Advice to a Mother on the Management of Her Children · Chapter 29On Disease, Etc. (5)
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Let me, again, urge you not to give aperients in these cases, or in any case, unless you are absolutely compelled. By following my advice you will save yourself an immense deal of trouble, and your child a long catalogue of misery. Again, I say, look well into the matter, and whenever it be practicable avoid purgatives.
Now, with regard to the best manner of returning the bowel, lay the child upon the bed on his face and bowels, with his hips a little raised; then smear lard on the forefinger of your right hand (taking care that the nail be cut close), and gently with, your fore-finger press the bowel into its proper place. Remember, if the above methods be observed, you cannot do the slightest injury to the bowel; and the sooner it be returned, the better it will be for the child; for if the bowel be allowed to remain long down, it may slough or mortify, and death may ensue. The nurse, every time he has a motion, must see that the bowel does not come down, and if it does, she ought instantly to return it. Moreover, the nurse should be careful not to allow the child to remain on his chair more than two or three minutes at a time.
Another excellent remedy for the protrusion of the lower bowel, is to use every morning a cold salt and water sitz bath. There need not be more than a depth of three inches of water in the bath; a small handful of table salt should be dissolved in the water; a dash of warm water in the winter time must be added, to take off the extreme chill; and the child ought not to be allowed to sit in the bath for more than one minute, or whilst the mother can count a hundred; taking care, the while, to throw either a square of flannel or a small shawl over his shoulders. The sitz bath ought to be continued for months, or until the complaint be removed. I cannot speak in too high praise of these baths.
252. Do you advise me, every spring and fall, to give my child brimstone to purify and sweeten his blood, and as a preventive medicine?
Certainly not; if you wish to take away his appetite, and to weaken and depress him, give brimstone! Brimstone is not a remedy fit for a child's stomach. The principal use and value of brimstone is as an external application in itch, and as an internal remedy, mixed with other laxatives, in piles—piles being a complaint of adults. In olden times poor unfortunate children were dosed, every spring and fall, with brimstone and treacle to sweeten their blood! Fortunately for the present race, there is not so much of that folly practised, but still there is room for improvement. To dose a healthy child with physic is the grossest absurdity. No, the less physic a delicate child has the better it will be for him, but physic to a healthy child is downright poison! And brimstone of all medicines! It is both weakening and depressing to the system, and by opening the pores of the skin and by relaxing the bowels, is likely to give cold, and thus to make a healthy, a sickly child. Sweeten his blood! It is more likely to weaken his blood, and thus to make his blood impure! Blood is not made pure by drugs, but by Nature's medicine; by exercise, by pure air, by wholesome diet, by sleep in a well-ventilated apartment, by regular and thorough ablution. Brimstone a preventive medicine! Preventive medicine—and brimstone especially in the guise of a preventive medicine—is "a mockery, a delusion, and a snare."
253. When a child is delicate, and his body, without any assignable cause, is gradually wasting away, and the stomach rejects all food that is taken, what plan can be adopted likely to support his strength, and thus probably be the means of saving his life?
I have seen, in such a case, great benefit to arise from half a tea-cupful of either strong mutton-broth or of strong beef-tea, used as an enema every four hours. [Footnote: An enema apparatus is an important requisite in every nursery; it may be procured of any respectable surgical instrument maker. The India-rubber Enema Bottle is, for a child's use, a great improvement on the old syringe, as it is not so likely to get out of order, and, moreover, is more easily used.] It should be administered slowly, in order that it may remain in the bowel. If the child be sinking, either a dessert-spoonful of brandy, or half a wine-glassful of port wine, ought to be added to each enema.
The above plan ought only to be adopted if there be no diarrhoea. If there be diarrhoea, an enema must not be used. Then, provided there be great wasting away, and extreme exhaustion, and other remedies having failed, it would be advisable to give, by the mouth, raw beef of the finest quality, which ought to be taken from the hip bone, and should be shredded very fine. All fat and skin must be carefully removed. One or two tea-spoonfuls (according to the age of the child) ought to be given every four hours. The giving of raw meat to children in exhaustive diseases, such as excessive long-standing diarrhoea, was introduced into practice by a Russian physician, a Professor Wiesse of St Petersburg. It certainly is, in these cases, a most valuable remedy, and has frequently been the means of snatching such patients from the jaws of death. Children usually take raw meat with avidity and with a relish.
254. If a child be naturally delicate, what plan would you recommend to strengthen him?
I should advise strict attention to the rules above mentioned, and change of air—more especially, if it be possible, to the coast. Change of air, sometimes, upon a delicate child, acts like magic, and may restore him to health when all other means have failed. If a girl be delicate, "carry her off to the farm, there to undergo the discipline of new milk, brown bread, early hours, no lessons, and romps in the hay-field."—Blackwood. This advice is, of course, equally applicable for a delicate boy, as delicate boys and delicate girls ought to be treated alike. Unfortunately in these very enlightened days there is too great a distinction made in the respective management and treatment of boys and girls.
The best medicines for a delicate child will be the wine of iron and cod-liver oil. Give them combined in the manner I shall advise when speaking of the treatment of Rickets.
In diseases of long standing, and that resist the usual remedies, there is nothing like change of air. Hippocrates, the father of medicine, says—
"In longis morbis solum mutare." (In tedious diseases to change the place of residence.)
A child who, in the winter, is always catching cold, whose life during half of the year is one continued catarrh, who is in consequence, likely, if he grow up at all, to grow up a confirmed invalid, ought, during the winter months, to seek another clime; and if the parents can afford the expense, they should at the beginning of October, cause him to bend his steps to the south of Europe—Mentone being as good a place as they could probably fix upon.
255. Do you approve of sea bathing for a delicate young child?
No: he is frequently so frightened by it that the alarm would do him more harm than the bathing would do him good. The better plan would be to have him every morning well sponged, especially his back and loins, with sea water; and to have him as much as possible carried on the beach, in order that he may inhale the sea breezes. When he be older, and is not frightened at being dipped, sea bathing will be very beneficial to him. If bathing is to do good, either to an adult or to a child, it must be anticipated with pleasure, and neither with dread nor with distaste.
256. What is the best method for administering medicine to a child?
If he be old enough, appeal to his reason; for, if a mother endeavour to deceive her child, and he detect her, he will for the future suspect her. If he be too young to be reasoned with, then, if he will not take his medicine, he must be compelled. Lay him across your knees, let both his hands and his nose be tightly held, and then, by means of the patent medicine-spoon, or, if that be not at hand, by either a tea or a dessert-spoon, pour the medicine down his throat, and he will be obliged to swallow it.
It may be said that this is a cruel procedure; but it is the only way to compel an unruly child to take physic, and is much less cruel than running the risk of his dying from the medicine not having been administered. [Footnote: If any of my medical brethren should perchance read these Conversations, I respectfully and earnestly recommend them to take more pains in making medicines for children pleasant and palatable. I am convinced that, in the generality of instances, provided a little more care and thought were bestowed on the subject, it may be done; and what an amount of both trouble and annoyance it would save! It is really painful to witness the struggles and cries of a child when nauseous medicine is to be given; the passion and excitement often do more harm than the medicine does good.]
257. Ought a sick child to be roused from his sleep to give him physic, when it is time for him to take it?
On no account, as sleep, being a natural restorative, must not be interfered with. A mother cannot be too particular in administering the medicine, at stated periods, whilst he is awake.
258. Have you any remarks to make on the management of a sick-room, and have you any directions to give on the nursing of a child?
In sickness select a large and lofty room; if in the town, the back of the house will be preferable—in order to keep the patient free from noise and bustle—as a sick-chamber cannot be kept too quiet. Be sure that there be a chimney in the room—as there ought to be in every room in the house—and that it be not stopped, as it will help to carry off the impure air of the apartment. Keep the chamber well ventilated, by, from time to time, opening the window. The air of the apartment cannot be too pure; therefore, let the evacuations from the bowels be instantly removed, either to a distant part of the house, or to an out-house or to the cellar, as it might be necessary to keep them for the medical man's inspection.
Before using either the night-commode, or the pot-de-chambre, let a little water, to the depth of one or two inches, be put in the pan, or pot; in order to sweeten the motion, and to prevent the faecal matter from adhering to the vessel.
Let there be frequent change of linen, as in sickness it is even more necessary than in health, more especially if the complaint be fever. In an attack of fever, clean sheets ought, every other day, to be put on the bed; clean body-linen every day. A frequent change of linen in sickness is most refreshing.
If the complaint be fever, a fire in the grate will not be necessary. Should it be a case either of inflammation of the lungs or of the chest, a small fire in the winter time is desirable, keeping the temperature of the room as nearly as possible at 60 degrees Fahrenheit. Bear in mind that a large fire in a sick-room cannot be too strongly condemned; for if there be fever—and there are scarcely any complaints without—a large fire only increases it. Small fires, in cases either of inflammation of the lungs or of the chest, in the winter time, encourage ventilation of the apartment, and thus carry off impure air. If it be summer time, of course fires would be improper. A thermometer is an indispensable requisite in a sick-room.
In fever, free and thorough ventilation is of vital importance, more especially in scarlet fever; then a patient cannot have too much air; in scarlet fever, for the first few days the windows, be it winter or summer, must to the widest extent be opened. The fear of the patient catching cold by doing so is one of the numerous prejudices and baseless fears that haunt the nursery, and the sooner it is exploded the better it will he for human life. The valances and bed-curtains ought to be removed, and there should be as little furniture in the room as possible.
If it be a case of measles, it will be necessary to adopt a different course; then the windows ought not to be opened, but the door must from time to time be left ajar. In a case of measles, if it be winter time, a small fire in the room will be necessary. In inflammation of the lungs or of the chest, the windows should not be opened, but the door ought occasionally to be left unfastened, in order to change the air and to make it pure. Remember, then, that ventilation, either by open window or by open door, is in all diseases most necessary. Ventilation is one of the best friends a doctor has.
In fever, do not load the bed with clothes; in the summer a sheet is sufficient, in winter a sheet and a blanket.
In fever, do not be afraid of allowing the patient plenty either of cold water or of cold toast and water; Nature will tell him when he has had enough. In measles, let the chill be taken off the toast and water.
In croup, have always ready a plentiful supply of hot water, in case a warm bath might he required.
In child-crowing, have always in the sick-room a supply of cold water, ready at a moment's notice to dash upon the face.
In fever, do not let the little patient lie on the lap; he will rest more comfortably on a horse-hair mattress in his crib or cot. If he have pain in the bowels, the lap is most agreeable to him; the warmth of the body, either of the mother or of the nurse, soothes him; besides, if he be on the lap, he can be turned on his stomach and on his bowels, which, often affords him great relief and comfort. If he be much emaciated, when he is nursed, place a pillow upon the lap and let him lie upon it.
In head affections, darken the room with a green calico blind; keep the chamber more than usually quiet; let what little talking is necessary be carried on in whispers, but the less of that the better; and in head affections, never allow smelling salts to be applied to the nose, as they only increase the flow of blood to the head, and consequently do harm.
It is often a good sign for a child, who is seriously ill, to suddenly become cross. It is then he begins to feel his weakness and to give vent to his feelings. "Children are almost always cross when recovering from an illness, however patient they may have been during its severest moments, and the phenomenon is not by any means confined to children."—Geo. McDonald.
A sick child must not be stuffed with much food at a time. He will take either a table-spoonful of new milk or a table-spoonful of chicken broth every half hour with greater advantage than a tea-cupful of either the one or the other every four hours, which large quantity would very probably be rejected from his stomach, and may cause the unfortunately treated child to die of starvation!
If a sick child be peevish, attract his attention either by a toy or by an ornament; if he be cross, win him over to good humour by love, affection, and caresses, but let it be done gently and without noise. Do not let visitors see him; they will only excite, distract, and irritate him, and help to consume the oxygen of the atmosphere, and thus rob the air of its exhilarating health-giving qualities and purity; a sick-room, therefore, is not a proper place, either for visitors or for gossips.
In selecting a sick-nurse, let her be gentle, patient, cheerful, quiet, and kind, but firm withal; she ought to be neither old nor young: if she be old she is often garrulous and prejudiced, and thinks too much of her trouble; if she he young, she is frequently thoughtless and noisy; therefore choose a middle-aged woman. Do not let there be in the sick-room more than, besides the mother, one efficient nurse; a greater number can he of no service—they will only be in each other's way, and will distract the patient.
Let stillness, especially if the head be the part affected, reign in a sick-room. Creaking shoes [Footnote: Nurses at these times ought to wear slippers, and not shoes. The best slippers in sick-rooms are those manufactured by the North British Rubber Company, Edinburgh; they enable nurses to walk in them about the room without causing the slightest noise; indeed, they might truly be called "the noiseless slipper," a great desideratum in such cases, more especially in all head affections of children. If the above slippers cannot readily be obtained, then list slippers—soles and all bring made of list—will answer the purpose equally as well.] and rustling silk dresses ought not to be worn in sick-chambers—they are quite out of place there. If the child be asleep, or if he be dozing, perfect stillness must he enjoined, not even a whisper should be heard:—
"In the sick-room be calm, More gently and with care. Lest any jar or sudden noise, Come sharply unaware.
You cannot tell the harm. The mischief it may bring, To wake the sick one suddenly, Besides the suffering.
The broken sleep excites Fresh pain, increased distress; The quiet slumber undisturb'd Soothes pain and restlessness.
Sleep is the gift of God: Oh! bear these words at heart, 'He giveth His beloved sleep,' And gently do thy part."
[Footnote: Household verses on Health and Happiness. London: Jarrold and Sons. A most delightful little volume.]
If there be other children, let them be removed to a distant part of the house; or, if the disease be of an infectious nature, let them be sent away from home altogether.
In all illnesses—and bear in mind the following is most important advice—a child must be encouraged to try and make water, whether he ask or not, at least four times during the twenty-four hours; and at any other time, if he express the slightest inclination to do so. I have known a little fellow to hold his water, to his great detriment, for twelve hours, because either the mother bad in her trouble forgotten to inquire, or the child himself was either too ill or too indolent to make the attempt.
See that the medical man's directions are, to the very letter, carried out. Do not fancy that you know better than he does, otherwise you have no business to employ him. Let him, then, have your implicit confidence and your exact obedience. What you may consider to be a trifling matter, may frequently be of the utmost importance, and may sometimes decide whether the case shall end either in life or death!
Lice.—It is not very poetical, as many of the grim facts of every-day life are not, but, unlike a great deal of poetry, it is unfortunately too true that after a severe and dangerous illness, especially after a bad attack of fever, a child's head frequently becomes infested with vermin—with lice. It therefore behoves a mother herself to thoroughly examine, by means of a fine-tooth comb, [Footnote: Which fine-tooth comb ought not to be used at any other time except for the purpose of examination, as the constant use of a fine-tooth comb would scratch the scalp, and would encourage a quantity of scurf to accumulate.] her child's head, in order to satisfy her mind that there be no vermin there. As soon as he be well enough, he ought to resume his regular ablutions—that is to say, that he must go again regularly into his tub, and have his head every morning thoroughly washed with soap and water. A mother ought to be particular in seeing that the nurse washes the hair-brush at least once every week; if she does not do so, the dirty brush which had during the illness been used, might contain the "nits"—the eggs of the lice—and would thus propagate the vermin, as they will, when on the head of the child, soon hatch. If there be already lice on the head, in addition to the regular washing every morning with the soap and water, and after the head has been thoroughly dried, let the hair be well and plentifully dressed with camphorated oil—the oil being allowed to remain on until the next washing on the following morning. Lice cannot live in oil (more especially if, as in camphorated oil, camphor be dissolved in it), and as the camphorated oil will not, in the slightest degree, injure the hair, it is the best application that can be used. But as soon as the vermin have disappeared, let the oil be discontinued, as the natural oil of the hair is, at other times, the only oil that is required on the head.
The "nit"—the egg of the louse—might be distinguished from scurf (although to the naked eye it is very much like it in appearance) by the former fastening firmly on one of the hairs as a barnacle would on a rock, and by it not being readily brushed off as scurf would, which latter (scurf) is always loose.
259. My child, in the summer time, is much tormented with fleas: what are the best remedies?
A small muslin bag, filled with camphor, placed in the cot or bed, will drive fleas away. Each flea-bite should, from time to time, be dressed by means of a camel's hair brush, with a drop or two of Spirit of Camphor; an ounce bottle of which ought, for the purpose, to be procured from a chemist. Camphor is also an excellent remedy to prevent bugs from biting. Bugs and fleas have a horror of camphor; and well they might, for it is death to them!
There is a famous remedy for the destruction of fleas manufactured in France, entitled "La Poudre Insecticide," which, although perfectly harmless to the human economy, is utterly destructive to fleas. Bugs are best destroyed either by Creosote or by oil of Turpentine: the places they do love to congregate in should be well saturated by means of a brush, with the creosote or with the oil of turpentine. A few dressings will effectually destroy both them and their young ones.
260. Is not the pulse a great sign either of health or of disease?
It is, and every mother should have a general idea of what the pulse of children of different ages should be both in health and in disease. "Every person should know how to ascertain the state of the pulse in health; then, by comparing it with what it is when he is ailing, he may have some idea of the urgency of his case. Parents should know the healthy pulse of each child, since now and then a person is born with a peculiarly slow or fast pulse, and the very case in hand may be of such peculiarity. An infant's pulse is 140, a child of seven about 80, and from 20 to 60 years it is 70 beats a minute, declining to 60 at fourscore. A healthful grown person beats 70 times in a minute, declining to 60 at fourscore. At 60, if the pulse always exceeds 70, there is a disease; the machine working itself out, there is a fever or inflammation somewhere, and the body is feeding on itself, as in consumption, when the pulse is quick."
261. Suppose a child to have had an attack either of inflammation of the lungs or of bronchitis, and to be much predisposed to a return: what precautions would you take to prevent either the one or the other for the future?
I would recommend him to wear fine flannel instead of lawn shirts; to wear good lamb's-wool stockings above the knees, and good, strong, dry shoes to his feet; to live, weather permitting, a great part of every day in the open air; to strengthen his system by good nourishing food—by an abundance of both milk and meat (the former especially); to send him, in the autumn, for a couple of months, to the sea-side; to administer to him, from time to time, cod-liver oil; in short, to think only of his health, and to let learning, until he be stronger, be left alone. I also advise either table salt or bay salt, or Tidman's Sea Salt, to be added to the water in which the child is washed with in the morning, in a similar manner as recommended in answer to a previous question.
262. Then do you not advise such a child to be confined within doors?
If any inflammation be present, or if he have but just recovered from one, it would be improper to send him into the open air, but not otherwise, as the fresh air would be a likely means of strengthening the lungs, and thereby of preventing an attack of inflammation for the future. Besides, the more a child is coddled within doors, the more likely will he be to catch cold, and to renew the inflammation. If the weather be cold, yet neither wet nor damp, he ought to be sent out, but let him be well clothed; and the nurse should have strict injunctions not to stand about entries or in any draughts—indeed, not to stand about at all, but to keep walking about all the time she is in the open air. Unless you have a trustworthy nurse, it will be well for you either to accompany her in her walk with your child, or merely to allow her to walk with him in the garden, as you can then keep your eye upon both of them.
263. If a child be either chicken-breasted, or if he be narrow-chested, are there any means of expanding and of strengthening his chest?
Learning ought to be put out of the question, attention must be paid to his health alone, or consumption will probably mark him as its own! Let him live as much as possible in the open air; if it be country, so much the better. Let him rise early in the morning, and let him go to bed betimes; and if he be old enough to use the dumb-bells, or what is better, an India-rubber chest-expander, he should do so daily. He ought also to be encouraged to use two short sticks, similar to, but heavier than, a policeman's staff, and to go, every morning, through regular exercises with them. As soon as he is old enough, let him have lessons from a drill-sergeant and from a dancing master. Let him be made both to walk and to sit upright, and let him be kept as much as possible upon a milk diet, [Footnote: Where milk does not agree, it may generally be made to do so by the addition of one part of lime water to seven parts of new milk. Moreover, the lime will be of service in hardening his bones, and, in these cases, the bones require hardening.] and give him as much as he can eat of fresh meat every day. Cod liver oil, a tea-spoonful or a dessert-spoonful, according to his age, twice a day, is serviceable in these cases. Stimulants ought to be carefully avoided. In short, let every means be used to nourish, to strengthen, and invigorate the system, without, at the same time, creating fever. Such a child should be a child of nature, he ought almost to live in the open air, and throw his books to the winds. Of what use is learning without health? In such a case as this you cannot have both.
264. If a child be round-shouldered, or if either of his shoulder-blades have "grown out," what had better be done?
Many children have either round shoulders, or have their shoulder blades grown out, or have their spines twisted, from growing too fast, from being allowed to slouch in their gait, and from not having sufficient nourishing food, such as meat and milk, to support them while the rapid growth of childhood is going on.
If your child be affected as above described, nourish him well on milk and on farinaceous food, and on meat once a day, but let milk be his staple diet; he ought, during the twenty four hours, to take two or three pints of new milk. He should almost live in the open air, and must have plenty of play. If you can so contrive it, let him live in the country. When tired, let him lie, for half an hour, two or three times daily, flat on his back on the carpet. Let him rest at night on a horse-hair mattress, and not on a feather bed.