prominent position in which they present themselves; but in the
majority of cases nothing but time is required to reduce them to their
proper station. But, whatever may be the peculiarities of each
individual case, the dentist will decide what may be required; only, I
would again repeat, do not neglect the occasional inspection of the
mouth at this age, if you regard the future comfort and appearance of
your child.
THEIR PRESERVATION.--The preservation of the teeth requires attention to
several points; the first and principal of which is, to enforce the
habit in the child of thoroughly cleaning the teeth by means of water
and a brush night and morning, and rinsing out the mouth after each
meal. The brush should not be very hard, as it will not only be more
difficult to clean the interstices between the teeth, the
part in which the tartar[FN#24] is most likely to be deposited, but by
its friction, will occasion the gradual absorption of the gum and the
exposure of the neck of the teeth. The hair of the brush should be firm
and elastic, and not too closely set.
[FN#24] A sort of calcareous substance, which becomes deposited at
the roots of the teeth, from a want of proper attention to
cleanliness; and, if allowed to remain, will destroy first their
beauty, and then the organ itself.
TARTAR.--If there is a tendency to the formation of tartar, then it will
be necessary to have recourse to some tooth-powder. Tooth-powders,
however, must be chosen with care, as many of them are composed of
substances highly injurious to the teeth. "Many of the tooth-powders
which are offered for sale, with the promise of rendering the teeth
beautifully white, perform, for a time, all that is promised, at the
expense of permanent and irremediable injury to the teeth; for they
often contain a quantity of tartaric or other acid, which effects a
gradual decomposition of the enamel."[FN#25] Prepared chalk is one of
the simplest and best tooth-powders.
[FN#25] Bell on the Teeth.
The following form, also, may be used with advantage:--
Prepared chalk, three ounces;
Orris root, powdered, half an ounce;
Powdered myrrh, half an ounce;
Cuttle fish, powdered, one ounce;
Essential oil of cinnamon, four drops.--Mix.
The best preservative, then, against the formation of tartar, is to
see that the child cleans his teeth thoroughly night and morning with
the brush, powder, and water, and also (if possible) that he rinses out
the mouth after each meal.
If the gums should be tender, irritable, and bleed (as is frequently
the case when an individual gets out of health, or the tartar
accumulates) the mouth may be washed night and morning with a tumbler of
tepid water, containing from ten to twenty drops of the tincture of
myrrh, and the same quantity of spirits of camphor; or the following
form may be used:--
Alum, one drachm and a half;
Tincture of myrrh, two drachms;
Camphor mixture, five ounces and a half.--Mix.
ACIDS.--The use of acids to the teeth cannot be too strongly deprecated:
they decompose their substance, and lead to their rapid decay. Hence
the whiteness produced by acid tooth-powders and washes is not less
deceitful than ruinous in its consequences. As has been just observed,
they perform all that their vendors promise, causing the teeth, for a
little while, to become very white and beautiful in their appearance,
but, at the same time, injuring them irremediably: the enamel becomes
gradually decomposed, the bone of the tooth exposed, and its death is
the inevitable consequence.
It is therefore of great importance when acid medicines are ordered
for children that they should be taken through a glass tube, to prevent
their coming in contact with the teeth. From a want of this precaution,
I know a lady (and there are many such instances) who once had as sound
and fine a set of teeth as any one could boast of, but from this cause
has had nearly the whole of the upper row destroyed. She was in
delicate health: it was judged requisite that she should take for a
considerable time (with other medicines) sulphuric acid; but the glass
tube was not thought of, and the consequences followed which have been
described.
CALOMEL.--This medicine, as it is frequently given, alone, or in the
little white powders, in infancy and childhood, by mothers and nurses,
is productive of serious and indeed irremediable injury to the teeth.
"The immoderate use of mercury in early infancy produces, more perhaps
than any other similar cause, that universal tendency to decay, which,
in many instances, destroys almost every tooth at an early age. It is
certainly not unimportant to bear this fact in mind, in the
administration of this sovereign remedy, this panacea, as many appear
to consider it, in infantile diseases."[FN#26]
[FN#26] Bell on the Teeth.
HEAT AND COLD.--The teeth are exceedingly apt to suffer from sudden
variations of temperature. Fluids, therefore, should never be taken
into the mouth so hot or so cold as to produce the slightest pain; and,
for the same reason, the water with which the mouth is cleansed should
in winter be always warm or tepid. When ices are taken, the precaution
of placing them in the centre of the mouth, so as to prevent contact
with the teeth, should be carefully observed.
There are many other causes which might be mentioned as tending to
induce decay of the teeth, but their consideration here is purposely
avoided.
It is hoped that enough has been said to draw the parent's attention
to the subject of the teeth, to prevent their neglect, and yet at the
same time to induce a cautious management.
CHAP. IV.
HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER.
Life is soon extinguished in infancy. At this epoch any disease is
formidable, and must be met most promptly. It is either sudden and
active in its assaults, or comes with slow and insidious approach. The
first signs of its coming on are not always visible to an unpractised
eye: it may have made dangerous advances before the mother's mind is
awakened to its presence; and medical aid may be solicited when
remedies and advice are no longer of any avail.
It is therefore highly important that a mother should possess such
information as will enable her to detect disease at its first
appearance, and thus insure for her child timely medical assistance.
This knowledge it will not be difficult for her to obtain. She has only
to bear in mind what are the indications which constitute health, and
she will at once see that all deviations from it must denote the
presence of disorder, if not of actual disease. With these changes she
must to a certain extent make herself acquainted.
Sect. I.--SIGNS OF HEALTH.
The signs of health are to be found, first, in the healthy performance
of the various functions of the body; the regular demands made for its
supply, neither in excess or deficiency; and a similar regularity in
its excretions both in quantity and appearance.
If the figure of the healthy infant is observed, something may be
learnt from this. There will be perceived such an universal roundness
in all parts of the child's body, that there is no such thing as an
angle to be found in the whole figure; whether the limbs are bent or
straight, every line forms a portion of a circle. The limbs will feel
firm and solid, and unless they are bent, the joints cannot be
discovered.
The tongue, even in health, is always white, but it will be free from
sores,--the skin cool,--the eye bright,--the complexion clear,--the head
cool,--and the abdomen not projecting too far,--the breathing regular,
and without effort.
When awake, the infant will be cheerful and sprightly, and, loving to
be played with, will often break out into its merry, happy, laugh;
whilst, on the other hand, when asleep, it will appear calm, every
feature composed, its countenance displaying an expression of
happiness, and frequently, perhaps, lit up with a smile.
Sect. II. SIGNS OF DISEASE.
Just in proportion as the above appearances are present and entire,
health may be said to exist; and just in proportion to their partial or
total absence disease will have usurped its place.
We will, however, for the sake of clearness examine the signs of
disease as they are manifested separately by the countenance,--the
gestures,--in sleep,--in the stools,--and by the breathing and cough.
OF THE COUNTENANCE.
In health the countenance of a thild is expressive of serenity in mind
and body; but if the child be unwell, this expression will be changed,
and in a manner which, to a certain extent, will indicate what part of
the system is at fault.
The brows will be contracted, if there is pain, and its seat is in the
head. This is frequently the very first outward sign of any thing being
wrong, and will occur at the very onset of disease; if therefore
remarked at an early period, and proper remedies used, its notice may
prevent one of the most fearful of infantile complaints--"Water in the
Head."
If this sign is passed by unheeded, and the above disease be
threatened, soon the eyes will become fixed and staring,--the head hot,
and moved uneasily from side to side upon the pillow, or lie heavily
upon the nurse's arm,--the child will start in its sleep, grinding its
teeth, and awake alarmed and screaming,--its face will be flushed,
particularly the cheeks (as if rouged),--its hands hot,--but feet cold,
its bowels obstinately costive, or its motions scanty, dark-coloured,
and foul.
If the lips are drawn apart, so as to show the teeth or gums, the seat
of the pain is in the belly. This sign, however, will only be present
during the actual existence of suffering; if, therefore, there be any
doubt whether it exist, press upon the stomach, and watch the eifect on
the expression of the countenance.
If the pain arise simply from irritation of the bowels excited from
indigestion, it will be temporary, and the sign will go and come just
as the spasm may occur, and slight remedial measures will give relief.
If, however, the disease be more serious, and inflammation ensue, this
sign will be more constantly present, and soon the countenance will
become pale, or sallow and sunken,--the child will dread motion, and
lie upon its back with the knees bent up to the belly,--the tongue will
be loaded,--and in breathing, while the chest will be seen to heave
with more than usual effort, the muscles of the belly will remain
perfectly quiescent.
If the nostrils are drawn upwards and in quick motion, pain exists in
the chest. This sign, however, will generally be the accompaniment of
inflammation of the chest, in which case the countenance will be
discoloured,--the eyes more or less staring, and the breathing will be
difficult and hurried; and if the child's mode of respiring be watched,
the chest will be observed to be unmoved, while the belly quickly
heaves with every inspiration.
Convulsions are generally preceded by some changes in the countenance.
The upper lip will be drawn up, and is occasionally bluish or livid.
Then there may be slight squinting, or a singular rotation of the eye
upon its own axis; alternate flushing or paleness of the face; and
sudden animation followed by languor.
These signs will sometimes manifest themselves many hours, nay days,
before the attack occurs; may be looked upon as premonitory; and if
timely noticed, and suitable medical aid resorted to, the occurrence of
a fit may be altogether prevented.
The state of the eyes should always be attended to. In health they are
clear and bright, but in disease they become dull, and give a heavy
appearance to the countenance; though after long continued irritation
they will assume a degree of quickness which is very remarkable, and a
sort of pearly brightness which is better known from observation than
it can be from description.
The direction of the eyes, too, should be regarded, for from this we
may learn something. When the infant is first brought to the light,
both eyes are scarcely ever directed to the same object: this occurs
without any tendency to disease, and merely proves, that regarding one
object with both eyes is only an acquired habit. But when the child has
come to that age when the eyes are by habit directed to the same
object, and afterwards it loses that power, this circumstance alone may
be looked upon as a frequent prelude to disease affecting the head.
OF THE GESTURES.
The gestures of a healthy child are all easy and natural; but in
sickness those deviations occur, which alone will often denote the
nature of the disease.
Suppose an infant to have acquired the power to support itself, to
hold its head erect; let sickness come, its head will droop
immediately, and this power will be lost, only to be regained with the
return of health; and during the interval every posture and movement
will be that of languor.
The little one that has just taught itself to run alone from chair to
chair, having two or three teeth pressing upon and irritating the gums,
will for a time be completely taken off its feet, and perhaps lie
languidly in its cot, or on its nurse's arm.
The legs being drawn up to the belly, and accompanied by crying, are
proofs of disorder and pain in the bowels. Press upon this part, and
your pressure will increase the pain. Look to the secretions from the
bowels themselves, and by their unhealthy character your suspicions, in
reference to the seat of the disorder, are at once confirmed.
The hands of a child in health are rarely carried above its mouth; but
let there be any thing wrong about the head and pain present, and the
little one's hands will be constantly raised to the head and face.
Sudden starting when awake, as also during sleep, though it occur from
trifling causes, should never be disregarded. It is frequently
connected with approaching disorder of the brain. It may forebode a
convulsive fit, and such suspicion is confirmed, if you find the thumb
of the child drawn in and firmly pressed upon the palm, with the
fingers so compressed upon it, that the hand cannot be forced open
without difficulty. The same condition will exist in the toes, but not
to so great a degree; there may also be a puffy state of the back of the
hands and feet, and both foot and wrist bent downwards.
There are other and milder signs threatening convulsions and connected
with gesture, which should be regarded:--the head being drawn rigidly
backwards,--an arm fixed firmly to the side, or near to it,--as also one
of the legs drawn stifly upwards. These signs, as also those enumerated
above, are confirmed beyond all doubt, if there be present certain
alterations in the usual habits of the child:--if the sleep is
disturbed,--if there be frequent fits of crying,--great peevishness of
temper,--the countenance alternately flushed and pale,--sudden animation
followed by as sudden a fit of languor,--catchings of the breath
followed by a long and deep inspiration,--all so many premonitory
symptoms of an approaching attack.
OF THE SLEEP.
The sleep of the infant in health is quiet, composed, and refreshing.
In very early infancy, when not at the breast, it is for the most
part asleep in its cot; and although as the months advance it sleeps
less, yet when the hour for repose arrives, the child is no sooner laid
down to rest, than it drops off into a quiet, peaceful slumber.
Not so, if ill. Frequently it will be unwilling to be put into its cot
at all, and the nurse will be obliged to take the infant in her arms;
it will then sleep but for a short time, and in a restless and
disturbed manner.
If it suffer pain, however slight, the countenance will indicate it;
and, as when awake, so now, if there is any thing wrong about the head,
the contraction of the eye-brow and grinding of the teeth will appear;
if any thing wrong about the belly, the lips will be drawn apart,
showing the teeth or gums,--and in both instances there will be great
restlessness and frequent startings.
OF THE STOOLS.
In the new-born infant the motions are dark coloured, very much like
pitch both in consistence and appearance. The first milk, however,
secreted in the mother's breast, acts as an aperient upon the infant's
bowels, and thus in about four-and-twenty hours it is cleansed away; or
if it should not, a tea-spoonful of castor oil accomplishes this
purpose.
From this time, and through the whole of infancy, the stools will be
of a lightish yellow colour, the consistence of thin mustard, having
little smell, smooth in appearance, and therefore free from lumps or
white curded matter, and passed without pain or any considerable
quantity of wind. And as long as the child is in health, it will have
daily two or three, or even four, of these evacuations. But as it grows
older, they will not be quite so frequent; they will become darker in
colour, and more solid, though not so much so as in the adult.
Any deviation, then, from the above characters, is of course a sign of
something wrong; and as a deranged condition of the bowels is
frequently the first indication we have of coming disease, the nurse
should daily be directed to watch the evacuations. Their appearance,
colour, and the manner in which discharged, are the points principally
to be looked to. If the stools have a very curdy appearance, or are too
liquid, or green, or dark-coloured, or smell badly, they are unnatural.
And in reference to the manner in which they are discharged, it should
be borne in mind, that, in a healthy child, the motion is passed with
but little wind, and as if squeezed out, but in disease, it will be
thrown out with considerable force, which is a sign of great
irritation. The number, too, of stools passed within the four-and-
twenty hours it is important to note, so that if the child does not
have its accustomed relief, (and it must not be forgotten that
children, although in perfect health, differ as to the precise number,)
a little castor oil may be at once exhibited, and thus mischief be
prevented.
This, however, is not the place to discuss the question of disordered
bowels, but simply to point out how this circumstance may be
known.[FN#27]
[FN#27] See section on Disorders of the Stomach and Bowels, p. 208.
OF THE BREATHING AND COUGH.
The breathing of a child in health is formed of equal inspirations and
expirations, and it breathes quietly, regularly, inaudibly, and without
effort. But let inflammation of the air-tubes or lungs take place, and
the inspiration will become in a few hours so quickened and hurried,
and perhaps audible, that the attention has only to be directed to the
circumstance to be at once perceived.
Now all changes which occur in the breathing from its healthy
standard, however slight the shades of difference may be, it is most
important should be noticed early. For many of the complaints in the
chest, although very formidable in their character, if only seen early
by the medical man, may be arrested in their progress; but otherwise,
may be beyond the control of art. A parent, therefore, should make
herself familiar with the breathing of her child in health, and she
will readily mark any change which may arise.
Of cough I should not have said any thing in this chapter, as it can
never fail to be noticed, except that it is highly necessary to throw
out one caution. Whenever a child has the symptoms of a common cold,
attended by hoarseness and a rough cough, always look upon it with
suspicion, and never neglect seeking a medical opinion. Hoarseness does
not usually attend a common cold in the child, and these symptoms may
be premonitory of an attack of "croup;" a disease excessively rapid in
its progress, and which, from the importance of the parts affected,
carrying on, as they do, a function indispensably necessary to life,
requires the most prompt and decided treatment.
The following observations of Dr. Cheyne are so strikingly
illustrative, and so pertinent to my present purpose, that I cannot
refrain inserting them:--"In the approach of an attack of croup, which
almost always takes place in the evening, probably of a day during
which the child has been exposed to the weather, and often after
catarrhal symptoms have existed for several days, he may be observed to
be excited, in variable spirits, more ready than usual to laugh than to
cry, a little flushed, occasionally coughing, the sound of the cough
being rough, like that which attends the catarrhal stage of the
measles. More generally, however, the patient has been for some time in
bed and asleep, before the nature of the disease with which he is
threatened is apparent; then, perhaps, without waking, he gives a very
unusual cough, well known to any one who has witnessed an attack of the
croup; it rings as if the child had coughed through a brazen trumpet;
it is truly a tussis clangosa; it penetrates the walls and floor of the
apartment, and startles the experienced mother,--'Oh! I am afraid our
child is taking the croup!' She runs to the nursery, finds her child
sleeping softly, and hopes she may be mistaken. But remaining to tend
him, before long the ringing cough, a single cough, is repeated again
and again; the patient is roused, and then a new symptom is remarked;
the sound of his voice is changed; puling, and as if the throat were
swelled, it corresponds with the cough," etc.
How important that a mother should be acquainted with the above signs
of one of the most terrific complaints to which childhood is subject;
for, if she only send for medical assistance during its first stage,
the treatment will be almost invariably successful; whereas, if this
"golden opportunity" is lost, this disease will seldom yield to the
influence of measures, however wisely chosen or perseveringly employed.
SECT. III.--OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION
OF DISEASE.
1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF
DISORDER.--The recollection of the fact, that at the different seasons
of
the year some diseases are more prevalent than at other periods, will
greatly aid a judicious parent in the early detection of the presence
of disorder, and its kind, in her child.
Thus, in the early part of the winter, what is called catarrh, viz. an
increased secretion of mucus from the membranes of the nose, fauces,
and air-tubes, with fever, and attended with sneezing and cough,
thirst, lassitude, and want of appetite, is generally prevalent.
As the winter advances, the air-tubes of the lungs, and the lungs
themselves, are liable to become the seat of disorder; and those signs
will present themselves, which have been pointed out in the previous
section as characteristic of such attacks.
In the spring, we have still the same diseases prevalent, and in
addition, measles, scarlet fever, small-pox, and chicken pox, which
increase in liability towards the close of this season, and with the
first weeks of summer.
In the summer, disease is less prevalent than at any other period of
the year; but towards its middle and close, and through the whole of
the autumnal months, bowel complaints may be expected, in the forms of
diarrhoea, cholera, and dysentery.
2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.--
Without entering into this subject at large, still it may be useful to
remark, that in some families there is a predisposition to some
diseases, which, occurring in the first child, will, as each succeeding
child is born, attack at the same age. Amongst other diseases of this
class are, croup, hooping-cough, and water in the head.
This observation should not only lead a mother to be alive to the
possibility of the successional occurrence of these diseases in her
family, and so early note their appearance, and seek medical advice,
but should at the same time make her most anxious, on the one hand, to
shield her child from all their exciting causes, and on the other, to
adopt those measures which may contribute indirectly to overcome the
constitutional predisposition to them.
Of the scrofulous constitution, I will merely mention here, that it is
of the greatest importance, where a predisposition to this disease
exists in a family, that a mother should immediately attend to any
alteration in the gait or contour of her child, and give prompt
attention also to any complaint made of swelling about a joint,
although it may be unattended with pain. The importance of this remark
will be seen by contrasting the result of the following cases which
occurred in children of the same family.
Case I.