so short, or its attachment to the tongue extended so near the tip, as
to interfere with the motions of the organ in sucking, and, in after
years, in speaking. It is a rare occurrence, although nothing is more
common than for medical men to have infants brought to them supposed to
be labouring under the above defect.
HOW ITS EXISTENCE MAY BE DETERMINED.--The best guide for a parent to
determine whether it exist or not, is for her to watch whether the
infant can protrude the tip of the tongue beyond the lips: if so, it
will be able to suck a good nipple readily, and nothing need or ought
to be done. No mother will unnecessarily expose her infant to an
operation, which, unless very carefully performed, is not altogether
unattended with danger; and, if she suspects any defect of this kind to
exist, she has only to observe the circumstance mentioned above, to
satisfy her mind upon the subject.
MOLES AND MARKS ON THE SKIN, ETC.
The supposed influence of the imagination of the mother, in the
production of the above appearances in the texture of the skin of her
infant, has been fully discussed in the author's work "Hints to
Mothers, etc." This part of the subject is, however, foreign to the
present inquiry, which chiefly has reference to the probable effect of
their presence upon the health of the child.
They may be divided into two classes: the brownish mole, and claret-
stain; and small but somewhat elevated tumours, either of a dark blue,
livid colour, or of a bright vermilion hue.
MOLES AND STAINS.--They are of no importance, as far as the health of
the infant is concerned. If situated in the face, however, they
frequently cause great disfigurement, as the claret-stain, which may be
seen sometimes to occupy nearly half the face. But they happily do not
increase in size, remaining stationary through life; and as any
operation that might be proposed for their removal, would only cause an
equal, if not greater, deformity, they ought to be left alone.
COLOURED SPOTS OR TUMOURS.--These vary in their number, size, and
situation. The same child is sometimes born with many of them. They may
be as small as a pea, or as large as a crown piece. They are not only
found on the skin, but on the lips, in the mouth, etc. etc.
These, also, sometimes remain stationary in their size, having no
tendency to enlarge, unless, indeed, they are subjected to friction or
pressure. But as they frequently require surgical aid, in which case,
the earlier the application of remedial measures, the less severe in
their kind, and the greater the probability of a speedy and successful
result,--so is it always important for the mother early to obtain a
medical opinion, that the measure of interference or non-interference
may be decided.
Sect. II. DISORDERS OF THE STOMACH AND BOWELS OF THE INFANT.
INDIGESTION, FLATULENCE, VOMITING, GRIPING, AND LOOSENESS.
Disorder of the stomach and bowels is one of the most fruitful sources
of the diseases of infancy. Only prevent their derangement, and, all
things being equal, the infant will be healthy and flourish, and need
not the aid of physic or physicians. Experience daily proves, that a
large proportion of the children who die in infancy are lost from
derangement of these organs, as the primary cause.
There are many causes which may give rise to these affections; many of
them appertain to the mother's system, some to that of the infant. All
are capable, to a great extent, of being prevented or remedied. It is,
therefore, most important that a mother should not be ignorant or
misinformed upon this subject. It is the prevention of these
affections, however, that will be principally dwelt upon in this
chapter; for let the mother ever bear in mind, and act upon the
principle, that the prevention of disease alone belongs to her; the
cure to the physician.
For the sake of clearness and reference, these disorders will be
spoken of as they occur:--
To the infant at the breast.
At the period of weaning.
And to the infant brought up by hand.
1. TO THE INFANT AT THE BREAST.
UNHEALTHY MILK.--The infant's stomach and bowels may become deranged
from the breast-milk becoming unwholesome.
This may arise from the parent getting out of health, a circumstance
which will be so manifest to herself, and to those more immediately
interested in her welfare, that it is only necessary just to allude to
it here. Suffice it to say, that there are many causes of a general
kind to which it may owe its origin; but that the most frequent is
undue lactation, a subject to which reference has already been made,
and the effects both upon mother and child fully dwelt upon.[FN#31] To
cure derangement of the bowels from this cause, a wet-nurse is the
only remedy.
[FN#31] See page 15.
Anxiety of mind in the mother will cause her milk to be unhealthy in
its character, and deficient in quantity, giving rise to flatulence,
griping, and sometimes even convulsions in the infant.[FN#32] A fit of
passion in the nurse will frequently be followed by a fit of bowel
complain in the child.[FN#33] These causes of course are temporary, and
when removed the milk becomes a healthy and sufficient for the child as
before.
[FN#32] See page 25.
[FN#33] See page 33.
Sudden and great mental disturbance, however, will occasionally drive
away the milk altogether, and in a few hours. A Mrs. S., aet. 21, a
fine healthy woman, of a blonde complexion, was confined of a boy in
October, 1836. She had a good time, and a plentiful supply of milk for
the child, which she continued to suckle till the following January, a
period of three months, when her milk suddenly disappeared. This
circumstance puzzled the medical attendant, for he could not trace it
to any physical ailment; but the milk never returned, and a wet-nurse
became necessary. In the following spring the husband of this lady
failed, an adversity which had been impending since the date when the
breast-milk disappeared, upon which day the deranged state of the
husband's affairs was made known to the wife,--a fact which at once
explained the mysterious disappearance of the milk.
Unwholesome articles of diet will affect the mother's milk, and
derange the infant's bowels. On the 25th May, 1836, I was called to see
an infant at the breast with diarrhoea. The remedial measures had but
little effect so long as the infant was allowed the breast-milk; but
this being discontinued, and arrow-root made with water only allowed,
the complaint was quickly put a stop to. Believing that the mother's
milk was impaired from some accidental cause which might now be passed,
the infant was again allowed the breast. In less than four-and-twenty
hours, however, the diarrhoea returned. The mother being a very healthy
woman, it was suspected that some unwholesome article in her diet might
be the cause. The regimen was accordingly carefully inquired into, when
it appeared that porter from a neighbouring publican's had been
substituted for their own for some little time past. This proved to be
bad, throwing down, when left to stand a few hours, a considerable
sediment; it was discontinued; good sound ale taken instead; the
infant again put to the breast, upon the milk of which it flourished,
and never had another attack.
In the same way aperient medicine, taken by the mother, will act on
the child's bowels, through the effect which it produces upon her milk.
This, however, is not the case with all kinds of purgative medicine,
nor does the same purgative produce a like effect upon all children. It
is well, therefore, for a parent to notice what aperient acts thus
through her system upon that of her child, and what does not, and when
an aperient becomes necessary for herself, unless she desire that the
infant's bowels be moved, to avoid the latter; if otherwise, she may
take the former with good effect.
Again; the return of the monthly periods whilst the mother is a nurse
always affects the properties of the milk, more or less, deranging the
stomach and bowels of the infant. It will thus frequently happen, that
a few days before the mother is going to be unwell, the infant will
become fretful and uneasy; its stomach will throw up the milk, and its
motions will be frequent, watery, and greenish. And then, when the
period is fully over, the milk will cease to purge. It is principally
in the early months, however, that the infant seems to be affected by
this circumstance; for it will be generally found that although the
milk is certainly impaired by it, being less abundant and nutritious,
still, after the third or fourth month it ceases to affect the infant.
Is then a mother, because her monthly periods return after her
delivery, to give up nursing? Certainly not, unless the infant's health
is seriously affected by it; for she will generally find that, as the
periods come round, by keeping the infant pretty much from the breast,
during its continuance, and feeding him upon artificial food, she will
prevent disorder of the child's health, and be able in the intervals to
nurse her infant with advantage. It must be added, however, that a wet-
nurse is to be resorted to rather than any risk incurred of injuring
the child's health; and that, in every case, partial feeding will be
necessary at a much earlier period than when a mother is not thus
affected.
The milk may also be rendered less nutritive, and diminished in
quantity, by the mother again becoming pregnant. In this case,
however, the parent's health will chiefly suffer, if she persevere in
nursing; this, however, will again act prejudicially to the child. It
will be wise, therefore, if pregnancy should occur, and the milk
disagree with the infant, to resign the duties of a nurse, and to put
the child upon a suitable artificial diet;--if, however, pregnancy
should take place before the infant is six month's old, a wet-nurse
ought to be procured.
FROM IRREGULAR NURSING.--This is one of the most frequent sources of
derangement of the stomach and bowels of the child. The infant that is
constantly at the breast will always be suffering, more or less, from
flatulence, griping, looseness of the bowels, and vomiting. This is
caused by a sufficient interval not being allowed between the meals for
digestion. The milk, therefore, passes on from the stomach into the
bowels undigested, and the effects just alluded to follow. Time must
not only be given for the proper digestion of the milk, but the stomach
itself must be allowed a season of repose. This evil, then, must be
avoided most carefully by the mother strictly adhering to those rules
for nursing which have been already laid down.[FN#34]
[FN#34] See page 5.
FROM TEETHING.--The bowels of the infant at the breast, as well as
after it is weaned, are generally affected by teething. And it is
fortunate that this is the case, for it prevents more serious
affections. Indeed, the diarrhoea that occurs during dentition, except
it be violent, must not be subdued; if, however, this is the case,
attention must be paid to it. It will generally be found to be
accompanied by a swollen gum; the freely lancing of which will
sometimes alone put a stop to the looseness: further medical aid may,
however, be necessary.
FROM COLD AND DAMP, ETC.--Of course there are other causes besides
these already alluded to, giving rise to bowel complaints, during this
epoch,--causes not cognisable by the mother, however, and not mentioned
therefore here. It is right, however, that she should be aware that
these affections are sometimes the result simply of impressions of cold
or damp, particularly at certain seasons of the year; in the autumn,
for instance, when, as is well known, bowel complaints are very
frequent. When thus produced, it is important early to seek medical
aid, as inflammation is generally the result.
2. AT THE PERIOD OF WEANING.
There is great susceptibility to derangements of the stomach and
bowels of the child at the period when weaning ordinarily takes place,
so that great care and judgment must be exercised in effecting this
object. Usually, however, the bowels are deranged during this process
from one of these causes; from weaning too early, from effecting it too
suddenly and abruptly, or from over-feeding and the use of improper and
unsuitable food. There is another cause which also may give rise to
diarrhoea at this time, independently of weaning, viz. the irritation
of difficult teething.
WEANING TOO EARLY.--The substitution of artificial food for the breast-
milk of the mother, at a period when the digestive organs of the infant
are too delicate for this change, is a frequent source of the
affections now under consideration.
The attempt to wean a delicate child, for instance, when only six
months old, will inevitably be followed by disorder of the stomach and
bowels. Unless, therefore, a mother is obliged to resort to this
measure, from becoming pregnant, or any other unavoidable cause, if she
consult the welfare of her child, she will not give up nursing at this
early period. But if she should be no longer competent to suckle, and
her infant be delicate, a wet-nurse must be obtained; for, the infant's
bowels becoming disordered, medicine or remedies will avail little
without healthy breast milk.
The age at which weaning ought to take place must ever depend upon
circumstances; the ninth month would not be too early for some, the
twelfth would be for others.[FN#35]
[FN#35] See page 51.
FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once
of the breast, and substituting artificial food, however proper under
due regulations such food may be, will invariably cause bowel
complaints. Certain rules and regulations must be adopted to effect
weaning safely, the details of which are given elsewhere.[FN#36]
[FN#36] See page 52.
OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These
causes are more productive of disorder of the stomach and bowels at the
time of weaning than any yet referred to.
If too large a quantity of food is given at each meal, or the meals
are too frequently repeated, in both instances the stomach will become
oppressed, wearied, and deranged; part of the food, perhaps, thrown up
by vomiting, whilst the remainder, not having undergone the digestive
process, will pass on into the bowels, irritate its delicate lining
membrane, and produce flatulence, with griping, purging, and perhaps
convulsions.
Then, again, improper and unsuitable food will be followed by
precisely the same effects; and unless a judicious alteration be
quickly made, remedies will not only have no influence over the
disease, but the cause being continued, the disease will become most
seriously aggravated.
It is, therefore, of the first importance to the well-doing of the
child, that at this period, when the mother is about to substitute an
artificial food for that of her own breast, she should first ascertain
what kind of food suits the child best, and then the precise quantity
which nature demands. Many cases might be cited, where children have
never had a prescription written for them, simply because, these points
having been attended to, their diet has been managed with judgment and
care; whilst, on the other hand, others might be referred to, whose
life has been hazarded, and all but lost, simply from injudicious
dietetic management. Over-feeding, and improper articles of food, are
more frequently productive, in their result, of anxious hours and
distressing scenes to the parent, and of danger and loss of life to the
child, than almost any other causes.
TEETHING.--The irritation caused by difficult teething may give rise to
diarrhoea at the period when the infant is weaned, independently
of the weaning itself. Such disorder of the bowels, if it manifestly
occur from this cause, is a favourable circumstance, and should not be
interfered with, unless indeed the attack be severe and aggravated,
when medical aid becomes necessary. Slight diarrhoea then, during
weaning, when it is fairly traceable to the cutting of a tooth (the
heated and inflamed state of the gum will at once point to this as the
source of the derangement), is of no consequence, but it must not be
mistaken for disorder arising from other causes. Lancing the gum will
at once, then, remove the cause, and generally cure the bowel complaint.
3. TO THE CHILD BROUGHT UP BY HAND.
Children brought up on an artificial diet are very liable to
indigestion and bowel complaints; indeed none more so: and it is from
these affections that so many of these infants perish. When, then, it
is absolutely necessary from untoward circumstances to have recourse to
this mode of nourishing the child, the rules and regulations laid down
in the section on "Artificial Feeding" must be most strictly followed
out, if the parent would hope to avoid disease and rear her
child.[FN#37] And if these affections should at any time unfortunately
manifest themselves, the mother ought carefully and diligently to
examine whether the plan of feeding pursued is in every particular
correct, particularly bearing in mind that the two causes most
frequently productive of disorder in the child are overfeeding and the
exhibition of unsuitable food--the two grand errors of the nursery.
These results, however, have already been sufficiently dwelt upon as
likely to take place at weaning, and they may of course occur to a
child who is brought up on an artificial diet at any period.
[FN#37] See page 34.
MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.
As must have been already seen, the maternal treatment chiefly
consists in the removal of the cause of the disorder; medicine may
occasionally be exhibited by the mother, but its use in her hands must
be very limited indeed.
Unfortunately the general resource and only remedy of most mothers in
affections of the stomach and bowels is an aperient, and a combination
containing calomel is the one too frequently selected. The primary
cause of the disorder is undetected, and consequently no measures taken
for its removal, but purgative powder after purgative powder is given,
the evil being supposed to rest in the bowels alone, and that such
means must eventually get rid of it. The mother is not aware all this
time that the real source of the derangement is probably in the diet
itself; that there is some error here, and that unless this is
corrected, the remedies must be worse than useless. The consequence of
such a plan of proceeding is usually very sad; a confirmed and
obstinate diarrhoea but too commonly ensues, and the infant is
sometimes reduced to the last extremity.
The removal of the cause of the disorder, then, in a large number of
instances of derangement of the stomach and bowels, if effected early,
will cure the disease, and without further remedy. But it will be
asked, by what method is this cause to be detected? In this way. In all
human probability the primary cause of the disorder is connected with
the diet; this is the case in ninety-nine instances out of a hundred.
Well, then, is the sick child at the breast? If so, ascertain whether
the breast-milk is healthy and wholesome, or whether any circumstances
exist which have rendered it otherwise? If nothing faulty is found
here, the next question would naturally be, whether the rules and
regulations laid down for suckling have been strictly adhered to? Or,
whether the infant is sufficiently old to render it at all probable
that a tooth may be irritating the gum?
Perhaps the child is being weaned; well, is there any error here? Is
the change being attempted too early? or too suddenly and abruptly? If
this is not the case, then, has the child been overfed, or is the food
given of the proper description?
Is the child being brought up by hand? Then, there is every reason to
suspect, either that the quality of the food given is not the most
suitable, or, that the quantity exhibited is too great; in fact, that
the rules laid down for "artificial feeding" have not been strictly
acted upon.
By a mode of investigation like this, any defect or error in the
dietetic management of the infant producing the disorder will be easily
detected by a careful mother; and its correction alone will, in very
many instances, be all that is necessary to remove the symptoms.
For example, if flatulence and griping, followed by diarrhoea, occur
to an infant at the breast; if at the same time it becomes pale, its
flesh flabby, its disposition fretful, always crying until it is put to
the breast, the nipple of which it grasps eagerly, sucking eagerly, yet
never satisfied, for its hunger continues, it is not nourished; if,
too, the more it sucks, the more the stomach and bowels are deranged,
the more it vomits and is purged; depend upon it the cause of all the
evil will be found to be unwholesome milk. No medicine will avail any
thing here; the cause must be removed; the best medicine, and the only
remedy, is a breast of healthy milk. And if this is not procured
early, there will be great danger of a diarrhoea setting in, which may
probably prove fatal to the child.
Again; if there is simply vomiting of the breast-milk almost
immediately after the child has been suckled, the milk coming up pure
and unchanged, and discharged without any apparent effort, and the
moment after the child is cheerful and happy, this will be found to
depend upon repletion, and not upon unwholesome milk; in fact, the
stomach has received too much. This must be prevented in future, not by
giving medicine, but simply by removing the infant from the nipple
immediately it ceases to draw strongly, the moment it begins to dally
with the breast.
Again; if flatulence and griping occur to the child brought up by
handy this derangement will generally be found to result from
overfeeding: abstinence and diminution of the quantity of the food will
generally be all that is necessary here. It will be well, however, for
the mother in this case, and she may do it with the utmost safety, to
unload the bowels of their indigestible contents by the exhibition of a
tea-spoonful of castor oil. A dose or two of this medicine will
effectually clear them out, without increasing the irritation, or
weakening the child, whilst it will in most instances altogether remove
the symptoms. If the flatulence, however, should continue, four or five
grains of magnesia may be mixed with the last meal at night, and a
little warm water thrown up into the bowel as an injection the next
morning.
Diarrhoea occurring in a child brought up by hand, if it be not the
result of overfeeding, will very frequently be found to arise from
unsuitable diet, the food given not being of a kind suited to the
infant's stomach; for what will agree with one child often disagrees
with another. Alteration of diet will sometimes alone suffice in these
cases to cure, if this alteration is only made early enough, before any
considerable irritation of the stomach and bowels has been induced.
Thin arrow-root made with water (prepared very carefully, or the child
will refuse it,) should be given for five or six days; the warm bath
used every night for the same period, a new flannel bandage rolled
round the body, and the child cautiously protected from a damp
atmosphere. The arrow-root, upon the cessation of the diarrhoea, may
have cows' milk added to it, if milk is not found to disagree: when
this is the case, chicken or weak mutton broth, free from fat, or beef-
tea, thickened with farinaceous food, with a little salt added, are the
best substitutes. Should not the diarrhoea yield to the foregoing
measures, and that readily, medical aid ought to be sought. Diarrhoea
is very frequent from the time of weaning to the third year of age, and
certainly in its effects forms so important a disease, that, unless in
the slight form noticed above, a mother is not justified in attempting
its relief.