THE
MATERNAL MANAGEMENT
OF
CHILDREN,
IN HEALTH AND DISEASE.
By Thomas Bull, M.D.
Physician Accoucheur To The Finsbury Midwifery
Institution, And Lecturer On Midwifery,
And On The Diseases Of Women
And Children;
Author Of "Hints To Mothers On The
Management Of Their Health."
1840.
PREFACE.
This little book has been written for the young and inexperienced
mother. It is intended to furnish her with that information which the
experience and observation of some years convince the author, young
mothers, almost without any exception, do not possess; and yet, from
ignorance of which, the constitution of many an infant has received
irretrievable injury, and life itself but too frequently fallen a
sacrifice.
In the first chapters, devoted to the general management of the child
in health, the author has endeavoured to teach the young mother, that
the prevention of disease is her province, not its cure; that to this
object all her best efforts must be directed; and, moreover, that to
tamper with medicine, when disease has actually commenced, is to hazard
the life of her offspring.
In the fourth chapter it has been attempted to point out, how the
first symptoms of disease may be early detected by the parent. The
subject has been felt to be a difficult one, and to give particular
directions quite out of the question; but it is hoped that the
suggestions thrown out will, in some measure, answer the purpose
intended. On the advantage of an early and prompt application of
remedies in the diseases of childhood, generally so active in their
progress and severe in their character, it is unnecessary to offer any
observation.
The latter part of the work, consisting of the maternal management of
disease, the author regards as a subject of high and serious moment.
Small as is the attention which has been hitherto paid to it, yet, in
the diseases of infancy and childhood, how invaluable is a careful and
judicious maternal superintendence to give effect to the measures
prescribed by the physician.
The author has endeavoured to arrange the contents of the work in a
manner which shall be most easily understood and readily available; and
he now publishes it with the desire to supply, in some degree, a
deficiency in this important department of knowledge.
Finsbury Place, June, 1840.
CONTENTS.
Chapter I.
ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
Sect. - Page
I. On the Dietetics of Infancy - 2
1. Maternal Nursing - 3
Plan of Suckling - 3
Deficiency of Milk - 11
The injurious Effects to Mother and Infant of undue and protracted
Suckling - 15
Mothers who ought never to suckle - 20
2. Wet-nurse Suckling - 27
Choice of a Wet-nurse - 28
Diet and Regimen of a Wet-nurse - 31
3. Artificial Feeding, (bringing up by hand) - 34
The Kind of artificial Food before the sixth Month - 35
The Kind of artificial Food after the sixth Month to the completion of
first Dentition - 44
The Kind of artificial Food most suitable under the different
Complaints to which Infants are liable - 48
II. Weaning - 51
The Time when - 51
The Mode - 52
The drying up of the Mother's Milk - 54
III. On the Dietetics of Childhood - 54
General Directions, and of animal Food - 55
Sugar - 60
Salt - 61
Fruits - 62
Water - 63
Wine, Beer, and Spirits - 63
IV. Sleep - 66
During Infancy - 66
During Childhood - 69
V. Bathing and Cleanliness - 72
During Infancy - 72
During Childhood - 75
VI. Clothing - 78
During Infancy - 78
During Childhood - 81
VII. Air and Exercise - 83
In Infancy - 83
In Childhood - 89
Chap. II.
ON THE USE AND ABUSE OF CERTAIN REMEDIES.
I. Aperient Medicine - 97
Castor Oil - 99
Manna - 101
Magnesia and Rhubarb - 102
The Lavement - 105
The Aperient Liniment - 107
II. Calomel - 107
III. Opiates - 110
IV. Leeching - 113
V. Blisters and Poultices - 114
VI. Baths - 117
The Cold-water Plunge Bath - 118
Sea Bathing - 120
The Shower Bath - 123
Ablution, or Sponging - 125
The Warm Bath - 188
Chap. III.
ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.
I. On Teething. - 134
The Manner in which the temporary or milk Teeth appear - 134
The Management of the Infant when Teething is without difficulty - 136
The Management of the Infant in difficult Teething - 139
II. Hints on the permanent or adult Teeth - 148
The Manner in which they appear - 248
Their Value and Importance - 152
Their Management and Preservation - 154
Chap. IV.
HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.
I. Signs of Health - 163
II. Signs of Disease - 164
Of the Countenance - 165
Of the Gestures - 169
Of the Sleep - 171
Of the Stools - 172
Of the Breathing and Cough - 175
III. Other Circumstances which will assist in the early Detection of
Disease - 178
The Influence of the Seasons in producing particular Forms of Disorder
- 178
The Influence of an hereditary Predisposition to certain Diseases - 179
Chap. V.
ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
I. Accidents and Diseases which may occur to the Infant at Birth, or
soon after - 187
1. Still-born - 187
2. Injuries received during Birth - 193
3. Retention of Urine - 194
4. Swelling of the Breasts - 195
5. Inflammation of the Eyes - 196
6. Hare-lip - 199
7. Bleeding from the Navel-string - 201
8. Ulceration or imperfect Healing of the Navel - 20l
9. Bleeding from the Navel - 203
10. Jaundice - 204
11. Tongue-tied - 205
12. Moles and Marks on the Skin, etc. - 206
II. Disorders of the Stomach and Bowels; viz., Indigestion -
Flatulence - Vomiting - Griping and Looseness - 208
1. In the Infant at the Breast - 21O
2. At the period of Weaning - 217
3. In the child brought up by Hand - 221
Maternal Treatment - 222
III. Costiveness - 229
In Infancy - 229
In Childhood - 231
IV. Worms - 234
Not so frequent as popularly supposed; an error productive of mischief
- 234
How produced and how best prevented - 237
V. Scarlet Fever - 239
Mild Form - 239
With Sore Throat - 242
Scarlet Fever compared with Measles - 245
Maternal Management - 246
VI. Measles - 253
Description - 253
Compared with Scarlet Fever and Small Pox - 255
Maternal Management - 256
VII. Small-Pox - 262
Natural Small-Pox - 263
Small-Pox in the Vaccinated - 266
Maternal Management - 268
VIII. Hooping Cough - 275
Description - 276
Maternal Management - 279
IX. Croup - 286
Signs of its Approach - 286
Maternal Management - 289
Its prevention - 289
X. Water in the Head - 291
Its Prevention - 292
Maternal Management - 298
THE MATERNAL MANAGEMENT OF CHILDREN.
Chapter I.
ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
The line of demarcation made between infancy and childhood, both by
ancient and modern writers, has always been arbitrary. I would draw the
line between the two, at a period of time which appears to me to be the
most natural, the most simple, and least likely to lead the reader into
the danger of misapplying any part of the practical directions of this,
or any future chapter of the work. We will consider, then, that--
Infancy, commencing with birth, extends to about the end of the second
year, when the first dentition is completed.
Childhood extends from about the second, to the seventh or eighth
year, when the second dentition is commenced.
Sect. I. DIETETICS OF INFANCY.
In the early months of infancy the organs of digestion are unsuited to
any other food than that derived from the breast of the mother. So
little capable are they, indeed, to digest any other, even of the
blandest and most digestible kind, that probably not more than one
infant in six or seven ever arrives at the more advanced periods of
life when deprived of the kind of nourishment nature intended for this
epoch.
It is not every parent, however, who is able to become a nurse; and
with many this office would not only be highly injurious to their own
health, but materially so to that of their offspring. This may arise
from various causes, hereafter to be noticed, but whenever they exist a
wet-nurse is demanded.
Again, the latter resource is not always attainable, so that the
hazardous experiment of an artificial diet, or bringing up by hand, as
it is then termed, is obliged to be resorted to.
Thus, infantile dietetics naturally divides itself into Maternal
Nursing, Wet-Nurse Suckling, And Artificial Feeding.
1. MATERNAL NURSING.
PLAN OF SUCKLING.
From the first moment the infant is applied to the breast, it must be
nursed upon a certain plan. This is necessary to the well-doing of the
child, and will contribute essentially to preserve the health of the
parent, who will thus be rendered a good nurse, and her duty at the
same time will become a pleasure.
This implies, however, a careful attention on the part of the mother
to her own health; for that of her child is essentially dependent upon
it. Healthy, nourishing, and digestible milk can be procured only from
a healthy parent; and it is against common sense to expect that, if a
mother impairs her health and digestion by improper diet, neglect
of exercise, and impure air, she can, nevertheless, provide as
wholesome and uncontaminated a fluid for her child, as if she were
diligently attentive to these important points. Every instance of
indisposition in the nurse is liable to affect the infant.
And this leads me to observe, that it is a common mistake to suppose
that, because a woman is nursing, she ought therefore to live very
fully, and to add an allowance of wine, porter, or other fermented
liquor, to her usual diet. The only result of this plan is, to cause an
unnatural degree of fulness in the system, which places the nurse on
the brink of disease, and which of itself frequently puts a stop to the
secretion of the milk, instead of increasing it. The right plan of
proceeding is plain enough; only let attention be paid to the ordinary
laws of health, and the mother, if she have a sound constitution, will
make a better nurse than by any foolish deviation founded on ignorance
and caprice.
The following case proves the correctness of this statement:--
A young married lady, confined with her first child, left the lying-in-
room at the expiration of the third week, a good nurse, and in perfect
health. She had had some slight trouble with her nipples, but this was
soon overcome.
The porter system was now commenced, and from a pint to a pint and a
half of this beverage was taken in the four and twenty hours. This was
resorted to, not because there was any deficiency in the supply of
milk, for it was ample, and the infant thriving upon it; but because,
having become a nurse, she was told that it was usual and necessary,
and that without it her milk and strength would ere long fail.
After this plan had been followed for a few days, the mother became
drowsy and disposed to sleep in the daytime; and headach, thirst, a hot
skin, in fact, fever supervened; the milk diminished in quantity, and,
for the first time, the stomach and bowels of the infant became
disordered. The porter was ordered to be left off; remedial measures
were prescribed; and all symptoms, both in parent and child, were after
a while removed, and health restored.
Having been accustomed, prior to becoming a mother, to take a glass or
two of wine, and occasionally a tumbler of table beer, she was advised
to follow precisely her former dietetic plan, but with the addition of
half a pint of barley-milk morning and night. Both parent and child
continued in excellent health during the remaining period of suckling,
and the latter did not taste artificial food until the ninth month, the
parent's milk being all-sufficient for its wants.
No one can doubt that the porter was in this case the source of the
mischief. The patient had gone into the lying-in-room in full health,
had had a good time, and came out from her chamber (comparatively) as
strong as she entered it. Her constitution had not been previously worn
down by repeated child-bearing and nursing, she had an ample supply of
milk, and was fully capable, therefore, of performing the duties which
now devolved upon her, without resorting to any unusual stimulant or
support. Her previous habits were totally at variance with the plan
which was adopted; her system became too full, disease was produced,
and the result experienced was nothing more than what might be expected.
The plan to be followed for the first six months.-Until the breast-
milk is fully established, which may not be until the second or third
day subsequent to delivery (almost invariably so in a first
confinement), the infant must be fed upon a little thin gruel, or upon
one third water and two thirds milk, sweetened with loaf sugar.
After this time it must obtain its nourishment from the breast alone,
and for a week or ten days the appetite of the infant must be the
mother's guide, as to the frequency in offering the breast. The stomach
at birth is feeble, and as yet unaccustomed to food; its wants,
therefore, are easily satisfied, but they are frequently renewed. An
interval, however, sufficient for digesting the little swallowed, is
obtained before the appetite again revives, and a fresh supply is
demanded.
At the expiration of a week or so it is essentially necessary, and
with some children this may be done with safety from the first day of
suckling, to nurse the infant at regular intervals of three or four
hours, day and night. This allows sufficient time for each meal to be
digested, and tends to keep the bowels of the child in order. Such
regularity, moreover, will do much to obviate fretfulness, and that
constant cry, which seems as if it could be allayed only by constantly
putting the child to the breast. A young mother very frequently runs
into a serious error in this particular, considering every expression
of uneasiness as an indication of appetite, and whenever the infant
cries offering it the breast, although ten minutes may not have elapsed
since its last meal. This is an injurious and even dangerous practice,
for, by overloading the stomach, the food remains undigested, the
child's bowels are always out of order, it soon becomes restless and
feverish, and is, perhaps, eventually lost; when, by simply attending
to the above rules of nursing, the infant might have become healthy and
vigorous.
For the same reason, the infant that sleeps with its parent must not
be allowed to have the nipple remaining in its mouth all night. If
nursed as suggested, it will be found to awaken, as the hour for its
meal approaches, with great regularity. In reference to night-nursing,
I would suggest suckling the babe as late as ten o'clock p. m., and not
putting it to the breast again until five o'clock the next morning.
Many mothers have adopted this hint, with great advantage to their own
health, and without the slightest detriment to that of the child. With
the latter it soon becomes a habit; to induce it, however, it must be
taught early.
The foregoing plan, and without variation, must be pursued to the
sixth month.
AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a
large supply of good and nourishing milk, and her child is healthy and
evidently flourishing upon it, no change in its diet ought to be made.
If otherwise, however, (and this will but too frequently be the case,
even before the sixth month[FN#1],) the child may be fed twice in the
course of the day, and that kind of food chosen which, after a little
trial, is found to agree best.
[FN#1] See Deficiency of Milk, p. 11.
Leman's tops and bottoms, steeped in hot water, with the addition of a
little fresh milk, and sweetened or not with loaf sugar, is one of the
best description.
If the stomach reject this, farinaceous food boiled in water, and
mixed with a small quantity of milk, may be employed. Or weak mutton or
veal broth, or beef tea, clear and free from fat, and mixed with an
equal quantity of farinaceous food.
If this artificial diet is used before the sixth month, it must be
given through the sucking-bottle; after this period with a spoon: in
either case it must be previously passed through a sieve.
When the large or grinding teeth have appeared, the same food is still
to be continued, but need not any longer be expressed through the sieve.
Such is the plan of nursing to be followed by the mother until she
wean her infant altogether from the breast. The period when this ought
to take place, as also the manner of accomplishing it, are detailed
in the section on "Weaning."[FN#2]
[FN#2] See page 51.
The diet from weaning to the termination of infancy is pointed out
under "Artificial Feeding."[FN#3]
[FN#3] See page 34.
DEFICIENCY OF MILK.
If this deficiency exist from the earliest weeks after delivery, and
it is not quickly remedied by the means presently to be pointed out, a
wet-nurse must be obtained. It will be of no avail partially to nurse,
and partially to feed the infant at this period and under such
circumstances, for if it is not soon lost, it will only live for a few
months, or a year at most, and be an object of the greatest anxiety and
grief to its parent. This condition arises from the unwholesomeness of
the mother's milk, united with the artificial food; for when the milk
is deficient from the first, and continues so notwithstanding the means
used for its increase, it is invariably unhealthy in its quality.
This deficiency, however, may exist, and even at a very early period
after delivery, and yet be removed. This, however, is not to be
accomplished by the means too frequently resorted to; for it is the
custom with many, two or three weeks after their confinement, if the
supply of nourishment for the infant is scanty, to partake largely of
malt liquor for its increase. Sooner or later this will be found
injurious to the constitution of the mother: but how, then, is this
deficiency to be obviated? Let the nurse keep but in good health, and
this point gained, the milk, both as to quantity and quality, will be
as ample, nutritious, and good, as can be produced by the individual.
I would recommend a plain, generous, and nutritious diet; not one
description of food exclusively, but, as is natural, a wholesome,
mixed, animal, and vegetable diet, with or without wine or malt liquor,
according to former habit; and, occasionally, where malt liquor has
never been previously taken, a pint of good sound ale may be taken
daily with advantage, if it agree with the stomach. Regular exercise in
the open air is of the greatest importance, as it has an extraordinary
influence in promoting the secretion of healthy milk. Early after
leaving the lying-in room, carriage exercise, where it can be
obtained, is to be preferred, to be exchanged, in a week or so, for
horse exercise, or the daily walk. The tepid, or cold salt-water shower
bath, should be used every morning; but if it cannot be borne, sponging
the body withsalt-water must be substituted.
By adopting with perseverance the foregoing plan, a breast of milk
will be obtained as ample in quantity, and good in quality, as the
constitution of the parent can produce, as the following case proves:
On the 17th September, 1839, I attended a lady twenty-four years of
age, a delicate, but healthy woman, in her first confinement. The
labour was good. Every thing went on well for the first week, except
that, although the breasts became enlarged, and promised a good supply
of nourishment for the infant, at its close there was merely a little
oozing from the nipple. During the next fortnight a slight, but very
gradual increase in quantity took place, so that a dessert spoonful
only was obtained about the middle of this period, and perhaps double
this quantity at its expiration. In the mean time the child was
necessarily fed upon an artificial diet, and as a consequence its
bowels became deranged, and a severe diarrhoea followed. A wet-nurse
was advised for the child as the only means of saving its life, and
change of air for the mother as the most likely expedient (in
connection with the general treatment pointed out above) for obtaining
a good breast of milk. Accordingly, on the 5th October, the patient,
taking with her the infant and a wet-nurse, went a few miles from town.
For three or four days it was a question whether the little one would
live, for so greatly had it been reduced by the looseness of the bowels
that it had not strength to grasp the nipple of its nurse; the milk,
therefore, was obliged to be drawn, and the child fed with it from a
spoon. After the lapse of a few days, however, it could obtain the
breast-milk for itself; and, to make short of the case, on the 25th of
the same month, the mother and child returned home, the former having a
very fair proportion of healthy milk in her bosom, and the child
perfectly recovered and evidently thriving fast upon it.
Where, however, there has been an early deficiency in the supply of
nourishment, it will most frequently happen that, before the sixth or
seventh month, the infant's demands will be greater than the mother can
meet. The deficiency must be made up by artificial food, which must be
of a kind generally employed before the sixth month, and given through
the bottle. If, however, this plan of dieting should disagree, the
child must, even at this period, have a wet-nurse.
Women who marry comparatively late in life, and bear children,
generally have a deficiency of milk after the second or third month:
artificial feeding must in part be here resorted to.
THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED
SUCKLING.
UPON THE MOTHER.--The period of suckling is generally one of the most
healthy of a woman's life. But there are exceptions to this as a
general rule; and nursing, instead of being accompanied by health, may
be the cause of its being materially, and even fatally, impaired. This
may arise out of one of two causes, either, a parent continuing to
suckle too long; or, from the original powers or strength not being
equal to the continued drain on the system.
Examples of the first class I am meeting with daily. I refer to poor
married women, who, having nursed their infants eighteen months, two
years, or even longer than this, from the belief that by so doing they
will prevent pregnancy, call to consult me with an exhausted frame and
disordered general health, arising solely from protracted nursing,
pursued from the above mistaken notion.
I most frequently meet with examples of the second class in the
delicate woman, who, having had two or three children in quick
succession, her health has given way, so that she has all the symptoms
arising from undue suckling, when perhaps the infant at her breast is
not more than two or three months old.
Since the health of the mother, then, will suffer materially from this
circumstance, she ought not to be ignorant of the fact; so that, when
the first symptoms manifest themselves, she may be able to recognise
their insidious approach; and tracing them to their real cause, obtain
medical advice before her health be seriously impaired.
SYMPTOMS.--The earliest symptom is a dragging sensation in the back
when the child is in the act of sucking, and an exhausted feeling of
sinking and emptiness at the pit of the stomach afterwards. This is
soon followed by loss of appetite, costive bowels, and pain on the left
side; then, the head will be more or less affected, sometimes with much
throbbing, singing in the ears, and always some degree of giddiness,
with great depression of spirits.
Soon the chest becomes affected, and the breathing is short,
accompanied by a dry cough and palpitation of the heart upon the
slightest exertion. As the disease advances, the countenance becomes
very pale, and the flesh wastes, and profuse night perspirations, great
debility, swelling of the ankles, and nervousness ensue. It is
unnecessary, however, to enter into a more full detail of symptoms.
TREATMENT.--All that it will be useful to say in reference to
treatment, is this; that, although much may be done in the first
instance by medicine, change of air, cold and sea bathing, yet the
quickest and most effectual remedy is to wean the child, and thus
remove the cause.
THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful
reason why the child should be weaned, or rather, have a young and
healthy wet-nurse, if practicable. The effects upon the infant, suckled
under such circumstances, will be most serious. Born in perfect health,
it will now begin to fall off in its appearance, for the mother's milk
will be no longer competent to afford it due nourishment; it will be
inadequate in quantity and quality. Its countenance, therefore, will
become pale; its look sickly and aged; the flesh soft and flabby; the
limbs emaciated; the belly, in some cases, large, in others, shrunk;
and the evacuations fetid and unnatural; and in a very few weeks, the
blooming healthy child will be changed into the pale, sickly, peevish,
wasted creature, whose life appears hardly desirable.
The only measure that can save the life, and recover an infant from
this state, is that which would previously have prevented it a healthy
wet-nurse.
If the effects upon the infant should not be so aggravated as those
just described, and it subsequently live and thrive, there will be a
tendency in such a constitution to scrofula and consumption, to
manifest itself at some future period of life, undoubtedly acquired
from the parent, and dependent upon the impaired state of her health at
the time of its suckling. A wet-nurse early resorted to, will prevent
this.
It will be naturally asked, for how long a period a mother ought to
perform the office of a nurse? No specific time can be mentioned, and
the only way in which the question can be met is this: no woman, with
advantage to her own health, can suckle her infant beyond twelve or
eighteen months; and at various periods between the third and twelfth
month, many women will be obliged partially or entirely to resign the
office.[FN#4]
[FN#4] See "Weaning," p. 51.
The monthly periods generally reappear from the twelfth to the
fourteenth month from delivery; and when established, as the milk is
found invariably to diminish in quantity, and also to deteriorate in
quality, and the child is but imperfectly nourished, it is positively
necessary in such instances at once to wean it.
OF MOTHERS WHO OUGHT NEVER TO SUCKLE.
There are some females who ought never to undertake the office of
suckling, both on account of their own health, and also that of their
offspring.
THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the
infant born of such a parent there will be a constitutional
predisposition to the same disease; and, if it is nourished from her
system, this hereditary predisposition will be confirmed.
"No fact in medicine is better established than that which proves the
hereditary transmission from parents to children of a constitutional
liability to pulmonary disease, and especially to consumption; yet no
condition is less attended to in forming matrimonial engagements. The
children of scrofulous and consumptive parents are generally
precocious, and their minds being early matured, they engage early in
the business of life, and often enter the married state before their
bodily frame has had time to consolidate. For a few years every thing
seems to go on prosperously, and a numerous family gathers around them.
All at once, however, even while youth remains, their physical powers
begin to give way, and they drop prematurely into the grave, exhausted
by consumption, and leaving children behind them, destined, in all
probability, either to be cut off as they approach maturity, or to run
through the same delusive but fatal career as that of the parents from
whom they derived their existence."[FN#5] There is scarcely an
individual who reads these facts, to whom memory will not furnish some
sad and mournful example of their truth; though they perhaps may have
hitherto been in ignorance of the exciting cause.
[FN#5] Combe's Principles of Physiology applied to the Preservation of
Health, etc.
It is, however, with the mother as a nurse that I have now to do, and
I would earnestly advise every one of a consumptive or strumous habit
(and if there is any doubt upon this point, the opinion of a medical
adviser will at once decide it) never to suckle her offspring; her
constitution renders her unfit for the task. And, however painful it
may be to her mind at every confinement to debar herself this
delightful duty, she must recollect that it will be far better for her
own health, and infinitely more so for that of the child, that she
should not even attempt it; that her own health would be injured, and
her infant's, sooner or later, destroyed by it.
The infant of a consumptive parent, however, must not be brought up by
hand. It must have a young, healthy, and vigorous wet-nurse; and in
selecting a woman for this important duty very great care must be
observed.[FN#6] The child should be nursed until it is twelve or fifteen
months old. In some cases it will be right to continue it until the
first set of teeth have appeared, when it will be desirable that a
fresh wet-nurse should be obtained for the last six months.[FN#7] If
the child is partially fed during the latter months (from
necessity or any other cause), the food should be of the lightest
quality, and constitute but a small proportion of its nutriment.
[FN#6] See "Choice of a Wet-nurse," p. 28.
[FN#7] One that has been confined about six weeks or two months.
But not only must the nourishment of such a child be regarded, but the
air it breathes, and the exercise that is given to it; as also, the
careful removal of all functional derangements as they occur, by a
timely application to the medical attendant, and maintaining,
especially, a healthy condition of the digestive organs. All these
points must be strictly followed out, if any good is to be effected.
By a rigid attention to these measures the mother adopts the surest
antidote, indirectly, to overcome the constitutional predisposition to
that disease, the seeds of which, if not inherited from the parent,
are but too frequently developed in the infant during the period of
nursing; and, at the same time, she takes the best means to engender a
sound and healthy constitution in her child. This, surely, is worth any
sacrifice.
If the infant derives the disposition to a strumous constitution
entirely from the father, and the mother's health be unexceptionable,
then I would strongly advise her to suckle her own child.
THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There
are other women who ought never to become nurses. The mother of a
highly nervous temperament, who is alarmed at any accidental change she
may happen to notice in her infant's countenance, who is excited and
agitated by the ordinary occurrences of the day; such a parent will do
her offspring more harm than good by attempting to suckle it. Her milk
will be totally unfit for its nourishment: at one time it will be
deficient in quantity, at another, so depraved in its quality, that
serious disturbance to the infant's health, will ensue. The young and
inexperienced mother, who is a parent for the first time, and
altogether ignorant of the duties of her office, and at the same time
most anxious to fulfil them faithfully, is but too frequently an
instance in point; although at a future period she will generally make
a good nurse. The following is an illustration:--
In December, 1838, I attended a young married lady in her first
confinement, and in excellent health. She gave birth to a fine, plump,
healthy boy. Every thing went on well for three weeks, the mother
having an abundant supply of milk, and the infant evidently thriving
upon it. About this time, however, the child had frequent fits of
crying; the bowels became obstinately costive;--the motions being
lumpy, of a mixed colour, quite dry, and passed with great pain. It
became rapidly thin, and after a while its flesh so wasted, and became
so flabby, that it might be said literally to hang on the bones. The
fits of crying now increased in frequency and violence, coming on every
time after the little one left the breast, when it would commence
screaming violently, beat the air with its hands and feet, and nothing
that was done could appease it. Having lasted for half an hour or more,
it would fall asleep quite exhausted; the fit recurring again, when
again it had been to the breast.
It was very evident that the infant's hunger was not satisfied, as it
was also but too evident its body was not nourished by the parent's
milk, which, although abundant in quantity (the breast being large and
full of milk), was at this time seriously deteriorated in its nutritive
quality. This was caused, I believe, from great anxiety of mind. Her
nurse became suddenly deranged, and the whole responsibility and care
of the child thus devolved upon the mother, of the duties connected
with which she was entirely ignorant.
A wet-nurse was obtained. In a very few hours after this change was
effected, the screaming ceased, the child had quiet and refreshing
sleep, and in twelve hours a healthy motion was passed. The child
gained flesh almost as quickly as it had previously lost it, and is now
as fine and healthy an infant as it promised to be when born.
Whenever there has existed previously any nervous or mental affection
in the parent, wet-nurse suckling is always advisable; this, with
judicious management of childhood, will do much to counteract the
hereditary predisposition.
THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE
OUGHT NOT.--The mother who cannot make up her mind exclusively to
devote herself to the duties of a nurse, and give up all engagements
that would interfere with her health, and so with the formation of
healthy milk, and with the regular and stated periods of nursing her
infant, ought never to suckle. It is unnecessary to say why; but I
think it right, for the child's sake, to add, that if it does not
sicken, pine, and die, disease will be generated in its constitution,
to manifest itself at some future period.
The child, then, under all the foregoing circumstances, must be
provided with its support from another source, and a wet-nurse is the
best.
2. WET-NURSE SUCKLING.
Ill health and many other circumstances may prevent a parent from
suckling her child, and render a wet-nurse necessary. Now, although she
will do wisely to leave the choice of one to her medical attendant,
still, as some difficulty may attend this, and as most certainly the
mother herself ought to be acquainted with the principal points to
which his attention is directed in the selection of a good nurse, it
will be well to point out in what they consist.
CHOICE OF A WET-NURSE.
The first thing to which a medical man looks, is the general health of
the woman; next, the condition of her breast, the quality of her milk
its age and her own; whether she is ever unwell while nursing; and,
last of all, the condition and health of the child.
IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the
marks of a sound constitution, and ought to be free from all suspicion
of a strumous character; her tongue clean, and digestion good; her
teeth and gums sound and perfect; her skin free from eruption, and her
breath sweet.
WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and
well formed; its size not dependent upon a large quantity of fat, which
will generally take away from its firmness, giving it a flabby
appearance, but upon its glandular structure, which conveys to the
touch a knotted, irregular, and hard feel; and the nipple must be
perfect, of moderate size, but well developed.
WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish-
white colour; sweet to the taste; and when allowed to stand, should
throw up a considerable quantity of cream.
WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely
expired, the wet-nurse to be hired ought certainly not to have reached
her second month. At this time, the nearer the birth of the child, and
the delivery of its foster-parent, the better: the reason for which
is, that during the first few weeks the milk is thinner and more watery
than it afterwards becomes. If, consequently, a new-born infant be
provided with a nurse, who has been delivered three or four months, the
natural relation between its stomach and the quality of the milk is
destroyed, and the infant suffers from the oppression of food too heavy
for its digestive power.
On the other hand, if you are seeking a wet-nurse for an infant of
four or five months old, it would be very prejudicial to transfer the
child to a woman recently delivered; the milk would be too watery for
its support, and its health in consequence would give way.
THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from
twenty-one to thirty admits of no question. And the woman who has had
one or two children before is always to be preferred, as she will be
likely to have more milk, and may also be supposed to have acquired
some experience in the management of infants.
INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her
at once. You will have no difficulty in ascertaining this point; for
this class of persons have an idea that their milk is renewed, as they
term it, by this circumstance, monthly; and, therefore, that it is a
recommendation, rendering their milk fitter for younger children than
it would otherwise have been. It produces, however, quite a contrary
effect; it much impairs the milk, which will be found to disagree with
the child, rendering it at first fretful,--after a time being vomited
up, and productive of frequent watery dark green motions.
Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the
sprightly appearance of health, to bear the marks of being well
nourished, its flesh firm, its skin clean and free from eruptions. It
should be examined in this respect, particularly about the head, neck,
and gums.
If a medical man finds that both mother and child answer to the above
description, he has no hesitation in recommending the former as likely
to prove a good wet-nurse.
DIET AND REGIMEN OF A WET-NURSE.
The regimen of a wet-nurse should not differ much from that to which
she has been accustomed; and any change which it may be necessary to
make in it should be gradual. It is erroneous to suppose that women
when nursing require to be much more highly fed than at other times: a
good nurse does not need this, and a bad one will not be the better for
it. The quantity which many nurses eat and drink, and the indolent life
which they too often lead, have the effect of deranging their digestive
organs, and frequently induce a state of febrile excitement, which
always diminishes, and even sometimes altogether disperses, the milk.
It will be necessary then to guard against the nurse overloading her
stomach with a mass of indigestible food and drink. She should live as
much as possible in the manner to which she has been accustomed; she
should have a wholesome, mixed, animal and vegetable diet, and a
moderate and somewhat extra quantity of malt liquor, provided it agree
with her system.
A very prevailing notion exists that porter tends to produce a great
flow of milk, and in consequence the wet-nurse is allowed as much as
she likes; a large quantity is in this way taken, and after a short
time so much febrile action excited in the system, that instead of
increasing the flow of milk, it diminishes it greatly. Some parents,
however, aware of this fact, will go into an opposite extreme, and
refuse the nurse even that which is necessary. Either excess is of
course wrong. It is difficult in general terms to say what ought to be
considered a proper daily allowance, but some is in general necessary;
and whenever a woman has been used to drink malt-liquor, she will
rarely make a good wet-nurse if she is denied a reasonable quantity of
that beverage. Good sound ale sometimes agrees better than porter. It
may be well here to remark, that in London, I frequently meet with
severe cases of diarrhoea in infants at the breast, fairly traceable to
bad porter, which vitiating the quality of the milk, no medical
treatment cures the disease, until this beverage is left off or
changed, when it at once disappears.
The nurse should take exercise daily in the open air. Nothing tends
more directly to maintain a good supply of healthy milk, than air and
exercise; and the best wet-nurse would soon lose her milk, if
constantly kept within doors. Sponging the whole body also with cold
water with bay-salt in it every morning, should be insisted upon, if
possible: it preserves cleanliness, and greatly invigorates the health.
United with this, the nurse should rise early, and also be regularly
employed during the day in some little portion of duty in the family, an
attendance upon the wants of the child not being alone sufficient.
An amiable disposition and good temper are very desirable. A violent
fit of passion may exert so peculiar an influence in changing the
natural properties of the milk, that a child has been known to be
attacked with a fit of convulsions after being suckled by a nurse while
labouring under the effects of a fit of anger. The depressing passions
frequently drive the milk away altogether. It is hence of no small
moment, that a wet-nurse be of a quiet and even temper, and not
disposed to mental disturbance.
3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.
Extreme delicacy of constitution, diseased condition of the frame,
defective secretion of milk, and other causes, may forbid the mother
suckling her child; and unless she can perform this office with safety
to herself, and benefit to her infant, she ought not to attempt it. In
this case a young and healthy wet-nurse is the best substitute; but
even this resource is not always attainable. Under these circumstances,
the child must be brought up on an artificial diet "by hand,"--as it is
popularly called.
To accomplish this with success requires the most careful attention on
the part of the parent, and at all times is attended with risk to the
life of the child; for although some children, thus reared, live and
have sound health, these are exceptions to the general rule, artificial
feeding being in most instances unsuccessful.
THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.
It should be as like the breast-milk as possible. This is obtained by
a mixture of cow's milk, water, and sugar, in the following
proportions:--
Fresh cow's milk, two thirds;
Boiling water, or thin barley water, one third;
Loaf sugar, a sufficient quantity to sweeten.
This is the best diet that can be used for the first six months, after
which some farinaceous food may be combined.
In early infancy, mothers are too much in the habit of giving thick
gruel, panada, biscuit-powder, and such matters, thinking that a diet
of a lighter kind will not nourish. This is a mistake; for these
preparations are much too solid; they overload the stomach, and cause
indigestion, flatulence, and griping. These create a necessity for
purgative medicines and carminatives, which again weaken digestion,
and, by unnatural irritation, perpetuate the evils which render them
necessary. Thus many infants are kept in a continual round of
repletion, indigestion, and purging, with the administration of
cordials and narcotics, who, if their diet were in quantity and quality
suited to their digestive powers, would need no aid from physic or
physicians.
In preparing this diet, it is highly important to obtain pure milk,
not previously skimmed, or mixed with water; and in warm weather just
taken from the cow. It should not be mixed with the water or sugar
until wanted, and not more made than will be taken by the child at the
time, for it must be prepared fresh at every meal. It is best not to
heat the milk over the fire, but let the water be in a boiling state
when mixed with it, and thus given to the infant tepid or lukewarm.
As the infant advances in age, the proportion of milk may be gradually
increased; this is necessary after the second month, when three parts
of milk to one of water may be allowed. But there must be no change in
the kind of diet if the health of the child is good, and its appearance
perceptibly improving. Nothing is more absurd than the notion, that in
early life children require a variety of food; only one kind of food is
prepared by nature, and it is impossible to transgress this law without
marked injury.
If cow's milk disagree with an infant--and this is sometimes
unfortunately the case, even from its birth ass's milk,--diluted with
one third its quantity of water, may be given as a substitute. I am now
attending a lady in her fourth confinement, who is unable, from defect
in her nipples, to suckle her children. The first child had a healthy
wet-nurse, and has grown a fine healthy lad. The second, a girl, was
unfortunate in her nurse, she being of a strumous and unhealthy
constitution, although to a casual observer bearing the appearance of
health. The child lived only three months, and the nurse died of a
rapid consumption shortly after. This discouraged the mother from
adopting wet-nurse suckling for the third child (a great error); and an
artificial diet of cow's milk was resorted to. The third day from
commencing this plan, flatulence, griping, purging, and vomiting came
on, one symptom quickly following the other; the child wasted, and on
the sixth day had several convulsive fits. The diet was immediately
changed for ass's milk, and in less than twelve hours the sickness and
purging ceased; the flatulence was relieved; the motions, from being
green, watery, and passed with great violence and pain, became of a
healthy consistence and colour, and the screaming ceased. The symptoms
did not return, the child thrived, very soon consuming regularly one
quart of the ass's milk daily, and is now a fine healthy girl two years
old. A fortnight since the parent was confined with a fourth child.
Cow's milk was given to it for two or three days (from the difficulty
of obtaining that of the ass), the same train of symptoms, precisely,
came on with which the third child had been affected, which again gave
way upon following up the same plan of diet--the substitution of the
ass's milk for that of the cow. The evident conclusion from this is,
that the breast-milk of a healthy woman is incomparably the most
suitable diet for the infant; but that, if she be not of a healthy
constitution, it may be destructive to the child; and that where this
cannot be obtained, and cow's milk is found to disagree, ass's milk may
sometimes be resorted to with the happiest results.[FN#8]
[FN#8] An infant will generally consume a quart, or a little more, of
ass's milk in the four and twenty hours; and as this quantity is
nearly as much as the animal will give, it is best to purchase an ass
for the express purpose. The foal must be separated from the mother,
and the forage of the latter carefully attended to, or the milk will
disagree with the child.
Sometimes the mother's breast, and every description of milk, is
rejected by the child; in which case recourse must be had to veal or
weak mutton broth, or beef tea, clear and free from fat, mixed with a
very small quantity of farinaceous food, carefully passed through a
sieve before it is poured into the sucking-bottle.
THE MODE OF ADMINISTERING IT.--There are two ways--by the spoon, and by
the nursing-bottle. The first ought never to be employed at this
period, inasmuch as the power of digestion in infants is very weak,
and their food is designed by nature to be taken very slowly into the
stomach, being procured from the breast by the act of sucking, in which
act a great quantity of saliva is secreted, and being poured into the
mouth, mixes with the milk, and is swallowed with it. This process of
nature, then, should be emulated as far as possible; and food (for this
purpose) should be imbibed by suction from a nursing-bottle: it is thus
obtained slowly, and the suction employed secures the mixture of a due
quantity of saliva, which has a highly important influence on digestion.