Hints on the Management of Children in Hot Climates.
Owing to the circumstance that it is more convenient to deal with the
subject of the feeding of infants in connection with that of the
prevention of infantile diarrhœa, but little of a nature special to hot
climates remains to be noticed in connection with the management of
young infants, for being concerned with little else than the
assimilation of nourishment, their well-being or otherwise is governed
almost entirely by the state of their digestion.
Putting aside the special danger of infantile diarrhœa, young infants
generally do well in hot climates, which are in many ways suitable to
their low powers of resistance to cold. Some writers, very competent to
speak on the subject, are indeed of opinion that very young infants do
better in India than in cold or temperate climates; and perhaps this may
be the case as regards breast-fed children, for, the air temperature
being but little below that of the body, they are almost entirely
protected from the coughs and colds of all sorts that do so much damage
at home, and lead to the poor children being confined to a stuffy
atmosphere instead of enjoying the enormous advantage of unlimited fresh
air, of which an infant requires proportionately even more than an
adult. On this account never allow a nurse, however experienced she may
be in her own conceit, to cover a child’s face with a handkerchief even
out of doors, as the re-breathing of air already polluted by passing
through the lungs is one of the most frequent causes of illness in human
beings of all ages, and if the air outside be really so cold as to be
harmful, the child will be better indoors, in a well-warmed and
ventilated room, than outside, if half stifled in this silly fashion.
If she has any lingering doubts on the matter, let the mother borrow an
ambulance, and try how much fresh air can be got, lying flat on the
back, with a handkerchief spread over the face, and a fussy old woman in
attendance to replace it should it chance to get disarranged.
The dangers of that abomination, the “baby’s comforter,” are elsewhere
adverted to, but to show that the writer is by no means singular in his
opinion, the following extract from _Science Siftings_ may be read with
advantage:--
“Most expert observers of the infectious nature of consumption have
stated that the bacilli almost invariably enter the system through the
nose or mouth, the respiratory system, in fact. Yet there are others who
state that the milk drunk by infants is a chief cause of infection. But
a new and deeply interesting theory is put forward by Drs. J. O. Symes
and T. Fisher in the _British Medical Journal_. All day long, they
write, babies are sucking an indiarubber comforter, and it no sooner
drops on to the dirty floor than it is hastily picked up and thrust
again into the mouth of the infant. Older children also, as they crawl,
take up every article they can lay hold of and put it into their mouths,
to the danger of which their dirt-begrimed cheeks bear witness. The
moral is obvious.”
Native attendants are especially fond of the contrivance, and hence it
is desirable to emphasise its dangers in a work on the present subject.
It should be needless in these days to warn mothers that all “soothing
syrups” are extremely harmful and even dangerous preparations; but there
is another preparation in almost universal use, which, in a smaller way,
does a great deal of harm. I allude to the abuse of dill water and
similar pungent stomachics. The usual pretext for its administration is
that the baby has got what is popularly termed “wind in the stomach,”
which may mean merely indigestion, due, in all probability, to the use
of some patented abomination in the way of “infants’ foods,” containing
farinaceous material; or that, as evidenced by belching, there really is
gas in stomach produced by fermentation, or by sucking in air from the
use of a “comforter.” Now the dill water will no doubt temporarily
relieve the pain, but it will rather aggravate the malady than cure the
condition that causes it; as the remedy is of exactly the same character
as the nip of gin which Mrs. Gamp found so useful in soothing her
“spasms,” and is probably even less suited for babies than the gin was
to the good lady so inimitably portrayed by Dickens.
It is astonishing how mothers, who would exclaim with horror at a few
wholesome grains of pepper to season the breakfast egg of a child of
five or six, will go on giving a new-born baby dose after dose of what
is much the same thing as a very pungent liqueur. Should the pain be
really due to “wind,” as shown by belching, some unirritating antiseptic
such as a grain or two of resorcin will rapidly check the fermentation
that is producing the gas, and so cure the disease. Though comparatively
little used for this purpose, the writer has found this drug most useful
in these little troubles, and has found that even infants of but a few
days old tolerate it perfectly. If, on the other hand, the pain be due
to indigestion, the trouble is probably caused by the character of the
food, and an effort should be made to find something that agrees better.
Probably the commonest cause of these disorders is the use of the
numerous much-advertised “infants’ foods,” most of which contain
farinaceous material of some sort. Now young infants cannot digest
starchy matter of any kind, and the only proper food for them is milk.
When the milk of the lower animals is used it is of course desirable to
modify it, so that its composition may be made to more closely resemble
that of human milk; and this in the case of cow’s milk is effected by
diluting the milk and adding a little sugar, preferably milk sugar.
Again the tendency of cow’s milk to clot in large mass has to be
neutralised by the addition of some material that will prevent this, and
the general ban against farinaceous materials need not extend to the use
of the deservedly popular barley water for this purpose, as the amount
of starchy matter it contains is too small to be harmful.
When goats’ milk is used, the goat should be kept tied up and its food
gathered for it, as although a clean feeder, it is apt, if left at
freedom, to eat acrid leaves which may affect the milk. Goats’ milk
requires somewhat less dilution than that of the cow, and may agree in
cases where cows’ milk fails.
In proportion as the heat is greater, so should the milk be more freely
diluted, as otherwise thirst may lead to the child taking more food than
is good for it; and if at such times the child craves too frequently for
food, a few teaspoonfuls of plain water should be given; as the craving
is merely an indication that the child, like larger people, is thirsty.
The water can do no harm, but irregular feeding is always injurious. As
the child grows older, the milk can be given less diluted, and after
eight or nine months the yolk of a raw egg beaten up with the milk may
be occasionally given, if the child appears to require more nourishment;
but this should not be overdone, as such food is apt to cause
“biliousness.” In the second year milk puddings and bread and gravy may
be given occasionally, and after the third the child should be
encouraged to eat plenty of well-cooked vegetables, but stewed fruits
should be given with caution.
In the case of older children brought up in hot climates, it must be
remembered that their appetite, like that of their elders, is apt to
suffer at trying times of the year, and hence it is important to
introduce as much variety as possible into the menu. A dish nearly
always much appreciated, and I believe perfectly wholesome, is a
curry;--not too highly spiced of course, but still a curry. The writer
had at one time, as a sole charge, the care of some five hundred
children, varying from four to seventeen years of age, in a large
school. For many years, on two days in the week, a curry had formed the
dinner for the children of all ages in this institution. That of the
“infants” had even less pepper in it than what was supplied to the elder
boys and girls, but was still distinctly appetising. Now no item of the
dietary was as thoroughly relished and finished with as hearty an
appetite as this; and there never appeared the least reason for
suspecting it was anything but useful and wholesome. Children are often
much to be pitied on account of the fads of their parents in the matter
of diet, for the poor little souls are continuously placed in the
position of Sancho Panza, when they made him governor of Barataria, and
the court physician would allow him nothing decent to eat. When children
have passed the stage of early infancy, and nature has furnished them
with teeth, one may be pretty sure that what is bad for them is equally
deleterious to oneself, and it is well, instead of denying them all
sorts of things on mere suspicion, to give a small quantity and notice
if it causes any discomfort. Otherwise, as likely as not you are denying
them things that may suit them excellently, and forcing them to eat
insipid traditional children’s dishes, which very possibly, do not
really suit them. Milk should of course be always given freely to all
growing children, but apart from this too great monotony is sure to be
harmful. There are some children, of course, to whom even small
quantities of usually wholesome articles of food seem to act as absolute
poisons. This is especially the case with sugar, extremely small
quantities of which will, in such peculiarly constituted children, bring
out an attack of nettle-rash. The skin is always abnormally irritable
under great heat; and hence such cases show themselves more commonly in
European children brought up in the Tropics than in those living in
temperate climates.
When, therefore, a child is greatly troubled with nettle-rash it is well
to suspend sugar, and should this fail, experiment with the stopping of
other articles of its dietary.
A very common mistake on the part of anxious mothers is to cut up a
child’s food too small. As soon as a child’s digestive organs have so
far developed as to be capable of digesting solid food at all, as shown
by its having come into the possession of a full set of first teeth, it
is very important that nothing should be swallowed without thorough
mastication; and the mincing of the food not only renders it possible
for the food to be swallowed without chewing, but actually makes it
difficult for the child to do otherwise, as anyone may convince himself
by trying to masticate any minced dish.
Now mincing is in no sense a substitute for chewing, and as it is
disagreeable to swallow a large piece of food without proper
mastication, it is better to err on the side of cutting too large than
too small. Moreover, the cutting up of the food too finely actually
trains the child to bolt its meals, and this causes it to acquire a most
harmful habit, of which it will be very difficult for him to break
himself in after life.
On the other hand, many children take up the almost equally injurious
habit of churning their food about in the mouth for an unreasonable
time. This habit is a very common one with Anglo-Indian children and
should always be checked, as the prolonged mumbling of each mouthful
stimulates an undue flow of saliva, and produces dyspepsia by flooding
the stomach with it. It is really, I believe, due to want of appetite,
and is generally caused by the monotonous and insipid diet to which
children are often confined, while they watch their parents consuming
appetising dishes which they are not allowed to touch. Surely it is hard
to expect the child to swallow a stodgy mass of boiled flour and milk,
with the savour of crisply fried bacon under its nose; and why should a
child whom Nature has already provided with a full set of teeth be less
able to digest a simple wholesome article of food, such as this, than an
adult? No one would suggest the giving of large quantities of such
delicacies, of which, indeed, adults very commonly consume a good deal
more than is good for them; but some bread and butter with a few scraps
of bacon and some bread crisply fried in the fat, eaten with a relish
that stimulates the proper flow of the digestive secretions, is surely
more likely to be properly assimilated than some insipid mess, eaten
under compulsion, with difficulty and loathing.
It is often impossible to find any good reason for popular maternal
notions as to what children should eat, drink and avoid, but the broad
principle underlying it appears to be that anything nice is necessarily
harmful. “Children should be given only simple food.” Doubtless!--but
what is “simple food”? Food, I take it, which it is a simple job to
digest. But it is quite a mistake to imagine that every insipid mess is
easy, and every tasty relish difficult, of digestion. Some insipid foods
are easily digestible and some not, and some tasty foods are
indigestible and some digestible. The taste and savour are in fact no
guide whatever. To pursue our particular example:--bacon fat is an
exceptionally easily assimilated form of fatty matter, rivalling cod
liver oil in that respect; and every whit as useful in the treatment of
malnutrition.
Again, the method of preparation makes all the difference as to
digestibility. Cheese, for instance, of the cheaper varieties, is
proverbially hard to digest, for the obvious reason that it is difficult
for the digestive organs to dissolve its rather leathery substance, but
a crumbling Stilton taken in reasonable quantities is far from being so;
and even less expensive cheeses, if grated and cooked, are quite
harmless, so that a dish of macaroni just flavoured with a little grated
cheese is a far more suitable food for a child than the pasty gruel that
passes under the style of oatmeal porridge southward of the Tweed.
The hardy Italian peasant children are as regularly brought up on the
dish I have just described as the young Scot on oatmeal porridge; and
as, unless given all day and every day, both are perfectly suited to
young digestions, there is no good reason why both should not take their
turn in the nursery cuisine.
A great deal that has been said is no doubt equally applicable to
temperate climates, but in these healthy children rarely suffer from
want of appetite, whereas in the trying time of the year in the Tropics
there is often a strong temptation to eat too little to keep up the
needs of the system, and hence this exhortation to the adoption for
children of a varied and tempting diet is especially applicable to those
brought up in hot countries.
A separate work would be required to deal adequately with the subject of
the present chapter, so that it is impossible to do more than offer a
few general hints on the subject, and it accordingly remains only to
consider the question of the necessity, or otherwise, of children being
sent off to a hill station during the worst part of the tropical year.
To do so is often a terrible tax on the financial resources of the
parents, and there can be no doubt that the advantages of the hill
climates over those of the plains, though no doubt very real, are much
over-rated; for the hills have special dangers of their own. Some years
ago I had occasion to compare the sick rates of a number of the largest
Indian boarding schools, and was much astonished to find that the justly
celebrated “La Martiniere,” at Lucknow, had a somewhat smaller sick rate
than the great Laurence Military Asylum for soldiers’ children, which
was then under my care. Now if the difference in favour of the hill
climate were as great as is popularly supposed, this could hardly be the
case; as Lucknow is by no means an exceptionally healthy plains station,
and the site of the La Martiniere leaves much to be desired. Yet the
hill school would have been counted a healthy one anywhere, for in two
years we had but two deaths among the whole half-thousand boys and
girls. Apart from the mere question of personal comfort, the main
advantage of the hill climates are their freedom from malaria, but this
ought to be guarded against in the plains by proper metallic gauze
protection of the nursery; while, on the other hand, hill climates are
extremely treacherous for children during the rains. Assuming the
adoption of rational precautions against malaria, I believe that
whatever may be the case during the dry, hot season, the majority of
children would be better in the plains than on the hills during rains.
Part of this is perhaps due to the increased sanitary difficulties; for
typhoid fever is endemic in almost all hill stations; but the bulk of it
is due to the raw, clammy chills of a sodden atmosphere, and given an
equal number of children, it is a matter of common experience with
medical officers that the doctor’s visiting book will often show an
enormously larger number of calls in these sanitaria (?) than in the
much maligned stations below.
Hence, while in no way counselling the retention of children in the
plains during the hot, dry season, by those who can well afford to send
them away, I trust that the facts adduced may tend to the comfort of
those whose finances do not admit of such a luxury, and the question
whether great sacrifices should be made to do so should be determined by
the comparative healthiness, or otherwise, of the locality in the plains
where they may be stationed.
The amount of sickness, both of a serious and trifling character, on
most hill stations is perfectly alarming, and there cannot be the least
doubt that there are a great many stations in the plains that are far
less unhealthy for Europeans the whole year round, so what is gained by
resorting to the hills is, in most cases, not health, but personal
comfort.
Another caution:--do not always jump to the conclusion that a child is
necessarily suffering from malaria when it becomes feverish. The
temperature-regulating mechanism of a child is much more delicate than
that of an adult, so that very little suffices to put it out of gear;
and an indiscretion in diet which would show its effects in an adult
merely in the form of a bad head and a worse temper, will perhaps send a
child’s temperature up to 104° F. or over. Such cases are almost as
common in Europe, but unlike the Anglo-tropical matron, the English
mother does not usually go about with a clinical thermometer in her
pocket, and they usually pass undetected, as far as the element of
temperature is concerned, and are ascribed to their true cause of some
upset of the digestive organs, which yields easily to some mild
laxative. More than half the cases of so-called fever are of this
nature, and as the diagnosis of malaria can only be made, even by a
doctor, by a careful examination of the patient’s blood under a powerful
microscope, it is wise in his absence to try the effect of such simple
measures as a dose of “Gregory” or grey powder before needlessly
drugging the child with quinine.
Lastly, and most important of all, do not always go rushing off to your
medicine cupboard because the dear child “looks so pale,” or is
protesting more vociferously than usual at the crumpling of some of the
rose leaves of its couch. Anyway, it is no good emptying drugs down the
interior of the poor child’s neck till you feel pretty sure of your
reason for doing so. It is very natural and excusable that a mother
should be so anxious to “do something”; but unless sure of your reasons
for acting, the something done is too apt to be something wrong. The
amount of needless drugging of children that goes on is cruel, even when
it is not harmful; and I cannot help thinking the little ones would be a
good deal better on the whole if mothers would make a rule of swallowing
a duplicate spoonful of nastiness for every one they are so anxious to
administer to their progeny.