First aid to the child : a guide to the feeding and treatment of infants in health and disease

Front matter

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UNIFORM WITH THIS VOLUME

Prefatory Note

The object of this small work is twofold ; it is intended to teach mothers and nurses how to maintain the health of infants and young children, and also to serve as a “First Aid” guide in the treatment of their diseases. For this purpose the book is divided into two sections, one dealing with infant feeding, which is the Alpha and Omega of good health in the little ones ; and the other with those ailments to which children are most liable.

The various diseases dealt with in the second section are treated by the Author in the same way which has been found so useful in his work “ First Aid to the Sick.” The disease is first defined, then the causes and symptoms clearly stated, so as to guide the mother or nurse to a right conclusion as to what the

VI

PREFATORY NOTE condition really is ; and lastly, the treatment is given to effect a cure where possible, or at least to give relief until* the services of a doctor can be obtained.

The Author desires to acknowledge his indebtedness to Dr Truby King, for many valuable suggestions on the subject of humanised milk, and infant feeding.

The desire is here expressed, that the public will find this work of more value as a preventive of sickness in infants and children, than as a cure for disease.

Section I.— The Feeding Of Infants

Ch. I. — The Mother’s Forethought. — General — The Care of the Breasts

Ch. II. — The Mother’s Milk. — For the Mother — For the Child — When to put the Baby to the Breast — Mixed Feeding — W eaning — U nliealthy Mothers — W et-Nurse

Ch. III. — Artificial Feeding. — Human Milk analysed — Cow’s Milk analysed

Ch. IV. — Humanised Milk. — Preparation of Humanised Milk — Errors committed in making Humanised Milk — Instructions for Feeding from Birth — Details regarding Strength of Food — Inferior Cow’s Milk — Quantity of Food for the Baby — Health and Weight — Infant Feeding-Table — Objections raised against Humanised Milk

Ch. V. — Other Methods of Using Cow’s Milk. — Dilution with Water and Addition of Cream — How to Prepare the Food — Quantities used — Diluted Cow’s Milk not Recommended — Sterilisation of Cow’s Milk — Boiling of Cow’s Milk — Pasteurising Cow’s Milk — Comparison of Sterilisation, Boiling, and Pasteurisation— Peptonised Milk — Condensed Milk — Advantages

of Condensed Milk — Disadvantages of Condensed Milk

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CONTENTS

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Ch. VI. — Proprietary or Patent Foods. — Milk Foods —

Farinaceous Foods ....... 59

Ch. VII. — The Feeding-Bottle. — Comforters ... 65

Ch. VIII. — Foods Suitable during Later Months of

First Year. — Foods Unsuitable for Young Children . 68

Section Ii.— Diseases Of Infants And Children

Introductory Remarks. — Temperature — The Pulse —

Breathing 75

Ch. I. — Premature and Weak Babies. — Food — Protection from Cold Air 78

Ch. II.— Infantile Diseases soon after Birth.— The Umbilical Cord — Primary Bleeding from the Cord —

Late or Secondary Bleeding from the Cord — Disfigurement of Head at Birth — Temporary Paralysis of the Face — Jaundice — Simple or Natural Jaundice — Infective or Septic Jaundice — Inflammation of the Eyes — Retention of Urine — Difficulty of Sucking, due to Tongue-tie, Hare-lip, Cleft-palate, Paralysis of the Face or Physical Weakness 82

Ch. III. — Diseases of the Digestive System. — Thirst — Diminished Appetite — Increased Appetite — Vomiting— Hiccough — Marasmus (Wasting) — Acute Indigestion— Gastric Catarrh (Gastritis) 91

Ch. IV. — Diseases of the Intestines. — Constipation (Costiveness) — Diarrhoea — Infantile Dysentery (Inflammatory Diarrhoea) — Intestinal Worms — Appendicitis . .103

Ch. V.— -Diseases of the Mouth, Throat, and Nose.

— Inflammation of the Mouth — Simple Catarrhal Stomatitis — Ulcerative Stomatitis — Thrush — Mumps (Parotitis) — Tonsilitis — Catarrhal Tonsilitis — Quinsy — Chronic Enlarged Tonsils— The Nose — Post-Nasal Growths— Nose-Bleeding 120

CONTENTS ix

Ch. VI.— Diseases of the Chest. — Bronchitis — Acute Bronchitis (Acute Bronchial Catarrh) — Acute Bronchitis in Children over Two Years — Acute Bronchitis in Infants and Children under Two Years — Chronic Bronchitis — Asthma — Pleurisy — “ Dry ” Pleurisy — “Wet” Pleurisy — Pneumonia (Acute Inflammation of the Lungs) — Bronclio-Pneumonia — Lobar-Pneumonia — Pleuro- Pneumonia

Ch. VII. — Diseases due to Infection. — Influenza — Diphtheria — Whooping Cough — Scarlet Fever (Scarlatina) — Measles — German Measles (False Measles) — Chicken-Pox — Croup (True Croup. Membranous Croup) — Catarrhal or False Croup (Acute Laryngitis) — Spasm of the Throat

Ch. VIII. — Rupture and Complaints of the Bladder and Rectum. — Rupture (Hernia) — Navel Hernia — Groin or Inguinal Hernia — The Bladder — Incontinence of Urine (Bed-Wetting) — Retentionof Urine — Phimosis (Tight Foreskin) — Prolapse or Protrusion of the Bowel

Ch. IX. — Rickets, Scurvy, and Anaemia. — Rickets — Fat Rickets — Infantile Scurvy — Anaemia (Bloodlessness) .

Ch. X. — Teething and Convulsions. — Teething (Dentition)— Prevention of Trouble when Teething is expected — Treatment during Teething— Care of the Milk Teeth — Convulsions — Possible Results of Convulsions

Ch. XI. — Paralysis, Epilepsy, and Rheumatism. — Infantile Paralysis — Epilepsy (Falling Sickness or Fits) — Rheumatism

Ch. XII.— Diseases of the Skin— Undue Moisture of the Skin — Undue Dryness of the Skin — Red Gum or Red Rash (Lichen) — Chafing of the Skin (Acute Eczema)— Scurfy Head or Cradle-Cap (Crusted Eczema) — Running Tetter (Impetigo or Pustular Eczema) — General Treatment in Eczema — Chilblains — Nettle- Rash (Urticaria) — Ringworm— Psoriasis— Vermin

Ch. XIII.— Pain, Headache, and Earache.— Pain— Crying—Colic (Belly-ache)— Headaches— Earache .

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CONTENTS

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Ch. XIV. — Stammering, Sleeplessness, and Nervousness.— Stammering or Stuttering — Sleep and Sleeplessness — Nightmare or Night - Terrors — Nervous Infants and Young Children 262

Ch. XV. — Accidents, Etc. — Sunstroke — Frost-Bite — Burns and Scalds — Bites of Animals — Snake and Adder Bites — Stings of Bees and Wasps — Wounds — When a Needle penetrates the Skin — Swallowing very Hot Liquids — Foreign Bodies in Special Organs (the Eye,

Nose, Ear, Throat — choking) ..... 270

Ch. XVI. — Poisoning. — By Acids — By Alkalies — By Narcotics — Irritant Poisons — Ptomaine Poisoning — Fungi Poisoning — Shock from Poisoning and Accidents 280

Ch. XVII. — Moral and Intellectual Training . . 287

Ch. XVIII. — General Hints. — Advice to Mothers on Consulting the Doctor about the Baby — Baths for Babies — Cold Douching — Baby Out-of-Doors — Fresh Air and Sunshine — Baby’s Clothes — Baby’s Diapers . 296

Lime Water — Barley Water — Rice Water — Oatmeal Water — Raw Meat Juice — Raw Meat Pulp — Albumen Water (White of Egg Solution) — Linseed Tea — Salt and Water Emetic — Drugs — Castor Oil — Other Aperients — Glycerine Enema — Soap and Water Enema — List of Medicines, etc. — Dusting Powders for Babies — Thermometers— Peptonised (Predigested) Milk — Whey . 303

Index .

. 315

“ The greatest miracle I can conceive is this : that a little piece of pink, squalling humanity can contain the potential powers of a Raphael, a Mozart, a Beethoven, or a Shakespeare.’’ — Porter.

As the result of applied modern science the world is not only growing wiser and better, but life itself is presenting fresh aspects, making existence more attractive. In spite of these days of strenuous living and so-called over-civilisation, the general death-rate of Great Britain and Ireland has fallen considerably during the past quarter of a century ; a circumstance undoubtedly due to a fuller understanding of the laws of hygiene and preventive medicine.

While the general mortality rate has been considerably reduced, strange to say, the death - rate of infants has not been appreciably affected. If the cause of this constant high infant mortality is due to over-civilisation, as some assert, then why does

A not over-civilisation equally act upon the general mortality ? Over - civilisation may be one cause, but it is quite a subordinate one. Over-civilisation may give us an heritage of neurotic children, rendering their rearing a question of greater care ; but as is the case with adult longevity, modern science applied to the rearing of infants and young children should more than compensate for this.

Of the total deaths at all ages which occur in England (including Wales) nearly one quarter are of infants under one year old. Between the years 1895 and 1904, ten children in every sixty - six born in England died before completing the first year of life, and one half of these deaths took place before the infants were three months old.

Amongst the various causes of death in infants, those arising from diseases of the stomach and bowels head the list, i.e., Gastritis, Enteritis, and Diarrhoea — essentially food diseases.

It is estimated that at least one half of these deaths can be avoided. They take place from preventable causes, and are therefore classed amongst preventable diseases. “ If they are preventable diseases, why are they not prevented ? ”

In Australia and New Zealand the death - rate of infants and young children is much less than in England, Scotland, or Ireland, due in part to the absence of over - crowded cities, but mainly to the higher standard of education amongst the working classes. This lower infant mortality cannot be said to be the result of climatic conditions, for the severe Australian summer is responsible for proportionately more deaths among infants than the severe English winter.

The mortality from war is deeply deplored, and the nation went into tears at the death toll from wounds and disease during the three years of the South African War. There is continually going on silently in our midst an annual preventable destruction greater than that which took place during the late war, and the British nation seems quite oblivious to this loss of life. Is it because this annual slaughter is taking place at our very doors, and we have become in consequence familiar with it, that we, as a nation, have become too callous to appreciate its full significance? Is it due, as has been said, to the British nation becoming more and more like the American nation, with whom the almighty dollar is considered in the commercial competitive struggle to be of more value than human life ? Whatever the reason, it must be admitted that as a nation we are quite reconciled to the wholesale destruction of infant life in our midst. That this high infant mortality is not due appreciably to the inherent weakness or infirmity of the babies at birth is recognised, for it is well known that weak mothers often bear healthy children, the child thriving in the womb at the expense of the mother.

The medical profession now fully realises that by far the majority of preventable deaths which occur in infants and young children are caused directly and indirectly by injudicious feeding, due to the culpable, and even criminal, ignorance and neglect of mothers. It is incumbent on the community, if not on the State itself, to do something which will materially reduce this shameful waste of infant life.

Of late years a much more extensive idea has been conceived in the minds of men regarding the duty of the State towards the preservation of the health and lives of its citizens. Fortunately the old crude idea that the functions and responsibilities of a government ended in the collection of taxes and the maintenance of law and order is dead. A new era has set in, in which human health and life is being considered a valuable factor in political economy, with the recognition of the fact that the strength and power of a nation depends not so much on its material wealth, as upon the vitality and numerical strength of its population.

We have a right to expect that every healthy child born should have a fair chance to live to the proverbial age of three score and ten, and it is incumbent on the State and municipalities to see that their duty is so carried out that filthy courts and alleys and dirty, narrow streets with congested populations are done away with by legal enactment. There should be a limit set to the population in a given area of land, and ill-ventilated, badly-drained houses should be things unknown. No doubt much has been done in this direction in the past by both legislatures and municipalities, but not enough ; the poor have a right to be protected from adverse conditions of want, filthy surroundings, and ignorance of the laws of health.

A nation is made up of an aggregation of units, and only in the proportion that those individual units are vigorous and healthy can the nation be said to be strong. To a nation as to an individual, there is more in life than mere material wealth.

A disregard of infant life is a symptom of national decadence. Rome decayed in the midst of material wealth, and a marked feature in the fall of that Empire was the utter neglect of infant life and the frequency of infanticide. The scroll of history clearly points out that empires and nations have died more by internal decay than by external forces.

National ascendency must always rest with the most virile and capable race, so the naval and commercial supremacy of Great Britain is doomed if her sons are stunted in body, dwarfed in mind, and are in consequence no longer able to compete in the battle of life against a more vigorous race with sea - power aspirations, whose paternal government protects its citizens from the cradle to the grave.

The political economist sees in the human life lost in infancy through preventable causes, a potential source of wealth and strength greater in value to the nation than all the gold obtained from the mines of the Empire. Dreadnoughts alone will not win the battles of a nation, and gold can at most but supply the means by which these engines of war are built.

Imperial press conferences may do much to disseminate and cheapen news, and so bind more closely the great family ties within the Empire ; Imperial defence conferences may do still more to knit the Empire against Great and Greater Britain’s foes; Budgets may be brought forth by any government in power, to adjust the incidences of taxation from the shoulders of the poor to those better able to bear the increased burden. These methods, though admirable in their way, will never alone provide the fighters necessary to win the coming Armageddon ; and whilst statesmen and legislatures are debating the problem of how to retain the supremacy of the sea, Death — the conqueror — is silently, yet surely, doing his work amongst the infants and little children, dispossessing the nation every month of a small army of potential men and women. Imperial insurance can never be complete without sufficient Imperial sons ; for mercenaries will never fight as those who fight for home and country. If Britannia’s young sons and daughters are allowed to die in the future at the same ratio as at present, then she must cease to “rule the wave,” and the trident pass to a race more worthy to carry the honour and bear its responsibilities.

An attempt has been made in these pages to explain the causes of this excessive infant mortality, which is, in reality, a very serious national peril. There is a consensus of opinion amongst authorities that the two main factors responsible for the high infant mortality are (1) the substitution of bottle-feeding for suckling, and (2) maternal ignorance.

(1) BOTTLE-FEEDING

Amongst the upper classes the main factor in robbing the baby of his natural right, to be suckled by his mother, is the latter’s excessive love of pleasure and amusement. The idea that social functions are of greater importance than the care of offspring is born of a false civilisation.

The father often has the same misconception of his duty, and encourages the mother in being false to her noblest function.

Bottle-feeding instead of breast-feeding is largely on the increase. No doubt some mothers, for various reasons, are unable to feed their babies from the breast, but they are exceptions, with the majority this is not so. Amongst the poor, the necessity of many mothers going out to work often prevents breast-feeding, a condition which may be excusable to the individual mother, but certainly not to the State.

Unless an effective alarm is sounded to check the prevalence of bottle-feeding, it must follow that the mammary glands not used for several generations will, in the ordinary course of evolution, cease to perform their proper function and become atrophied. As the social cry is “ back to the land,” so the maternal cry should be “ back to the breast,” if we are to save ourselves from becoming a nation of milkless mothers.

Nature intended that babies should be fed on the milk of the mother, and that calves (not babies) should be fed on the milk of the cow. The human breast milk is not only the perfect food for baby life, but between each mother and her child there exists a relationship and affinity, which makes mother’s milk peculiarly suited to the digestive and physiological needs of her own child, so that even a wet - nurse is not an efficient substitute.

The child being bone and flesh of the mother, the foregoing special relationship will be reasonably evident. This important fact is borne out by common observation that babies fed from the breasts of their own mothers not only thrive better, but their mortality is less than hand-fed or bottle-fed babies.

A striking example of the truth of this, even in a time of extreme distress and poverty, may be quoted. During the Franco - Prussian War, when Paris was besieged, the general death-rate in that city increased 100 per cent., yet that of infants was actually reduced by 40 per cent., because mothers were compelled to suckle.

If the high death-rate of infants is the price for the advantages of our so-called high state of civilisation, then this slaughter of the innocents, with all its accompaniments of sorrow and grief to the parents, expense to the community, and loss of manhood to the nation, is too high a toll to pay.

(2) MATERNAL IGNORANCE

Every woman entering into matrimony should be prepared to face the responsibilities of motherhood. To this end she should understand the general laws governing her own health and that of her prospective offspring. Unfortunately, this subject is not included in the education of most young women, and, as a consequence of a faulty educational system, the nation suffers owing to the high infant mortality already mentioned. We hear much of kindergartens to train the intelligence of young children; much of model institutions to train young women to become efficient domestic helps ; but the most urgent problem of how to teach the coming mothers of the nation the art of motherhood, with its duties and responsibilities, has not yet been solved by our reformers or by the State.

The principle of infant life preservation is one of the most urgent and pressing questions for the nation to grapple with. If the public conscience was thoroughly awakened to the importance of this question, public opinion would hold up to scorn a mother who lost her infant from any disease resulting from bad or improper feeding — such as stomach or bowel disease.

The difficulties which face every medical practitioner and nurse, when trying to instil into many women the principles attached to the vocation of motherhood, are appalling. Rational feeding, scrupulous cleanliness, proper clothing, good ventilation, adequate supply of fresh air and sunlight, are all subjects which demand the attention of every mother for the sake of her offspring. It is a common experience to find that instructions given by the doctor regarding the care of the child, the preparation of the food, the cleaning of the feeding-bottle, etc., are deliberately ignored.

There unfortunately seems to be an idea amongst a certain class of mothers that such details are unnecessary and irksome.

Their faith is pinned to a bottle of physic, which is expected to perform the miraculous. To lazy, indolent women the ease with which medicine is given no doubt appeals to their idea of the fitness of things. For a doctor to visit and take a vast amount of pains in explaining details necessary to the preparation of a sick baby’s food, or to insist on measures of relief being applied which entail care and attention on the part of the mother, and then go away without prescribing the miraculous bottle of medicine, may mean the dispensing with his services. They have no idea that a doctor’s chief function is to advise, and not necessarily to write a prescription.

Allusion has already been made to irrational feeding setting up inflammation of the stomach and bowels in children, but there are other diseased conditions, which have their primary cause in defective diet, such as scurvy and rickets.

While the choice of food and its regularity in administration may be all that is desired, yet there may be that want of care and scrupulous cleanliness with regard to the feeding-bottle, etc., which will cause the food to ferment and set up that common disease of the mouth — thrush.

Chafed skin is a common result of the want of regularity in bathing the child and drying him well afterwards ; while general neglect causes lice, itch, etc.

Ignorance of the requisite amount and quality of clothing for a young child frequently results in attacks of bronchitis, inflammation of the lungs, and

IS even rheumatism. It is not an infrequent experience to see a child very warmly wrapped over the body, and yet the lower limbs naked and blue with cold.

Light, open-wove, woollen garments should be always worn next the skin of a child.

The close confinement of a child indoors in a stuffy, ill-ventilated room, into which little or no sunshine penetrates, always leads to want of appetite, depressed vitality, undue nervousness, and anaemia.

This book, and others of its character, are written expressly for mothers who need instruction most. Yet we recognise that those who need instruction in these matters most are the ones who seek it least. It is an unhappy experience to feel that one is writing on behalf of all mothers and their babies, yet knowing that those who most need knowledge in such things will probably not take the trouble to peruse these pages.

To a medical man it is always a healthy sign to observe parents reading and studying on behalf of their charges. It signifies a desire to exert themselves for the welfare of their children.

SECTION I

THE FEEDING OF INFANTS

CHAPTER I The Mother’s Forethought

1. — GENERAL.

Many mothers who are unable to suckle their infants could do so if they but exercised forethought during the time of pregnancy. Throughout the whole period of that important experience the prospective mother should take especial care of her health and habits. Anything approaching a sedentary life must be avoided, and a fair amount of exercise in the fresh air taken daily — a walk of at least two miles per day. She should sleep in a well-ventilated bedroom and have a daily bath in tepid water. Many women find a plunge bath too great a shock ; for these a sponge bath would be better.

Special attention should be given to the state of the stomach and bowels, for authorities are now agreed that

indigestion and constipation have a great deal to do with both the quality and quantity of the mother’s milk. Her food should be simple, yet nutritious, and the meals taken at regular intervals. A fair quantity of cow’s milk is recommended, and if there is any objection to it in liquid form it may be taken in custard or puddings. All foods rich in fats, overcooked, highly seasoned, or of an indigestible character, should be avoided.

Alcohol in any form does harm. Regularity of the bowels is absolutely essential, and this is best obtained by the free use of fresh fruits, porridge, plenty of fluids, and open air exercise. Strong aperients must be avoided during the whole period of pregnancy, but there can be no objection to the occasional use of the enema syringe to keep the lower bowel open.

All things which tend to excite the nervous system should be avoided, such as late nights, irregular sleep, worry, social gaiety and the like. The wearing of corsets is to be deprecated, especially after the third month of pregnancy, for abundance of room must be given in the abdominal cavity for the proper development of the growing child. The use of corsets is always more or less associated with constipation, as the pressure exercised on the bowels and other abdominal organs prevents their natural play, and so impedes their functional activity. More particularly is this the case during the period of pregnancy, and anything approaching tight-lacing then greatly pre-

THE MOTHERS FORETHOUGHT 15 judices the vitality, and even the life of the coming child. No tight bands should be worn around the waist ; an under bodice with buttons to which the under garments can be attached is recommended, so that their weight hangs from the shoulders.

2. — THE CARE OF THE BREASTS

During pregnancy tight clothing over the breasts is to be avoided. There is a form of corset which presses the breasts upwards in order to lengthen the appearance of the waist. Even though such a garment does not impinge on the nipples, it has nevertheless a very direct effect upon the secreting parts of the breasts. It is bad enough to wear such abominations at any time, but during the state of pregnancy the practice is morally culpable, for a prospective mother so doing is simply paving the way to bottle-feed her baby.

For a few months before the expected confinement attention must be directed to the condition of the nipples. If the nipples tend to be short, depressed, or badly shaped, they should be gently rubbed between the fingers and drawn out. This toughens and develops them, and so prevents cracking during nursing.

Chapter II

It is very desirable that whenever possible the mother should suckle her own baby ; it is best for the physical well-being of both the mother and the child.

For the mother. — Before birth the child is nourished in the womb, and the abdominal organs become temporarily enlarged and congested for the purpose of supplying that nourishment.

After the birth of the child these organs become reduced to their normal size, as their enlargement is no longer required. Nature provides for this, and in the process of suckling the excessive blood supply is then diverted to the breasts, which enlarge and take on increased activity. The nursing mother then resumes her normal figure.

When suckling does not take place the abdominal organs (womb chiefly) do not so readily become reduced in size, as there is not the same diversion of the blood, and consequently they are left in a more or less flabby state of enlargement. When the woman resumes her

ordinary active life, the womb, in such condition, is liable to become displaced or twisted, and set up no end of future trouble and expense — Nature’s penalty for disobedience of her laws.

For the child. — The mother’s milk is the only perfect food ; and there can be no food, however scientifically prepared, which can compare with it in composition and suitability to the requirements of the infant. The child brought up on the mother’s breast has a greater chance to thrive, and is not so liable to suffer owing to fluctuations in the quality of food as a bottle-fed infant.

In composition, human milk contains elements in different proportions to that of cows, or any other kind of milk, and as a baby’s food is materially distinct in other ways.

The mother’s milk has the following advantages over every other food : — (1) purity, (2) freshness, (3) even temperature (blood heat), (4) freedom from germs, (5) readily digestible, (6) suitability for nutrition and growth, (7) less work, and more healthy for the mother, and (8) suckling establishes a greater mother love.

When to put the Baby to the Breast. — Towards the end of pregnancy the breasts begin to secrete preparatory to the advent of the child. During the first two or three days after the birth of the child the composition of the mother’s milk differs from that which comes afterwards. It then contains a substance

B called colostrum, which acts as a mild and natural purge to the baby. It is desirable that the baby should get this purge, for at the time of birth his bowels contain a dark greenish substance (meconium) which is got rid of by the colostrum. It is therefore advisable that the child be put to the breast as soon as the mother has attained sufficient rest after delivery. Six to eight hours after birth is considered a reasonable time, but it should not exceed twelve hours. As the breast secretion is small in amount until the third day, it is not advisable that the child be put to the breast oftener than every four hours during the first two days.

During this period two to four teaspoonfuls of a solution of sugar of milk in boiled water (£ oz. to a pint) may be given after each attempt at suckling.