Part 22

After it is a month old, if it has no cough, fever, nor eruption, the bath should be colder and colder (if the season be mild) and by degrees it may be used as it comes from the spring. After carefully drying the whole body, head, and limbs, a second dry soft cloth, somewhat warmed, should be gently used, to take all the damp from the wrinkles or soft parts of the body. Then rub the limbs; but when the body is rubbed, take special care not to press upon the stomach or belly. On these parts, the hand should move in a circle, because the bowels lie in that direction. If the skin be chafed, hair-powder is to be used. The utmost tenderness is necessary in drying the head; and a small, soft, brush, lightly applied, is safer than a comb.

Clean cloths, every morning and evening, will tend greatly to a child’s health and comfort.

The dress of the child by day should be light and loose, and for the night, it may be a shirt, a blanket to tie on, and a thin gown to tie over the blanket.

The unnecessary haste in which some nurses are accustomed to dress children, cannot be too strongly reprehended. In addition to this hurried dressing, its clothes are often injuriously tight. Pins should never be used in an infant’s clothes; and every string should be so loosely tied, that two fingers may be introduced under it. Bandages round the head should be strictly forbidden, for to this error many instances of idiotism, fits, and deformity, may be traced.

Never allow the infant to be held opposite to open doors and windows. The air is beneficial, when it is in motion, and the weather is moderate, but it should always have some covering besides that which it wears in the house, when taken out; and it must not be laid on the cold ground, nor allowed to step on it, when it begins to use its feet. The intense heat of a summer day should likewise be avoided; excessive heat or cold being equally injurious.

The wisest maxim in treating infants with respect to food and drink, is to follow the simple dictates of nature; yet some nurses give them wine, spirits, spices, sugar, &c. which the stomach of a grown person would reject. At all times the utmost care will be necessary to avoid hurting its gums when feeding it. Its food should be gradually cooled in a saucer, and it should be given to it in a small spoon, only half filled, which will save its clothes from being soiled, and keep its bosom dry. Let it swallow one small portion, before another is offered, and raise its head, that it may pass the gullet easily. Never entice or press it to take more, if it once refuses, for it knows best when it has had enough.

As long as it has its mother’s milk, no other sustenance will be wanting, if she be a good nurse. If there should be the least doubt of her having milk enough, the child may have cow’s milk, mixed with two-thirds soft boiled water, presented to its lips very frequently; but it never should be urged to accept it.

Rising early in the morning is good for all children, provided they awake of themselves, which they generally do; but they ought never to be waked out of their sleep. As soon as possible, however, they should be brought to regular sleep in the day.

Children, till they are two or three years’ old, must never be suffered to walk so long at a time as to be weary.

In laying a child to sleep, it should be placed on the right side oftener than on the left. Laying it on its back when it is awake, is enough of that posture, in which alone it can move its legs and arms with freedom.

Infants cannot sleep too long; and it is a favourable symptom when they enjoy calm and continued rest, of which they should by no means be deprived, as this is the greatest support granted to them by nature. Sleep promotes a more calm and uniform circulation of the blood, and it facilitates assimilation of the nutriment received. The horizontal posture, likewise, is the most favourable to the growth and bodily developement of the infant.

Sleep ought to be in proportion to the age of the infant, and this salutary refreshment should fill up the greater part of a child’s existence. After the age of six months, the periods of sleep, as well as all other animal functions, may, in some degree, be regulated; yet, even then, a child should be suffered to sleep the whole night, and several hours both in the morning and afternoon. Nurses should endeavour to accustom infants, from the time of their birth, to sleep in the night in preference to the day, and for this purpose they will remove all external impressions which may disturb their rest, but especially they ought to avoid obeying every call for taking them up, and giving food at improper times.

To awaken children from their sleep with a noise, or in an impetuous manner, is certainly injudicious and hurtful; nor is it proper to carry them from a dark room immediately into a glaring light, against a dazzling wall; for the sudden impression of light debilitates the organs of vision, and causes weak eyes from early infancy.

Infants are sometimes very restless at night, which is generally owing either to their eating a heavy supper, to their tight night-clothes, or their being over-heated by too many blankets.

Wages 18_l._ to 25_l._ Perquisites at christenings.

_Diseases of Children, &c._

THE YELLOW GUM.

The yellow gum is known by a yellow tinge of the skin, with languor and a tendency to sleep. It is to be relieved by giving a tea-spoonful or more of castor oil, to clear the intestines. When the disease does not give way to this treatment, three drops of antimonial wine are to be given in a tea-spoonful of water, so as to prove emetic. In about eight or ten hours, this is to be followed by ½ a grain of calomel, or four grains of rhubarb.

VOMITING.

When the food is vomited in an unaltered state, it is generally a sign of over feeding: but when the vomiting is bilious, or when the food is partly digested, the diet ought to be changed, and the bowels opened by one grain of calomel, given in sugar. This is to be followed by a tea-spoonful of castor oil on the following morning. If the vomiting should still continue, give a gentle emetic, and the calomel powder (containing one or two grains, according to the age) soon afterwards. If there be much irritation, apply a blister to the stomach; and, if possible, give a tea-spoonful of the saline medicine, in a state of effervescence, and containing two drops of laudanum.

HICCUPS.

These generally arise from acidity in the stomach, and may be remedied by the administration of eight grains of prepared chalk, with two grains of powdered rhubarb, given in a little syrup, or gruel. If very severe, the stomach is to be rubbed with soap liniment, or opodeldoc, to which a little laudanum has been added.

GRIPING AND FLATULENCY.

These are known by continual crying, restlessness, and drawing up of the legs. When attended by diarrhœa and green stools, they are to be relieved, in general, by the administration of a few grains of rhubarb and magnesia. If sour belchings, &c. still continue, a tea-spoonful of very weak solution of tartar emetic should be given every quarter of an hour, until the child vomits. After this, particularly if there be any purging, it may be proper to give a little rhubarb and magnesia again, and now and then a little chalk mixture.

_Absorbent Mixture._

If the pains are very great, so as to make the child scream violently, two tea-spoonfuls of the following mixture, with five or six drops of laudanum, may be given directly:—

Mix together, prepared chalk, 1 scruple, tincture of caraway seeds, 3 drams, compound spirit of lavender, 1 do. and of peppermint water, 2 oz.

As soon as there is diminution of pain, a purgative should be given, particularly if the bowels happen to be in a costive state. The best will be castor oil. The above mixture may afterwards be occasionally continued, but without the laudanum.

_Anodyne Plaster._

The late Dr. Clarke, of Burlington Street, frequently ordered the following plaster to be applied over the bowels of infants, in case of griping and inflammatory excitement of the intestines:—

Take of compound plaster of laudanum, 1½ oz. diachylon plaster, 2 drams, purified opium, 1 do. oil of peppermint, 1 do. camphor, 1 do. Mix for a plaster, and spread on soft leather.

DIARRHŒA.

This may, in general, if the stools are green, be relieved by a brisk purgative, of from one to two grains of calomel, with four or five of rhubarb, according to the age of the child.

EXCORIATIONS OF THE SKIN.

Children are apt to be chafed between the thighs, behind the ears, and in the wrinkles of the neck, for want of proper attention to cleanliness. In such cases it will be necessary to bathe the parts twice a day, (or every time that the child’s clothes are changed,) with a little water gruel, and to apply a puff with a little hair powder immediately afterwards, so as to keep the parts dry.—When _discharges_ take place behind the ears, they must not be dried up too suddenly, as such a circumstance might produce a divertion to the brain. In this case it will always be best to give frequent doses of castor oil, or calomel, every night, in the proportion of one grain to three grains of rhubarb.

CUTANEOUS ERUPTIONS.

No real danger attends these eruptions, which are generally known by the names of red-gum, nettle-rash, &c. All that is required to be done, is to keep the bowels open by such means as are prescribed in the foregoing articles; and to guard against cold, which might drive the eruption inwardly, and thus produce internal inflammations of a critical nature. If the milk or food be considered the cause, the nurse, or diet, ought to be changed: and if sickness and vomiting should prevail, it will be proper to give the _absorbent mixture_ mentioned under the head GRIPING AND FLATULENCY.

THE THRUSH.

This disease makes its appearance by little ulcerations in the mouth, tongue, &c. of a white colour, and sometimes of a yellow appearance. They are generally owing to acidities in the stomach, &c.

In this disorder nothing avails more than an emetic at first, and then a little magnesia and rhubarb, (if there is diarrhœa,) with thin chicken-water as drink. Testaceous powders, or the _absorbent mixture_ (_see_ GRIPING AND FLATULENCY,) will also be proper. If there is no looseness, it will be proper to give a grain or two of calomel, with three or four grains of rhubarb. The mouth and throat should at the same time be cleansed by gargles.

_Syrup of Black Currants._

Take of the juice of black currants, strained, 1 pint, double refined sugar, 24 oz. Dissolve the sugar, and boil to make a syrup.

A tea-spoonful of this to be given to children in the thrush.

FALLING DOWN OF THE FUNDAMENT.

This happens frequently to children who cry much, or who have had a diarrhœa, or from straining on going to stool. If it proceed from costiveness, give lenitive clysters. In case the gut be swelled or inflamed, foment with warm milk, or decoction of oak bark, or wash frequently with cold water. The protruded parts are now to be replaced by the finger, and supported by a truss or bandage. The internal use of tonics will be proper.

DENTITION.

When children are about cutting their teeth, they slaver much, are feverish, hot, and uneasy; their gums swell, and are very painful; they are sometimes loose in the bowels, and at other times costive; and occasionally convulsions come on.

Leeches are often serviceable when applied behind the ears; as are also blisters.

_Scarifying the Gums._

Instead of giving narcotics to children cutting their teeth, it is strenuously recommended to have their tumid gums divided by a lancet down to the tooth; an operation at once safe and unattended with pain. If done in time, by removing the cause of the complaint, all the symptoms will disappear of themselves. Instead of giving preparations of opium, it will be found, in the majority of cases, far better to administer calomel, in minute doses, as this medicine is well known to possess peculiar efficacy in promoting absorption in these parts. The body, if costive, should be kept regularly open, and if there should be looseness of the bowels, it should by no means be discouraged. Instead of coral, or any other hard body, let the child nibble at a piece of wax candle.

CONVULSIONS.

Children are particularly liable to convulsions at the period of teething, small pox, measles, and other eruptive diseases; sometimes, also, from external causes, such as strait clothes, bandages, &c. When they proceed from any of these, bathing the feet, or the whole body, in warm water, of 92 or 94 degrees, and administering a mild clyster, will almost immediately relieve them. To shorten the duration of the fit, cold water should be poured over the face and neck, whilst the rest of the body is in the bath.

The return of convulsions is to be prevented only by the removal of the cause of the existing irritation; but, in general, when the body is kept carefully open, there will be little reason to fear a return.

INWARD FITS.

In these fits the infant appears as if asleep, the eyelids however are not quite closed, but frequently twinkle and shew the whites turned upwards. The muscles of the face are sometimes slightly distorted, the mouth having the appearance of a laugh or smile. The breath is sometimes very quick, and at others stops for a time; whilst the eyelids and lips are alternately pale and dark. The infant startles on the least noise, and sighs deeply, or breaks wind. This relieves him for a little, but he soon relapses into a doze. Whenever the above-mentioned symptoms are observed, it will be right to awaken the infant, by stirring or otherwise, and to rub its back and belly well before the fire, until wind escapes. At the same time it will be proper to give half a tea-spoonful of drink or pap, containing two drops of oil of anise or caraways. As soon after as possible, a purgative of castor oil, or a grain or two of calomel (according to the age,) with two or three grains of rhubarb, is to be given, to empty the bowels of whatever crude matter may occasion the disorder.

THE RICKETS.

This disorder affects the bones of children, and causes a considerable protuberance, incurvation, or distortion of them. It may arise from various causes, but more particularly when proper care has not been taken with children: when they have been too tightly swathed in some parts, and too loose in others; keeping them too long in one and the same position; and not keeping them clean and dry. Sometimes it may proceed from a lax habit, and at others from costiveness.

It usually appears about the eighth or ninth month, and continues till the sixth or seventh year of the child’s age. The head becomes large, and the fontanelle keeps long open; the countenance is full and florid; the joints knotty and distorted, especially about the wrists; less near the ancles. The ribs protuberate, and grow crooked; the belly swells; a cough and disorder of the lungs succeed; and the child moves but weakly, and waddles in walking.

_Regimen, &c._

The regimen should be light and properly seasoned; the air dry and clear. Exercise and motion should be encouraged, and bandages, as well as instruments, contrived to keep the limbs in a proper situation; but care should be taken that they be so formed as not to put the child to pain, or restrain it too much.

Cold sea-bathing is of infinite use; after which friction should be used, and the child placed between two blankets, so as to encourage perspiration. The back should be well rubbed with opodeldoc, or good old rum, every night.

A few grains of ipecacuanha or calomel may occasionally be proper, and chalybeates are also very serviceable.

A decoction of Peruvian bark is also good with red wine: and should be used with moderation in the forenoon and after dinner.

DISTORTION OF THE SPINE.

Examine the child’s back-bone frequently and closely, and on the slightest trace of any distortion wash the same with brandy every morning and night, and pay the strictest attention to the child’s keeping a straight posture; both sleeping and waking; and if it can be bathed from time to time, it will be advisable.

RING WORM AND SCALD HEADS.

It is well known that these disorders, which are in many respects similar, are contagious; therefore, no comb or hair-brush used by a child affected by them is to be used by another child, either in a school or in the same family. Nor should the hat or cap of such a child be worn by any other.

_Treatment._

Let the hair be removed carefully with a razor, dipped frequently in olive oil; and afterwards apply the following lotion by means of fine linen, and cover the whole or part of the head with it.

Take of liquor of acetated lead, 2 drams, distilled vinegar, 6 drams, sulphuric æther, 2 drams, rain water, 1 pint. Mix.

This lotion should be kept occasionally applied in the night as well as in the day, and an oil-silk cap should be fitted close to the head, and worn continually.

_Ointment for the same._

Take of spermaceti ointment, 1 oz. tar ointment, 1 oz. powdered angustura bark, 3 drams. Rub the whole well in a marble mortar, and apply to the parts affected.

_Alterative Medicines._

In six cases out of ten, this disease is aggravated by a scrofulous taint of the system; and, when this is the case, the following alterative medicine accelerates the cure.

Take of oxide of zinc, precipitated sulphur of antimony, each 9 grains, resin of guaiacum, extract of bark, extract of hemlock, each 2 scruples. Mix, and form into 20 pills.

To Children from six to ten years of age, give one pill night and morning; under six years, half a pill night and morning, mixed in raspberry jam.

Instead of the above, one grain of calomel may be given going to rest, and repeated every night; also the use of salt water externally and internally, as an alterative, has been found very useful.

In all cases the bowels ought to be kept open, and the diet should consist of wholesome and nutritive food; avoiding fish and salt meats. Cleanliness, and an occasional use of the warm bath, will likewise be of service.

HOOPING COUGH.

In this complaint, next to occasional vomiting, the daily use of the warm bath is most useful. Bleeding may sometimes be useful, to prevent inflammation of the internal membranes, or cupping between the neck and shoulders. Gentle antimonial emetics should be given repeatedly, because the symptoms are always relieved when the child vomits.

_Parisian Remedy._

Take of sulphuret of potass, tincture of fox-glove, each, 1 dram, extract of liquorice root, 2 drams, almond emulsion, 6 oz. gum arabic powder, 3 drams. Mix.

A dessert-spoonful to be given to a child from three to six years of age; a table-spoonful from six to ten; two dessert-spoonsful from ten to fifteen; and two table-spoonsful from fifteen to twenty; three times a day.

_Embrocation for Hooping Cough._

Take of emetic tartar, 2 drams, boiling water, 2 oz. tincture of cantharides, 1 dram, oil of wild thyme, 3 drams. Mix. A dessert-spoonful to be rubbed upon the chest every night and morning.

_Regimen, &c._

A frequent change of air is exceedingly useful in hooping cough, particularly short voyages at sea; at the same time flannel is to be worn next the skin. Young children should lie with their heads and shoulders raised; and when the cough occurs, they ought to be placed on their feet and bent a little forward, to guard against suffocation. The diet should be light, and the drink warm and mucilaginous.

THE CROUP.

The CROUP is a disease peculiar to children, and generally fatal, if care is not taken in the commencement. It commonly approaches with the usual signs of a catarrh, but sometimes the peculiar symptoms occur at the first onset; namely, a hoarseness, with a shrill ringing sound both in speaking and coughing, as if the noise came from a brazen tube. At the same time there is a sense of pain about the larynx, and some difficulty of respiration, with a whizzing sound in inspiration, as if the passage of air was diminished; which is actually the case. The cough is generally dry, but if any thing is spit up, it is a purulent matter, sometimes resembling small portions of a membrane. There are also a frequent pulse, restlessness, and an uneasy sense of heat. The inside of the mouth is sometimes without inflammation, but frequently a redness, and even a swelling exist. Sometimes there is an appearance of matter on them like that rejected by coughing.

_Remedies._

As soon as possible a brisk emetic should be administered for the purpose of freeing the patient from the coagulable lymph which is already secreted. Topical bleeding, by means of leeches, should immediately succeed, and the discharge be encouraged. As soon as it diminishes, a blister, sufficiently large to cover the whole throat, should be applied, and suffered to lie on for thirty hours or longer. The steam of warm water should be inhaled, and the bowels should be evacuated by calomel.

As soon as the emetic has operated sufficiently, opium may be administered, by which means the breathing will in general be soon relieved; but should it become more difficult in the course of a few hours, the emetic is to be again repeated, and after its operation the opium again employed. This practice is to be alternately used till the patient is out of danger, which will, in general, be in the course of three or four days. The child should be kept nearly upright in bed.

Children, until the age of six years, are liable to be attacked by BILIOUS FEVER, which is gradually developed, by irregularity in the bowels, which are either too costive, or too much relaxed.

On its first appearance, the child becomes peevish and fretful, his lips are dry, his hands hot, accompanied by shortness of breath, pains in the head, and quickness of pulse, which beats from 110 to 112 in a minute; he shows an unwillingness to stir or speak, starts in his sleep, and has a loathing for food. The stools have often a mucous and slimy appearance; some children are affected with delirium, others dull and stupid, and many are for a time speechless. Several slight accessions of fever take place in the course of the day, during which the child is usually drowsy; in the intervals of these paroxysms he appears tolerably well, though, at times, unusually peevish.

These symptoms are more or less prevalent for eight or ten days, when suddenly a more violent paroxysm of fever will ensue, preceded by a shivering fit, and sometimes an incessant vomiting of bile. The pulse rises to 140; the cheeks are flushed, the child’s drowsiness increases, and when awake, he resorts to picking at the skin of the nose, lips, and eyes, to a most painful degree.

This species of fever is mild at the commencement, slow in its progress, and very uncertain in its event. The desire for food is destroyed, and the child will take neither aliment nor medicine. The stools are changed from their natural appearances, being sometimes black, and smelling like putrid mud; and at other times they are curdled, with shreds of coagulable lymph floating in a dark green fluid.

_Treatment._