The Maternal Management Of Children, In Health And Disease Part 6

The material and quant.i.ty of the clothes should be such as to preserve a sufficient proportion of warmth to the body, regulated therefore by the season of the year, and the delicacy or strength of the infant's const.i.tution. In effecting this, however, the parent must guard against the too common practice of enveloping the child in innumerable folds of warm clothing, and keeping it constantly confined to very hot and close rooms; thus running into the opposite extreme to that to which I have just alluded: for nothing tends so much to enfeeble the const.i.tution, to induce disease, and render the skin highly susceptible to the impression of cold; and thus to produce those very ailments which it is the chief intention to guard against.

In their make they should be so arranged as to put no restrictions to the free movements of all parts of the child's body; and so loose and easy as to permit the insensible perspiration to have a free exit, instead of being confined to and absorbed by the clothes, and held in contact with the skin, till it gives rise to irritation.

In their quality they should be such as not to irritate the delicate skin of the child. In infancy, therefore, flannel is rather too rough, but is desirable as the child grows older, as it gives a gentle stimulus to the skin, and maintains health.

In its construction the dress should be so simple as to admit of being quickly put on, since dressing is irksome to the infant, causing it to cry, and exciting as much mental irritation as it is capable of feeling. Pins should be wholly dispensed with, their use being hazardous through the carelessness of nurses, and even through the ordinary movements of the infant itself.

The clothing must be changed daily.--It is eminently conducive to good health that a complete change of dress should be made every day. If this is not done, washing will, in a great measure, fail in its object, especially in insuring freedom from skin diseases.

IN CHILDHOOD.--The clothing of the child should possess the same properties as that of infancy. It should afford due warmth, be of such materials as do not irritate the skin, and so made as to occasion no unnatural constriction.

In reference to due warmth, it may be well again to repeat, that too little clothing (that state of semi-nudity which the vanity of some parents encourage) is frequently productive of the most sudden attacks of active disease; and that children who are thus exposed with naked b.r.e.a.s.t.s and thin clothing in a climate so variable as ours are the frequent subjects of croup, and other dangerous affections of the air- pa.s.sages and lungs. On the other hand, it must not be forgotten, that too warm clothing is a source of disease,--sometimes even of the same diseases which originate in exposure to cold,--and often renders the frame more susceptible of the impressions of cold, especially of cold air taken into the lungs. Regulate the clothing, then, according to the season; resume the winter dress early; lay it aside late; for it is in spring and autumn that the vicissitudes in our climate are greatest, and congestive and inflammatory complaints most common.

With regard to material (as was before observed), the skin will at this age bear flannel next to it; and it is now not only proper, but necessary. It may be put off with advantage during the night, and cotton maybe subst.i.tuted during the summer, the flannel being resumed early in the autumn. If from very great delicacy of const.i.tution it proves too irritating to the skin, fine fleecy hosiery will in general be easily endured, and will greatly conduce to the preservation of health.

It is highly important that the clothes of the boy should be so made that no restraints shall be put on the movements of the body or limbs, nor injurious pressure made on his waist or chest. All his muscles ought to have full liberty to act, as their free exercise promotes both their growth and activity, and thus insures the regularity and efficiency of the several functions to which these muscles are subservient.

The same remarks apply with equal force to the dress of the girl; and happily, during childhood, at least, no distinction is made in this matter between the s.e.xes. Not so, however, when the girl is about to emerge from this period of life; a system of dress is then adopted which has the most pernicious effects upon her health, and the development of the body, the employment of tight stays, which impede the free and full action of the respiratory organs, being only one of the many restrictions and injurious practices from which in latter years they are thus doomed to suffer so severely.

Sect. VII. AIR AND EXERCISE.

IN INFANCY.--The respiration of a pure air is at all times, and under all circ.u.mstances, indispensable to the health of the infant. The nursery therefore should be large, well ventilated, in an elevated part of the house, and so situated as to admit a free supply both of air and light. For the same reasons, the room in which the infant sleeps should be large, and the air frequently renewed; for nothing is so prejudicial to its health as sleeping in an impure and heated atmosphere. The practice, therefore, of drawing thick curtains closely round the bed is highly pernicious; they only answer a useful purpose when they defend the infant from any draught of cold air.

The proper time for taking the infant into the open air must, of course, be determined by the season of the year, and the state of the weather. "A delicate infant born late in the autumn will not generally derive advantage from being carried into the open air, in this climate, till the succeeding spring; and if the rooms in which he is kept are large, often changed, and well ventilated, he will not suffer from the confinement, while he will, most probably, escape catarrhal affections, which are so often the consequence of the injudicious exposure of infants to a cold and humid atmosphere."[FN#17] If, however, the child is strong and healthy, no opportunity should be lost of taking it into the open air at stated periods, experience daily proving that it has the most invigorating and vivifying influence upon the system. Regard, however, must always be had to the state of the weather; and to a damp condition of the atmosphere the infant should never be exposed, as it is one of the most powerful exciting causes of consumptive disease. The nurse-maid, too, should not be allowed to loiter and linger about, thus exposing the infant unnecessarily, and for an undue length of time; this is generally the source of all the evils which accrue from taking the babe into the open air.

[FN#17] Sir James Clark on Consumption.

Exercise, also, like air, is essentially important to the health of the infant. Its first exercise, of course, will be in the nurse's arms.

After a month or two, when it begins to sleep less during the day, it will delight to roll and kick about on the sofa: it will thus use its limbs freely; and this, with carrying out into the open air, is all the exercise it requires at this period. By and by, however, the child will make its first attempts to walk. Now it is important that none of the many plans which have been devised to teach a child to walk, should be adopted--the go-cart, leading-strings, etc.; their tendency is mischievous; and flatness of the chest, confined lungs, distorted spine, and deformed legs, are so many evils which often originate in such practices. This is explained by the fact of the bones in infancy being comparatively soft and pliable, and if prematurely subjected by these contrivances to carry the weight of the body, they yield just like an elastic stick bending under a weight, and as a natural consequence become curved and distorted.

It is highly necessary that the young and experienced mother should recollect this fact, for the early efforts of the little one to walk are naturally viewed by her with so much delight, that she will be apt to encourage and prolong its attempts, without any thought of the mischief which they may occasion; thus many a parent has had to mourn over the deformity which she has herself created.

It may be as well here to remark, that if such distortion is timely noticed, it is capable of correction, even after evident curvature has taken place. It is to be remedied by using those means that shall invigorate the frame, and promote the child's general health (a daily plunge into the cold bath, or sponging with cold salt water, will be found signally efficacious), and by avoiding the original cause of the distortion--never allowing the child to get upon his feet. The only way to accomplish the latter intention, is to put both the legs into a large stocking; this will effectually answer this purpose, while, at the same time, it does not prevent the free and full exercise of the muscles of the legs. After some months pursuing this plan, the limbs will be found no longer deformed, the bones to have acquired firmness and the muscles strength; and the child may be permitted to get upon his feet again without any hazard of perpetuating or renewing the evil.

The best mode of teaching a child to walk, is to let it teach itself, and this it will do readily enough. It will first crawl about: this exercises every muscle in the body, does not fatigue the child, throws no weight upon the bones, but imparts vigour and strength, and is thus highly useful. After a while, having the power, it will wish to do more: it will endeavour to lift itself upon its feet by the aid of a chair, and though it fail again and again in its attempts, it will still persevere until it accomplish it. By this it learns, first, to raise itself from the floor; and secondly, to stand, but not without keeping hold of the object on which it has seized. Next it will balance itself without holding, and will proudly and laughingly show that it can stand alone. Fearful, however, as yet of moving its limbs without support, it will seize a chair or anything else near it, when it will dare to advance as far as the limits of its support will permit. This little adventure will be repeated day after day with increased exultation; when, after numerous trials, he will feel confident of his power to balance himself, and he will run alone. Now time is required for this gradual self-teaching, during which the muscles and bones become strengthened; and when at last called upon to sustain the weight of the body, are fully capable of doing so.

IN CHILDHOOD.--When the child has acquired sufficient strength to take active exercise, he can scarcely be too much in the open air; the more he is habituated to this, the more capable will he be of bearing the vicissitudes of the climate. Children, too, should always be allowed to amuse themselves at pleasure, for they will generally take that kind and degree of exercise which is best calculated to promote the growth and development of the body. In the unrestrained indulgence of their youthful sports, every muscle of the body comes in for its share of active exercise; and free growth, vigour, and health are the result.

If, however, a child is delicate and strumous, and too feeble to take sufficient exercise on foot,--and to such a const.i.tution 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 subst.i.tute. 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 const.i.tution 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-pa.s.sages 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 trespa.s.s on that s.p.a.ce 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 inc.u.mbent 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 circ.u.mstances 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 pa.s.sed without pain, or any considerable quant.i.ty 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.