The mother's work with sick children

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Author's Preface

There are two sorts of maternity — that of blood, and that involved in the care of children — the one being the complement of the other. Tenderness is the jsivot of the former ; intelligence, that of the latter.

Mothers exert a decisive influence upon the future health of their children, not merely by the hereditary qualities which they transmit to them, but also, and perhaps to an equal extent, by the physical education which they give them. Careful training may compensate for inherited defects ; whereas the advantages of inherited health 'may be conrpletely neutralized by an ill-conducted education.

Prejudicial as it is to the welfare of an infant to be subjected to the blundering, not to say the brutality, of empirical medication, replete with prejudices and false ideas, displaying the barbarism of ignorance ; it is of equal importance that his mother should possess sound ideas in regard to the duty which she is to perform in case of his sickness, that she may be able to judge when the necessity arrives for seeking the prompt assistance of the physician, and that she be fortified with that nice and exact knowledge which should qualify her to second the physician's efforts.

These two ideas have given rise to this book; having

VI AUTHOE S PEEFACE.

been constantly present in the author's mind while writing it.

Previous works of a like purpose have fallen upon one or the other, if not upon both, of these two stumbling blocks : either they have not been sufficiently clear, by reason of a too strictly technical language, or because too much has been attempted ; or they have inspired in mothers a dangerous confidence, leading them to take the place of the physician. Fully impressed with these mistakes, the author has spared no pains to avoid them.

The sphere of the mother and that of the physician are, and must ever remain, perfectly distinct. The one instructs and aids the other ; they are, or should be, common workers for the child's welfare. The physician prescribes, the mother executes — well or ill, accordingly as she has well understood, now the bearing of a circumstance, now the importance of a measure, always the value of time. Doubtless the physician's action is that of deciding, but it is cursory and transitory; the mother endows it with real efficiency by her own conduct, which is enduring, incessant, persevering. Which one of us, in his career as a pihysician, has not had a thousand occasions to notice the difference between the assistance offered him, on the one hand, by one of those mothers with narrow ideas, meddlesome prejudices, wearisome demands, and misapplied methods, and, on the other hand, by that other mother who, well understanding her part, is calm in demeanor, firmly reposing her confidence where she has once deliberately fixed it, and aiding the physician by her intelligent and devoted nursing ? "Whenever we meet a mother of this sort, whose child has recovered, we should freely share with her the merit of success ; it often happens that her part has been equal to our own.

AUTHOR S PREFACE. Vll

But devotion and intelligence are not sufficient ; knowledge is necessary in addition, and in order to possess it, it is requisite to have acquired it. The art of nursing sick children is not to be improvised. Doubtless it may be attained by experience ; but experience comes slowly, and the exigencies of the art are pressing, and will not be put off. Some guidance therefore is necessary, and the author has endeavored to furnish it to the mother in this book, which speaks to her of her dearest interest. A double task was before him : to free the ground, as much as he could, of the prejudices which encumbered it ; and to replace them by sound and precise teachings. He has done his best to achieve it.

Above all else, this book is designed to uproot routine, and to this end the cooperation of the intelligent and educated mother, for whom it is intended, is invoked. Her spirit of beneficence leads her to the bedside of sick children weighed down by misery and ignorance. She must add the alms of her intelligence to that of her purse ; good counsel is worth as much as bread ; in this war against ignorance, she has a true apostolate to fulfil, of which her goodness of heart makes the mere mention sufficient.

Certainly, she will not reproach the author with having belittled the scope of her action by discountenancing her meddling with medicine : to be of value, a contribution should be fitting ; her mission is not in medication : it is in the faithful carrying out of the measures of which she is the minister, at once so effective and so sublime. And let her not think that this partition of labor is the work of a profession jealous of its privileges, shutting itself up in its temple, and sedulously barring the gates. No ; medicine is defending her interests, not its own ; it knows the frail tenure of life, the deadly

Vlll AUTHORS PREFACE.

influence of prejudices and of routine, the aggressive effrontery of incompetence, the dangers of negligence, and seeks to avert them ; it is more than its right, it is its duty.

The author has heen forced to speak to mothers in this language of sentiment and reason, which addresses at once their heart and their intelligence. It was his wish to enlist both alike. He does not seek success; should he meet with it, he will be especially pleased with the more general diffusion of the ideas contained in this book. At all events, it is hoped that the double character of a serious attempt, and one proceeding from conviction, will not be denied it.

Chapter I. The Value Of Health, And The Caee Of Children

11 Only a healthy youth can assure a comfortahle old age."

Plutarch.

"She layeth her hands to the spindle." * * *

Proverbs xxxi. 19.

Health is the chief of all blessings, it is constantly and enthusiastically reiterated. It would seem, then, that all pains should be taken to acquire it, and every care to maintain it, and yet there is scarcely anything which really receives so little attention ; — when we possess it, we risk it in a thousand hazards ; when it is no longer ours, we do nothing calculated to reoover it. Health is accorded only a purely Platonic devotion, a false cultus, to which neither a habit, a desire, a prejudice, nor a penny would often be sacrificed. The explanation of this is, that health is an abstract advantage, which we do not perceive while we possess it, and which asserts itself only by its absence and by the contrast of suffering. It is fondly imagined to constitute a fund which can be drawn upon indefinitely, without ever becoming exhausted ; we call up the memory of past impunity, count on exceptions, and, as in many other matters, profit nothing by the experience of others.

All sorts of inconsistency gather upon this ground ; but they are not frankly acknowledged, and physicians, in pointing them out, are accused of attempting to further their own interests.

And yet, how many good reasons there are for appreciating the value of health, in comparison with which all other blessings, fortune, honors, pleasures, are but negative, if not cruelly deceptive, advantages ! We are told in Ecclesiasticus, that " Better is the poor, being sound and strong of constitution, than a rich man that is afflicted in his body " (xxx. 14) ; and that " There is no riches above a sound body, and no joy above the joy of the heart " (xxx. 16). The mind accepts and maintains these abstract propositions ; but yet we launch ourselves into the pursuit of fortune with an ardor equal to the indifference with which we treat the preservation of health. This inconsistency has long been manifested, and there appears no sign of its coming to an end. I have already examined into its causes,* and need not recur to the subject in extenso ; I intend to consider it here only as it concerns the health of children.

It is at once the foundation pillar of domestic happiness, the condition of all fruitful education and instruction, and the guarantee of the future vigor and happiness of children.

Sad is that hearthstone at which disease is an habitual visitor ; cheerfulness is crowded out by it, and an air of melancholy pervades the whole house. There are murmurs, silence, and sorrowful looks, instead of merriment ; bottles of medicine instead of playthings ; a sombre alcove instead of a lawn ; * * * * what mother does not * Sante et Hygiene, octavo, Montpellier, 18G4. .

recognize this picture, and has not tasted the bitterness of those sad days, which often, it is true, end in convalescence, but sometimes also in grief?

Moreover, the emotions excited by acute diseases too often give place only to the prolonged gloom of chronic illness ; if there is less immediate danger to life, yet the future is uncertain or threatening ; the sufferings and privations which have been bravely endured will perhaps prove in vain, and the reward of sacrifice and anxiety be lost.

And then, if life indeed be saved, perhaps strength will have gone forever ; thereafter, instead of a patient, a valetudinarian is to be cared for, unfitted for the struggles of life, and whose strength will become expended in his mere maintenance. The child makes the sunshine and storm of domestic happiness, to warm and illumine the mother's heart or to weigh it down in sorrow. Its health is the pivot of these changes, controlling the whole aspect of the household. Family mirth has to yield to its moods.

Mothers, I need not strive to convince you of all this ; every day teaches it to your hearts better than I could ever do ; but you will allow me to summon your mind to the aid of your heart, and to demand that you work courageously and without ceasing, to give to your children that vigorous health which is equally important to their happiness and to your own.

To their happiness, I say, for health is the foundation of all education, that is to say, of all discipline of the will, of the affections, and of the intelligence. Doubtless it would be possible to endow a defective body with the virtues of a manly spirit ; but how often is education held in check by ill health ! Everything is in disorder : a course of action is marked out to-day, to be abandoned to morrow ; whims have to be respected ; everything must yield to the imperative demands of feebleness and suffering ; there is caprice without end, disobedience, self-will, and rebellion, which count on impunity. In a word, a child is spoiled on account of that very commendable, but very unfortunate, feeling — the fear of doing him an injury which shall cost his life.

There can be no discipline with a child habitually ailing, no real culture of the mind, no instruction. Either his duty is not done at all, or it is badly done. The slightest effort at work drives the color from bis face and draws a dark circle around his eyes. An accession of fever, an unwonted pallor, an attack of cough, lead to restlessness, and keep him from his class. The child, observing these forced interruptions, takes a liking to them, since they free him from the necessity of emulation, and foster his innate laziness. Months and years follow each other, and the period of adolescence arrives, loaded with an accumulation of work which it is now too late to accomplish. Hence a spoiled career, an unstable mental constitution, and all the material and moral consequences which flow therefrom. An imperious law has joined happiness to duty and work. What wonder, then, that sickly children, possessing at once less moral energy and less in tellectual culture than others, often vegetate in after life in the sad consciousness of their incompetency and uselessness ?

But a danger threatens them also ; that, namely, of never emerging from the sickliness of their childhood. The first years are decisive as to future health, and we cannot too often ponder the Spanish proverb, which expresses a sad and unvarying truth : " What enters with the swaddling comes out only with the shroud." If, as Joseph de Maistre said, mothers form the moral man on their knees, they form the physical man also, and not one of their methods, either in health or in sickness, fails to affect their future vigor. An English poet, Wordsworth, has said that the Child is father of the Man, and a profound meaning lies hidden beneath the odd appearance of this saying. The man indeed inherits from the child, and mothers have a great influence upon the value of this heritage. The whole of maternity is comprised in these four words — blood, food, care, devotion; and what ministry is at the same time more august, more complex, and more exalted ?

Such is the mother's mission in that grand work which is to give to the future family a father possessed of a sound body and a correct mind and heart, and to the State a man in the broad and beautiful meaning of the word. If they fulfill this well they can, without envy, leave to us the harassing affairs of public life and the higher intellectual pursuits. * * * * To them has been given the better part.

I have elsewhere* treated of the mother's part in the physical education of children, and I have endeavored to show that if she acts powerfully upon them by means of heredity — that is to say, through her blood flowing in their veins, she acts none the less powerfully by her conduct in regard to them ; she can, if she goes about it in the right way, mitigate the bad, improve the commonplace, and perfect the good. That people which includes the greatest number of devoted and intelligent mothers will always be the strongest upon the battle-field of action, as well as upon that of thought. They confer honor and strength upon the State, as well as upon the family, that seminary of the republic — seminarium reipublicm — as Cicero so aptly named it.

But her care cannot prevail against innate weakness, * Entretiens familiers sur Fhygiene, 2d ed., Paris, 18G9.

C THE MOTHER'S WORK

or the accidental loss of health ; the child is sick, and needs another sort of care. He will find it if, during health, he has received from his mother that firm and intelligent direction, that comprehension of his real interests, that enlightened solicitude without which there is no fruitful training. Everything plays a part in this matter, since the means of prevention and those of treatment depend-upon the same qualities of heart and mind. With them, all is security ; without them, all is peril. If the mother has correctly estimated the value of health preserved, she will correctly appreciate that of health restored, and she will aid the physician by an earnest, discreet, and intelligent co-operation. In treatises on the diseases of children the chances of the favorable or unfavorable termination of the different maladies are calculated, allowing due weight to all the elements of prognosh, as they say in the schools : constitution, temperament, external influences, nothing is forgotten that can furnish an omen ; but the moral and material value of maternal care is scarcely thought of, and yet its importance is great, and well deserves recognition. Intelligence and education are defensive weapons; a sick child's bed is well guarded with these around it ; they ward off the perils of routine, the narrow ideas of prejudice, the meddling of incompetence and recklessness, and all goes well, because everything is done properly and at the proper time. It is generally believed that the physician alone incurs the responsibility of treatment. This is a grievous error ; the mother bears a considerable part ; she contributes to failure as well as to success, and when' after good care, her child has recovered, she may legitimately reflect that she has contributed to the result and it should be said that, " Having borne the pain, it is but jast that she should have the honor.''''

Let lis inquire now what she has to learn at first, and to practise subsequently, in order to fulfill properly the role of nurse, which in name is so lowly, so vulgar in its details, but which ennobles the woman, be she workwoman or duchess, who understands how to enact it, and who puts her whole heart and mind into it ; whatever, that is to say, inspires devotion and renders it effective. There is nothing lowering in it ; it is an added glory to those of a maternity rightly understood.

Chapter II. The Mother And The Physician

La Fontaine.

The first exercise of maternal solicitude is in the choice of a physician. The matter is as delicate as it is difficult ; but it is commonly freed from all this by the inconceivable frivolity with which it is treated. " Incompetence observes and chance decides." In some cases less care is given to it than to the choice of a purveyor of fashions. People take the first physician whom they may happen to think of: — the fashionable doctor, their friends' doctor ; one whom they have never seen, or one whose personal appearance pleases them, and thus, without more ado, the most serious possible contract is concluded.

This abdication of the judgment is deplorable. An unsatisfactory physician is not as easily got rid of as an unwelcome visitor; artifice is rendered necessary by his position, by his assiduous services, his good intentions, the good he has done ; all of which considerations are very stringent with persons possessed of delicacy. A temporizing course is pursued. You have a physician, but your confidence is in another. Tou seek clandestine advice here and there, now from a worthless system of medicine, now from a fraternity which is either faithless or pushed to its last ditch. You carry out the prescriptions timidly, or only in part; sometimes not at all. The child thus harassed does not get along ; the doctor does not understand the matter, and things go on from bad to worse. Thus you continue for a longer or shorter time, between artifice and peril, and, if the physician have not sufficient penetration to perceive that the confidence due him has been encroached upon, and does not, with praiseworthy resolution, put an end to the awkward situation, this state of things, in every way deplorable, has no definite limit.

In former times there was such a person as the family •physician y he exists no longer, except in the few small towns where old-time customs are still kept up, and in which, free thus far from the cosmopolitan mania, the various generations of a family quietly succeed each other under the same roof, and live and die amid the same surroundings. Under such circumstances, we still find physicians who, after forty years of practice, can count on handing down to their sons who succeed them both the confidence of families and what experience has taught them of their constitutions. Such a state of things aids the practitioner and gives greater security to his families. This reciprocity, of confidence on the one side and of devotion on the other, lasts through a whole lifetime. The physician performs the first services for the child ; he follows him amid the many vicissitudes of his earlier years, directs his adolescence (often a wild one), gives counsel as to his choice of a vocation, and, recognizing the peculiar qualities which he has inherited, and which would otherwise elude observation, his medical treatment of his ailments is successful and creditable.

But how vastly different is the ordinary course of things ! This placid home-life is becoming the exception; the house is giving place to the tent ; we are born in one town, reared in another, married in a third, and we shall die, God knows where. Thus situated — encamped, as it were — we do not dream of providing ourselves with a physician. There comes an emergency, and we go from door to door in quest of the first one we may meet. He may know nothing about either the child or the family, but that fact does not prevent him, to meet the urgency of the case, from giving a snap judgment of the disease in ten minutes and producing a prescription. Whatever may be the ability of the practitioner, thus called in at hap-hazard, his treatment can scarcely be more than indifferent.

I cannot too strongly urge young mothers to employ for their children, whenever possible, the physician who has attended themselves, and who preserves among his notes, or at least in his memory, their family health record. Such a one may be old-fashioned, inferior in brilliant qualities, or less enterprising ; but if, nevertheless, he is devoted and well-educated, he should on no account be superseded. It is dangerous to lose sight of the fact that the practice of medicine is an affair of the heart as well as of the understanding.

The choice of a physician is certainly a delicate matter, and calls for rare discernment. It is all the more difficult from the fact that medicine, of all arts, is the only one which must always be subject to the judgment of incompetent persons. With a little taste, judgment, and instruction, you may reason well enough upon matters and things in general — music, literature, or poetry ; but, with a good deal of taste, judgment, and instruction, you may reason very badly in regard to medicine. It behooves one, then, to be well advised.

If a medical friend, whose years have led him to retire from practice, recommends a physician, you should make haste to profit by such good fortune ; in default thereof, take counsel with those careful mothers who give their whole mind to their children ; a physician's scientific standing may doubtless escape them (only physicians can judge of each other in this respect), but they certainly will not be deceived in regard to his patient services, his attentive observation, his devoted sympathy, and his ardent desire to do things correctly. If to these qualities be added cleverness (and we may well envy women their capacity to judge in this respect), there is no need to seek further.

The medical treatment of children is of a truly special character, and the inhabitants of large cities do well to select for this purpose physicians who have given particular attention to the diseases of early life. The physiology and the habits of children possess characters peculiarly their own, which, for their nice interpretation, demand a particular sort of training. To be able to catch and analyze the facial expression in children, to recognize their imperfectly expressed wants, to understand how they are affected by medicines, to have a precise knowledge of hygiene as applied to them — all this is not to be improvised, but presupposes a practical experience, which is acquired the more rapidly the more one has to do with the care of children.

Therefore, other things being equal, it is best to choose a physician who, having children of his own, lives in close contact with them, has learned to know them, knows how to talk to them at once with authority and gentleness, and to show a tender sympathy, so much needed by the little ones, in the performance of his duties towards them, and who knows the secrets of control over them.

I will not burden either my readers or myself by sketching the portrait of the typical physician. Moliere made up his Sganarelle by taking the nose of one, the eye of another, the foot of another, and the voice of still another. His type will be enduring, because it exists in nature, although in fragments, scattered here and there. So with the perfect physician, who is the quintessence of qualities belonging to very diverse individuals. Perfection in this form is as rare as in any other ; I have never met with it, either in myself or in any one else, and I should advise but moderate expectations in this respect. Only the perfect mother can expect to find a perfect physician, one of unerring judgment, a resolute and pru dent spirit, possessing originality with judicial habits of thought, firmness with gentleness, a correct conscience and intelligent apprehension, etc., etc. You may go a good distance in this programme, but it is well to be content with less.

Quesnay, the economist, who was also a physician, says somewhere : " Why don't persons of pure and impregnable virtue have a square-cut nose ? It would be very convenient for governments, and things would go on capitally." It is also very much to be regretted that good doctors cannot be distinguished by some such palpable mark ; it would be very convenient for mothers, and things would go on capitally with their children's health. But, since that is impossible, let them exercise prudence in their choice ; let their trust rest upon reason (although it must be confessed that trust does not reason, when it is a question of doctors), and let them maintain it when once bestowed. Let them, in short, reflect upon the intimate bonds which are to bind them to the physician who is to have charge of their children's health. They will be found together at the bedside, enduring the same anxieties, sharing the same hopes, striving for the same ends — the one in her capacity as nurse ; the other with his judgment and knowledge. Let the mother beware of cooling a zeal of which she has need, a devotion of which an unlucky day will teach her the worth. A strange physician will not suffice her then, she will want one who is a friend also. If she has found him, let her, as a matter of prudence, hold fast to him.

It is not enough to have chosen a good physician, one who repays in cleverness and zeal what is accorded him of affection and trust ; you must know how to make use of him. A physician, strong in his own convictions, and earnest in his work (and, very fortunately, there are many such), is a delicate creature to manage. He is easily exalted or cast down. A word of unmerited distrust draws him down from enthusiastic duty to mere duty ; a word of trust and attachment increases his zeal tenfold. Your doctor's care of you depends on yourself, be it remembered, and the best way (I will even say the only way,) of getting yourself well taken care of, is by giving yourself up unreservedly to the one you have chosen, leaving to him the whole responsibility, without hindering his action by any ill-timed and meddlesome interference.

An affectionate indulgence must be shown him ; he meets with so many dreary experiences in his career, that he really has some rights of which he has reason to feel tenacious.

Physicians are accused of being thin sJcimied, and, in a general way, that is true enough. But in whom was it ever more excusable ? The sensitiveness of mere self-love is puerile, and not worth talking about ; but that which is rooted at the same time in scientific conviction, in a sense of responsibility, and in conscientious anxiety, is worthy of consideration, and needs careful management.

A physician who is not sensitive is apt to be indifferent, and the mediocrity of his services offsets his easy-going "ways.

On the other hand, we should not confound a certain ruggedness of language, or a shocking brusqueness of manner, with a lack of feeling ; they oftener denote solicitude than harshness, and they almost always cover a good heart. I knew an old doctor whose rudeness was, to a certain extent, proverbial, but who never could sleep when his mind was exercised in regard to a patient. He would become taciturn, would scarcely touch food, and the sound of his footsteps pacing his room during the entire night was, for his family, a sure indication of his anxiety. An attack of apoplexy finally carried him off, after a martyrdom of thirty years. Let it not be supposed that this is a solitary instance,

There is the secret of those requirements which are so often set down to our discredit. We may have health, reputation and fortune, and gather about our hearth all the elements of happiness, and yet never taste it, because, outside of all these, almost daily, we encounter annoyances which poison all, and make of life a veritable punishment. And we are envied the enjoyment of leading a peaceful life, and the serenity of spirits which nothing agitates ! The gruff benefactor is a privileged character, and medicine claims the same consideration. I have just said that nothing is so dangerous and unreasonable as to wait for an attack of illness before choosing a physician, as is too often done. A fine time for making a judicious selection, and for introducing an utter stranger into the sanctuary of one's dearest ties ! There is another mistake, which I must point out to mothers (without, however, slighting the fathers, they may well believe) — that, namely, of looking upon the physician, once chosen, as having no part or function in the family, except when illness calls him there. It is a very narrow and a very dangerous conception of his role, and one which simply ignores one-half of practical medicine, i. e., hygiene. It is said that the Chinese pay their physicians with a liberality proportioned to their freedom from sickness during the year. I do not advise that we should imitate the Chinese, but this stimulus to hygienic care certainly smacks of the judicious. We make our appearance in. families only to take charge of patients, many grave questions being resolved without our participation. Children often receive a guidance the reverse of what is proper, and we are called upon to fulfil the ungrateful office of repairing the damages we might generally have prevented. It is better to care for a mail's health than for his disease.