infancy, without medical direction.
Sect. V.--BLISTERS AND POULTICES.
A blister should never be applied for any infantile disease, except
when ordered by a medical man, as its injudicious use might greatly
aggravate the complaint.
There are also one or two precautions in reference to the mode of the
application of a blister, which it is always right for a parent to
attend to. From the great irritability of the skin, it should never be
allowed to remain on longer than from two to four hours. At the
expiration of this time, the surface will usually become red and
inflamed; and, if the blister is removed, and the part dressed with
fresh spermaceti ointment spread on lint, or with a soft bread and
water poultice, a full blister will soon be raised: the little patient
is thus saved much suffering, and a very troublesome sore prevented. A
piece of tissue or silver paper, interposed between the blister and the
skin, will answer the same purpose; the blister will act well, and the
evils before alluded to will be prevented.
After a blister has been two or three hours applied, its edge should
be carefully raised, to ascertain the effect produced; and if the
surface be much inflamed, more particularly if little points of
vesication (watery bladders) are present, it should be removed, and the
above directions attended to.
Mustard poultices are invaluable in some of the diseases of infancy
and childhood, and therefore frequently ordered.
A mustard poultice is made by mixing two thirds of mustard flour and
one third of wheaten flour with warm water or vinegar, in sufficient
quantity to render the powder of the consistence of paste. It is then
spread on linen from the size of a half-crown to that of the palm of
the hand, according to the effect intended, and placed on the skin. How
long it is to be kept on will depend upon the individual sensibility of
the skin of the child; but, in general, from fifteen to twenty minutes
will be found amply sufficient. The application, however, must at all
times be carefully watched; for if it remain on too long, ulceration,
and death of the part, might ensue; therefore, directly the skin is
found tolerably red, the poultice should be removed. After its removal,
the part may be exposed, or, if very painful, smeared over with fresh
cream or common cerate.
A bread and water poultice, although one of the commonest applications
in use, is rarely well made or properly applied. It thus becomes
injurious rather than useful; adding to the inflammation or irritation
of the part, instead of soothing and allaying it. Nothing, however, is
more simple than the mode of its preparation.
Cut slices of stale bread of sufficient quantity, scald out a bason,
put the bread into it, pour upon it boiling water, cover it over, and
let it stand for ten minutes; next strain the water oft, gently squeeze
the saturated bread in a thin cloth, so that the poultice shall not be
too moist, and then spread it upon a cloth so that it shall be in
thickness half an inch, and of a size large enough to cover the whole
of the inflamed part, and a little more. Apply it just warm enough to
be borne, and cover it well with oiled silk. A poultice thus made, will
act as a local tepid bath to the inflamed part; and the oiled silk
preventing evaporation, it will be found, when taken off, as moist as
the first moment that it was put on.
Sect. VI.--BATHS.
Baths are much resorted to during infancy and childhood, both in
health and in disease. In the former state, they constitute an
important measure of hygeiene (this has been briefly alluded to under
the section "Bathing"), and in the latter, a valuable remedial agent.
Their indiscriminate use, however, might be followed by serious
consequences; it is therefore important to point out a few rules for
their judicious employment.
THE COLD WATER PLUNGE BATH.
It consists of water in its natural degree of heat; its temperature
varying, according to the season of the year or other circumstances,
from 30 degrees to 60 degrees.
The phenomena produced upon a strong and healthy boy plunging into
this bath will be as follows:--He will first experience a sensation of
cold, followed by slight shuddering, and, if the immersion has been
sudden, a peculiar impression in the nervous system, called a shock.
Almost immediately after the shock, the feeling of cold will vanish,
and give place to a sensation of warmth, speedily diffusing itself over
the whole frame. If the boy leaves the bath at this time, or, at all
events, before the warmth of the body goes off, and quickly dresses
himself, a renewal of the reaction which had followed the shock of
immersion will be experienced; he will be in a most delightful glow,--
there will be a general feeling of enjoyment, accompanied by a sensible
increase of animal power, and invigoration of the whole system. But, on
the other hand, if the boy greatly prolong his stay in the water, no
reaction will ensue, and he will become chilly, which will gradually
increase to a strong and general shivering;--his feet and legs will
become benumbed, and the whole body will soon be languid, exhausted,
and powerless. The same result will happen to the young and delicate
infant, if plunged into this bath; the same sensations will be
produced; except that here the shock is scarcely followed by any
reaction, and therefore from the first moment of the immersion, the
shivering and consequent train of sensations occur. This arises from
the infant at birth having less power of producing heat than when
further advanced in age.
From the foregoing remarks, then, it will be seen, that, in early
infancy, the cold bath is inadmissible, and water of a higher
temperature than that which feels cool to the hand of the nurse should
always be used at this age. But that, as the child grows older,--if of
a healthy and vigorous constitution,--the cold bath is unquestionably
most desirable; and, if used in a proper manner, will be found to act
as a most powerful tonic to the system. The summer is of course the
only period of the year when the cold plunging bath can be resorted to
for the child.
SEA BATHING.
When sea bathing can be obtained, it is even more conducive to the
health of the child than the fresh water plunge bath; for the sea water
is more tonic, stimulant, and bracing, than fresh. The period of the
year best adapted for sea bathing is the summer and autumn. The best
time of the day for bathing is two or three hours after breakfast;
except in very hot weather, when an earlier hour must be chosen.
Exercise is always useful previously to the bath; but it must be
gentle, so as not to induce fatigue or much perspiration, Then the bath
must be entered suddenly, with a plunge, inasmuch as an instantaneous
immersion produces a greater reaction than a gradual immersion.[FN#22]
The length of time of remaining in will depend upon circumstances. One
dip only is enough at the first bath. Subsequently the time of
remaining in the water may be prolonged, but this must be increased
gradually; the positive necessity of leaving the bath while there still
remains sufficient power of reaction being always kept in mind.
Exercise in the water, particularly that of swimming, is highly useful.
The body should be speedily and well dried, immediately upon coming
out; a rough jack towel is an excellent means of accomplishing this
purpose, while at the same time it insures considerable friction of the
surface of the skin. If the boy is in sound health, he may bathe daily.
[FN#22] It is a matter of importance in bathing children, that they
should not be terrified by the immersion, and every precaution should
be taken to prevent this.
As a remedy, sea bathing is highly serviceable. Its employment,
however, requires much caution, and great mischief is sometimes
committed by its indiscriminate use.
The child of a strumous habit may be greatly benefited by sea bathing,
united with a few years' residence on the coast. Indeed, by carefully
following up a course of sea bathing, a suitable diet, and a judicious
mode of living, the very temperament of the individual may be all but
changed, and a power and activity imparted to the system, productive
eventually of comparatively strong and robust health. A parent will do
wisely, therefore, to send a child of such a habit to a school on the
coast. Great caution, however, must be observed when bathing is
commenced, lest the shock be too powerful for the energies of the
system, and be not followed by the necessary degree of reaction. It
will be prudent to begin with the tepid bath (85 degrees to 92
degrees), and gradually reduce the temperature until the open sea can
be resorted to without fear. The measures already mentioned for
promoting reaction--exercise previous to immersion; the immersion at
first only momentary, and followed by strong friction--must be
diligently regarded in such a case.
In the child of a delicate and feeble habit, much out of health, whose
general debility is dependent on some organic disease, sea bathing is
not only improper, but dangerous. Instead of being strengthened, such a
child will be rendered more weak and debilitated. On the other hand,
when the child is of a weak and relaxed habit, but free from organic
disease, the cold bath will be highly useful, provided sufficient power
of reaction exist in the system. In this case the skin and flesh of the
child is relaxed and flabby; there is a great tendency to warm
perspirations in bed, capricious appetite, confined or relaxed bowels,
indisposition to exertion, and weariness from the slightest effort.
THE SHOWER BATH.
The effects of the shower bath are, on the whole, similar to those of
the plunge bath of the same degree of temperature, except that the
immediate shock of the shower bath is in general felt to be greater
than that from simple immersion. This, however, may be met by putting
warm water into the bottom of the bath in sufficient quantity to cover
the ankles of the individual taking the bath, which tends at once to
lessen the shock, and to increase the reaction.
The apprehension and alarm experienced by young children in entering
this kind of bath is easily overcome, by using at first a modification
of it, lately brought into use. It consists of a tin vessel in the form
of a large bottle, pierced at the bottom like a colander, and
terminating in the upper part in a narrow tube, with an open mouth.
When put into water it becomes filled, which is retained by closing the
mouth of the tube with the finger; on removing which the water flows
gradually out of the sieve-like bottom in a gentle shower. This may be
used to the youngest child. At first the quantity of water employed
should be small, and its temperature warm; as, however, the child grows
older and accustomed to the bath, the former may be increased, and the
latter lowered. Its tonic effect may be augmented by the addition
ofbay salt, and by much active rubbing.
As the child gets older the common form of shower bath may be used,
and throughout the year, if he enjoy robust health; during the winter
season, however, the water should be made tepid. This bath should be
taken immediately upon rising from bed.
ABLUTION, OR SPONGING.
By ablution is meant the process of applying water to the surface of
the body by means of a sponge or towel. It is one of the best
substitutes for the cold bath; and if done quickly and thoroughly,
produces a glow and invigoration of frame almost equal to the former.
It is also the surest preventive against catching cold.
Every child in health ought to be obliged, every morning of its life
(when other means of bathing cannot be obtained), upon rising, and
while the body still retains all the warmth of the bed, to sponge the
whole body. If too young to do it for himself, it must be done for him.
Salt or vinegar should be added to the water; and if the boy be robust,
cold water may be used throughout the year; if not, in the winter
season it must be made tepid.
As a remedy, cold water sponging, and the application of ice and iced
water, are often ordered under certain states of disease by the medical
attendant, and frequently followed by delightful results. But it is
necessary that they should be properly applied to do good.
Cold water sponging is a convenient and grateful method of moderating
febrile heat of the surface, provided undoubted powers of reaction be
present in the system. It is frequently ordered, therefore, to be
employed in eruptive fevers, as measles, scarlet fever, smallpox, and
other fevers; and also in some local inflammations, particularly of the
brain. Vinegar may be added to the water under these circumstances
with advantage. It should at first be used tepid or cool, but
afterwards cold. As a general rule, the more dry and parched the heat
of the surface, the more urgent the necessity for the application of
the cold, and the more frequently and fearlessly ought it to be
renewed,--every hour or half-hour not being too often. Should the child
fall asleep during the process, and begin to perspire, it must be
intermitted, but resumed again on a recurrence of the parching heat.
Ice and iced water are most frequently employed in affections of the
brain. The former is most conveniently applied in a well-cleaned pig's
bladder, which should be half filled with broken fragments of the ice.
The bladder prevents moisture about the clothes, and, from its smooth
and pliant nature, readily accommodates itself to every part of the
child's head. If iced water is used, care must be taken that the cloths
are sufficiently large to cover the whole of the head, and they should
be doubled to prevent their getting rapidly warm. Indeed, in applying
cold locally, as in inflammation of the brain, one rule it is of the
utmost importance to observe, viz. that the application of the cold
shall be continuous; therefore a second set of cold cloths or bags of
ice should be applied before the former has become warm. This plan,
especially pursued during the night, along with judicious internal
treatment, will save many children from perishing under the most
insidious and fatal disease of childhood--water on the brain.
If neither water of a sufficiently low temperature, nor ice, can be
procured, then recourse may be had to refrigerating mixtures, of which
the following is a good form:--
Common water, five pints;
Vinegar, two pints;
Nitre, eight ounces;
Sal ammoniac, four ounces.
THE WARM BATH.
The warm bath judiciously prescribed is one of the most valuable
remedial agents we possess; but although powerful for good, when
misapplied, it is equally powerful for mischief. For instance, in
active inflammatory affections, before the loss of blood, the use of
the warm bath would greatly aggravate the disease; and yet, for an
infant with active inflammation of the respiratory organs, it is
continually resorted to. Again, nothing is more common than for a
child, when attacked with convulsions, to be put immediately in the
warm bath; and, generally speaking, it is extremely beneficial in this
class of diseases; but it is sometimes no less prejudicial, when
applied without due examination of the peculiarities of individual
cases. For, in plethoric and gross children, the local abstraction of
blood from the head, and the complete unloading of the alimentary
canal, are often necessary to render such a measure beneficial, or even
free from danger. In convulsions, however, and particularly when
arising from teething, a parent may, without hesitation, at any time
immerse the feet of the infant in water as warm as can be borne, at the
same time that cloths wet with cold water are applied to the head and
temples.
As a preventive, where there is a tendency to disease, the warm bath
may be employed without scruple, and will be found most serviceable.
Its value in this point of view is very great, and it is to be
regretted that it is not sufficiently appreciated and used. For
example, a severe cold has been taken, and inflammation of the air-
tubes is threatened: only put the child into a warm bath, and, with the
common domestic remedies, a very serious attack may be warded off.
Again, in the commencement of a diarrhoea, a warm bath, and
discontinuing the cause of the attack, will alone suffice to cure; and,
more-over, in the protracted diarrhoea attendant upon teething, where,
after various remedies have been tried in vain, the child has lost
flesh and strength to an apparently hopeless degree, Recovery has been
brought about by the simple use of the warm bath.
In the treatment of scrofulous children, warm and tepid bathing is of
great value. In such cases, a course of warm sea bathing, with active
friction over the whole surface after each bath, will at once relieve
that abdominal fulness which is generally present, improve the
functions of the skin, and give tone and vigour to the whole system.
Towards the termination of such a course of baths, their temperature
must be gradually reduced till they become tepid (85 degrees to 92
degrees).
The opinion that warm baths generally relax is erroneous: they are, no
doubt, debilitating when used by persons of a weak and relaxed
constitution, or when continued too long; but, on the contrary, they
invariably give tone when employed in the cases to which they are
properly applicable.
A partial warm bath, such as the foot-bath, is of much service in
warding off many complaints. If a child get the feet wet, plunging them
into warm water will often prevent any ill consequences; and even when
the first chill and slight shiverings which usher in colds, fevers, and
other inflammatory complaints, have been complained of, the disease may
be cut short by the use of a foot-bath, continued till free
perspiration occurs.
RULES FOR THE USE OF THE WARM BATH.
TEMPERATURE OF THE WATER.--When the warm bath is used as a measure of
hygeiene, as a general rule, any degree of temperature may be chosen
between 92 degrees and 98 degrees, which appears to be most agreeable
to the child; but on no account must 98 degrees be exceeded. When
ordered as a remedial measure, the temperature will of course be fixed
by the medical attendant.
The same degree of temperature must be kept up during the whole period
of immersion. For this purpose the thermometer must be kept in the
bath, and additions of warm water made as the temperature is found to
decrease. These additions of warm water, however, must be regulated by
the indications of the thermometer, and not by the feelings of the
child.
PERIOD OF REMAINING IN THE BATH.--This must depend upon circumstances.
As a measure of hygeiene, it must be varied according to the age of the
child. For the first four or five weeks, the infant should not be kept
in beyond three or four minutes; and the duration must afterwards be
gradually prolonged as the child advances in age, until it extends to a
quarter of an hour, a period which may be allowed after it has attained
the age of four years.
When the bath is employed as a remedial agent, the time of immersion
must be prolonged; this will be determined by the medical adviser.
Speaking generally, a quarter of an hour may be said to be the shortest
period, an hour the longest, and half an hour the medium.
When in the bath, care must be taken that the child's body is immersed
up to the shoulders or neck, otherwise that part of the body which is
out of the bath (the shoulders, arms, and chest), being exposed to the
cooler temperature of the air, will be chilled.
When the infant or child is taken out of the bath, the general
surface, especially the feet, must be carefully rubbed dry with towels
previously warmed; and when one of the objects of the bath is to excite
much perspiration, the child should be immediately wrapped in flannel
and put to bed. When, however, the object is not to excite
perspiration, the child may be dressed in his ordinary clothing, but
should not be allowed to expose himself to the open air for at least an
hour.
TIME OF USING THE BATH.--When resorted to for sudden illness, the bath
must of course be employed at any time needed. When used for any
complaint of long standing, or a measure of hygeiene, as a general
rule, it should be taken between breakfast and dinner, about two hours
after the former, or an hour and a half before the latter. This implies
that the infant should never be put into the bath after having been
freely nourished at the breast. Neither should it ever be used when the
child is in a state of free perspiration from exercise, or on awaking
from sleep.
Chap. III.
OF TEETHING, AND HINTS ON THE PERMANENT OR ADULT TEETH.
The infant at birth has no teeth visible: the mouth is toothless. It
possesses, however, hidden in the jaw, the rudiments of two sets. The
first of these which makes its appearance, are called the Temporary or
Milk Teeth; the second, the Permanent or Adult Teeth, and these come up
as the former fall out, and so gradually replace them.
Sect. I.--ON TEETHING.
THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set
of teeth, or milk-teeth as they are called, are twenty in number; they
usually appear in pairs, and those of the lower jaw generally precede
the corresponding ones of the upper. The first of the milk-teeth is
generally cut about the sixth or seventh month, and the last of the set
at various periods from the twentieth to the thirtieth months. Thus the
whole period occupied by the first dentition may be estimated at from a
year and a half to two years. The process varies, however, in different
individuals, both as to its whole duration, and as to the periods and
order in which the teeth make their appearance. It is unnecessary,
however, to add more upon this point.
Their developement is a natural process. It is too frequently,
however, rendered a painful and difficult one, by errors in the
management of the regimen and health of the infant, previously to the
coming of the teeth, and during the process itself.
Thus, chiefly in consequence of injudicious management, it is made the
most critical period of childhood. Not that I believe the extent of
mortality fairly traceable to it, is by any means so great as has been
stated; for it is rated as high as one sixth of all the children who
undergo it. Still, no one doubts that first dentition is frequently a
period of great danger to the infant. It therefore becomes a very
important question to an anxious and affectionate mother, how the
dangers and difficulties of teething can in any degree be diminished,
or, if possible, altogether prevented. A few hints upon this subject,
then, may be useful. I shall consider, first, the management of the
infant, when teething is accomplished without difficulty;--and,
secondly, the management of the infant when it is attended with
difficulty.
MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.
In the child of a healthy constitution, which has been properly, that
is, naturally, fed, upon the milk of its mother alone, the symptoms
attending teething will be of the mildest kind, and the management of
the infant most simple and easy.
SYMPTOMS.--The symptoms of natural dentition (which this may be fairly
called) are, an increased flow of saliva, with swelling and heat of the
gums, and occasionally flushing of the cheeks. The child frequently
thrusts its fingers, or any thing within its grasp, into its mouth. Its
thirst is increased, and it takes the breast more frequently, though,
from the tender state of the gums, for shorter periods than usual. It
is fretful and restless; and sudden fits of crying and occasional
starting from sleep, with a slight tendency to vomiting, and even
looseness of the bowels, are not uncommon. Many of these symptoms often
precede the appearance of the tooth by several weeks, and indicate that
what is called "breeding the teeth" is going on. In such cases, the
symptoms disappear in a few days, to recur again when the tooth
approaches the surface of the gum.
TREATMENT.--The management of the infant in this case is very simple,
and seldom calls for the interference of the medical attendant. The
child ought to be much in the open air, and well exercised: the bowels
should be kept freely open with castor oil; and be always gently
relaxed at this time. Cold sponging employed daily, and the surface of
the body rubbed dry with as rough a flannel as the delicate skin of the
child will bear; friction being very useful. The breast should be given
often, but not for long at a time; the thirst will thus be allayed, the
gums kept moist and relaxed, and their irritation soothed, without the
stomach being overloaded. The mother must also carefully attend, at
this time, to her own health and diet, and avoid all stimulant food or
drinks.