sixth days are the ordinary periods of the detachment. The cord has been
known to remain undetached as long as fifteen days; but such cases must
be very rare.
Complete cicatrization is commonly effected by the end of the second
week. The healing powers vary somewhat in different cases. In one case,
where both the father and the mother were of scrofulous tendency, it was
a number of weeks before the healing process was fully completed. The
child, however, in the end did well.
OF STILL-BIRTH.
The child may be born _still_, from its not having passed to its full
period, or from various causes it may not have vital stamina enough to
enable it to live. In some cases the child is born without any
manifestations of life whatever appearing. The face is swollen and
livid, the body flaccid, and the navel-string does not pulsate.
In such cases we should not at once wholly despair of life, although
there is not usually much to hope for; yet, inasmuch as cases of this
kind are now and then recovered, they ought not to be immediately
abandoned without making suitable efforts for the resuscitation of the
vital powers.
A frequent cause of the absence of respiration in the new-born infant
is, separating the umbilical cord too soon after birth. Such is the
opinion of Denman, Burns, Baudeloque, Dewees, Elberle, etc., etc., and
there can be no doubt that many a child has been destroyed by this
inconsiderate practice. By all well-qualified and skillful practitioners
it is laid down as a rule, “_that the cord is not to be tied until the
pulsations in its arteries have ceased_;” and this any person of
ordinary understanding, and without medical knowledge, can easily
ascertain, by simply taking the cord between the thumb and forefinger.
In consequence of the neglect of this rule, Doctor Dewees tells us that
he had reason to believe he had seen several instances of death, and
this of a painful and protracted kind. “And that this is probably one of
the causes of the many deaths, in the hands of ignorant midwives and
practitioners,” this author observes, “we have too much reason to
suppose.” The practice with many is, to apply a ligature to the cord the
instant the child is born, without any regard whatever to its pulsation,
or the state of the child’s respiration.
_Treatment._—In the cases of asphyxia, to which I have referred, various
methods of treatment have been adopted, some of which are, no doubt,
valuable, while others are meddlesome, and worse than useless.
If the child is livid and dark-colored, it has been recommended to
abstract blood. This is best done at the umbilical cord; that is, by
separating it. If the blood will not flow, it is recommended to strip
some blood from it. It is, however, admitted that, in general, very
little, if any, can be obtained in this way.
It has also been recommended to apply a cupping-glass to the umbilicus,
so that by exhausting the air from the part the blood may be brought
into motion, and thus made to flow, and this even after the heart has
ceased to act. I know of no author, however, who has succeeded in this
method.
The object of abstracting blood in any of these various ways is to set
the vital fluid in motion, and to relieve the congested parts. But it
appears to me that there is a far better method than this, and that is
simply by friction with the wet hand. The child has in no case _too
much_ blood; it is only in the wrong place. The wet hand does not at all
injure the skin; the cold water—for cold only should be used here—acts
as a stimulus to the vital power, and the motion of the hand and the
pressure will set a hundred-fold more blood in circulation than the mere
separating of the umbilical cord could do. Hence it is that I would
depend much upon friction, and very little, if any, upon the abstraction
of blood. This latter practice is destined to become as obsolete in
time, as that of bleeding in a severe injury or shock of the system—a
method which has deservedly gone out of date among all scientific
practitioners of the medical art.
In conjunction with the measure which I have just recommended, there is
another of importance, which should be faithfully made; and that is, an
effort to excite the respiratory function by artificial inflation of the
lungs, and compression of the chest with the hands, so as to imitate in
a measure the natural acts of inspiration and expiration. In doing this
the operator must apply his mouth to that of the infant—the latter
having been first freed of the mucus that attaches to it—at the same
time closing its nostrils, and endeavor by a moderate but uniform force
of expelling the air from the mouth, to fill the lungs of the child. As
the air is thrown into the lungs, the chest of the child must be allowed
to expand as much as it will; and then, as this act is discontinued, the
chest should be compressed a little, carefully, so as to imitate the
natural motion of these parts.
Authors disagree as to the amount of force allowable in forcing air into
the lungs of a new-born child. Some have recommended a “forcible
insufflation,” while others contend that such a practice is fraught with
danger to the child. It appears from a series of experiments that have
been made in France on animals, and from observations relative to the
human subject, that no very great force of insufflation is necessary to
rupture the delicate air-cells, and cause a fatal emphysema of the
pulmonary structure. In sheep, and in the dead human subject, the
air-cells were ruptured by a force of insufflation not greater than that
which may be made by a person of ordinary respiratory vigor, without any
very violent effort.
To obviate the unfortunate accident of rupturing the air-cells of the
lungs, the air should be thrown into the respiratory passage through a
silk handkerchief folded double, or a fine napkin laid over the mouth of
the infant.
In all cases of retarded, impeded, or suspended respiration immediately
after birth, care should be promptly paid to the removal of the viscid
mucus, which is usually to be found lodged in the mouth and throat of
new-born infants. In some instances the quantity of mucus is so great,
and its quality so tough, that it is believed the child could not
possibly breathe if the obstruction was not removed from the parts. In
all cases, therefore, if there appears to be any difficulty whatever in
regard to respiration, it is best to remove this mucus by means of the
finger, surrounded by a handkerchief or piece of soft linen. If there is
reason to believe that the mucus is also lodged in the throat and beyond
the reach of the finger, it has been recommended that the child should
be turned with its face downward, and the body raised higher than the
head. In this position, the child’s back, between the shoulders, is to
be patted with the hand, and its body gently shaken, so as to disengage
any matters that may be lodged in the trachea, and permitting it to flow
out of the mouth by making this the depending part. At the same time, if
the back is rubbed with the hand wet in cold water, the stimulating
effect will aid in the expulsion of the offending cause from the throat.
Infants are sometimes born in a state of asphyxia, when, instead of
lividity and swelling of the countenance, there is the opposite extreme,
the face and surface of the body, generally, being pale, exhibiting a
want of vitality. In such cases, it is of the utmost importance that the
cord be not divided too hastily; on no account, indeed, should this be
done until the pulsation has ceased. The viscid mucus should at once be
removed from the mouth and fauces by the methods before mentioned; and
it has been recommended to apply brandy, spirits of camphor, hartshorn,
etc., to the mouth and nostrils, with the view of exciting the
respiratory function. It is doubtful, however, if such articles do any
permanent good whatever, and they are certainly liable to harm. At any
rate, it is better, I am confident, to sprinkle cold water upon the
surface, and to make friction with the cold wet hand. This will set the
blood in motion, and aid the vital powers incomparably more than the
stimulants mentioned.
It is also advisable in these cases, if respiration is particularly
tardy, to inflate the lungs carefully, according to the method before
recommended. But the applying hot brandy, flannels wrung out of hot
spirits, etc., which have often been used on such occasions, are worse
than useless, and ought never to be resorted to.
Infants, in this condition, should not be given up too hastily. Numbers
of cases have happened in which a half hour or more has elapsed before
respiration has been established. Even a much longer period than thirty
minutes has transpired in some cases before the breathing has been
established.
The time will come, probably, when electricity will become so well
understood as to enable us to make it a valuable agent in cases of
still-birth and suspended animation. In the present state of knowledge,
however, it is better, I think, to depend on the stimulus of cold water,
frictions, and the other means to which I have already referred. But
great care is necessary in the management of all such cases; and I have
no doubt that many more infants have been killed by too meddlesome and
injudicious management, than have been saved by the use of artificial
means. The tendency in cases of this kind always has been to do too
much. It is one of the greatest acquirements in art to learn when _not_
to do.
WASHING AND DRESSING THE CHILD.
I have a few words to say here on these topics; but I must refer you to
my Treatise on Children for a much more full and explicit explanation of
them than the limits of this work would admit of. You can all of you who
have need obtain that work, I trust; and surely, after you have borne a
child, you will feel the greatest interest in learning all that it is
possible for you to know respecting the best modes of rearing it.
In general terms, then, I remark, that a child should, soon after its
birth, be carefully cleansed by means of pure water and the addition of
a little mild soap. The water should not be either too warm or too cold;
a moderate temperature, as from 70° to 80° Fah., will be found best. The
child should be _carefully_ washed, I said; and in all that is done in
handling it, you should remember that it is a frail, delicate thing. Nor
need I hint to a _mother_ that inasmuch as some one had to perform all
of these small yet multiform offices for us, so should we be willing to
perform them for others.
The _dress_ should be loose, and merely sufficient for the purposes of
warmth. The child should not be in any way _bound_ with its clothing;
nor should a binder or bandage be used.
LETTER XXX.
HYGIENE OF NURSING.
Lactation a Natural and Healthful Process—Rules for Nursing—At what time
should Lactation cease?—Food and Drink proper during the Period.
You who reside in the country—as, indeed, most of you do—can hardly
credit me when I tell you that it is getting to be quite fashionable in
our large cities for a woman _not to nurse her own child_.
There is in some cases policy on the part of the physician, which lies
at the root of this matter. “Why, madam, you are too weak,” the
fashionable pill-monger sagely says. “It will injure your constitution,
and you cannot raise your child; you must have a wet-nurse.”
Now, all this is very easy for a man to declare. Some say it from
ignorance, no doubt, and some from other motives; for physicians,
although as a body of men they are as honest as any other, are yet
sometimes selfish, and do that which is dishonest and wrong. The selfish
doctor knows, of course, very well where his money comes from. He
knows—if he is not an ignoramus—that the mother, if she does not nurse
her child, is more apt to become sick, so that she will need his
services; and, what is more, she is more apt to become pregnant, in
which case he will look for another job at midwifery, which pays well.
I would have every one of you to understand that the health of the
unnatural mother, who will not nurse her child, suffers from her not
fulfilling the order of nature in giving suck. Her system must
inevitably get harm from not allowing it to go through the period of
lactation naturally. Her life of dissipation, too, is poorly calculated
to contribute to health, compared with staying at home and fulfilling
the order of nature, as God designed she should do. But she gets her
reward even here. There is no period of woman’s life in which she has so
great enjoyment, such perfect physical health, as when she is nursing
the offspring of her own blood. Her shattered nerves and broken health
are poor pay for the so-called enjoyments of a dissipated life.
But it will be said, there are cases in which it is impossible for a
mother to fulfill the office of nursing. She may be physically unable;
that is, she may not have any milk to give it; her health may be so
feeble, and her constitution so much depraved, that it would not be
admissible to do so. All this I admit; but such cases are the exception
and not the rule.
What are we to think of the mother who voluntarily permits her child to
nurse at another breast? How are we to regard the morals of such a
mother—one who willingly allows another person to gain the affections of
her child—for it always becomes more attached to the one who nurses it
than to its own parent? Besides, too, the character of the one who
suckles the child is, to a great degree, stamped upon it, and that
indelibly, too. Is a mother, then, willing that the child shall take on
the character of another, and of one whose disposition and mental
peculiarities she probably knows nothing? For one, I cannot envy the man
who has a wife that can willingly resign her child to another to nurse.
_Rules for Nursing._—After the birth of the child, the mother having
rested herself some hours from the pains and anxiety she has passed
through, it should be put to the breast with the view of exciting the
mammiferous glands to their proper and healthful action. This is better
for both mother and child. It may be necessary to make the attempt a
number of times, and perhaps for days before the lacteal secretion will
be found to take place. But letting the child every now and then make
the effort to get milk will be one of the most efficient means of
inducing it to flow.
_How often to Nurse the Child._—This is a question of great importance;
great not less to the parent than the offspring, but one which is by for
too much neglected.
It may not be possible to ascertain exactly at what periods it is best
to give a child the breast; but one thing may be predicated with the
greatest confidence, which is, that there should be a _regularity_ in
regard to it. To give the child the breast every half hour one day, and
then, perhaps, the next, for the mother to go away for many hours, is
certainly not a good practice.
I am led to believe, after having spent a good deal of thought on this
subject, that to nurse a child once in about three hours, is perhaps as
good a plan as can be fixed upon. Some have regarded four hours as a
proper period; but one thing I am satisfied of, that the three hour rule
is a good one; there is far more danger of nursing the child too often
than there is from the opposite extreme.
It is common, I believe, for mothers to allow the child to take the
breast during the night time. I am of the opinion that this practice,
likewise, is not a good one. How much do you become fatigued, worn down,
as it were, many of you, by allowing the child to take the nipple as
often as it chooses in the night? In such cases, how much better you
perceive it would be, to rest during the proper hours, so that when the
morning comes, instead of being unrefreshed and stupid, you feel buoyant
and elastic as a deer.
I am willing, however, to admit that it is probably the better rule for
the child to be nursed somewhat late at night; for example, when you
retire to rest; after that it should not be allowed nourishment till
morning.
_At what time to cease Nursing._—This, too, is a question which deserves
a careful consideration—one on which the health of both parent and
offspring very much depends.
It is probably true that women in the civilized and refined parts of the
world do not, as a general fact, nurse their children for as long a
period as is the case among the savage nations.
The Indian women of our own country, it would appear, are in the habit
of continuing to suckle their children two years or more before weaning
them. Nor do they at all allow of cohabitation during this period—a
practice which might well be imitated by the more enlightened portions
of the human race. “I shall not undertake to determine,” says Dr. Rush,
“how far the wholesome quality of the mother’s milk is increased by her
(the Indian woman’s) refusing the embraces of her husband during the
time of giving suck.” If, then, the mother’s _milk_ is to be
deteriorated by the practice referred to, her health, also, must suffer
in a corresponding ratio.
It would appear, also, that in Bible times the period of nourishing
children at the breast was prolonged to a much greater period than is
common in these latter times, for we read of the giving of suck _three_
years.
_Reappearance of the Menses._—Some have supposed that the period of
nursing should be graduated according to the reappearance of the
catamenial discharge, because, as they have supposed, the milk is
deteriorated by that circumstance.
Let us inquire, in the first place, at what time after a woman has given
birth to a child, does the menstrual function ordinarily commence?
Some authors tell us that this does not happen for nine or ten months,
usually. Dr. Meigs tells us that he expects his patients “to become
unwell at the seventh month of lactation.” “But more frequently than is
generally believed,” says Dr. Tilt, “the periodical flow coincides with
the secretion of milk as early as the second or third month of
lactation, and this in perfectly healthy women; and I am in a great
measure able to confirm the assertion of certain authors, that
menstruation often continues regularly from the beginning of lactation.”
These, however, are exceptional cases, the rule being that a number of
months, ranging probably from seven or eight to fifteen, elapses before
the menses reappear.
But it is by no means proved that lactation should be made to cease as
soon as the woman has her monthly discharge. I have myself known numbers
of cases in which nursing was continued for some months after, and
apparently with good results to both mother and child. How is it in
those cases where the menses do not cease at all, or, at farthest, come
on at a much earlier period than it would be advisable to wean the
child? Must we be obliged to wean the child in these cases? I think not.
Dr. Hassall, of London, we are informed, examined with a microscope the
milk of a lady taken from her on the second day of menstruation, which
had come on for the first time at the ninth month of lactation, and he
reported that the milk was perfectly normal in quality.
Dr. Tilt informs us that, having carefully interrogated one hundred
women in whom menstruation had returned at different periods of
lactation, he learned that the quantity and quality of the milk were
varied as follows:
The same in 45
Diminished only at the menstrual time 8
Completely checked in 1
Impoverished only at the menstrual time 5
Impoverished then and thenceforth 2
Increased at the menstrual time 24
A rush of milk afterward 15
———
100
In making the above observations, the thriving of the children was the
estimate of the quality of the milk. By “impoverishment,” was meant that
the milk looked like whey, and sickened the children.
My belief, then, you will understand to be, that some other criterion
than the reappearance of the menses is to be looked for in regard to the
time you should continue to suckle a child. Your own health, the
infant’s health, the season of the year, the stage of teething, and a
variety of circumstances, are to be taken into the account. And I am
fully persuaded that the mere fact of the menstrual discharge coming on,
is not a sufficient reason why the child should be weaned. Moreover,
weaning should be a _gradual_ process, which it cannot be if a woman
must cease to nurse it as soon as the menses come upon her.
_Food and Drink proper during Lactation._—As a general principle, it may
be stated that whatever is best for the constitution of the mother, is
also best for that of the child.
Every thing that goes to injure the mother during the period of
lactation operates powerfully upon the mammary secretion, deteriorating
it in the same proportion that it acts as an unfriendly agent upon her.
This secretion, too, be it remembered, is one of the very first of the
fluids of the body to become affected under unfavorable circumstances.
We know how quickly the milk of a distillery-fed cow becomes
impoverished and unhealthy, when the improper food is given to the cow;
and precisely the same great physiological principles hold good in the
woman as the animal.
Suppose you have a fine cow, to which you have become very much
attached, and that has a fine calf; or even suppose you have a sow, to
which you have devoted a more than ordinary share of attention, and that
she has a fine brood of pigs. It is naturally to be supposed that you
would take as much pains as possible with the cow, that she might give
good milk for the calf; and if you have a fancy for raising pigs, you
would be equally careful in regard to the sow. We will suppose you think
there is danger that the animal will not produce milk enough for the
required purpose. In such a case, would you give it tea, coffee, or
porter to drink? Most assuredly you would not; nor would you consider
any woman in her right mind who would. Now, it is just as improper and
inconsistent for you to take these articles, any one of them, with the
view of improving either the quantity or quality of the milk, as it
would be to give them to animals for the same purpose. Farmers can tell
you how much better it is for animals, when they are giving milk, to
have pure water to drink; and the purer and softer it is, the better
does the animal thrive in every respect.
I will not deny that a woman probably needs more fluid when she is
nursing than she does at other times, and I presume that she feels a
desire for more; if so, she can take it. But surely no one will tell me
that there is any thing in the wide world that will at all compare with
pure water as a means of quenching the thirst.
In nursing, as well as in all situations, you will find the diet to have
a great influence in regulating the desire for drink. If you eat salt,
and highly seasoned or sweetened articles, you will experience much more
thirst than you would if the diet were more simple. A stimulating diet
causes a degree of fever in the body; and water being the best and most
natural of all substances for curing fever, nature sets up a demand for
it. Remember, then, when you eat any thing that makes you _dry_, you are
doing unwisely, because you are causing a degree of gastric fever,
greater or less.
I need not, I think, go any more into details concerning what you should
eat and drink while giving suck. The great thing is to do the best
possible for your own health, and that also will be best for the child.
You should not eat or take nourishing drink any oftener than you would
do at other times, nor should you overdo in quantity, because you think
you have two to support.
LETTER XXXI.
OF TWINS, TRIPLETS, ETC.
Twins, Triplets, and Quadrigemini of comparatively rare Occurrence—Of
the Signs of two or more Children in the Womb—Management of Twin and
Triplet Cases—The Nursing of Twins.