The handbook for mothers: a guide in the care of young children

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

The Gift of

Preface To The Second Edition

in presenting this second edition of the Handbook for Mothers, it is proper to say that it is done in accordance with the repeated and urgent requests of friends and strangers, both in and out of the medical profession, and from all parts of the country. The author is deeply sensible of, and grateful for, the uniformly kind reception given to the first edition by his professional brethren, as well as the public generally, and trusts that this will be received with equal favor. But slight alterations have been made in the text, and these are mostly of a verbal character.

POUGHKEEPSLE, N. Y.

PREFACE,

A book which could be placed in the hands of mothers, and be to them a safe and sufficient guide in the management of their children, has often been sought by me. Those which are to be found, seem to me faulty, by including too much on some topics, while on others they are deficient. I doubt the policy of placing full and technical descriptions of all varieties of disease in the hands of mothers. Their anxieties, which are at the best great, are increased by the array of half-understood technicalities. By morbidly dwelling upon symptoms as described in books, each movement of the child becomes a source of alarm. Water on the brain, 01 other terrible disease, is constantly apprehended, and the mother not only suffers herself, but is tempted to injure her child by unnecessary dosing. My inten-

VI PREFACE.

tion has been to avoid these errors, and to give to the mother just that information which she needs as a mother, and not that 'which will make her believe that she can do without the services of a physician when her child is sick. A smattering of medical knowledge, is an especially dangerous thing. If the directions which I have given as to the care of the child in health, seem to be occasionally too particular and full, when it was not necessary, I can only say that these are just the points upon which mothers have frequently asked for instruction, and for which they have been especially grateful. I have had repeated occasion to dwell upon all these topics in conversation with mothers, and should have been glad of just this book to place in their hands.

New Yore, 279 Fourth Avenuo.

Contents

Chipteb. Page

I. -On the Care of the Child before its Birth, 11 II. — On the Birth of the Child, .... 22 III. — Concerning the First Month, . • . .31

Of Nursing ; of Sleeping ; of Bathing ; Dress ; of Exposure to the Fresh Air.

Chapter I. ON THE CARE OP THE CHILD BEFORE ITS BIRTH

The mother's care of her child should commence with its very conception, and continue till it goes out to take its share in the responsibilities of life. Too many are either ignorant of this, or neglect to consider the child's welfare, till it commences its separate existence at birth ; and yet, the popular belief in marks evinces a general opinion that the mother may influence her child, physically, while it is yet unborn. It is not decided to the satisfaction of the medical profession, whether or not objects producing great mental impressions on the pregnant woman, may leave their traces in spots on, or deformities of, her child. Many facts of interest have been collected - •

12 CARE OF THE CHILD

Mother's marks. Avoiding surprises and shockt, EJfect of anxiety.

some of which support one, and some the other view of the question. The mother's duty is, therefore, evidently this : to avoid, while enceinte, all situations in which she may expect to be exposed to meet sudden and disagreeable surprises ; to avoid the sight of every strange animal or deformed person so far as is practicable ; and if such sights or surprises are encountered, not to allow her mind to dwell upon them for a moment. That all the " strawberry " or " cherry marks," or " claret stains," or other discolorations of the skin, are the result of longings, there is little reason to believe — if, indeed, any can justly be entitled to consideration. The instances of physical marking are the exceptions. If, then, any one who reads this fears she has marked her unborn offspring, let her at once lay aside every thought of it. The possibility of it is very slight, and to indulge in anxiety about it, if it has any influence in this respect, is to produce the dreaded result — while the possibility of injury in other ways, from excessive anxiety, is not only possible, but probable.

I have said, however, that the mother should care for her child long before its birth. Although it may not be true that children are marked, it is undeniably so that the child's physical, mental, or moral

The child's constitution depends on Us mother. A healthy mind and body

constitution may be permanently affected by the mother. The sickly, feeble mother rarely has a robust and healthy child. The mother of small mental abilities does not often bear an intellectual giant, nor does she who gives way to every impulse and passion, find in her offspring that gentleness and equability of temper in which she is deficient. These are the extremes ; but within these limits the same rule holds true. To adduce authorities in support of these statements is not now my purpose, but rather to insist upon the practical deductions from them.

As soon as a woman knows, or even suspects, that she is about to become a mother, she should do everything in her power to give to her child a healthy mind in a healthy body. Not that she should indulge in such excessive anxiety upon the subject as to destroy her peace of mind — for that would defeat the very purpose which is aimed at — but that she should take that reasonable and intelligent care of her child, which shall, so far as she is concerned, permit it to cast no reproaches on its parents.

During the period of life within the womb, the child receives all its nourishment from the blood of the mother. By an arrangement most exquisite in

14 CARE OF THE CHILD

Sow the child is nourished. The mother's diet. Erroneous idea.

its adaptation to the purpose to be accomplished, the blood of the mother is brought into almost immediate contact with that of the child, a delicate membrane alone intervening, and through it those elements of the child's blood which are injurious to it are removed, while the. elements of the child's growth are at the same time taken into its circulation. If then the blood of the mother is not fitted to nourish her own body, it cannot give to the child, in abundance, those nutrient materials the best fitted to build up for it a vigorous constitution. If her blood is not purified from those elements which are injurious, (as the gases which should be thrown off by the lungs,) the blood of the child cannot be purified to that degree which its well-being demands.

For these reasons, she who is about to be a mother should at once pay especial attention to her general health. Her diet should be simple and nourishing, not selected from spiced food, nor with an excess of stimulants, either solid or fluid.

There is an idea, not very uncommonly entertained, that if the mother limits herself very closely to just as little food as will barely enable her to avoid suffering from hunger — that is, if she almost starves herself — her child will be smaller, and she will there-

The most desirable condition.

fore suffer less at the time of its birth. If such a course has such an effect, it must be by interfering with the development of the child, and thus giving the mother a sickly infant, in place of one that is healthy. No intelligent, reasonable woman can, it seems to me. thus deliberately entail upon her child a life of ill-health, that she may avoid a few moments suffering, for the difference that is thus produced in the pains is almost inappreciable.

In the most desirable, the most perfect condition of the mother, she finds herself with an appetite which is greater than ordinary,. but which is satisfied with simple meats, fruits, and vegetables, with no sensation but that of perfect health, and except from her increasing size, with no intimation of the new life developing itself within, till her child commences its movements, or as it is commonly called, till quickening occurs. To this condition every mother should endeavor to attain. For this purpose care should be taken that the bowels are moved once every day, for when constipation occurs at this time it brings with it many discomforts and annoyances. The appetite even may fail, and both mother and child suffer in consequence. When constipation does occur, if slight, the more abundant use of fruit, the selection

16 CARE OP THE CHUB

Constipation. Injections. Prescription

of coarser food, — as cracked wheat or corn, — will frequently entirely remove the sluggishness of the bowels ; but if this does not suffice, recourse must be had to some of the following modes of treatment. Simple water injections, neither very warm nor very cold, are good for those who are accustomed to them, or can, with convenience, use them. Several kinds of apparatus are now sold, which allow any desired quantity of fluid to be thrown into the bowels without the annoyance of removing for refilling, and with these, an injection becomes almost a luxury. When depended upon, the injection requires to be used at the same time of day, that the tendency may be to create in the bowels such a habit of moving that it may be dispensed with. Not more than a pint of fluid should be used, and it is not well to add anything to the water, as there is some danger, if that is done, that a miscarriage will be produced. If these methods do not answer the purpose, pills may be used, made of these ingredients : — Take of powdered rhubarb, - - one drachm. " " " jalap, - - - one "

" " " myrrh, - - one "

" " castile soap, - - one-half "

Mix and make sixty pills.

Acidity 0/ the stomach. Taking medicine. Habit.

Should there be excessive acidity of the stomach, an equal quantity of bicarbonate of soda may be substituted for the myrrh.

Of these, if the constipation is very great, two may be taken every morning, and two every night, until the bowels move more freely, when one may be taken every morning and night, or what is better still, two at night, those for the morning being omitted. If these are found to answer the purpose too fully, one may be omitted, — and the other as soon as it is not needed. It is always to be borne in mind, that taking medicine is an evil, to be resorted to only to avoid a greater evil, and, therefore, it is to be omitted as soon as the occasion which called for it has passed away. Fruits and coarse food should continue to be used while the tendency to constipation lasts, and if they answer the purpose sufficiently, it is vastly better than a resort to medicines. It should also be remembered, that habit accomplishes very much in this respect, and a certain hour being devoted regularly to expecting an evacuation, is very apt to assist in the uniform performance of this function. Should these methods alone, or in combination, fail to afford relief, the medical adviser should be at once consulted, for the habit should not be allowed to continue, 2

18 CARE OP THE CHILD

Diarrhcea. Its treatment

— and the use of more potent remedies, requires the constant superintendence of a physician.

Sometimes from imprudence in diet, a sudden chill, or some other cause, the opposite condition — namely, that of diarrhcea — is produced, and demands immediate attention. Its continuance is full of risk to the unborn child. When it occurs, the mother should at once lie down (and it is better, from the anatomical arrangement of the large intestine, to lie upon her right side), and remain in that position. The effort to " keep about," which it is the temptation to make, is only a waste of time. Abstinence from food and drink for a few hours will do much, with position, to remove the difficulty. Cold water, especially, should be avoided — a pretty strong tea, either green or black, being far preferable. Toasted bread, rice, crackers, &c, are the best food, while a half teaspoonful of paregoric, or from five to ten drops of laudanum may be taken on a little sugar every two or three hours. If the attack is anything more than very slight, a physician should be called. I scarcely need to say that it is a suggestion of ordinary prudence, to avoid what has once caused, or been even suspected of producing diarrhoea. For those who are distant from a physician— as is the case with

Prescription. Indigestion. 2he urine.

many on the plantations of the South, or the scattered farms of the North — it may be well to have this mixture constantly by them : — Take of tincture of opium, - two teaspoonfuls.

" " tincture of red pepper, one

" " tincture of camphor, one "

" " comp. spirits of lavender, four The dose of this is fifteen or twenty drops, to be repeated every two hours if necessary. It should be lessened as the disease abates, till six drops only are taken. Or a very small injection (not more than one or two tablespoonfuls) of a thick solution of starch, containing thirty or forty drops of laudanum, may be used ; and, if necessary, may be repeated in three hours, provided there is no great drowsiness produced by it.

It is important, in the first months of pregnancy especially, that the mine should not be allowed to accumulate in the bladder so as to distend it excessively. Particular care must be taken to avoid this in journeying, or serious results may follow. This is a consideration of peculiar importance to the mother, but is not without it for the child. It does not require to be dwelt upon.

From the fact that a very considerable portion of

20 CAREOFTHECHILD

Battling. Exercise Dancing.

the substances, which arise from the wearing out of the tissues, is thrown off by the skin, bathing is at all times of hygienic value. The substances poured out upon the skin by the perspiration, whether sensible or insensible, should be removed frequently ; requiring not simply a washing of the hands and face, but of the whole body. Its value increases at this period, and should be conscientiously attended to.

Exercise should be regular and gentle ; if there is any known tendency to miscarriage, it should be very gentle. It should be in the open air as much as possible ; walking in moderation, and riding in easy carriages are the best modes of enjoying it. Excessive fatigue, from any cause, should be scrupulously avoided, as well as jumping from a carriage, and all such jars as from horseback riding. Dancing, if violent, is injurious ; if in heated rooms, and protracted to late hours, it is equally bad ; but as the gentle and moderate recreation which it should be, it is harmless. The greatest care should be taken to avoid lifting heavy objects, from making great efforts to reach things not easily accessible — as those upon upper shelves, beyond easy access — and, in short, to avoid whatever may tend to produce any strain. The same rule of constant moderation should be

Mental fatigue. The emotions. Summary.

observed in the operations of the mind. Excessive mental fatigue, whether from intellectual labor or from excitements, must be shunned. For this reason, it is sometimes necessary to lay aside for a time, the use of coffee — which is an active stimulant of the brain, leaving, after its effects have passed away, a proportional exhaustion. Moral emotions, as joy and grief, should also be kept within moderate bounds ; and if these, much more those which, when stronger, are more violent — as anger, jealousy, and hate.

The brief summing up of the mother's duties during this period, is this : — That she should strive to give every perfection to the physical development of her child, by carefully attending to her own physical condition ; and that, by the preservation of that uniform and equable temperament, both mental and moral, which finds its most perfect development in woman, she should, as far as possible, give her child this same precious inheritance, assured, as she may be, that the practice of this discipline and restraint will be richly repaid to her by the greater ease with which she will meet the constant trials which a mother endures, in the cares devolving upon her on the birth of her dearest infant.

22 ON THE BIETH OP THE CHILD,

Child-bearing not sickness.

Chapter II. ON THE BIRTH OP THE CHILD

At the time of confinement there is but little to be done on the part of the mother, for the benefit of the child. Her sufferings are sufficient, one would suppose, to occupy her every thought ; and yet I have frequently seeu a woman far more anxious to know that her child is safe, than that her pains are ended. The mother should remember that the birth of a child is a strictly natural function, one which is a healthy process, and not to be confounded with sickness, which it is so frequently called. It is a period of peculiar exposure to disease and injury, and I cannot conceive of an intelligent woman approaching it, without much grave thought, and something of that putting of her house in order which danger suggests. But she should remember that the vast

ON THE BIRTH OF THE CHILD. 23

Encouragements. Ether and chloroform.

majority of her sex'pass through these perils entirelyunscathed, and that the best preventive of danger is, after having taken every precaution against it of which she is informed, to think no more of it, but to trust all to the great Disposer of events. If she has successfully followed the directions of the preceding chapter, she must be prepared completely for this period, — herself healthy, her child healthy, she has made every physiological preparation for the perfection of this physiological process. The expulsion of the child from the womb is simply mechanical, requiring in the vast majority of cases no interference. It is attended with more or less pain to the mother, this being Eve's legacy to her sex, but the pain is rarely if ever an indication of danger. Ether and chloroform now remove even this without interfering with the perfection of the function. Knowing these things, the mother should enter upon her confinement without anxiety, and endure her pain with that fortitude which is a characteristic of woman, leaving the care of herself and her child to her attendants.

It is for these reasons that the selection of the nurse and the physician, should be made with care and deliberation. To leave either to the last moment is unwise, as it is unsafe. The perfection of a nurse

Selection of the nurse. A good nurse. The physician.

is found in an intelligent -woman ; not so conceited as to be unwilling to be taught, nor so opinionated as to insist upon having her own way, regardless of the wishes of the patient, or the directions of the physician ; who is patient and gentle, forgetting her own ease when the comfort and well-being of her patient requires it; not too talkative, and yet not morosely silent ; not above doing whatever necessity demands ; scrupulously neat, prudent, thoughtful, considerate, and kind. Such persons cannot be often found serving in this capacity, but the nearer the approach to it the better the nurse. Sis weeks care by such a person, will do wonders for the mother and the child, and money expended for her wages, will be largely returned in their increased health and comfort. The nurse should be engaged for, and be present at, the time of confinement.

The physician should be a gentleman, — not in manner only, but in feeling ; of high moral and intellectual qualifications ; attentive, sympathizing, calm amid dangers, with a wise head, a brave heart, and a skilful hand. Age does not, of necessity, bring any of these virtues, and a young man who possesses these qualifications, should be preferred to one who is destitute of them, or, if he be not fully occupied, to

ON THE BIRTH OF THE CHILD. 25

lemale practitioners. An emergency.

his equally able elder who is crowded with occupation. He should be personally agreeable to the patient, and one to whom she can trust herself with perfect confidence. Either of these conditions being uncomplied with, may protract the labor for hours. A great and constant doser is to be avoided, as is also the timid and vaccillating. It is wise for the patient to see the physician two or three times before her confinement, that there may be no feeling as of a stranger's presence, but that he may be welcomed as a friend, whose very presence soothes*

There is but one emergency which is likely to arise, of which it is necessary for me to speak. Although the mother is not often able to give directions concerning it, she sometimes is compelled to do so, or allow her child to die in the moment of its birth. I refer to the birth of the child in the absence of the physician. If this occurs, — and it sometimes will in spite of every precaution, — the child should be allowed to remain upon the bed, protected from the cold, with access of the air to the

* As to female practitioners, I would gladly recommend them, could I do so conscientiously, but they are usually very imperfectly educated, and I would no more trust to them than to a student just commencing medicine. When this defect does not exist, the instances of which are very few, there Is the objection that woman has not the mental and physical powers which may be demanded, — no one can say when. No doubt, however, some women are to be preferred to tome men.

The nurse's duty in such a case. Bow to tie the cord.

mouth, that it may be able to breathe. The nurse should pinch the cord which goes from the child's navel tightly between her thumb and fingers, so as to stop the beating in the arteries of the cord beyond her fingers. She may take hold of the cord for this purpose about six inches from the child's body. If the physician is expected to arrive soon, and there is no flowing from the mother, or severe fainting, she should continue thus to hold the cord till he comes. If he cannot be present for some time, she may tie the cord, proceeding in this way : take a strong string (a piece of stout sadlers' silk is preferred by me), twelve or fifteen inches long, and put it round the cord once, tying it in the usual way of a single knot. It should be about two inches from the child's body. Then it should be drawn tight, so as entirely to stop all beating beyond it, the precaution being taken not to let either hand slip, for fear the cord should be torn away from the body of the child, which is a very grave accident. This may be avoided by taking the string between the thumb and forefinger of each hand, allowing it to pass across the inside of the others and over the little fingers. The thumbs should now be pressed together and the string drawn tight by separating the little fingers. The hands will thus

ON THE BIRTH OF THE CHILD. 27

Cutting the card. How to guard against its bleeding.

roll on each other, but will not be likely to slip away from their position. The knot is secured by another tie, that is, it is made a hard knot. The ends should not be cut off yet. Another similar string must now be tied round the cord about two inches farther from the child than the first one : and then, with a sharp pair of scissors, the cord may be cut in two. All this should be done in a good light, and especial care should be taken that a toe or finger is not included in either string, or much more, that nothing is in the way of the scissors so as to be injured by them. After the cord is divided, the cut end next the child, should be wiped clear of blood, and then carefully examined to be ' sure there is no bleeding from it. If it does bleed, the cord must be again tied a little nearer the child's body than the first string, and with the same precautions as before. The cord, however, is not to be again cut. When it is ascertained that there is no bleeding from the cord, the ends of the string may be cut off within an inch of ' the knot, and the child may be carefully wrapped in a warm and soft blanket or sheet, and kept from all exposure to the cold, it being allowed air enough to breathe.

Sometimes it happens that the child does not

23 ON THE BIRTH OF THE CHILD.

How to make the child breathe. What to do if there is flowing.

breathe when it is first born. This should be thought of; and if it is found to be the case, the child's uaked chest should be blown upon, with short but rigorous and repeated puffs from the mouth ; its chest may be rubbed smartly with the hand, or a towel — with or without the aid of spirit ; or it may be sprinkled with cold water, smartly snapped with the hand ; or a little cold water or spirit may be taken into the mouth, and spirted upon the chest so as to strike it with some force ; or, if these fail, the nurse should put her mouth over the mouth and nose of the child and blow up its lungs, at the same time that the other means continue to be used. Very rarely will all of these measures fail to produce the desired result. When breathing is fairly established, the child should be allowed to remain without separation of the cord, till all the purple color has passed off from the face, and then the nurse may proceed as before directed to tie the cord.

If there is very great bleeding from the mother, or if she is very faint, some one else should be called to hold the cord, as before directed, while friction is made over the lower part of the abdomen to stop the flow ; or cloths are applied, wet with cold water or containing pieces of ice ; while, at the same time, the

Restoratives, die. Use of ether and chloroform.

usual restoratives for fainting are resorted to, such as spirits of hartshorn, laying the patient flat on the bed, and giving her a little brandy. If no one else is present, the nurse should put on the string as first described, and then attend to the mother, leaving the application of the second string, and the cutting of the cord, till the mother is in a safer condition. But the care of the mother is incidental to the subject of the chapter, and one upon which its purpose does not allow me to dwell.

It may be a question for some, whether or not they can, so far as the child's welfare is concerned, use ether or chloroform at the time of their confinement. This, evidently, is not the place for discussing all the views which are entertained concerning the use of these agents. They are regarded very differently by different practitioners ; some objecting entirely to the use of either, some preferring one and some the other. Although I have had frequent occasion to use both, I have yet to see any injurious effects from them, when given at the time of labor. I prefer chloroform when it is pure, being very careful in selecting that which I use. To the mother the relief from suffering which it affords is immense, the recovery being often very much hastened by it. To the

Effect of anaesthetics on the child.

child there is no injurious effect when the labor is of a natural length, and I have never seen any harm arise from using it when the labor was protracted, though it is said to have been witnessed. I always use chloroform without hesitation, unless the patient objects to it, when I, of course, do not insist upon it.

CONCERNING THE FIRST MONTH. 31 1 he mother to keep quiet.

Chapter III. CONCERNING THE FIRST MONTH

The care of the child immediately after its birth, and during the first month of its life, is a matter of great importance to its future well-being. The mother is not often able to attend to this herself, but she can usually see that everything is done properly. With a perfect nurse no oversight would be necessary, and, in fact, the mother would learn much from her. But perfection is as rare in this occupation as in others, and it is often a great satisfaction to the mother, and a great advantage to the child, that she is able to give directions concerning its care to her attendant. As to herself, she should not attempt to do anything that another can do ; rest and quiet are of great importance to restore her rapidly, after her fatigues and exhaustion. It is a great saving of