CHAPTER V.

Hints on the Management of Children in Hot Climates.

Owing to the circumstance that it is more convenient to deal with the subject of the feeding of infants in connection with that of the prevention of infantile diarrhœa, but little of a nature special to hot climates remains to be noticed in connection with the management of young infants, for being concerned with little else than the assimilation of nourishment, their well-being or otherwise is governed almost entirely by the state of their digestion.

Putting aside the special danger of infantile diarrhœa, young infants generally do well in hot climates, which are in many ways suitable to their low powers of resistance to cold. Some writers, very competent to speak on the subject, are indeed of opinion that very young infants do better in India than in cold or temperate climates; and perhaps this may be the case as regards breast-fed children, for, the air temperature being but little below that of the body, they are almost entirely protected from the coughs and colds of all sorts that do so much damage at home, and lead to the poor children being confined to a stuffy atmosphere instead of enjoying the enormous advantage of unlimited fresh air, of which an infant requires proportionately even more than an adult. On this account never allow a nurse, however experienced she may be in her own conceit, to cover a child’s face with a handkerchief even out of doors, as the re-breathing of air already polluted by passing through the lungs is one of the most frequent causes of illness in human beings of all ages, and if the air outside be really so cold as to be harmful, the child will be better indoors, in a well-warmed and ventilated room, than outside, if half stifled in this silly fashion.

If she has any lingering doubts on the matter, let the mother borrow an ambulance, and try how much fresh air can be got, lying flat on the back, with a handkerchief spread over the face, and a fussy old woman in attendance to replace it should it chance to get disarranged.

The dangers of that abomination, the “baby’s comforter,” are elsewhere adverted to, but to show that the writer is by no means singular in his opinion, the following extract from _Science Siftings_ may be read with advantage:--

“Most expert observers of the infectious nature of consumption have stated that the bacilli almost invariably enter the system through the nose or mouth, the respiratory system, in fact. Yet there are others who state that the milk drunk by infants is a chief cause of infection. But a new and deeply interesting theory is put forward by Drs. J. O. Symes and T. Fisher in the _British Medical Journal_. All day long, they write, babies are sucking an indiarubber comforter, and it no sooner drops on to the dirty floor than it is hastily picked up and thrust again into the mouth of the infant. Older children also, as they crawl, take up every article they can lay hold of and put it into their mouths, to the danger of which their dirt-begrimed cheeks bear witness. The moral is obvious.”

Native attendants are especially fond of the contrivance, and hence it is desirable to emphasise its dangers in a work on the present subject.

It should be needless in these days to warn mothers that all “soothing syrups” are extremely harmful and even dangerous preparations; but there is another preparation in almost universal use, which, in a smaller way, does a great deal of harm. I allude to the abuse of dill water and similar pungent stomachics. The usual pretext for its administration is that the baby has got what is popularly termed “wind in the stomach,” which may mean merely indigestion, due, in all probability, to the use of some patented abomination in the way of “infants’ foods,” containing farinaceous material; or that, as evidenced by belching, there really is gas in stomach produced by fermentation, or by sucking in air from the use of a “comforter.” Now the dill water will no doubt temporarily relieve the pain, but it will rather aggravate the malady than cure the condition that causes it; as the remedy is of exactly the same character as the nip of gin which Mrs. Gamp found so useful in soothing her “spasms,” and is probably even less suited for babies than the gin was to the good lady so inimitably portrayed by Dickens.

It is astonishing how mothers, who would exclaim with horror at a few wholesome grains of pepper to season the breakfast egg of a child of five or six, will go on giving a new-born baby dose after dose of what is much the same thing as a very pungent liqueur. Should the pain be really due to “wind,” as shown by belching, some unirritating antiseptic such as a grain or two of resorcin will rapidly check the fermentation that is producing the gas, and so cure the disease. Though comparatively little used for this purpose, the writer has found this drug most useful in these little troubles, and has found that even infants of but a few days old tolerate it perfectly. If, on the other hand, the pain be due to indigestion, the trouble is probably caused by the character of the food, and an effort should be made to find something that agrees better. Probably the commonest cause of these disorders is the use of the numerous much-advertised “infants’ foods,” most of which contain farinaceous material of some sort. Now young infants cannot digest starchy matter of any kind, and the only proper food for them is milk. When the milk of the lower animals is used it is of course desirable to modify it, so that its composition may be made to more closely resemble that of human milk; and this in the case of cow’s milk is effected by diluting the milk and adding a little sugar, preferably milk sugar. Again the tendency of cow’s milk to clot in large mass has to be neutralised by the addition of some material that will prevent this, and the general ban against farinaceous materials need not extend to the use of the deservedly popular barley water for this purpose, as the amount of starchy matter it contains is too small to be harmful.

When goats’ milk is used, the goat should be kept tied up and its food gathered for it, as although a clean feeder, it is apt, if left at freedom, to eat acrid leaves which may affect the milk. Goats’ milk requires somewhat less dilution than that of the cow, and may agree in cases where cows’ milk fails.

In proportion as the heat is greater, so should the milk be more freely diluted, as otherwise thirst may lead to the child taking more food than is good for it; and if at such times the child craves too frequently for food, a few teaspoonfuls of plain water should be given; as the craving is merely an indication that the child, like larger people, is thirsty. The water can do no harm, but irregular feeding is always injurious. As the child grows older, the milk can be given less diluted, and after eight or nine months the yolk of a raw egg beaten up with the milk may be occasionally given, if the child appears to require more nourishment; but this should not be overdone, as such food is apt to cause “biliousness.” In the second year milk puddings and bread and gravy may be given occasionally, and after the third the child should be encouraged to eat plenty of well-cooked vegetables, but stewed fruits should be given with caution.

In the case of older children brought up in hot climates, it must be remembered that their appetite, like that of their elders, is apt to suffer at trying times of the year, and hence it is important to introduce as much variety as possible into the menu. A dish nearly always much appreciated, and I believe perfectly wholesome, is a curry;--not too highly spiced of course, but still a curry. The writer had at one time, as a sole charge, the care of some five hundred children, varying from four to seventeen years of age, in a large school. For many years, on two days in the week, a curry had formed the dinner for the children of all ages in this institution. That of the “infants” had even less pepper in it than what was supplied to the elder boys and girls, but was still distinctly appetising. Now no item of the dietary was as thoroughly relished and finished with as hearty an appetite as this; and there never appeared the least reason for suspecting it was anything but useful and wholesome. Children are often much to be pitied on account of the fads of their parents in the matter of diet, for the poor little souls are continuously placed in the position of Sancho Panza, when they made him governor of Barataria, and the court physician would allow him nothing decent to eat. When children have passed the stage of early infancy, and nature has furnished them with teeth, one may be pretty sure that what is bad for them is equally deleterious to oneself, and it is well, instead of denying them all sorts of things on mere suspicion, to give a small quantity and notice if it causes any discomfort. Otherwise, as likely as not you are denying them things that may suit them excellently, and forcing them to eat insipid traditional children’s dishes, which very possibly, do not really suit them. Milk should of course be always given freely to all growing children, but apart from this too great monotony is sure to be harmful. There are some children, of course, to whom even small quantities of usually wholesome articles of food seem to act as absolute poisons. This is especially the case with sugar, extremely small quantities of which will, in such peculiarly constituted children, bring out an attack of nettle-rash. The skin is always abnormally irritable under great heat; and hence such cases show themselves more commonly in European children brought up in the Tropics than in those living in temperate climates.

When, therefore, a child is greatly troubled with nettle-rash it is well to suspend sugar, and should this fail, experiment with the stopping of other articles of its dietary.

A very common mistake on the part of anxious mothers is to cut up a child’s food too small. As soon as a child’s digestive organs have so far developed as to be capable of digesting solid food at all, as shown by its having come into the possession of a full set of first teeth, it is very important that nothing should be swallowed without thorough mastication; and the mincing of the food not only renders it possible for the food to be swallowed without chewing, but actually makes it difficult for the child to do otherwise, as anyone may convince himself by trying to masticate any minced dish.

Now mincing is in no sense a substitute for chewing, and as it is disagreeable to swallow a large piece of food without proper mastication, it is better to err on the side of cutting too large than too small. Moreover, the cutting up of the food too finely actually trains the child to bolt its meals, and this causes it to acquire a most harmful habit, of which it will be very difficult for him to break himself in after life.

On the other hand, many children take up the almost equally injurious habit of churning their food about in the mouth for an unreasonable time. This habit is a very common one with Anglo-Indian children and should always be checked, as the prolonged mumbling of each mouthful stimulates an undue flow of saliva, and produces dyspepsia by flooding the stomach with it. It is really, I believe, due to want of appetite, and is generally caused by the monotonous and insipid diet to which children are often confined, while they watch their parents consuming appetising dishes which they are not allowed to touch. Surely it is hard to expect the child to swallow a stodgy mass of boiled flour and milk, with the savour of crisply fried bacon under its nose; and why should a child whom Nature has already provided with a full set of teeth be less able to digest a simple wholesome article of food, such as this, than an adult? No one would suggest the giving of large quantities of such delicacies, of which, indeed, adults very commonly consume a good deal more than is good for them; but some bread and butter with a few scraps of bacon and some bread crisply fried in the fat, eaten with a relish that stimulates the proper flow of the digestive secretions, is surely more likely to be properly assimilated than some insipid mess, eaten under compulsion, with difficulty and loathing.

It is often impossible to find any good reason for popular maternal notions as to what children should eat, drink and avoid, but the broad principle underlying it appears to be that anything nice is necessarily harmful. “Children should be given only simple food.” Doubtless!--but what is “simple food”? Food, I take it, which it is a simple job to digest. But it is quite a mistake to imagine that every insipid mess is easy, and every tasty relish difficult, of digestion. Some insipid foods are easily digestible and some not, and some tasty foods are indigestible and some digestible. The taste and savour are in fact no guide whatever. To pursue our particular example:--bacon fat is an exceptionally easily assimilated form of fatty matter, rivalling cod liver oil in that respect; and every whit as useful in the treatment of malnutrition.

Again, the method of preparation makes all the difference as to digestibility. Cheese, for instance, of the cheaper varieties, is proverbially hard to digest, for the obvious reason that it is difficult for the digestive organs to dissolve its rather leathery substance, but a crumbling Stilton taken in reasonable quantities is far from being so; and even less expensive cheeses, if grated and cooked, are quite harmless, so that a dish of macaroni just flavoured with a little grated cheese is a far more suitable food for a child than the pasty gruel that passes under the style of oatmeal porridge southward of the Tweed.

The hardy Italian peasant children are as regularly brought up on the dish I have just described as the young Scot on oatmeal porridge; and as, unless given all day and every day, both are perfectly suited to young digestions, there is no good reason why both should not take their turn in the nursery cuisine.

A great deal that has been said is no doubt equally applicable to temperate climates, but in these healthy children rarely suffer from want of appetite, whereas in the trying time of the year in the Tropics there is often a strong temptation to eat too little to keep up the needs of the system, and hence this exhortation to the adoption for children of a varied and tempting diet is especially applicable to those brought up in hot countries.

A separate work would be required to deal adequately with the subject of the present chapter, so that it is impossible to do more than offer a few general hints on the subject, and it accordingly remains only to consider the question of the necessity, or otherwise, of children being sent off to a hill station during the worst part of the tropical year. To do so is often a terrible tax on the financial resources of the parents, and there can be no doubt that the advantages of the hill climates over those of the plains, though no doubt very real, are much over-rated; for the hills have special dangers of their own. Some years ago I had occasion to compare the sick rates of a number of the largest Indian boarding schools, and was much astonished to find that the justly celebrated “La Martiniere,” at Lucknow, had a somewhat smaller sick rate than the great Laurence Military Asylum for soldiers’ children, which was then under my care. Now if the difference in favour of the hill climate were as great as is popularly supposed, this could hardly be the case; as Lucknow is by no means an exceptionally healthy plains station, and the site of the La Martiniere leaves much to be desired. Yet the hill school would have been counted a healthy one anywhere, for in two years we had but two deaths among the whole half-thousand boys and girls. Apart from the mere question of personal comfort, the main advantage of the hill climates are their freedom from malaria, but this ought to be guarded against in the plains by proper metallic gauze protection of the nursery; while, on the other hand, hill climates are extremely treacherous for children during the rains. Assuming the adoption of rational precautions against malaria, I believe that whatever may be the case during the dry, hot season, the majority of children would be better in the plains than on the hills during rains. Part of this is perhaps due to the increased sanitary difficulties; for typhoid fever is endemic in almost all hill stations; but the bulk of it is due to the raw, clammy chills of a sodden atmosphere, and given an equal number of children, it is a matter of common experience with medical officers that the doctor’s visiting book will often show an enormously larger number of calls in these sanitaria (?) than in the much maligned stations below.

Hence, while in no way counselling the retention of children in the plains during the hot, dry season, by those who can well afford to send them away, I trust that the facts adduced may tend to the comfort of those whose finances do not admit of such a luxury, and the question whether great sacrifices should be made to do so should be determined by the comparative healthiness, or otherwise, of the locality in the plains where they may be stationed.

The amount of sickness, both of a serious and trifling character, on most hill stations is perfectly alarming, and there cannot be the least doubt that there are a great many stations in the plains that are far less unhealthy for Europeans the whole year round, so what is gained by resorting to the hills is, in most cases, not health, but personal comfort.

Another caution:--do not always jump to the conclusion that a child is necessarily suffering from malaria when it becomes feverish. The temperature-regulating mechanism of a child is much more delicate than that of an adult, so that very little suffices to put it out of gear; and an indiscretion in diet which would show its effects in an adult merely in the form of a bad head and a worse temper, will perhaps send a child’s temperature up to 104° F. or over. Such cases are almost as common in Europe, but unlike the Anglo-tropical matron, the English mother does not usually go about with a clinical thermometer in her pocket, and they usually pass undetected, as far as the element of temperature is concerned, and are ascribed to their true cause of some upset of the digestive organs, which yields easily to some mild laxative. More than half the cases of so-called fever are of this nature, and as the diagnosis of malaria can only be made, even by a doctor, by a careful examination of the patient’s blood under a powerful microscope, it is wise in his absence to try the effect of such simple measures as a dose of “Gregory” or grey powder before needlessly drugging the child with quinine.

Lastly, and most important of all, do not always go rushing off to your medicine cupboard because the dear child “looks so pale,” or is protesting more vociferously than usual at the crumpling of some of the rose leaves of its couch. Anyway, it is no good emptying drugs down the interior of the poor child’s neck till you feel pretty sure of your reason for doing so. It is very natural and excusable that a mother should be so anxious to “do something”; but unless sure of your reasons for acting, the something done is too apt to be something wrong. The amount of needless drugging of children that goes on is cruel, even when it is not harmful; and I cannot help thinking the little ones would be a good deal better on the whole if mothers would make a rule of swallowing a duplicate spoonful of nastiness for every one they are so anxious to administer to their progeny.