Hints for the general management of children in India, in the absence of professional advice

Front matter

ARMY iii mil i i. 1 1 ii

22101940227

ROYAL army medical COuLLoE library.

Preface To The Fourth Edition

Ix bringing before the public another Edition of Dr. Goodeve’s valuable little work (which is more in demand than ever,) the Publishers have the pleasure to announce that it has undergone a most careful revision, and an addition has been made of several fresh Chapters,— two of which, those on the subject of Poultices and Foxlextatioxs, have been extracted from that invaluable work of the celebrated Dr. South, entitled Household Suhgeiiy. — a little Book without which no Domestic Library can be complete.

Preface To The Third Edition

When I published tbe Second Edition of tbis book in 1844, a few months before I retired altogether from professional life, I had reason to suppose that long ere this time it would have been superseded by some more efficient work of the kind. This I understand has not occurred, and whilst the former editions are out of print, a demand for the book itself continues. Some spurious copies having in consequence been produced in the meantime, I have complied with my Publishers’ request to bring out another, and I hope an amended edition of my own.

London , October, 1852.

Preface To The Second Edition

This little work was printed orginally for private circulation only. It was intended to supply, in a more convenient form, the place of certain written directions I was accustomed to give my patients.

By mistake, a well meaning friend, without my knowledge or desire, noticed its existence in one of the public papers. The result was a demand upon the booksellers in Calcutta for copies, which they were not at liberty to supply, and they have requested me to permit a public edition to he produced ; for it appears that a hook of the kind is much required. To this arrangement I have consented, though, I confess, somewhat unwillingly, as I believe the work is scarcely worthy of a more important position than that originally destined for it to assume.

TUI

Preface To The Second Editiok

It may, however, supply to a certain extent, the present deficiency in the Indian nursery ; and imperfect as it is, it may occasionally prove useful, until its place is supplied by some abler writer, an event, which, for the sake of the public, may, I trust, speedily occur.

September 1, 1844.

ORIGINAL PREFACE.

In offering these few pages to my patients, I do not, for a moment, pretend to give them a complete treatise on children’s diseases. Nor do I wish, in any way, to prevent their taking medical advice, where it can he obtained. On the contrary, I would earnestly caution them never to trust to their own judgment, when they can procure professional assistance. The observations and advice contained in this little pamphlet, are intended, merely to aid those (a large class in India) who are placed at a distance from the advice of medical practitioners : and if this work prove beneficial in a single case, I shall be amply repaid for the time I have bestowed upon the subject.

Calcutta, March 15, 1844.

MANAGEMENT OF CHILDREN.

PRELIMINARY OBSERVATIONS.

lie all diseases of children, it must be remembered, that the two most fertile sources of complaint, and at the same time the most frequent aggravation of other diseases, are teething and irritation of the bowels, the latter generally arising from improper food or indigestion. Therefore, the mouth must always be well examined, and the gums lanced freely, when there is the remotest cause to apprehend that teeth are coming through. Next, the bowels must be well cleansed out before other medicines are administered, and the strictest attention paid to the diet at all times.

The chief dangers in the progress of children’s diseases are, a tendency to inflammation in the stomach, lungs, and brain ; and a liability to sinking from apparently trifling causes. Hence we must always be on the watch for the former, and be prepared to combat it with leeches and purgatives when it arises, but we must, at the same time, recollect, how easily children are pulled down by severe evacuations of any kind, especially by bleeding and undue purging. In

XIV

PRELIMINARY OBSERVATIONS.

the management of all these diseases, even during their continuance, therefore, children require more proportionate nourishment than adults under similar circumstances.

Another peculiarity of children is, the facility with which they are affected by opium. Young children, at the breast, have been poisoned by a single drop of laudanum.

No diseases are, perhaps, so rapidly benefited by change of air as those of children. A very few miles’ journey is often sufficient to prove exceedingly beneficial, in protracted complaints, which have resisted every other remedy ; more particularly those of the lungs, diarrhoea and dysentery. The sea especially, possesses a peculiar charm, and if possible, should always be resorted to where diseases prove uncontrollable by medicine. This remark is quite as applicable to native children as to those of European or mixed birth.

It is almost unnecessary to add, that amongst the two latter classes, certainly, many diseases of this kind are incurable, except by sending the child to reside in a cold climate free from all tropical influence whatever.

GENERAL MANAGEMENT

OF

CHILDREN.

When the newly born child has been washed and dressed, it is customary to administer to it a teaspoonful of castor oil, and though this is objected to by some authors, it is, in this country at least, a very useful proceeding ; for, the mother’s milk, which is sometimes regarded as sufficient to purge the infant, does not generally appear till the third or even the fourth day. The oil may be repeated occasionally, say every two or three days at first, hut the practice of administering a dose every morning for months together, is very reprehensible. If at any time the child’s bowels are confined for more than twenty -four hours, or it is restless and uneasy from griping, a mild aperient should be given and repeated if necessary.* Cas-

* Under ordinary circumstances an injection of warm water mixed with soap or sweet oil will frequently suffice, or the introduction of the pawn stalk practised by the native nurses may be employed. For cases of habitual costiveness, these methods are preferable to the constant administration of purgatives.

B 2

Infants castor oil at first.

GENERAL MANAGEMENT

Constant purgatives to be avoided.

Grey

powder.

tor oil,* in a little warm sugared water, answers this purpose, and if there be much griping or wind, a drop of aniseed oil and two of sal volatile may he added to the dose. If the motions are sour and lumpy or greenish, the rhubarb and magnesia or red mixturef should be substituted for the oil ; and for older children the syrup of senna may be used ; but carefully avoid the practice of constant purgatives which nurses are so fond of, and especially abstain from mercury, in the shape either of calomel or grey powder, unless there is some decided necessity for it by the presence of actual diseases. Occasionally, it is true, a dose of grey powder with ipecacuanha may be required ; for instance, where the ordinary aperients do not relieve the child from griping and uneasiness, and the motions continue for two or three days lumpy, and green and sour, in spite of the effects of the red mixture. Under these circumstances three grains, or at most four, of the

* A teaspoonful every four hours till it operates.

f Vide page 87. Under these circumstances great advantage is often obtained by giving one or two grains of plain magnesia twice daily. For similar derangements of the infant’s bowels the following powder often proves beneficial : rhubarb, prepared chalk, cinnamon powder, each one grain, twice or thrice daily, and where the motions are very loose and watery and frequent, half a grain of Dover’s powder may be added, or the chalk mixture (page 50) substituted.

OF CHILDBED.

grey powder, combined with one grain of J ames’s powder, will often improve the state of the bowels at once. Where there is slight fever present, this dose also may be used ; but in general it is given much too frequently. In the slight derangements otthe infant’s bowels above-mentioned, particularly where the child screams much with flatulence, a few drops of Dalby’s carminative is a Dalby for more desirable remedy : from five to ten drops, SriPin£’ gradually increased to twenty for a child above one year old, may be given in a dose of castor oil, and repeated in two hours— in very obstinate cases of colic, even as far as three doses. But Mischief this medicine very often becomes an exceedingly uae mischievous agent in the nursery. The momentary relief it affords induces the attendants to fly to it whenever the child screams, and at last the infant, though not perhaps absolutely poisoned by it, has its digestive powers and nervous system seriously injured. Dalby’s mixture in the hand of a medical man, a skilful nurse, or an intelligent parent, may be a most valuable remedy, but it should never be trusted to the ordinary nursery servants.

The chief cause of almost all diseases in young Errors of children is error in diet, committed chiefly by c^et‘ attempting to deviate from the food pointed out by nature for the infant’s support. More infants die from improper feeding than from any other cause.

b 3

GENERAL MANAGEMENT

Mother’s milk alone to be given if possible.

Time of nursing.

But sickness may also be produced by the improper administration of the natural food, or by its quality being unfit for the nourishment of the child.

Until the mother’s milk is sufficient, which Is rarely the case till the third or fourth day, the infant must be fed upon thin arrowroot or barley water, given by a feeding bottle if possible ; but as soon as there is sufficient natural nourishment, the child should depend upon that entirely, till it has begun to cut some of its teeth, i. e., till it is about six months old at the earliest. If there is milk sufficient, no other food whatever should be given. If, however, from any cause there is a temporary deficiency, a little arrowroot, milk and water, barley water, or thin pap, may be substituted ; but if it is possible to avoid it, these articles ought never to form a regular part of the child’s diet. If the mother’s milk should fail, a wet nurse should at once be procured. The child should not be put to the breast oftener than once in three or even four hours after the first week or ten days. A very short time accustoms the infant to these regular periods, and its own health, as well as the comfort of the nurse, is materially benefited by this systematic method of feeding. During the night a well-managed infant will not require to be nursed at all, say from ten o’clock till four or five in the morning. All this is a

OF CHILDREN.

matter of habit, easily acquired by a little firmness and good management at first. A material step in this process is never to allow the child to sleep with its nurse, but always in a separate couch.

When two teeth have come fairly through the More food gums, a little extra food may be allowed : arrow- ecj. root or sago, prepared barley or soojee, with milk twice daily ; and at nine or ten months, provided four teeth are cut, chicken broth, with bread or pishpash, may be given once in twenty-four hours.

When the teeth are all through the gums, meat may generally be allowed for dinner daily ; but in very warm weather — during the hot winds, for example — meat should not be given to children oftener than once in two days. In cases of plethoric children, twice a week will suffice during that period ; and this remark is applicable to children of all ages in India.

The child should not be entirely weaned till it Weaning, is sixteen or seventeen months old, if it is possible to continue so long ; perhaps a better rule is, not until all the teeth, except the last four grindingteeth, are cut. It is improper to continue the nursing beyond that period. It is true that many children are weaned without bad consequences at eight or nine months’ old, but they are naturally strong and healthy, and form exceptions to the general rule. Every experienced person must

GENERAL MaKAGEMEXT have had frequent opportunities of witnessing the fatal effects of early weaning upon infants. Danger of. When the child has been weaned too early, and the consequences of such mismanagement show themselves by bowel complaints, convulsions, emaciation, &c., no time should be lost in endeavouring to induce the child to take again to the breast. Should it refuse to do so, which is most probable, if it is above six months’ old, Donkey’s donkey’s milk must he substituted, and must form the sole diet under these circumstances. From half to a quarter of a pint three times daily is usually enough, but it may be given four times if the child is not satisfied with less. A dessert spoonful of lime-water* should be added to each pint of the milk. The lives of hundreds of children, reduced to the brink of the grave by improper food, have been preserved by adopting this system.

Change of It frequently happens that the milk of one nurses. woman disagrees with a child, when another will restore it to health ; when, therefore, an infant does not thrive, though confined to breast milk for food, it is desirable to change the nurse. Frequent changing of nurses, unless from urgent necessity, must however be avoided.

* This is best procured at the druggist’s, but it may be made by dissolving two ounces of lime in three pints of water; let it stand, and pour off the clear liquid,

OF CHILDREN.

After weaning, their diet should be always Food after simple, consisting of meat (flesh or fowl), with g

thoroughly cooked vegetables or rice, and a light pudding, if they like the latter, varied by pishpash or mild curry for dinner ; bread, rice, arrowroot, soojee, or tapioca and milk, or milk and water, and bread and butter, for breakfast and supper, with an egg added to the former meal, if desired. Very little fruit or sweetmeats should he given, and the meals should be regularly taken at stated times. Cold iced water forms the best drink usually, but delicate children are sometimes much benefited by a glass of bitter ale daily.

Wine is of very doubtful advantage, unless in cases of great exhaustion from actual disease.

Children should be dressed very lightly in the Dress, warm season, with additional covering for the cold weather. The head should always be kept uncovered in the day time, and socks should be worn at all times — cotton in hot, worsted in cold weather. Unless the child is very delicate, flannel should not be worn next the slim ; but when children are liable to colds, bowel complaints, or convulsions, it is advisable to use a thin flannel banyan or shirt reaching to the knees. For children who have no longer any necessity to wear napkins, the lower portion of the dress should always be made in the shape of trowsers.

These are particularly useful at night, when the

GENERAL MANAGEMENT

Fresh air.

Form of dress.

Should

sleep

alone.

child throws off the bed-clothes, and is apt in consequence to be chilled suddenly. The nursery should be thoroughly open and airy at all times, and a punkah is by no means objectionable at any time during hot weather. Even at night there should be a free circulation of the air in the room, the Venetians of one or more windows being left open, but the child’s bed should be carefully kept out of a draught. It is much better to use a night punkah than to allow children to be cooled by the external wind blowing on them, or to be restless from heat. Of course, in the hot winds during the day-time, the glass windows must be shut in the nursery, as well as in every other part of the house, but as soon as it is possible to open them it must be done. During the hot weather and rains, in the day-time the best dress for children to wear in the house is a thin cotton shirt, drawers and stockings forming one continuous garment. This may be made of flannel, if it is desirable, and forms by far the best description of night-clothes at all times.

Children from their earliest infancy, as before remarked, should be accustomed to sleep in separate beds, and never permitted to remain in bed with the nurse, unless, and that but rarely, in case of severe illness.

The practice of keeping children shut up all day between sun rise and sun set in dark closed

Or CHILDEEIf.

rooms is very objectionable. Light and air are Fresh air. necessary to the healthful growth of nearly all Light, living things, and certainly European children, even in India, cannot with impunity infringe this rule. It is not well to permit the sun to glare directly into the room, but I much question, except during the few weeks’ continuance of the very hot winds, whether it is not much more healthful to keep the glass windows of the nursery always open, and the Venetians only closed during the time the sun is absolutely shining on the windows.

Exercise is equally essential to the health of Exercise, all children. After the first week they should be taken out morning and evening by the nurse, and as soon as they can walk, they should be permitted to run about out of doors as much as they possibly can without exposure to the sun. It is much better to allow them to use their own lees than to carry children about in the arms of servants or in carriages. When they are of sufficient age they may ride on horseback with great advantage. This forms in all seasons an admirable description of exercise for children in India.

The utmost attention should be paid to cleanli- cieauli ness of person and dress. Every child in India, ness, who is not suffering from sickness, should, if possible, be bathed and dressed twice daily, in cold water generally, but in very cold weather

GEN'ERAE MANAGEMENT

Bathing.

Salt

■water.

V accination.

Teething.

the water may he made tepid. For very young infants warm water may be used ; but as soon as possible they should be bathed in water of the Ordinary temperature. In cases of weakly, delicate children, it may be necessary to use tepid water at all times, and not to bathe them oftener than once in twenty-four hours ; but these are rare exceptions. In some cases of constitutional debility, the common black salt in the proportion of a seer to four gallons of water, forms a useful and strengthening addition to the bath where ordinary sea water cannot be procured, but the latter, if it can be obtained, is far preferable.

Every child should be vaccinated within three or four months of its birth, if possible, but the period must depend somewhat upon the season of the year. Vaccination is rarely effective in the hot weather and rains. It is best performed between the months of November and March. It is safe to operate upon infants after they are a month old, and even earlier under urgent circumstances.

The most important as well as the most dangerous period of infantile life in India as in Europe — after the first week — is that of teething. The two first teeth usually begin to appear about the sixth month, and the whole set continue to be cut at intervals of from six weeks to two months, generally in pairs, till the third year. In regular teething the two centre upper teeth are

OP CHILDBED.

tho first to come through the gums, followed by the lower corresponding pair, then the next upper and lower front pah1, the upper and lower grinders, and lastly of the temporary set, the eye teeth ; while from six to twelve months after the latter, the first of the permanent grinders appear. This natural succession often varies materially, as well as does the period of commencing the whole process, without producing any apparently injurious effect upon the child’s health ; though as a general rule teething is a safer operation when there is hut little variety from the ordinary course above described.

When children are taken ill in any way during this period, attention therefore should always he paid at once to the mouth, for if not the direct cause of the complaint, the latter is almost always much aggravated by the irritation of teething, and medicines are comparatively of little avail till this irritation is removed. If there is the slightest reason to suspect, from unusual swelling or redness of the gums in any part, that the child is cutting teeth, the gums over them should he freely lanced. This trifling operation causes little pain and cannot possibly, in the most unskilful hand be attended with danger ; it may he performed with a lancet, a penknife, or any sharp cutting instrument, care being taken to cut down if possible to the coming tooth. This lancing may he repeated c

GENERAL MANAGEMENT, ETC.

Sending children to Europe.

advantageously every two or three days while the child continues to suffer.

With regard to the period of sending children to Europe, it is difficult to lay down precise directions, so much depends upon their health. In cases of delicate children it may be necessary that they leave as soon as they are weaned. On the other hand we find c\i&<\.venapparently thriving here, until they are ten or twelve years old ; and on the hills they may, perhaps, as far as physical education is concerned, be reared to maturity as safely as in Europe. As a general rule, children in ordinary health should not be detained in India after they are six years of age.*

* When children of delicate or scrofulous constitutions are compelled to remain in the Indian plains, great benefit is sometimes derived from the use of cod liver oil, given in teaspoonful doses twice or thrice, daily, in a little milk or peppermint water, or from four to five drops of the wine of iron in water may be given with an occasional aperient ; but the cod liver oil should be first tried.

TABLE OF COMMON DISEASES OF CHILDREN.

1. Simple Fever (Mild, Remittent, Typhoid,

Intermittent.)

2. Complicated Fever.

3. Cough.

4. Croup.

5. Hooping Cough.

6. Diarrhoea.

7. Dysentery.

8. Protrusion of the Bowels.

9. Colic.

10. Cholera.

11. Worms.

12. Thrush.

13. Mesenteric Disease.

14. Eruptive Diseases.

15. Mother’s Marks.

16. Eruptive Fevers.

17. Jaundice.

18. Dropsy.

19. Inflamed Eyes.

20. Stoppage of Urine.

21. Convulsions.

22. Accidents.

23. Ruptures.

24. Deformities at Birth.

c 2

DISEASES OF CUILDUEX.

SIMPLE FEVER.

Symptoms. The symptoms of fever are a dry heat of skin, especially of the forehead, hands and feet, quick pulse, flushed face, redness of eyes, white tongue, restlessness, fretfulness, thirst, high coloured and scanty urine ; and if the child can speak, complaints are made of pain in the head and limbs.

With these symptoms there may be cough or costiveness, or diarrhoea, or several other accidental symptoms complicated, but the signs above noted, are the essential symptoms. The subsidence of these denote the passing away of the paroxysm, and the first observed and most marked indication of this occurrence is the appearance of a moisture on the forehead, or in the bends of the various joints of the body and limbs.

If the attack be severe, give an emetic at once, and two hours after that lias ceased operating,

Treat-

ment.

DISEASES OE CHILDREN.

give a dose of calomel and James’s powder.* Put Severe the child into a warm bath at 100° to 105° for case9‘ ten minutes or a quarter of an hour ; and two hours after the calomel, give a dose of castor oil, or a teaspoonful of senna mixture.f If the child’s bowels are not moved two or three times within six hours after the calomel has been given, repeat the oil, and again in four hours after this, — if Mild needed, administer also an injection of oil and hot cases‘ water. In mild fevers — by far the most frequent form — instead of calomel the grey powder, (mercury with chalk) in doses of five grains may be substituted, followed by oil, and repeated once or twice — of course, in cases of fever arising from teething , the gunis must he lanced.

If the fever does not subside in twelve hours, repeat the calomel, the oil, and the bath, and in very urgent cases, administer small doses of tartar emetic. J The whole may be again repeated in twelve hours more, if the fever continues unabated. The child’s head, if hot, must, from the commencement, be kept cool with vinegar and

* Equal parts of each. One grain for a child under one year; two grains for ditto, under two years ; three grains for ditto, under four years, t Vide page 88.

+ The simplest mode of giving this is to mix half a gram of tartar emetic in four ounces, i. e., eight large tablespoonsful of water, and give a tea-spoonful of the mixture every two hours.

DISEASES OF CHILD RE>\

Leeches to head.

To the stomach.

Quinine.

Eepeated doses of calomel in obstinate cases.

water or iced water. If after free purging in the first twenty-four hours, the child’s head appears heavy, or the light hurts its eyes, the fever still continuing, leeches must be applied to the temples, {vide p. 98). If the fever continues severe for twenty-four hours, in spite of free vomiting and purging, while the head does not appear much affected ; but especially if the belly is swollen and tender to the touch, and vomiting is frequent, the leeches must be applied to the pit of the stomach instead of to the head. Leeches, however, must always be used with caution for children, and at an early period of fever ; no later than the third, or at most the fourth day. They are not required in moderate degrees of the disease, or except under the circumstances above-mentioned, but many obstinate and severe cases of children’s fever are greatly relieved by a single application of leeches to the pit of the stomach or head, especially to the former. When the skin becomes perfectly soft and perspiring, the bowels have been freely opened, the child’s head does not appear very heavy, and the eyes look bright, small doses of quinine may be given, {vide page 33).

If in spite of leeching the head or stomach, calomel, purging, and tartar emetic, the fever continues unabated on the third day — calomel should be given in small and repeated doses every

DISEASES OE CHILDREN.

three or four horn's* with the tartar emetic mixture. Care must be taken at the same time to keep the bowels freely open.

If the child’s head becomes very heavy and it grows stupid, and there is any tendency to squinting, or to convulsive movements of the muscles, a blister must be applied to the nape of the neck ; Blisters, mustard plasters to the calves of the legs ; the calomel must be continued, and if the child’s bowels are at all obstinate, a full dose of senna mixture or compound scammony powder must be given every four hours till it operates freely. If this does not succeed, an injection composed of castor oil and turpentine, of each a tablespoonful in a pint of warm water, should be administered and repeated every two hours till it operates.

The purgative must be repeated daily while these symptoms last. While the skin continues hot and dry the utmost advantage is derived from springing the surface with water and applying wet cloths continually to it ; but a still more soothing application and far more effectual in producing perspiration, is the wet sheet, employed so em-

* One grain to a child under two years old, and one and a-half under three. There is a good fever powder for this purpose made by mixing calomel four grains, tartar emetic half a grain, powdered chalk twelve grains. Divide into twelve powders ; one to be taken every second or third hour.

DISEASES OF CHILDBEX.

Remitting character of Indian fevers.

pirically by the Hydropathists. There are few remedies equally powerful for the purpose, and at the same time more safe than this one, as I have found hy considerable experience. The mode of using it is as follows. Spread upon the floor or a table, a blanket, and cover that with a sheet which has been soaked in water and subsequently wrung out. There is really no danger in the water being perfectly cold, but to avoid all apprehension, it may be as well to take the chill off it. The patient being stripped must then be placed upon the sheet, which with the blanket must be wrapped round him entirely and closely, leaving the head and face only uncovered ; but a wet cloth may also be kept upon the former. He may be left for an hour or two in this state, unless copious perspiration ensues earlier, when the apparatus should be removed and some light but warm clothing substituted, care being taken not to check the action of the skin. If perspiration does not follow the first operation, it may be repeated every four or six hours while the fever lasts.