The Mother's Manual of Children's Diseases Part 5

There are four different conditions in which it may be right to have the child's gums lanced:

First. When a tooth is very near the surface, and by cutting through the thin gum the child may be spared some needless suffering.

Second. When the gums are very red and hot and swollen; only in this case the gum is scratched or cut, to bleed it, not with the idea of letting out the imprisoned tooth.

Third. When the child has for some week or two been feverish and suffering; while, though the gum is tense and swollen, the tooth does not seem to advance.

Fourth. As an experiment, when during the progress of teething a child is suddenly seized with convulsions for which there is no obvious cause.

The irritation of the teeth may have to do with their occurrence; and the chance of relieving it by so simple a means is not to be thrown away.

If the process of teething is going on quite naturally, no interference, medical or other, is either necessary or proper. The special liability of children to illness at this time must indeed be borne in mind, and care must be taken not to make any alteration in the infant's food while it is actually cutting its teeth, but rather to choose the opportunity of some one of those pauses to which reference has been made, as occurring between the dates of appearance of the successive teeth, for making any such change. If the child is feverish, a little soda or seltzer water sweetened and given after the effervescence has subsided will be taken eagerly, and avoid the risk of putting the child too often to the breast, or giving it food too frequently. It seeks the one or the other because it is thirsty, and craves for moisture to relieve its hot mouth; not because it is hungry and needs nourishment. If the child has been weaned, still greater care will be required, for it will often be found that it is no longer able to digest its ordinary food, which either is at once rejected by the stomach, or else pa.s.ses through the intestines undigested. Very thin arrowroot made with water, with the addition of one third of milk, will suit in many cases, or equal parts of milk and water with isingla.s.s, or equal parts of milk and the white decoction. The bowels of course must be kept open with very simple and mild aperients, but the bowels are in general more inclined to diarrh[oe]a than to constipation, and the diarrh[oe]a of teething children is often troublesome and requires good medical advice.

The ulcerated state of the mouth is usually connected with special disorder of the digestive organs, and that condition of acidity for which I have already recommended soda, magnesia, and similar remedies, while locally the mouth needs just that local care which is applicable in cases of thrush. Now and then, severe inflammation of the gums occurs, in which they become extremely swollen; and ulceration takes place of the gum just above where the tooth should come through, and even around some of those which have already appeared. These are cases in which lancing the gums would do nothing but mischief. They require the local care already insisted on, a mild plan of diet, and treatment to reduce any feverishness; and above all one medicine, the chlorate of pota.s.s, which in doses of four grains every four hours for a child a year old, is almost a specific.

AFFECTIONS OF THE SKIN.--There are a few affections of the skin to which children in early infancy are especially liable, concerning which a few words must be said.

The Latin word _intertrigo_ is used for that _chafing_ of the skin of the lower part of the body of an infant which is by no means unusual, and is often very distressing. It is almost invariably due to want of care. Either wetted napkins are dried, and put on again without previous rinsing in water, or they have been washed in water containing soda, and not pa.s.sed through pure water afterwards, or attention is not paid to change the infant's napkin immediately that it requires; or a fresh napkin is put on without previous careful ablution of the child; or lastly it occurs almost unavoidably in cases of diarrh[oe]a from the extension of irritation beginning at the edge of the bowel.

Care is usually all that is needed to remove, as it is to prevent this condition. The precautions which I have referred to with regard to cleanliness must be carefully observed, and moreover, each time even after pa.s.sing water, the child should be carefully washed with thin gruel, or barley water, then dusted abundantly with starch powder, while the napkin must be thickly greased with zinc ointment. After the first six or seven months of life the napkin can be almost always dispensed with, if the child has been brought up in good habits, and in all cases of chafing, it is much the better way to put no napkin on the child when in bed, but to lay under it a folded towel, which can be removed, and a clean one subst.i.tuted for it as soon as it becomes soiled.

There is a very obstinate form of chafing, with great redness of the skin, and disposition to crack about the edge of the bowel which depends on const.i.tutional causes, and calls at once for the interference of the doctor.

Besides this purely local ailment, there is another skin affection which is seen over the body generally, and is known popularly by the name of _red gum_, or in Latin _strophulus_. I mention the Latin name because I have known persons sometimes, misled by the similarity of sound, fancy that it had some connection with scrofula. It is met with less commonly now than formerly, when people were accustomed to keep infants unduly wrapped up, and to be less careful than most are now-a-days about washing and bathing. It depends on over-irritation of the sweat glands of the delicate skin of the infant, the result of which shows itself in the eruption on the body and face of a number of small dry pimples sometimes surrounded by a little redness, itching considerably, and when their top has been rubbed off by scratching having a little speck of dried blood at their summit.

A rash like this, a sort of _nettle rash_, more blotchy and causing little lumps on the skin, which in a day or two come and go, sometimes appears in the intervals between the pimples, sometimes takes their place, and causes, as they do, much irritation. This nettle rash is usually dependent on some error of diet, on some acidity of the stomach, and, on their being corrected soon pa.s.ses away, leaving the pimples as they were before, but sometimes being reproduced if the pimples cause excessive irritation of the tender skin.

The matter of chief importance for a mother to know, is that these rashes have no serious signification. Their treatment is very simple. It consists in dressing the child very lightly, in bathing it very frequently with tepid water, avoiding as far as may be the use of soap, and in sponging it often to relieve the irritation with some simple alkaline lotion; such for instance as one recommended by the late Dr.

Tilbury Fox, and which is composed of twenty grains of carbonate of soda, two teaspoonfuls of glycerine, and six ounces of rose water. Of course if the stomach is out of order that must be attended to, but a little fluid magnesia, once or twice a day, is all that is usually needed in the way of medicine.

One other affection of the skin, very common, very distressing, very tedious, of which there are many varieties, generally known by the technical name of _eczema_, from a compound Greek word which signifies to flow, needs that I should say something about it. It is not limited in its occurrence to infancy, nor does it of necessity cease when childhood is over, but continues to recur even in grown persons, and shows itself still from time to time even in the aged.

For the most part, however, it makes its appearance between the fifth and twelfth month; sometimes seeming to be induced by the change of food when the child is weaned, and that even though the weaning may have been wisely managed; at other times showing itself when the irritation of teething begins, and in every instance being aggravated by the approach of each tooth to the surface, and abating in the intervals.

It does not occur in all children with equal frequency or severity, and though there is no doubt but that it is often hereditary, and this especially in families some members of which have suffered from gout, yet it is by no means unusual for two or three of the children of the same parents to be affected by it severely, while no trace of it appears in the others.

It shows itself in general first on the cheeks and sides of the face, where the skin becomes red and rough, and slightly puffy. On looking very closely--more closely indeed than most persons are wont to do--this appearance will be seen to be produced by innumerable small pimples, smaller than pins' heads, and which itch violently. Now and then, even in the course of a few hours, these pimples disappear, leaving the skin rough, and peeling off in branny scales, while the surface beneath is red and irritable, a condition which also in a few days may subside.

This, however, is less frequent than the opposite course of the affection, in which a drop of fluid forms at the top of each tiny pimple, and escaping forms a yellowish, thin, transparent, watery, irritating discharge, which reddens still more the raw and weeping surface of the skin. The fluid when abundant dries at length into yellowish flakes or crusts, which sometimes a.s.sume a brownish colour if the surface is made to bleed by irritating or scratching. If the crusts are not removed, the fluid which still continues to be poured out beneath them soon changes into matter or _pus_ as it is called, and this, shut up beneath the hard crust above, increases the irritation, and thickens the deposit. After a time the inflammation lessens of its own accord, the secretion diminishes, the crusts dry up, and at length fall off, leaving the skin red, slightly swollen, and its surface scaling off in flakes, which gradually cease to form, and the skin by degrees becomes quite sound again, and so remains, until perhaps the irritation caused by the approach of a new tooth to the surface, rekindles the old trouble, to go once again through the same stages as before.

It is on the cheeks, the sides of the face, and the top of the head that these changes may be best studied, but there are other situations in which the same kind of process often goes on. It may be seen in the creases of the neck, or the folds of the thigh in fat children, only as two surfaces of skin are there in contact the fluid never dries to a crust, but the skin, red and sore and swollen, pours out an abundant secretion which, just as when it occurs behind the ears, gives out a strong and offensive smell. It occurs, too, at the bends of the joints, as under the knee, and at the inside of the elbow joint, as well as on the front of the chest, the back, and sometimes even over the whole body, and especially at any part where the pressure of the dress irritates the skin. When thus general, it seldom fails to pa.s.s into a chronic state such as to call for constant, skilled medical treatment.

The attack often comes on with general feverishness, a hot skin, fretfulness, and restlessness, which subside when the skin begins to discharge, though the discomfort produced by the local irritation still continues. At other times, and this perhaps more often when the eruption first appears on the head, its onset is more gradual, and slight scurfiness and redness at the top of the head are first noticed, and then a little crust forms there which is firmly adherent, and is, therefore, often not entirely removed as it should be, and thus bit by bit the mischief extends until its cure becomes tedious and troublesome.

When either from neglect, or from the ailment having set in acutely, the affection of the scalp is severe, the child's state is one of much suffering. The whole of the scalp becomes hot and swollen, and covered over a large surface by a thick dirty crust, through cracks in which a thick ill-smelling greenish-yellow matter exudes on pressure. At different points around, pimples form with mattery heads,--pustules they are called--while the glands on each side of the neck become swollen and tender. When thus severe on the head it will be found also not merely on the face, but also on the body, and the poor suffering child is not only a miserable object to look upon, but, worn by constant restlessness, it loses flesh, and seems almost as though it could not long survive.

Happily, however, the condition scarcely ever terminates fatally, though feeble health and stunted growth are not seldom the results of the early suffering. But besides, severe eczema in infancy always returns again and again in childhood and in after-life, and there is also a distinct connection between liability to eczema and to asthma; and this not simply nor mainly that the disappearance of an attack of eczema may be succeeded by an attack of asthma, but that the child who in infancy has had severe general eczema is more p.r.o.ne than another to develop a disposition to asthma as he attains the age of five or six, and this even though he should not have had any return of the skin affection in a severe form.

It is evident then, that one cannot take too much pains to guard against the occurrence of eczema if possible, and at any rate to prevent its becoming severe. The disposition to it is often controlled by very simple precautions, such as bathing the face, the moment the skin shows any redness or roughness, with thin gruel or barley water, then powdering it with starch powder, and when the infant goes out, smearing the spot very lightly with benzoated zinc ointment, and making the child wear a veil. It will be observed that the exclusion of the air is in all these cases the object of the application far more than any specific virtue which it is supposed to possess, and many of the worst cases of eczema in grown persons are treated, in the great hospital for skin diseases in Paris, by an india-rubber mask, or by india-rubber covering of the affected part, and benefit thereby without any medicated application whatever. The thin layer of scurf which often forms on an infant's head should not be allowed to remain there, since its presence is a source of irritation. If it is very adherent, the surface may be well greased overnight with a little clarified lard which will soften it, so that it can be readily washed off with weak soap and water in the morning. If, however, the skin is very irritable soap must not be used, but the head must be washed with yelk of egg and warm water, and instead of a sponge, which would be too harsh, it is better to employ a very large camel's hair brush or a soft shaving brush, which is more handy, and the surface after careful drying may be lightly smeared with zinc ointment. All ointments used must be washed off most scrupulously every day, otherwise they become rancid, irritate, and make matters worse.

When eczema sets in acutely, with general feverish disturbance, cooling medicines are required, and the help of the doctor becomes necessary.

These are the cases in which the eruption is not confined to the head or the face, but extends over the body generally. The child must be dressed as loosely as possible; and when in its cot, should lie there with no other covering than its little shirt; and nothing gives so much relief to the irritation as the abundant use of powder, either simple starch powder, or ten parts of starch powder to one of oxide of zinc, or carbonate of bis.m.u.th. All powders must be absolutely free from grit, or, in other words, quite impalpable; otherwise they irritate the surface.

On the face and other parts where it can be employed, the puff may be used to apply the powder; but between the creases of the skin--which it is important to keep apart--fine linen, lint, or charpie must be employed, covered freely with powder, so as to prevent the surfaces from coming into contact. If the irritation is very distressing, a weak spirit lotion with a little carbolic acid may sometimes be sponged over the surface, and the powder renewed immediately; or other forms of soothing lotions may be used to abate the irritation.

When the scalp is affected in the acute form of eczema crusts form very quickly; or in other cases they collect because people fear to disturb them when they see the raw surface beneath. It is, however, a grievous mistake to allow them to collect; they are in themselves a source of irritation, and they entirely prevent any application reaching the skin beneath. They must always be removed, and never be allowed to form again. They can be removed either by the employment of a poultice, half of bread, half of linseed meal, or by the application over-night of a handkerchief soaked in sweet oil, and covered over with a piece of oiled silk, which softens the crusts effectually, and allows of their easy removal by abundant washing with weak soap and water.

The best applications afterwards vary so much that it is impossible to lay down any positive rule. Sometimes the Carron oil, as it is termed: a liniment compound of equal parts of linseed oil and lime-water--a popular and most useful application in burns--gives most ease to the irritated skin; sometimes the mere exclusion of the air by means of the india-rubber cap; sometimes the abundant use of powder. In every case, at least once in every twenty-four hours the whole surface must be washed quite clean with barley water or thin gruel; and when the discharge lessens or ceases, as it will do in the course of time, then, but not till then, various ointments may be of service.

When the chronic stage arrives, in which the skin becomes dry and scaly, then is the time for tonics, for iron, sometimes for cod-liver oil, and for a.r.s.enic; of which latter remedy, however, the results are uncertain; while in the acute stage, its influence is simply mischievous. Nothing is more difficult, nor calls for more skill, or larger medical experience, than the proper management of the various forms of chronic eczema.

The question is sometimes asked whether it is safe to cure, or, as people call it, to dry up these eruptions in teething children. There can be no doubt but that it is very desirable to prevent their occurrence as far as may be by the use of the precautionary measures which I have explained. But when they have existed for some time, either attended with profuse discharge, or causing great irritation by their extent, there is no doubt but that care must be exercised in attempts at their cure, that soothing measures such as I have advocated should be chiefly employed, and that the sudden drying up of the discharge by a too abundant use of dusting powders must be avoided. If, too, the diminution of the rash were followed by a worsening of the child's condition, by feverishness, by heaviness of the head, or any sign of disturbance of the brain, the attempt to cure the rash must at once be abandoned. At the same time I must add that such occurrences are very rare, and that for one case where I have had to regret my success in curing the rash, I have seen fifty in which I have been mortified by the failure of my endeavour.

FOOTNOTES:

[8] The directions given by the distinguished chemist, Dr. Frankland, to whom I am indebted for the suggestion, are as follows: 'One-third of a pint of new milk is allowed to stand until the cream has settled; the latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk vessel placed in warm water.' (I may add that the artificial rennet sold by most chemists may be subst.i.tuted for the other.) 'In about five minutes the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling to prevent its becoming sour. A further quant.i.ty of curd separates, and must be removed by straining through calico. In one quarter of a pint of this hot whey is to be dissolved three-eighths of an ounce of milk sugar, and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. This will const.i.tute the food for an infant of from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quant.i.ty required for twenty-four hours. It is absolutely necessary that a fresh quant.i.ty should be prepared every twelve hours; and it is scarcely necessary to add that the strictest cleanliness in all the vessels used is indispensable.'

[9] In our tables of mortality we find teething registered as having occasioned the death of nearly 5 (4.8) per cent. of all children who died in London under one year old; and of 7.3 per cent. of those who died between the age of twelve months and three years.

PART III.

_ON THE DISORDERS AND DISEASES INCIDENT TO ALL PERIODS OF CHILDHOOD._

The ailments. .h.i.therto noticed are by no means all that may occur during infancy and early childhood, but those only which either happen then exclusively, or at least with far greater frequency than at other times.

It will be most convenient to consider the others under the different systems to which they belong, as diseases of the head, of the chest, and of the bowels.

Before entering on these new subjects, however, a few words may not be out of place with reference to what may be termed the second period of childhood. It is above all a time of wonderfully lessened sickness and mortality. We have not the means of stating exactly the rate at which mortality is lessened between the cessation of the first and the commencement of the second dent.i.tion; but we do know that it is ten times less between the age of one and five, and nearly twenty times less between five and ten than it was in the first year of existence.[10] A mother's anxiety then may safely be quieted after the first year of her infant's life, and still more after the first set of teeth have been cut, for if her child is strong and healthy then, there will be comparatively little to fear for its future.

Four years or thereabouts now follow, before any important change takes place in the child's condition, for it is not until between six and seven years old that the first set of teeth begin to be shed, and the second to take their place. This change of teeth too is of far less moment as far as the health is concerned, than was the cutting of the first set. The first dent.i.tion was the preparation for an entirely new mode of life for the child, and was intended to fit it for a life independent of its mother. The second has no such signification; it is a mere local alteration rendered necessary by the growth of the jaws, and takes place quietly, by the gradual absorption of the roots of the first set of teeth, brought about by the pressure of the others as they approach the surface. Four teeth in each jaw are new, and replace no others, but usually they are cut without much discomfort, and the wisdom teeth do not concern us here, for they do not appear until childhood has long pa.s.sed.

But, though between the age of two years and of ten there is no important change, nor even preparation for a change in the const.i.tution, the time is yet one of most active growth of the body, and consolidation of the skeleton. The stature increases from 2 ft. 6 in. to 4 ft. 6 in., and the weight nearly doubles, while at the same time the ends of the long bones previously connected with the shafts by means of cartilage or gristle, become firmly united by the conversion of that cartilage into bone, and a similar process goes on, though not completed till later, in the ribs and the breast bone.

Rapid increase of height and weight; conversion of the elements of bone into bone itself, formation of muscle out of the fat, which in the young child was stored up as so much building material for an edifice in course of construction, require for their accomplishment perfect health, and the power of converting to its highest purposes all the nourishment received. What wonder then, if from time to time, the machinery thus hardly taxed, fails to be quite equal to the demands upon it, if pains in the limbs--growing pains, as they are commonly called, or head-ache, tell of the inadequate nerve supply. Or if from the same cause, a vague feverish condition comes on, in which the temperature is slightly raised, and the child listless, and yet fretful, loses its cheerfulness, is dull at its easy tasks, and yet indifferent to play. This too is the time when any unsuspected defects, physical, or mental, or moral, begin to show themselves distinctly; when short sight becomes apparent so soon as the child has to learn its letters, when the dull hearing is perceived which makes it seem inattentive, and gives to its manner an unchildlike nervousness; and the weak intellect is displayed in causeless laughter, causeless mischief, causeless pa.s.sion, imperfect power of articulation, or want of words, and by a restless busyness in doing nothing.

Of all these things I shall have to speak later on more fully. They are the things however, which only those mothers notice who live much with their children, who do not banish them all day long to the nursery or the school-room, and learn from another whether they fare well or ill.

They and only they will notice these things in whom there dwells that which the poet tells us of:

The mother's love that grows From the soft child, to the strong man; now soft, Now strong as either, and still one sole same love.

FOOTNOTES:

[10] The exact numbers as given at p. xiv of the forty-fifth Report of the Registrar-General for all England in 1881 are to 1,000 living under one year 58 deaths; from one to five 6.1; from five to ten 3.3.

CHAPTER VI.