The Maternal Management Of Children, In Health And Disease Part 8

Sect. III.--OPIATES.

This cla.s.s of medicine is often kept in the nursery, in the forms of laudanum, syrup of white poppies, Dalby's carminative, and G.o.dfrey'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 G.o.dfrey's cordial are, perhaps, more frequently used than any other forms; and some striking cases, ill.u.s.trative 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 G.o.dfrey'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 G.o.dfrey'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 const.i.tution at last becoming completely undermined. Such an object is to be seen daily among the poorer cla.s.ses,--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.

If none of these measures are successful, the a.s.sistance 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 quant.i.ty 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 quant.i.ty, 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 const.i.tute 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 circ.u.mstances, 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 const.i.tution,--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 circ.u.mstances. 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.