The maternal management of children in health and disease

Front matter

THE

MATERNAL MANAGEMENT

OP

Chapter I. Maternal Nursing

8ECT. PAGB

I. The Duty and Advantages of the Mother nursing her

II. Of Mothers who cannot suckle 15

III. Of Mothers who ought not to suckle . . . . 16

IV. Rules for Nursing the Infant 21

V. Rules for the Health of the Nursing Mother . . 30

VI. The Injurious Effects to the Mother and Infant of

Undue and Protracted Suckling .... 38

VII. Of Weaning . . . . . . . . 41

Chapter II. Of Wet-nurses

I. Choico of a Wet-Nurse ..... 46

II. Diet of a Wot-Nurse ...... 49

III. General Directions for the Management of a Wet-

Nurse 51

X

CONI ENTS.

Chapter III. Artificial Feeding

fflEOT. PAGB

I. The Food suitable until the first Teeth appear . . 56

II- The Food suitable after the first Teeth have appeared 64

Chapter IV. From The Second Tear To The Eighth

I. General Directions . 71

II. Animal Food 74

III. Vegetables ....... 76

IV. Sugar and Salt .78

V. Fresh and Dried Fruits and Sweetmeats ... 79

VI. Water, Wine, Beer, and Spirits 82

Chapter V

GENERAL MANAGEMENT OF INFANTS UP TO THE SECOND YEAR, AND OF CHILDREN UP TO THE EIGHTH.

I. Of the Children’s Apartments and Servants . . 86

IT. Sleep 99

IH. Bathing and Cleanliness 108

IV. Clothing 109

V. Air and Exercise .115

HINTS FOR THE MOTHER’S EARLY DETECTION OF DISEASE IN THE CHILD.

I. Signs of Health 191

II. Signs of Disease 192

III. Other circumstances which assist in the early Detection

CONTENTS.

xii

Chapter XI. Accidents And Diseases Which May Occur At Birth Or Soon After

SECT.

I. Still-born

II. Injuries received during Birth

III. Bleeding from the Navel-String •

IV. Ulceration, and Bleeding from the Navel . • •

V. Jaundice . • • •

VI. Retention of Urine and Motions

VII. Swelling of the Breasts

VIII. Inflammation of the Eyes

IX. Hare-lip and Cleft-palate ....

X. Tongue-tied

XI. Moles and Marks on the Skin

PAGE

216 216 217

Chapter XII. Other Accidents Of Infancy And Childhood

I. Scalds and Burns

II. Swallowing Boiling Water

III. Bruises

IV. Wounds

V. Broken Limbs

VI. Sprains '

VII. Eoreign Bodies in the Ears and Nose

VIII. Choking

IX. Stings of Insects

X. Poisons

228 229 231

Chapter XIII. Disorders Of The Stomach And Bowels Of Infants

no

I. In the Infant at the Breast

II. At the Period of Weaning 24

III. In the Infant brought up by Hand ... 24

IV. Matornal Management of these Disorders . • • 24

CONTENTS. Xlii

Chapter XIV. The Diseases Oe Children

SECT. PAGE

I. Colds and Coughs 249

II. Costiveness . . . . . . . 251

III. Protrusion of the Bowel ..... 254

VI. Thrush . . 261

VII. Nocturnal Incontinence 263

VIII. Skin Diseases ....... 264

Red-Gum 264

Tooth Rash 265

Milky Scale 267

Nettle Rash 269

Dandruff 270

Ringworm 271

Baldness 271

IX. Inflammation and Abscess in the Ear . . . 272

X. Deformities:

Of the Feet 274

Of the Chest 274

XL Bleeding from the Nose ..... 276

XII. Chilblains ........ 277

XIII. Scarlet Fever 277

XIV. Measles 293

XV. Small-pox 299

XVI. Chicken-pox . 306

XVII. Hooping-Cough 308

XVIII. Croup 314

XTX. Water in the Head 320

XX. Convulsions 327

Chapter XV. On The Prevention Of Scrofula And Consumption 329

THE

MATERNAL MANAGEMENT

OF

CHILDREN.

Introductory Remarks on the Great Mortality of Children, and the Lessons which this Knowledge teaches.

In the Supplement to the Thirty-fifth Annual Report of the Registrar-General 1 we find it stated that one child out of every six that are horn dies within the first five years of its birth, even in the healthy districts; and that in Liverpool, ‘ which serves to represent the most unfavourable sanitary conditions,’ * nearly half the number born die in the five years following their birth.’ It can be seen also, by reference to the elaborate tables of mortality, that more than one -half of the entire number of the deaths takes place during and within the first year of life.

Dr. Farr, hi referring to this subject, says : ‘ The mortality of infants evidently depends, to some extent,

1 Published by Messrs. Eyre and Spottisvoode. London, 1875.

B

MORTALITY OF CHILDREN, AND on the midwifery of a country : on the way the children are fed by the mothers ; on the water ; and on the cleanliness observed, as well as on the other sanitary conditions.’

Now these observations ai-e founded on actual statistics, compiled by order of the Government, and can be consulted by anyone who feels inclined to doubt their accuracy. It is exceedingly probable that this rate of mortality (which is computed for the whole of England) is higher than that which actually occurs in the class of people who care to consult such a book as this. But although certain social and sanitary conditions surround the children of this class which undoubtedly tend to lessen the mortality, it is yet only too evident that much remains to be accomplished, and that the conditions which alone render a child vigorous at its birth and enable it to live through the most critical period of its life are either misunderstood, neglected, or ignored. To show what these conditions are, and how they may best be carried out, and above all, to prove that they cannot be neglected ivith impunity, is one of the objects of this little work. Whatever be the mortality in any given class of the community — small or great, it may be greatly diminished. The distress of witnessing a suffering infancy cut short by an early death just as the child is beginning to reward all the parents’ care and anxiety, may be prevented in multitudes of cases. But the early death of offspring is not the only penalty that must be paid. For, what is still worse, they survive only to struggle with all the consequences of weak constitutions, and to perish just as they begin to fulfil all the hopes of their friends. Or, if this do not happen, they carry through life, as long as it lasts,

DUTY OF MOTHERS.

a state of health which deprives their minds of elasticity, their tempers of serenity, and their duties of enjoyment.

Since the diligent observance of what is to be recommended to her involves so great a reward, and its neglect so painful a retribution, no appeal to the mother’s sense of duty can be needed. It is true she must be content to take the representations here given on trust, unless she extend her studies beyond these pages. If she is alive to her responsibilities, she will not withhold her earnest and conscientious attention, until she has mastered the evidence on which the medical profession urge compliance with all the means of ensuring- health.

The causes which affect the health and life of offspring fall under two heads : those which have reference to the state of the parents before the birth of the child; and those which act directly upon the child after the commencement of its independent existence.

The first class includes, of course, those tendencies to disease which are derived from both parents at the time of conception, and those which act through the medium of the mother’s system alone, and which are especially under her control — -viz., her state of health and conduct during pregnancy. Of the influence of those which operate at the time of conception, the most striking contrasts are met with in diffei’ent families. Amongst the wealthy of the land, where the nurture of the body is sedulously pursued, and under the greatest advantages, it is sometimes found to be difficult, and in many instances impossible, to rear the children to maturity. Consumption, or Btrumous disease in one or other of its manifold phases, or some other hereditary disorder, carries off

MORTALITY OF CHILDREN, AND one child after another, the utmost care not being more than enough to save one sickly child ; whilst in the families of another class, and where the external circumstances are not so favourable to the cultivation of health, you may see one child after another horn with a perfectly healthy system, and growing up to a vigorous manhood, such a thing as disease being scarcely known in their nursery, if you except those disorders which all, in infancy, are more or less liable to. The disease in the former case is transmitted from the parents to the offspring, and the stock is unhealthy, whilst in the latter the children are healthy because the constitutions of those from whom they have derived their being are so. External circumstances and management will not explain the different result ; indeed, we have supposed them in favour of the delicate and sickly. In all ages this fact of hereditary influence upon the constitution of offspring has been admitted; and although here and there you may meet with an apparent exception, the genei’al rule holds true. If this exception be traced on for a few years, it will sometimes prove to be no exception at all ; for hereditary disease after awhile manifests itself. Its seeds had evidently existed at birth, and have only been lying dormant in the system. But over this source of mischief to infant life, I confess the mother has little immediate control. She has, however, a very absolute control over those tendencies which arise from her conduct and state of health during the pregnant state. The natural dispositions and capabilities of children are inherited or produced by favourable or unfavourable circumstances, operating on the parents previous to the birth.

1. Observation shows that the first children of

DUTY OF MOTHERS.

very young mothers, whatever sprightliness they may evince from a high flow of animal spirits, are generally deficient in strength of intellect and stability of character. How, indeed, could it be otherwise, when the parents had spent the first years of married life in a career of dissipated amusements, in which the cultivation of the mind had been totally neglected; neither reading, rational conversation, nor reflection had been practised to exercise and strengthen it 1

2. Many strong-minded observing mothers have recognised in their children the same sentiments in which they indulged, and the peculiar habits which they had practised, during the whole period of their jyregnancy. Hence, it ought to be an object of the first importance with every woman about to become a mother, to exercise her mental perceptions, reasoning faculties, and moral sentiments, to their full extent — to cultivate kind feelings and noble aspirations — to indulge in no pursuits unworthy of a rational immortal being — and to ascertain and live in accordance with the laws instituted by the Creator for the preservation of health ; so that her child may be perfect in mental, moral, and physical organisation.

The young mother is, perhaps, little aware Iioav much the health and vigour of her expected offspring depend upon her care and prudence, and how she ma.y entail on it the evils of a weak, suffering, and brief existence by an ignorant or wilful neglect. Let it be impressed on her mind that she must consider herself a mother, not only from the birth of her child, but even from the first moment of its conception, and that from that moment her duties commence. ‘ Physical education commences with the pregnancy of the mother. There is so remarkable and intimate a. con-

MORTALITY OR CHILDREN, AND nection between the child and its parent, that it is difficult to say whether any important change can take place in the physical or mental condition of the mother, which is not liable to produce some corresponding change upon the condition of the child ; and even supposing some physiologists to have carried the theory of this connection too far, yet the mere possibility of such important consequences as are involved in its being true, ought to be quite sufficient motive with every rational woman for the extremest discretion. It is certain, however, that the future health and constitution of the offspring are greatly, though it may be to an indefinite extent, dependent upon the conduct of the mother. If she carefully adopt the means of management to which allusion has been made, experience shows that she takes the most likely steps to ensure a healthy progeny. If, however, she is careless and negligent upon this head, and also fails in attention to the measures which her new condition demands, perhaps indulging in that course which under ordinary circumstances would be directly opposed to the maintenance of health, her child will inevitably be variously and injuriously affected, these causes operating through her system upon that of the child.’1 But this subject is one which concerns the pai’ent’s health, and does not immediately belong to the present inquiry, and has been fully dwelt upon in the work just quoted. I need only once for all observe, that the great aim and object of the mother ought to be to maintain the general health in the state of the grea test vigour, and that this can only be accomplished by a daily and strict compliance with the laws of health.

Hints to Mothers, p. 17.

DUTY OF MOTHERS.

One word only in regard to the menial health of the mother. It has often been remarked, that great and eminent men receive from their mothers, even before they see the light, half the mental disposition and other peculiarities of character by which they are afterwards distinguished. It is of curious significancy that in the lower animals, habits which are the result of training in the parent will manifest themselves in the young without that process — as, for instance, particular modes of hunting. It is quite agreeable to analogy to think that the disposition and temper of the expected offspring may be influenced (independently of its bodily healthiness) by the moral feelings which the mother either permits or cultivates in herself. This consideration may well be allowed to give additional energy to all efforts of self-government on the part of those who expect to be mothers ; though irascibility, ill temper, and all the other foes to cheerfulness and peace, had better be encountered and subdued before this fresh responsibility arrives. 1 As the bodies of children are imperceptibly affected by the air they breathe, so are their minds by the moral atmosphere which surrounds them.’

Of the causes which after birth act directly upon the system of the child , and undermine its health, it is not too much to affirm that by far the greater part are owing to ignorance and mismanagement. The infectious and unavoidable diseases to which infantile life is liable, are of course productive of a certain amount of mortality; but this bears no proportion whatever to that produced by the causes just mentioned. That the latter are the grand source of destruction (however unwilling we may be to admit it), the experience of the past and present time

MORTALITY OF CHILDREN, AND affords most undeniable proof. If it would not tire the reader, facts might be given of the most striking character. To mention one example only. About a century ago the workhouses in London presented the astounding result of twenty -three deaths in every twenty-four infants under the age of one year ! In consequence of a parliamentary inquiry, an improved system of management was adopted ; and the proportion of deaths was quickly reduced from 1,600 to 450 a year. In these institutions alone, then, there was an annual loss of 1,150 lives clearly traceable to ignorance and mismanagement. The various returns of the causes of death which have been compiled from time to time, not only in England, but in various t parts of the continent of Europe, most unequivocally show that infant existence is mostly cut short by a want of the necessaries of life and of rational procedure, rather than by causes which cannot be avoided. It is very manifest to those who are at the post of observation, that few families, even of the wealthier class, act on the principles and laws of health. Hence in some families the services of a medical man are scarcely ever required, whilst in others he is scarcely out of the house. It must not be said that the children of the two families have not equally healthy constitutions. The observation of many years has proved that this explanation will not always apply. The real secret of the difference is traceable to the kind of domestic treatment followed in each. Again and again have I seen a delicate and sickly child become vigorous and healthy under a judicious system, whilst, in another family, the child that was born strong and healthy has withered, pined, and died, simply from bad management. Here, surely, the probabilities were in favour of the latter. Or it

DUTY OF MOTHERS.

may be, the first-born child grows up delicate and weakly ■ but the parents arc wise enough to use their dear-bought experience, and the adoption of a more rational course secures a better lot for the future children. Such instances unequivocally prove that health is not a mere matter of chance, but the natural reward of an intelligent and persevering prudence.

Then, again, in reference to teething, and to those complaints of infant life to which all are more or less subject, it is most important that the mother should distinctly understand that the adoption from the first of a mode of management in accordance with the nature and wants of the infant constitution, is by far the most effectual way to diminish their danger. A large proportion of the diseases, which do destroy life in early infancy, are more or less directly connected with the condition of the digestive organs and bowels, and one of the principal sources of derangement is undoubtedly errors in diet. Mistaken kindness, sacrificing the health of a child to the indulgence of the false love of the parent, constantly occasions this evil. I have seen a child, who, from the careful management of the mother, had never had a day’s illness, sustain an attack of diarrhoea, which endangered its life, from the father giving an improper article of food. Now this mistake in a minor degree is constantly practised by parents ; and although the mischief may not be manifested so quickly, a sure and permanent injury is being inflicted.

The consideration of all the points in which ‘bad management ’ may be exemplified, would be premature in an introductory chapter. But let us take that of ventilation. The want of it, in the apartments occupied by children, is fruitful of evil. To be convinced

10 MORTALITY OP CHILDREN, AND

of the influence of atmosphere on health, it is only necessary to consult the tables of the Registrar- General, or to stroll through some of the back slums of a populous town, and compare the pale-faced puny children playing about there with the rosy-cheeked ‘ bairns ’ of a country village, and then judge for oneself. Common sense will at once suggest that it is the Want of pure fresh air which causes the marked difference in the appearance of these two classes of children. But we must not allow ourselves to be deceived by the appearances, nor are we to suppose that these marked effects will be produced all at once ; on the contrary, the effects of bad ventilation will be sIoav, possibly imperceptible, and insidious ; and this is one of its worst features, for the health of a child may become undermined before the parents’ attention is drawn to the fact : they have become so gradually familiar with the pallid and sallow face, that its real significance may have been overlooked ; or, again, the effects of deficient air and overcrowding may not show themselves until these children have in their turn become parents, and then their weakly and undergrown offspi’ing will tell the tale, that may have remained silent and hidden for so many years.

And in localities where necessity, not choice, compels her to reside, the mother may, by judicious arrangements, successfully combat all that is unfriendly to health and long life. It is enough that most of the conditions on which the health of offspring depends can be more or less completely secured by the generality of parents. They may not be able to remove to a detached villa in a choice locality ; but most of those who will purchase a book of instructions, such as this professes to be, have the means of provid-

DUTY OF MOTHERS.

mg their children with all that is required for more than an average degree of healthiness. This conviction is surely sufficient to animate the parent’s resolution to act up to her responsibilities.

The majority of young married women usually leave this sort of knowledge to be acquired at the cost of a dear experience. It ought not, and it needs not, be paid for at such a rate. ‘ She becomes a mother without a suspicion of her deficiency in even the most ordinary information concerning the nature and functions of the infant being whom she is so suddenly called upon to chei’ish and bring up.’ She has then to educate herself, or rather she becomes educated very often at the sacrifice of her first-born. How much wiser if, from the moment the wife finds herself likely to become a mother, she commenced seeking the knowledge which would fit her for her duties.

It cannot be supposed for a moment that I believe in the possibility of banishing illness from the nursery. Illness must and will come more or less to all. Hereditary disease will produce it — infection will give rise to it — as will other causes over which we have but little control. All I argue for is the use of the best means to prevent that large amount of sickness and death due to ignorance and mismanagement, which may be assuredly greatly diminished by the mother early fitting herself for all that the title of mother implies. So live that your offspring shall inherit a healthy body — so bring them up, that health shall be preserved, and life worth having — and if disease attack them, study to help and not to impede the efforts made to restore them.

I will only further observe, that in looking around me I can safely affirm, as the result of an experience

MORTALITY OF CHILDREN.

of above twenty years, that, in those families in which the principles laid doAvn in this work have been followed out with persevering care, patience, and judgment— with the exception of disease from unavoidable causes, the children have grown up strong and healthy. But then parents and dependents have steadily acted day by day up to these principles, in themselves simple enough, but demanding the exercise of constant self-control, until they become the very habit of nursery government.

It is necessary to apprise the reader that throughout this book the period of Infancy is considered to be under two years of aye — and that of Childhood from two to eiylit years of aye.

PART I.

MANAGEMENT OE CHILDREN IN HEALTH.

Chapter I. Maternal Nursing

Sect. 1.— The Duty and Advantages cf the Mother Nursing her Infant.

It may be called a fixed law of Nature that a healthy woman should suckle her offspring. There are exceptions; but as a general rule it holds good, and, like all other laws in natui’e, it cannot be broken with impunity. To refuse to comply with this arrangement of Providence, is to foi-ego the first reward of previous suffering. It is plainly intended to cherish and increase the love of the parent herself, and to establish in the dependent and helpless infant from the first hours of its existence those associations on which its affection and confidence afterwards will be most securely founded. The evidence of design is manifest. So long as the child is unborn, no milk is secreted in the mother’s breast, but no sooner does she give it birth, than this fluid is prepared and poured forth, admirably fitted in its qualities for the rapid

MATERNAL NURSING.

growth of the babe’s delicate organism. It embraces the three principles (the albuminous, the oleaginous, and saccharine) of which the diet of man consists in his most perfect physical development and greatest intellectual vigour ; and moreover is the only food supplied by nature, in which such a combination does exist. ‘It is a model,’ says Dr. Prout., ‘ of what an alimentary substance ought to be — a land of prototype, as it were, of nutritious materials in general.’ And thus it continues to be secreted day by day, until, having acquired the power of assimilating other kinds of food, and of extracting from them those elements which are necessary to its further growth, the digestive organs of the infant no longer require this compound food.

Nursing would also seem to be as beneficial to the system of the healthy woman as to her child. In the lying-in month it undoubtedly is the means of preventing or diminishing the tendency to disease. During the whole period of nursing it contributes greatly to preserve and promote the mother’s health ; for no period of the woman’s life, generally speaking, is so healthy as this, and many a woman who has previously been delicate will become robust and strong at this time. In most women it prevents the too frequent recurrence of pregnancy, than which nothing tends so surely to undermine the constitution, and to induce a premature old age. It diminishes the disposition to cancerous affections of the breast ; for although women who have had children are still liable to these, ‘ yet it is undoubtedly true, that breasts which have been unemployed in suckling in women who have been married, but are childless, and in those who have remained single, are more prone t-o malignant

MATERNAL NURSING.

diseases than those of women, who have nursed large families.’ 1

It is very clear that there is no noui'ishment so well suited to the constitution of the individual child as its own mother’s milk ; there is a natural relation between the two, which is not so perfectly realised when the child is transferred to another breast. This practice, however, when it does not arise from necessity, is not nearly so prevalent as in former times. There are few women in the present day disposed to devolve the dearest and greatest privilege of a mother on a stranger. But whenever, without due reason, the healthy woman of fashionable life, from caprice, the fear of trouble, the loss of pleasure, the anxiety to avoid the confinement which suckling necessarily imposes, or any cause of a like frivolous kind— feels disposed to break this law of her being, it behoves her to look to the possible consequences to herself of being out of harmony with it — for no one can fail to perceive the significance of the facts to which allusion has just been made. Animals, even those of tire most ferocious character, show affection for their young ; they do not forsake or neglect them, but yield them their milk and watch over them with the tenderest care — woman, who is possessed of reason as well as instinct, must not manifest a love below that of the brute creature.

Sect. 2. — Of Mothers who cannot Suckle.

There are circumstances undoubtedly which disqualify the parent from the performance of this duty, and I believe such individuals for the most part will

1 Sir Antley Cooper on Diseases of the Breast, p. 137.

MATERNAL NURSING.

be found less liable to the consequences of such neglect (just referred to) than the robust and healthy. Sometimes a delicate state of the system will fox-bid it. Here, however, it will be well to make the attempt, if sanctioned by the medical attendant ; and if persevering attoixtion is given to the vai-ious measui-es that invigorate the system, it may be that the delicate woman will become strong, and be enabled to nxxx-se, beneficially to herself and her child. The experiment should always be fairly tided, and never given up hastily ; and if it fail, the consequence of the trial, uuder judicious medical sxxpei-intendence, will not be attended with injury. Sometimes a defect in the structure of the bi-easts or nipples renders them unfit to yield milk ; here thei-e is no l-emedy, and the disqualification must be submitted to. Sometimes the defect is simply in the nipple. It may be too small and sunken — or, from disease, it may be excoriated or cracked ; and whenever the attempt to suckle is made, it is attended with gi-eat agony ; persevex-ance in the use of proper means will frequently i-emedy this defect in both cases. 1 There are now and then, howevci-, instances in which experience strongly proves that the parent ought most assuredly not to attempt nux-sing her offspring, as it woxdd inflict in-emediable injury ; and to these cases I shall devote the next section.

Sect. 3. — Of Mothers who ought not to Suckle.

There are some women who ought never to undei*- take the office of suckling, not so much on account of their own health, as that of their offspring.

1 Soc Hints to Mothers, pp. 205 and 200.

MATERNAL NURSING.

The woman of a consumptive and strumous constitution.— In the infant born of such a parent there will be a constitutional predisposition to the same disease ; and, if it is nourished from her system, this hereditary transmission will be strengthened. ‘ No fact in medicine is better established than that which proves the hereditary transmission from parents to children of a constitutional liability to pulmonary disease, and especially to consumption ; yet no condition is less attended to in forming matrimonial engagements. The children of scrofulous and consumptive parents are generally precocious, and their minds being early matured, they engage early in the business of life, and often enter the married state before their bodily frame has had time to consolidate. For a few years everything seems to go on prosperously, and a numerous family gathers around them. All at once, however, even while youth remains, their physical powers begin to give way, and they drop prematurely into the grave, exhausted by consumption, and leaving children behind them, destined, in all probability, either to be cut off as they approach maturity, or to run through the same delusive but fatal career as that of the parents from whom they derived their existence.’ 1 There is scarcely an individual who reads these statements who will not recall some illustration of their truth, though they perhaps may have hitherto been in ignorance of the cause. The constitution, then, of such a female renders her unfit for the task of nursing ; and however painful to her feelings it may be, she must recollect that it will be far better for her own health, and infinitely more so for that of