Produced by Albert R. Mann Library. 2003. Home Economics Archive:
Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. Mann
Library, Cornell University. http://hearth.library.cornell.edu (Version
January 2003).

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.

Too much care cannot be taken to keep the bottle perfectly sweet. For
this purpose there should always be two in the nursery, to be used
alternately; and, if any food remain after a meal, it must be emptied
out. The bottle must always be scalded out after use. The flat glass
nursing-bottle itself is too well known to need description; it may be
well, however, to say a word about the teat that covers its narrow
neck, and through which the infant sucks the food. If the artificial
or prepared cow's teat is made use of, it should be so attached to the
bottle that its extremity does not extend beyond its apex more than
half or three quarters of an inch; for if it projects more than this,
the child will get the sides of the teat so firmly pressed together
between its gums, that there will be no channel for the milk to flow
through. This remark applies equally to the teat made of soft wash-
leather, which many ladies prefer to that of the cow, and it is a good
substitute; but then a fresh piece of leather must be made use of
daily, otherwise the food will be tainted, and the child's bowels
deranged. It is also necessary that both of these, when used, should
have a small conical piece of sponge inclosed.

The most cleanly and convenient apparatus is a cork nipple, upon the
plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork,
being of a particularly fine texture, is supple and elastic, yielding
to the infant's lips while sucking, and is much more durable than the
teats ordinarily used.

[FN#9]  Sold by Weiss et Son, 62. Strand,

Whatever kind of bottle or teat is used, however, it must never be
forgotten that cleanliness is absolutely essential to the success of
this plan of rearing children.

THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.--This must be regulated
by the age of the child, and its digestive power. A little experience
will soon enable a careful and observing mother to determine this
point.--As the child grows older the quantity of course must be
increased.

The chief error in rearing the young is overfeeding; and a most
serious one it is; but which may be easily avoided by the parent
pursuing a systematic plan with regard to the hours of feeding, and
then only yielding to the indications of appetite, and administering
the food slowly, in small quantities at a time. This is the only way
effectually to prevent indigestion, and bowel complaints, and the
irritable condition of the nervous system, so common in infancy, and
secure to the infant healthy nutrition, and consequent strength of
constitution. As has been well observed, "Nature never intended the
infant's stomach to be converted into a receptacle for laxatives,
carminatives, antacids, stimulants, and astringents; and when these
become necessary, we may rest assured that there is something faulty in
our management, however perfect it may seem to ourselves."

THE FREQUENCY OF GIVING FOOD.--This must be determined, as a general
rule, by allowing such an interval between each meal as will insure the
digestion of the previous quantity; and this may be fixed at about
every three or four hours. If this rule be departed from, and the child
receives a fresh supply of food every hour or so, time will not be
given for the digestion of the previous quantity, and as a consequence
of this process being interrupted, the food passing on into the bowel
undigested, will there ferment and become sour, will inevitably produce
cholic and purging, and in no way contribute to the nourishment of the
child.

THE POSTURE OF THE CHILD WHEN FED.--It is important to attend to this.
It must not receive its meals lying; the head should be raised on the
nurse's arm, the most natural position, and one in which there will be
no danger of the food going the wrong way, as it is called. After each
meal the little one should be put into its cot, or repose on its
mother's knee, for at least half an hour. This is essential for the
process of digestion, as exercise is important at other times for the
promotion of health.

THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION
OF FIRST DENTITION.

As soon as the child has got any teeth,--and about this period one or
two will make their appearance,--solid farinaceous matter boiled in
water, beaten through a sieve, and mixed with a small quantity of milk,
may be employed. Or tops and bottoms, steeped in hot water, with the
addition of fresh milk and loaf sugar to sweeten. And the child may
now, for the first time, be fed with a spoon.

When one or two of the large grinding teeth have appeared, the same
food may be continued, but need not be passed through a sieve. Beef tea
and chicken broth may occasionally be added; and, as an introduction to
the use of a more completely animal diet, a portion, now and then, of a
soft boiled egg; by and by a small bread pudding, made with one egg in
it, may be taken as the dinner meal.

Nothing is more common than for parents during this period to give
their children animal food. This is a great error. "To feed an infant
with animal food before it has teeth proper for masticating it, shows a
total disregard to the plain indications of nature, in withholding such
teeth till the system requires their assistance to masticate solid
food. And the method of grating and pounding meat, as a substitute for
chewing, may be well suited to the toothless octogenarian, whose
stomach is capable of digesting it; but the stomach of a young child is
not adapted to the digestion of such food, and will be disordered by
it."[FN#10]

[FN#10]  Sir James Clarke on Consumption.

"If the principles already laid down be true, it cannot reasonably be
maintained that a child's mouth without teeth, and that of an adult,
furnished with the teeth of carnivorous and graminivorous animals, are
designed by the Creator for the same sort of food. If the mastication
of solid food, whether animal or vegetable, and a due admixture of
saliva, be necessary for digestion, then solid food cannot be proper,
when there is no power of mastication. If it is swallowed in large
masses it cannot be masticated at all, and will have but a small chance
of being digested; and in an undigested state it will prove injurious
to the stomach and to the other organs concerned in digestion, by
forming unnatural compounds. The practice of giving solid food to a
toothless child, is not less absurd, than to expect corn to be ground
where there is no apparatus for grinding it. That which would be
considered as an evidence of idiotism or insanity in the last instance,
is defended and practised in the former. If, on the other hand, to
obviate this evil, the solid matter, whether animal or vegetable, be
previously broken into small masses, the infant will instantly swallow
it, but it will be unmixed with saliva. Yet in every day's observation
it will be seen, that children are so fed in their most tender age; and
it is not wonderful that present evils are by this means produced, and
the foundation laid for future disease."[FN#11]

[FN#11]  Dr. John Clarke's Commentaries.

The diet pointed out, then, is to be continued until the second year.
Great care, however, is necessary in its management; for this period of
infancy is ushered in by the process of teething, which is commonly
connected with more or less of disorder of the system. Any error,
therefore, in diet or regimen is now to be most carefully avoided. 'Tis
true that the infant, who is of a sound and healthy constitution, in
whom, therefore, the powers of life are energetic, and who up to this
time has been nursed upon the breast of its parent, and now commences
an artificial diet for the first time, disorder is scarcely
perceptible, unless from the operation of very efficient causes. Not
so, however, with the child who from the first hour of its birth has
been nourished upon artificial food. Teething under such circumstances
is always attended with more or less of disturbance of the frame, and
disease of the most dangerous character but too frequently ensues. It
is at this age, too, that all infectious and eruptive fevers are most
prevalent; worms often begin to form, and diarrhoea, thrush, rickets,
cutaneous eruptions, etc. manifest themselves, and the foundation of
strumous disease is originated or developed. A judicious management of
diet will prevent some of these complaints, and mitigate the violence
of others when they occur.

THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT
COMPLAINTS TO WHICH INFANTS ARE LIABLE.

Artificial food, from mismanagement and other causes, will now and
then disagree with the infant. The stomach and bowels are thus
deranged, and medicine is resorted to, and again and again the same
thing occurs.

This is wrong, and but too frequently productive of serious and
lasting mischief. Alteration of diet, rather than the exhibition of
medicine, should, under these circumstances, be relied on for remedying
the evil. Calomel, and such like remedies, "the little powders of the
nursery," ought not to be given on every trivial occasion. More
mischief has been effected, and more positive disease produced, by the
indiscriminate use of the above powerful drug, either alone or in
combination with other drastic purgatives, than would be credited.
Purgative medicines ought at all times to be exhibited with caution to
an infant, for so delicate and susceptible is the structure of its
alimentary canal, that disease is but too frequently caused by that
which was resorted to in the first instance as a remedy. The bowels
should always be kept free; but then it must be by the mildest and
least irritating means.

It is a very desirable thing, then, to correct the disordered
conditions of the digestive organs of an infant, if possible, without
medicine; and much may be done by changing the nature, and sometimes
by simply diminishing the quantity, of food.

A diarrhoea, or looseness of the bowels, may frequently be checked by
giving, as the diet, sago thoroughly boiled in very weak beef-tea, with
the addition of a little milk. The same purpose is frequently to be
answered by two thirds of arrow-root with one third of milk, or simply
thin arrow-root made with water only; or, if these fail, baked flour,
mixed with boiled milk.

Costiveness of the bowels may frequently be removed by changing the
food to tops and bottoms steeped in hot water, and a small quantity of
milk added, or prepared barley,--mixed in warm water and unboiled milk.

Flatulence and griping generally arise from an undue quantity of food,
which passing undigested into the bowels, they are thus irritated and
disturbed. This may be cured by abstinence alone. The same state of
things may be caused by the food not being prepared fresh at every
meal, or even from the nursing-bottle or vessel in which the food is
given not having been perfectly clean. In this case weak chicken-broth,
or beef-tea freed from fat, and thickened with soft boiled rice or
arrow-root, may be given.

Sect. II. WEANING.

THE TIME WHEN TO TAKE PLACE.--The time when weaning is to take place
must ever depend upon a variety of circumstances, which will regulate
this matter, independently of any general rule that might be laid down.
The mother's health may, in one case, oblige her to resort to weaning
before the sixth month, and, in another instance, the delicacy of the
infant's health, to delay it beyond the twelfth. Nevertheless, as a
general rule, both child and parent being in good health, weaning ought
never to take place earlier than the ninth (the most usual date), and
never delayed beyond the twelfth month.

I should say further, that if child and parent are both in vigorous
health, if the infant has cut several of its teeth, and been already
accustomed to be partially fed, weaning ought to be gradually
accomplished at the ninth month. On the other hand, that if the child
is feeble in constitution, the teeth late in appearing, and the mother
is healthy, and has a sufficient supply of good milk, especially if it
be the autumnal season, it will be far better to prolong the nursing
for a few months. In such a case, the fact of the on-appearance of the
teeth indicates an unfitness of the system for any other than the
natural food from the maternal breast.

And again, if the infant is born of a consumptive parent, and a
healthy and vigorous wet-nurse has been provided, weaning should most
certainly be deferred beyond the usual time, carefully watching,
however, that neither nurse nor child suffer from its continuance.

THE MODE.--It should be effected gradually. From the sixth month most
children are fed twice or oftener in the four-and-twenty hours; the
infant is in fact, therefore, from this time in the progress of
weaning; that is to say, its natural diet is partly changed for an
artificial one, so that when the time for complete weaning arrives, it
will be easily accomplished, without suffering to the mother, or much
denial to the child.

It is, however, of the greatest importance to regulate the quantity
and quality of the food at this time. If too much food is given (and
this is the great danger) the stomach will be overloaded, the digestive
powers destroyed, and if the child is not carried off suddenly by
convulsions, its bowels will become obstinately disordered; it will
fall away from not being nourished, and perhaps eventually become a
sacrifice to the overanxious desire of the parent and its friends to
promote its welfare.

The kind of food proper for this period, and the mode of administering
it, is detailed in the previous section, on "Artificial Feeding."[FN#12]

[FN#12]  The kind of food after the sixth month to the completion of
first dentition, p. 44.

Much exercise in the open air (whenever there is no dampness of
atmosphere) is highly necessary and beneficial at this time; it tends
to invigorate the system, and strengthens the digestive organs, and
thus enables the latter to bear without injury the alteration in diet.

THE DRYING UP OF THE MOTHER'S MILK.--This will generally be attended
with no difficulty. When the weaning is effected gradually, the milk
will usually go away of itself without any measures being resorted to.
If, however, the breasts should continue loaded, or indeed painfully
distended, a gentle aperient should be taken every morning, so that the
bowels are kept slightly relaxed; the diet must be diminished in
quantity, and solid nourishment only taken. The breast, if painfully
distended, must be occasionally drawn, but only just sufficiently to
relieve the distention. In either case they must be rubbed for five or
ten minutes, every four or five hours, with the following liniment,
previously warmed:--

Compound soap liniment, one ounce and a half;
Laudanum, three drachms.

Sect. III. DIETETICS OF CHILDHOOD.

Childhood, as has been before intimated, extends from about the second
to the seventh or eighth year, when the second dentition is commenced.

No precise rules of diet can be laid down for this period, as this
requires to be adapted in every case to the particular constitution
concerned. There are, however, certain general principles which must be
acted upon, and which can be easily modified by a judicious and
observant parent, as circumstances and constitution may require.

GENERAL DIRECTIONS, AND OF ANIMAL FOOD.--The diet of the latter months
of infancy is still to be continued, but with the important addition of
animal food, which the child has now got teeth to masticate. This must
be given in small quantity; it should be of the lightest quality, only
allowed on alternate days, and even then its effects must be carefully
watched, as all changes in the regimen of children should be gradual.

A child at this age, then, should have its meals at intervals of about
four hours:--thus its breakfast between seven and eight o'clock, to
consist of tops and bottoms, steeped in hot water, a little milk added,
and the whole sweetened with sugar; or bread may be softened in hot
water, the latter drained off, and fresh milk and sugar added to the
bread. Its dinner about twelve o'clock, to consist, every other day, of
a small quantity of animal food (chicken, fresh mutton, or beef, being
the only meats allowed) with a little bread and water; on the alternate
days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow-
root pudding, containing one egg; or farinaceous food, with beef-tea.
Its afternoon mealy about four o'clock, the same diet as formed the
breakfast. At seven, a little arrow-root, made with a very small
proportion of milk, or a biscuit, or crust of bread, after which the
child should be put to bed.

The child must be taught to take its food slowly, retain it in it's
mouth long, and swallow it tardily. Nothing must be given in the
intervals of the meals. The stomach requires a period of repose after
the labour of digestion; and if the child is entertained by its nurse,
and its mind occupied, there will be no difficulty in following out
this important direction.

As the child grows older, the quantity at each meal should be
increased; the tops and bottoms changed for bread and pure milk, boiled
or not; meat may be taken daily, except circumstances forbid it; and a
small quantity of vegetable also.

If a child, then, be of a sound constitution, with healthy bowels, a
cool skin, and clean tongue, the diet may be liberal, and provided it
is sufficiently advanced in age, animal food may be taken daily. Too
low a diet would stint the growth of such a child, and induce a state
of body deficient in vigour, and unfit for maintaining full health:
scrofula and other diseases would be induced. At the same time let the
mother guard against pampering, for this would lead to evils no less
formidable, though of a different character. And as long as the general
health of this child is unimpaired, the body and mind active, and no
evidence present to mark excess of nutriment, this diet may be
continued. But if languor at any time ensue, fever become manifested,
the skin hotter than natural, the tongue white and furred, and the
bowels irregular, then, though these symptoms should bebonly in slight
degree, and unattended with any specific derangement amounting to what
is considered disease, not only should the parent lower the diet, and
for a time withdraw the animal part, but the medical adviser should be
consulted, that measures may be taken to correct the state of repletion
which has been suffered to arise. For some time after its removal, care
should also be taken to keep the diet under that, which occasioned the
constitutional disturbance.

But if the child be of a delicate and weakly constitution (and this is
unfortunately the more common case), it will not bear so generous a
diet as the foregoing. During the three or four earliest years, it
should be restricted chiefly to a mild farinaceous diet, with a small
allowance only of meat on alternate days. The constant endeavour of the
parent now should be, to seek to increase the digestive power and
bodily vigour of her child by frequent exercise in the open air, and by
attention to those general points of management detailed in the after-
part of this chapter. This accomplished, a greater proportion of animal
food may be given, and, in fact, will become necessary for the growth
of the system, while at the same time there will be a corresponding
power for its assimilation and digestion.

A great error in the dietetic management of such children is but too
frequently committed by parents. They suppose that because their child
is weakly and delicate, that the more animal food it takes the more it
will be strengthened, and they therefore give animal food too early,
and in too great quantity. It only adds to its debility. The system, as
a consequence, becomes excited, nutrition is impeded, and disease
produced, ultimately manifesting itself in scrofula, disease in the
abdomen, head, or chest. The first seeds of consumption are but too
frequently originated in this way. A child so indulged will eat
heartily enough, but he remains thin notwithstanding. After a time he
will have frequent fever, will appear heated and flushed towards
evening, when he will drink greedily, and more than is usual in
children of the same age; there will be deranged condition of the
bowels, and headach,--the child will soon become peevish, irritable, and
impatient; it will entirely lose the good humour so natural to
childhood, and that there is something wrong will be evident enough,
the parent, however, little suspecting the real cause and occasion of
all the evil. In such a child, too, it will be found that the ordinary
diseases of infancy, scarlet fever, measles, small pox, etc., will be
attended with an unusual degree of constitutional disturbance; that it
will not bear such active treatment as other children, or so quickly
rally from the illness.

"Strength is to be obtained not from the kind of food which contains
most nourishment in itself, but from that which is best adapted to the
condition of the digestive organs at the time when it is taken."

SUGAR.--This is a necessary condiment for the food of children, and it
is nutritious, and does not injure the teeth, as is generally imagined.
"During the sugar season," observes Dr. Dunglison, "the negroes of
the West India islands drink copiously of the juice of the cane, yet
their teeth are not injured; on the contrary, they have been praised by
writers for their beauty and soundness; and the rounded form of the
body, whilst they can indulge in the juice, sufficiently testifies to
the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats,
on the other hand, are most indigestible, and seriously injurious.

[FN#13]  Elements of Hygiem. Philadephia, 1835.

SALT.--This is necessary for the health of a child; it acts as a
stimulant to the digestive organs, and if not allowed in sufficient
quantity with the food, worms will result.[FN#14] It may, therefore, be
added in small quantity, and with advantage, even to the farinaceous
food of infants. Salted meats, however, should never be permitted to
the child; for by the process of salting the fibre of the meat is so
changed, that it is less nutritive, as well as less digestible.

[FN#14]  Lord Sommerville, in his Address to the Board of Agriculture,
gave an interesting account of the effects of a punishment which
formerly existed in Holland. "The ancient laws of the country ordained
men to be kept on bread alone, un-mixed with salt, as the severest
punishment that could be inflicted upon them in their moist climate.
The effect was horrible: these wretched criminals are said to have been
devoured by worms engendered in their own stomachs."

"The wholesomeness and digestibility of our bread are undoubtedly
much promoted by the addition of the salt which it so universally
receives. A pound of salt is generally added to each bushel of flour.
Hence it may be presumed, that every adult consumes two ounces of salt
per week, or six pounds and a half per annum, in bread alone."

Dr. Paris on Diet.

FRUITS.--These, and of all kinds whether fresh or dried, a delicate
child is better without; except the orange, which when perfectly ripe
may be allowed to any child, but the white or inner skin should be
scrupulously rejected, as it is most indigestible.

A healthy child may be permitted to partake of most fresh fruits. Of
the stone-fruits, the ripe peach, the apricot, and nectarine, are the
most wholesome; but cherries, from the stones being but too frequently
swallowed, had better not be allowed. Apples and pears, when ripe and
well masticated, are not unwholesome; and the apple when baked affords
a pleasant repast, and where there is a costive habit, it is useful as
a laxative. The small-seeded fruits, however, are by far the most
wholesome. Of these, the ripe strawberry and raspberry deserve the
first rank. The grape is also cooling and antiseptic, but the husks and
seeds should be rejected. The gooseberry is less wholesome on account
of the indigestibility of the skin, which is too frequently swallowed.

Dried fruits a child should never be permitted to eat.

WATER.--This should be the only beverage throughout childhood. Toast-
and-water, if the child prefer it, which is rendered slightly more
nutritive than the more simple fluid. The water employed in its
preparation, however, must be at a boiling temperature, and it ought to
be drunk as soon as it has sufficiently cooled; for by being kept, it
acquires a mawkish and unpleasant flavour.

WINE, BEER, etc.--The practice of giving wine, or, indeed, any
stimulant, to a healthy child, is highly reprehensible; it ought never
to be given but medicinally.

The circulation in infancy and childhood is not only more rapid than
in the adult, but easily excited to greater vehemence of action; the
nervous system, too, is so susceptible, that the slightest causes of
irritation produce strong and powerful impressions: the result in
either case is diseased action in the frame, productive of fever,
convulsions, etc.; wine, accordingly, is detrimental to children.

An experiment made by Dr. Hunter upon two of his children illustrates,
in a striking manner, the pernicious effects of even a small portion of
intoxicating liquors in persons of this tender age. To one of the
children he gave, every day after dinner, a full glass of sherry: the
child was five years of age, and unaccustomed to the use of wine. To
the other child, of nearly the same age, and equally unused to wine, he
gave an orange. In the course of a week, a very marked difference was
perceptible in the pulse, urine, and evacuations from the bowels of the
two children. The pulse of the first was raised, the urine high
coloured, and the evacuations destitute of their usual quantity of
bile. In the other child, no change whatever was produced. He then
reversed the experiment, giving to the first the orange, and to the
second the wine, and the results corresponded: the child who had the
orange continued well, and the system of the other got straightway
into disorder, as in the first experiment.[FN#15]

[FN#15]  Marcellin relates an instance of seven children in a family
whose bowels became infested with worms, from the use of stimulants.
They were cured by substituting water for the pernicious beverage.

In this town, spirits, particularly gin, are given to infants and
children to a frightful extent. I have seen an old Irish woman give
diluted spirits to the infant just born. A short time since one of
those dram-drinking children, about eight years of age, was brought
into one of our hospitals. The attendants, from its emaciated
appearance, considered the child was dying from mere starvation; which
was true enough in a certain sense. Food was accordingly offered and
pressed upon it, but the boy would not even put it to his lips. The
next day it was discovered that the mother brought the child very
nearly a pint of gin, every drop of which before night he had consumed.

It is easy to discover when children have been fed upon spirits: they
are always emaciated; have a lean, yellow, haggard look: the eyes
sunk, the lips pale, and the teeth discoloured, the cadaverous aspect
of the countenance being most fearful. They are continually suffering
from bowel complaints and convulsive disorders; which, under these
circumstances, terminate invariably in an early death.

Sect. IV. SLEEP.

DURING INFANCY.--For three or four weeks after birth the infant sleeps
more or less, day and night, only waking to satisfy the demands of
hunger; at the expiration of this time, however, each interval of
wakefulness grows longer, so that it sleeps less frequently, but for
longer periods at a time.

This disposition to repose in the early weeks of the infant's life
must not be interfered with; but this period having expired, great care
is necessary to induce regularity in its hours of sleep, otherwise too
much will be taken in the day-time, and restless and disturbed nights
will follow. The child should be brought into the habit of sleeping in
the middle of the day, before its dinner, and for about two hours,
more or less. If put to rest at a later period of the day, it will
invariably cause a bad night.

At first the infant should sleep with its parent. The low temperature
of its body, and its small power of generating heat, render this
necessary. If it should happen, however, that the child has disturbed
and restless nights, it must immediately be removed to the bed and care
of another female, to be brought to its mother at an early hour in the
morning, for the purpose of being nursed. This is necessary for the
preservation of the mother's health, which through sleepless nights
would of course be soon deranged, and the infant would also suffer from
the influence which such deranged health would have upon the milk.

When a month or six weeks has elapsed, the child, if healthy, may
sleep alone in a cradle or cot, care being taken that it has a
sufficiency of clothing, that the room in which it is placed is
sufficiently warm, viz. 60 degrees, and the position of the cot itself
is not such as to be exposed to currents of cold air. It is essentially
necessary to attend to these points, since the faculty of producing
heat, and consequently the power of maintaining the temperature, is
less during sleep than at any other time, and therefore exposure to
cold is especially injurious. It is but too frequently the case that
inflammation of some internal organ will occur under such
circumstances, without the true source of the disease ever being
suspected. Here, however, a frequent error must be guarded against,--
that of covering up the infant in its cot with too much clothing
throwing over its face the muslin handkerchief--and, last of all,
drawing the drapery of the bed closely together. The object is to keep
the infant sufficiently warm with pure air; it therefore ought to have
free access to its mouth, and the atmosphere of the whole room should
be kept sufficiently warm to allow the child to breathe it freely: in
winter, therefore, there must always be a fire in the nursery.

The child up to two years old, at least, should sleep upon a feather
bed, for the reasons referred to above. The pillow, however, after the
sixth month, should be made of horsehair; for at this time teething
commences, and it is highly important that the head should be kept cool.

DURING CHILDHOOD.--Up to the third or fourth year the child should be
permitted to sleep for an hour or so before its dinner. After this time
it may gradually be discontinued; but it must be recollected, that
during the whole period of childhood more sleep is required than in
adult age. The child, therefore, should be put to rest every evening
between seven and eight; and if it be in health it will sleep soundly
until the following morning. No definite rule, however, can be laid
down in reference to the number of hours of sleep to be allowed; for
one will require more or less than another.[FN#16] Regularity as to
the time of going to rest is the chief point to attend to; permit
nothing to interfere with it, and then only let the child sleep without
disturbance, until it awakes of its own accord on the following
morning, and it will have had sufficient rest.

[FN#16]  The amount of sleep necessary to preserve health varies
according to the state of the body, and the habits of the individual.
As already observed, infants pass much the greater portion of their
time in sleep. Children sleep twelve or fourteen hours. The schoolboy
generally ten. In youth, a third part of the twenty-four hours is spent
in sleep. Whilst, in advanced age, many do not spend more than four,
five, or six hours in sleep.

It is a cruel thing for a mother to sacrifice her child's health that
she may indulge her own vanity, and yet how often is this done in
reference to sleep. An evening party is to assemble, and the little
child is kept up for hours beyond its stated time for retiring to rest,
that it may be exhibited, fondled, and admired. Its usual portion of
sleep is thus abridged, and, from the previous excitement, what little
he does obtain, is broken and unrefreshing, and he rises on the morrow
wearied and exhausted.

Once awake, it should not be permitted to lie longer in bed, but
should be encouraged to arise immediately. This is the way to bring
about the habit of early rising, which prevents many serious evils to
which parents are not sufficiently alive, promotes both mental and
corporeal health, and of all habits is said to be the most conducive to
longevity.

A child should never be suddenly aroused from sleep; it excites the
brain, quickens the action of the heart, and, if often repeated,
serious consequences would result. The change of sleeping to waking
should always be gradual.

The bed on which the child now sleeps should be a mattress: at this
age a feather bed is always injurious to children; for the body,
sinking deep into the bed, is completely buried in feathers, and the
unnatural degree of warmth thus produced relaxes and weakens the
system, particularly the skin, and renders the child unusually
susceptible to the impressions of cold. Then, instead of the bed being
made up in the morning as soon as vacated, and while still saturated
with the nocturnal exhalations from the body, the bed-clothes should be
thrown over the backs of chairs, the mattress shaken well up, and the
window thrown open for several hours, so that the apartment shall be
thoroughly ventilated. It is also indispensably requisite not to allow
the child to sleep with persons in bad health, or who are far advanced
in life; if possible, it should sleep alone.

Sect. V. BATHING AND CLEANLINESS.

DURING INFANCY.--Too much attention cannot be paid to cleanliness; it
is essential to the infant's health. The principal points to which
especial attention must be paid by the parent for this purpose are the
following:--

TEMPERATURE OF THE WATER.--At first the infant should be washed daily
with warm water; and a bath every night, for the purpose of thoroughly
cleaning the body, is highly necessary. To bathe a delicate infant of a
few days or even weeks old in cold water with a view "to harden" the
constitution (as it is called), is the most effectual way to undermine
its health and entail future disease. By degrees, however, the water
with which it is sponged in the morning should be made tepid, the
evening bath being continued warm enough to be grateful to the feelings.

A few months having passed by, the temperature of the water may be
gradually lowered until cold is employed, with which it may be either
sponged or even plunged into it, every morning during summer. If
plunged into cold water, however, it must be kept in but a minute; for
at this period, especially, the impression of cold continued for any
considerable time depresses the vital energies, and prevents that
healthy glow on the surface which usually follows the momentary and
brief action of cold, and upon which its usefulness depends. With some
children, indeed, there is such extreme delicacy and deficient reaction
as to render the cold bath hazardous; no warm glow over the surface
takes place when its use inevitably does harm: its effects, therefore,
must be carefully watched.

DRYING THE SKIN.--The surface of the skin should always be carefully
and thoroughly rubbed dry with flannel,--indeed, more than dry, for the
skin should be warmed and stimulated by the assiduous gentle friction
made use of. For this process of washing and drying must not be done
languidly, but briskly and expeditiously; and will then be found to be
one of the most effectual means of strengthening the infant. It is
especially necessary carefully to dry the arm-pits, groins, and nates;
and if the child is very fat, it will be well to dust over these parts
with hair-powder or starch: this prevents excoriations and sores, which
are frequently very troublesome. Soap is only required to those parts
of the body which are exposed to the reception of dirt.

NAPKINS.--The frequency of the discharges from the bowels and bladder
requires a frequent change of napkins. A nurse cannot be too careful of
this duty from the first, so that she may be enabled to discover the
periods when those discharges are about to take place, that she may not
only anticipate them, but teach the child, at a very early age, to give
intelligent warning of its necessities. Thus a habit of regularity with
regard to those functions will be established, which will continue
through life, and tend greatly to the promotion of health. As the child
grows older, the system of cleanliness must in no particular be
relaxed, and it will be found the best preservative against those
eruptive disorders which are so frequent and troublesome during the
period of infancy.

DURING CHILDHOOD.--When this period arrives, or shortly after, bathing
is but too frequently left off; the hands and face of the child are
kept clean, and with this the nurse is satisfied; the daily ablution of
the whole body, however, is still necessary, not only for the
preservation of cleanliness, but because it promotes in a high degree
the health of the child.

PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.--A child of a
vigorous constitution and robust health, as he rises from his bed
refreshed and active by his night's repose, should be put into the
shower-bath, or, if this excites and alarms him too much, must be
sponged from head to foot with salt water. If the weather be very cold,
the water may be made slightly tepid, but if his constitution will bear
it, the water should be cold throughout the year. Then the body should
be speedily dried, and hastily but well rubbed with a somewhat coarse
towel, and the clothes put on without any unnecessary delay. This
should be done every morning of the child's life.

If such a child is at the sea-side, advantage should be taken of this
circumstance, and seabathing should be substituted. The best time is
two or three hours after breakfast; but he must not be fatigued
beforehand, for if so, the cold bath cannot be used without danger.
Care must be taken that he does not remain in too long, as the animal
heat will be lowered below the proper degree, which would be most
injurious. In boys of a feeble constitution, great mischief is often
produced in this way. It is a matter also of great consequence in
bathing children that they should not be terrified by the immersion,
and every precaution should be taken to prevent this. The healthy and
robust boy, too, should early be taught to swim, whenever this is
practicable, for it is attended with the most beneficial effects; it is
a most invigorating exercise, and the cold bath thus becomes doubly
serviceable.

PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.--If a child is of a
delicate and strumous constitution, the cold bath during the summer
is one of the best tonics that can be employed; and if living on the
coast, sea-bathing will be found of singular benefit. The effects,
however, of sea-bathing upon such a constitution must be particularly
watched, for unless it is succeeded by a glow,--a feeling of increased
strength,--and a keen appetite, it will do no good, and ought at once
to be abandoned for the warm or tepid bath. The opinion that warm baths
generally relax and weaken, is erroneous; for in this case, as in all
cases when properly employed, they would give tone and vigour to the
whole system; in fact, the tepid bath is to this child what the cold
bath is to the more robust.

In conclusion: if the bath in any shape cannot from circumstances be
obtained, then cold saltwater sponging must be used daily, and all the
year round, so long as the proper reaction or glow follows its use; but
when this is not the case, and this will generally occur, if the child
is delicate and the weather cold, tepid vinegar and water, or tepid
salt water, must be substituted.

Sect. VI. CLOTHING.

IN INFANCY.--Infants are very susceptible of the impressions of cold; a
proper regard, therefore, to a suitable clothing of the body, is
imperative to their enjoyment of health. Unfortunately, an opinion is
prevalent in society, that the tender child has naturally a great power
of generating heat and resisting cold; and from this popular error has
arisen the most fatal results. This opinion has been much strengthened
by the insidious manner in which cold operates on the frame, the
injurious effects not being always manifest during or immediately after
its application, so that but too frequently the fatal result is traced
to a wrong source, or the infant sinks under the action of an unknown
cause.

The power of generating heat in warm-blooded animals is at its minimum
at birth, and increases successively to adult age; young animals,
instead of being warmer than adults, are generally a degree or two
colder, and part with their heat more readily; facts which cannot be
too generally known. They show how absurd must be the folly of that
system of "hardening" the constitution (to which reference has been
before made), which induces the parent to plunge the tender and
delicate child into the cold bath at all seasons of the year, and
freely expose it to the cold, cutting currents of an easterly wind,
with the lightest clothing.

The principles which ought to guide a parent in clothing her infant
are as follows:--

The material and quantity of the clothes should be such as to preserve
a sufficient proportion of warmth to the body, regulated therefore by
the season of the year, and the delicacy or strength of the infant's
constitution. In effecting this, however, the parent must guard against
the too common practice of enveloping the child in innumerable folds of
warm clothing, and keeping it constantly confined to very hot and close
rooms; thus running into the opposite extreme to that to which I have
just alluded: for nothing tends so much to enfeeble the constitution,
to induce disease, and render the skin highly susceptible to the
impression of cold; and thus to produce those very ailments which it
is the chief intention to guard against.

In their make they should be so arranged as to put no restrictions to
the free movements of all parts of the child's body; and so loose and
easy as to permit the insensible perspiration to have a free exit,
instead of being confined to and absorbed by the clothes, and held in
contact with the skin, till it gives rise to irritation.

In their quality they should be such as not to irritate the delicate
skin of the child. In infancy, therefore, flannel is rather too rough,
but is desirable as the child grows older, as it gives a gentle
stimulus to the skin, and maintains health.

In its construction the dress should be so simple as to admit of being
quickly put on, since dressing is irksome to the infant, causing it to
cry, and exciting as much mental irritation as it is capable of
feeling. Pins should be wholly dispensed with, their use being
hazardous through the carelessness of nurses, and even through the
ordinary movements of the infant itself.

The clothing must be changed daily.--It is eminently conducive to good
health that a complete change of dress should be made every day. If
this is not done, washing will, in a great measure, fail in its object,
especially in insuring freedom from skin diseases.

IN CHILDHOOD.--The clothing of the child should possess the same
properties as that of infancy. It should afford due warmth, be of such
materials as do not irritate the skin, and so made as to occasion no
unnatural constriction.

In reference to due warmth, it may be well again to repeat, that too
little clothing (that state of semi-nudity which the vanity of some
parents encourage) is frequently productive of the most sudden attacks
of active disease; and that children who are thus exposed with naked
breasts and thin clothing in a climate so variable as ours are the
frequent subjects of croup, and other dangerous affections of the air-
passages and lungs. On the other hand, it must not be forgotten, that
too warm clothing is a source of disease,--sometimes even of the same
diseases which originate in exposure to cold,--and often renders the
frame more susceptible of the impressions of cold, especially of cold
air taken into the lungs. Regulate the clothing, then, according to the
season; resume the winter dress early; lay it aside late; for it is in
spring and autumn that the vicissitudes in our climate are greatest,
and congestive and inflammatory complaints most common.

With regard to material (as was before observed), the skin will at
this age bear flannel next to it; and it is now not only proper, but
necessary. It may be put off with advantage during the night, and
cotton maybe substituted during the summer, the flannel being resumed
early in the autumn. If from very great delicacy of constitution it
proves too irritating to the skin, fine fleecy hosiery will in general
be easily endured, and will greatly conduce to the preservation of
health.

It is highly important that the clothes of the boy should be so made
that no restraints shall be put on the movements of the body or limbs,
nor injurious pressure made on his waist or chest. All his muscles
ought to have full liberty to act, as their free exercise promotes both
their growth and activity, and thus insures the regularity and
efficiency of the several functions to which these muscles are
subservient.

The same remarks apply with equal force to the dress of the girl; and
happily, during childhood, at least, no distinction is made in this
matter between the sexes. Not so, however, when the girl is about to
emerge from this period of life; a system of dress is then adopted
which has the most pernicious effects upon her health, and the
development of the body, the employment of tight stays, which impede
the free and full action of the respiratory organs, being only one of
the many restrictions and injurious practices from which in latter
years they are thus doomed to suffer so severely.

Sect. VII. AIR AND EXERCISE.

IN INFANCY.--The respiration of a pure air is at all times, and under
all circumstances, indispensable to the health of the infant. The
nursery therefore should be large, well ventilated, in an elevated part
of the house, and so situated as to admit a free supply both of air
and light. For the same reasons, the room in which the infant sleeps
should be large, and the air frequently renewed; for nothing is so
prejudicial to its health as sleeping in an impure and heated
atmosphere. The practice, therefore, of drawing thick curtains closely
round the bed is highly pernicious; they only answer a useful purpose
when they defend the infant from any draught of cold air.

The proper time for taking the infant into the open air must, of
course, be determined by the season of the year, and the state of the
weather. "A delicate infant born late in the autumn will not generally
derive advantage from being carried into the open air, in this climate,
till the succeeding spring; and if the rooms in which he is kept are
large, often changed, and well ventilated, he will not suffer from the
confinement, while he will, most probably, escape catarrhal affections,
which are so often the consequence of the injudicious exposure of
infants to a cold and humid atmosphere."[FN#17] If, however, the child
is strong and healthy, no opportunity should be lost of taking it into
the open air at stated periods, experience daily proving that it has
the most invigorating and vivifying influence upon the system. Regard,
however, must always be had to the state of the weather; and to a damp
condition of the atmosphere the infant should never be exposed, as it
is one of the most powerful exciting causes of consumptive disease. The
nurse-maid, too, should not be allowed to loiter and linger about, thus
exposing the infant unnecessarily, and for an undue length of time;
this is generally the source of all the evils which accrue from taking
the babe into the open air.

[FN#17]  Sir James Clark on Consumption.

Exercise, also, like air, is essentially important to the health of
the infant. Its first exercise, of course, will be in the nurse's arms.
After a month or two, when it begins to sleep less during the day, it
will delight to roll and kick about on the sofa: it will thus use its
limbs freely; and this, with carrying out into the open air, is all
the exercise it requires at this period. By and by, however, the child
will make its first attempts to walk. Now it is important that none of
the many plans which have been devised to teach a child to walk, should
be adopted--the go-cart, leading-strings, etc.; their tendency is
mischievous; and flatness of the chest, confined lungs, distorted
spine, and deformed legs, are so many evils which often originate in
such practices. This is explained by the fact of the bones in infancy
being comparatively soft and pliable, and if prematurely subjected by
these contrivances to carry the weight of the body, they yield just
like an elastic stick bending under a weight, and as a natural
consequence become curved and distorted.

It is highly necessary that the young and experienced mother should
recollect this fact, for the early efforts of the little one to walk
are naturally viewed by her with so much delight, that she will be apt
to encourage and prolong its attempts, without any thought of the
mischief which they may occasion; thus many a parent has had to mourn
over the deformity which she has herself created.

It may be as well here to remark, that if such distortion is timely
noticed, it is capable of correction, even after evident curvature has
taken place. It is to be remedied by using those means that shall
invigorate the frame, and promote the child's general health (a daily
plunge into the cold bath, or sponging with cold salt water, will be
found signally efficacious), and by avoiding the original cause of the
distortion--never allowing the child to get upon his feet. The only way
to accomplish the latter intention, is to put both the legs into a
large stocking; this will effectually answer this purpose, while, at
the same time, it does not prevent the free and full exercise of the
muscles of the legs. After some months pursuing this plan, the limbs
will be found no longer deformed, the bones to have acquired firmness
and the muscles strength; and the child may be permitted to get upon
his feet again without any hazard of perpetuating or renewing the evil.

The best mode of teaching a child to walk, is to let it teach itself,
and this it will do readily enough. It will first crawl about: this
exercises every muscle in the body, does not fatigue the child, throws
no weight upon the bones, but imparts vigour and strength, and is thus
highly useful. After a while, having the power, it will wish to do
more: it will endeavour to lift itself upon its feet by the aid of a
chair, and though it fail again and again in its attempts, it will
still persevere until it accomplish it. By this it learns, first, to
raise itself from the floor; and secondly, to stand, but not without
keeping hold of the object on which it has seized. Next it will balance
itself without holding, and will proudly and laughingly show that it
can stand alone. Fearful, however, as yet of moving its limbs without
support, it will seize a chair or anything else near it, when it will
dare to advance as far as the limits of its support will permit. This
little adventure will be repeated day after day with increased
exultation; when, after numerous trials, he will feel confident of his
power to balance himself, and he will run alone. Now time is required
for this gradual self-teaching, during which the muscles and bones
become strengthened; and when at last called upon to sustain the weight
of the body, are fully capable of doing so.

IN CHILDHOOD.--When the child has acquired sufficient strength to take
active exercise, he can scarcely be too much in the open air; the more
he is habituated to this, the more capable will he be of bearing the
vicissitudes of the climate. Children, too, should always be allowed to
amuse themselves at pleasure, for they will generally take that kind
and degree of exercise which is best calculated to promote the growth
and development of the body. In the unrestrained indulgence of their
youthful sports, every muscle of the body comes in for its share of
active exercise; and free growth, vigour, and health are the result.

If, however, a child is delicate and strumous, and too feeble to take
sufficient exercise on foot,--and to such a constitution the respiration
of a pure air and exercise are indispensable for the improvement of
health, and without them all other efforts will fail,--riding on a
donkey or pony forms the best substitute. This kind of exercise will
always be found of infinite service to delicate children; it amuses the
mind, and exercises the muscles of the whole body, and yet in so
gentle a manner as to induce little fatigue.

The exercises of horseback, however, are most particularly useful
where there is a tendency in the constitution to pulmonary consumption,
either from hereditary or accidental causes. It is here beneficial, as
well through its influence on the general health, as more directly on
the lungs themselves. There can be no doubt that the lungs, like the
muscles of the body, acquire power and health of function by exercise.
Now during a ride this is obtained, and without much fatigue to the
body. The free and equable expansion of the lungs by full inspiration,
necessarily takes place; this maintains their healthy structure, by
keeping all the air-passages open and pervious; it prevents congestion
in the pulmonary circulation, and at the same time provides more
completely for the necessary chemical action on the blood, by changing,
at each act of respiration, a sufficient proportion of the whole air
contained in the lungs,--all objects of great importance, and all
capable of being promoted, more or less, by the means in question.

And be it remembered that these remarks apply with equal force to the
girl as to the boy. She should be allowed, and even encouraged, to take
the same active exercise. Fortunately, this course is followed during
childhood; not so, unfortunately (in the majority of cases, at least),
after this period. Young females are then subjected to those unnatural
restraints, both in exercise and dress, which fashion and vanity
impose, to be followed by effects which, though not immediately
obvious, are capable of laying the foundation of evils that cannot
afterwards be remedied.

A good carriage is the point aimed at (and to which I particularly
refer), and the means adopted for its cultivation fail, after all, in
their end, just in proportion to their rigid employment. For this
purpose the head is kept erect, and the shoulders drawn back, and they
are to be kept in this position not for an hour or so, but continually.
To preserve, however, this unnatural and constrained position, requires
considerable muscular powers, such as no girl can exercise without
long, painful, and injurious training; nor even by this, unless other
measures be resorted to in aid of her direct endeavours. For instead of
the muscles obtaining increased power and strength by these efforts (to
enforce a good carriage), they are enfeebled, and soon become more and
more incapable of performing what is required of them. This fact soon
becomes perceptible; weakness is noticed; but instead of correcting
this by the only rational mode, that of invigorating the weakened
muscles, mechanical aid is called in to support them, and laced
waistcoats are resorted to. These undoubtedly give support--nay, they
may be so used as almost wholly to supersede the muscular efforts, with
the advantage of not tiring, however long or continuously employed.
Improvement of carriage is manifested, the child is sensible of relief
from a painful exertion, the mother is pleased with the success of her
management, and this success appears to superficial observation fully
to confirm the judgment which superintends it. Yet what are the
consequences to which her measures tend, and which such measures are
daily and hourly producing? The muscles of the back and chest,
restrained in their natural and healthful exercise by the waistcoat
called in to aid them, and more signally, in after-life, by the tightly-
laced stays or corsets, become attenuated, and still further enfeebled,
until at length they are wholly dependent on the mechanical aid, being
quite incapable of dispensing with it for any continuance.

By and by a taper waist becomes an object of ambition, and the stays
are laced more closely than ever. This is still done gradually, and, at
first, imperceptibly to the parties. The effect, however, though slow,
is sure; and the powers of endurance thus exercised come in time to
bear, almost unconsciously, what, if suddenly or quickly attempted, no
heroism could possibly sustain. This increased pressure impedes the
motion of the ribs. For perfect respiration these motions should be
free and unrestrained, and perfect respiration is necessary to those
changes in the blood which fit it for nutrition, and the other purposes
of the animal frame. In proportion as respiration is impeded, is the
blood imperfectly vitalised, and in the same ratio are the nutrient and
other functions dependent on the blood inadequately performed. Here,
then, is one source of debility, which affects the whole frame,
reducing every part below the standard of healthful vigour. Quickened
respiration soon ensues, the heart becomes excited, the pulse
accelerated, and palpitation is in time superadded.

There are still further evils produced by tight lacing. For the
pressure being chiefly made on the lower part of the chest, the stomach
and liver are necessarily compressed, to the great disturbance of their
functions; and being pressed downwards too, these trespass on that
space which the other abdominal viscera require, superinducing still
further derangements. Thus almost every function of the body becomes
more or less impeded.

And again, the girl not being able always to have her body cased in
the tight-laced stays, some relaxation must take place. Under it the
muscles of the back, deprived of their accustomed support, and
incapable of themselves to sustain the incumbent weight, yield, and the
column of the spine bends, at first anteriorly, causing round shoulders
and an arched back; but eventually inclines to one or other side,
giving rise to the well-known and too frequently occurring state of
lateral curvature. This last change most frequently commences in the
sitting posture, such females being, through general debility, much
disposed to sedentary habits. Such, though but very slightly sketched,
are a few of the evils attending this baneful practice.

But how, then, is a good carriage to be obtained; which is not only
pleasing to the eye, but is, when natural, absolutely conducive itself
to health? To insure a good carriage, the only rational way is to give
the necessary power, especially to the muscles chiefly concerned; and
this is to be done, not by wearying those muscles by continual and
unrelieved exertion, but by invigorating the frame generally, and more
especially by strengthening the particular muscles through varied
exercise alternated with due repose. Attention to general health,
suitable diet, regular bowels, moderate but regular exercise, not of
particular muscles only, but of the whole frame, cold-bathing or
sponging, and other such measures, will maintain a good carriage, by
giving that power which the more direct means so generally practised
serve but to exhaust.[FN#18]

[FN#18]  The above remarks on "good carriage" are almost wholly taken
from a valuable article of Dr. Barlow's, in the "Cyclopaedia of
Practical Medicine."

Chap. II.

ON THE USE AND ABUSE OF CERTAIN REMEDIES.

Sect. I.--APERIENT MEDICINE.

One of the greatest errors of the nursery is the too frequent and
indiscriminate exhibition by the mother or nurse of purgative medicine
to the infant. Various are the forms in which it is given; perhaps the
little powders obtained from the chemist is the most frequent, as it is
certainly the most injurious, form, their chief ingredient being
calomel.

The choice of the aperient, or the dose, or the exact condition of the
health of the infant, or whether it is an aperient at all that is
required, are points entirely overlooked: a little medicine is thought
necessary, because the child appears unwell, and a purgative, or a
little white powder, is forthwith given. The great art of
medicine is the proper application of the proper medicine, in the
proper dose, at the proper time; points never considered in the
nursery. For example, I have known a large dose of magnesia given by a
nurse to an infant, that had been suffering from a diarrhoea of some
days' standing, and very quickly cause death. Now, magnesia is one of
the most useful and harmless medicines that can be given to an infant
when indicated; when prescribed in a dose suited to its age, and when
the proper time is fixed upon for its exhibition; in the foregoing
case, however, every thing forbad its use, but none of these points
were considered.

Aperient medicine, too, is sometimes unwittingly repeated to remove
those symptoms which it has itself produced. Some incidental pain and
uneasiness, some slightly greenish appearance of the motions, leads the
mother to believe that more purging is necessary, when, in fact, both
circumstances have probably been induced by the irritation caused by
the purgatives already too freely administered. How frequently is this
the case, during the first week or ten days of the infant's life, when
the nurse doses the child with tea-spoonful after tea-spoonful of
castor oil, for the relief of pain, which her repeated doses of
medicine have alone created.

The bowels of an infant in health should be relieved two, three, or
four times in the twenty-four hours. The stools should be of the
consistence of thin mustard, and of a lightish yellow colour, having
little smell, free from lumps or white curdy matter, and passed without
pain, or any considerable quantity of wind. And a parent is only
justified in giving aperient medicine, when any deviation from these
conditions exists; and only then, when what may be called healthy
costiveness is present, viz. either the stools less frequent than they
ought to be, or lumpy and partially solid. Then, the only purgative
medicines that can be given with safely to an infant, without medical
sanction, are, castor oil, manna, rhubarb, and magnesia; the
application of the lavement, and the aperient liniment.

CASTOR OIL

This is one of the mildest aperients, prompt in its action, and
effective in clearing out the contents of the bowels; it is a
medicine, therefore, particularly applicable to infants.

During teething there is generally much torpor of the bowels; here,
then, castor oil is a very appropriate and useful artificial means of
increasing the frequency of the alvine discharges.

Then, again, no purgative can be so much relied on for overcoming
habitual costiveness as castor oil; it may for this purpose be given
daily for some weeks, gradually reducing the dose until only a few
drops be taken; after which the bowels generally continue to act
without further artificial assistance. Even its occasional
administration leaves the bowels in a relaxed state; a great advantage
over other purgatives, which generally cause, after their action is
passed off, a confined state.

The proper dose will depend upon the age, and the known effect of
aperient medicine upon the childsome requiring more, others less:

Under one year, one small tea-spoonful.

Under three years, two ditto.

Under six years, three ditto.

Under ten years and upwards, a table spoonful. The quantity being more
or less according to the facility with which the bowels are purged.

It may be given in various ways; poured upon a little mint water, or
blended with a little moist sugar;--or, if the stomach is unusually
delicate, the oil may be made into an emulsion with some aromatic
water, by the intervention of the yolk of an egg and a little syrup of
roses or sugar combined with it. The following proportions make an
elegant and not at all a disagreeable mixture, of which a desert-
spoonful (or more, according to the age,) may be repeated every hour
until it operate:

Castor oil, six drachms;
The yolk of an egg;
Mix well together, and add
Dill water, two ounces,
Syrup of roses, two drachms.

MANNA.

This also may be given with impunity to the youngest infant; it is
sweet to the taste, and mild in its operation. It should be exhibited
in doses of one to two drachms in a little warm milk; or if it cause
flatulence in this form, in some aromatic water, a desert spoonful of
carraway-seed or dill water. For children above two years, it must
always be given with some other aperient: thus, it may be combined with
castor oil by the medium of mucilage or the yolk of an egg; in fact, it
might be substituted for the syrup of roses in the previous
prescription for castor oil.

MAGNESIA AND RHUBARB.

Magnesia, besides being a laxative, allays irritability of the
stomach; it is consequently useful during dentition, at which period
there is both much irritability and a prevailing acescency of the
stomach. The dose is from five grains to ten for an infant, increasing
the quantity to fifteen grains or twenty to children of nine or ten
years of age. When taken alone the best vehicle is hot milk, which
greatly quickens its aperient operation. And whenever the bowels are
distended with wind, the pure magnesia is preferable to the carbonate.

It is well to mention here, that when the infant throws up the nurse's
milk it is generally curdled; a fact which leads the inexperienced
mother to infer that the child is suffering from acidity; and to
counteract the supposed evil magnesia is given again and again. This is
a useless and pernicious practice, for curdling or coagulation of the
milk always takes place in the stomach, and is produced by the gastric
juice, and is so far from being a morbid process, that milk cannot be
properly digested without it.

Rhubarb, it should always be recollected, has an astringent as well as
purgative property, according to the extent of the dose in which it is
administered; the former of which never opposes or interferes with the
energy of the latter, since it only takes effect when the substance is
administered in small doses, or, if given in larger ones, not until it
has ceased to operate as a cathartic. This latter circumstance renders
it particularly eligible in cases of diarrhoea, as it evacuates the
offending matter before it operates as an astringent upon the bowels.

As a purgative it operates mildly, and may be given to the youngest
infant; if from two to twelve months old, from three to six grains; for
children above that age, the dose may range from ten grains to twenty.
Its operation, however, is much quickened by the addition of magnesia;
both of which are more effective when thus united than when given
separately. The following form, in a costive and flatulent state of the
bowels, will be found useful[FN#19]; a tea-spoonful or more may be given
every three or four hours until the desired effect is obtained:--

Powdered rhubarb, half a drachm;

Magnesia, two scruples;

Compound spirits of ammonia, twenty drops;

Dill water, two ounces;

Simple syrup, two drachms.

[FN#19]  This may be made up and kept in the nursery for a long time
without spoiling.

Rhubarb, mixed with flour and warm water, may be made into a poultice,
and applied to the abdomen of a child that obstinately refuses to
swallow medicine, and it will be found to produce the same effect as if
the medicine had been taken into the stomach; it will purge briskly.

THE LAVEMENT.

This is an excellent nursery remedy when the bowels are obstinately
costive. It may then be employed as a substitute for medicine, a
protracted and frequent use of which (even of the mildest aperients) is
apt to injure the digestive functions, and to give rise to some degree
of intestinal irritation. Lavements, however, like aperient medicine,
must not be resorted to for a long time together; for whilst the latter
irritate, the former most certainly tend, after a long continued use,
to debilitate the bowels, and thus render them less than ever disposed
to act for themselves. They are an excellent occasional remedy.

The simplest form of an aperient enema, is warm water; but barley-
water, or thin gruel, or even milk and water, are to be preferred at
all times, as they are of a more bland and less irritating nature. If
it be desirable to increase the strength of the injection, castor oil
may be added. The proportions of fluid which are necessary for the
different stages of life, under ordinary circumstances, maybe stated
as follows:--An infant at its birth requires about one fluid ounce; a
child between the age of one and five years, from three to four fluid
ounces; and a youth of ten or fifteen, from six to eight fluid ounces.

The mode of administering an injection to an infant deserves
particular attention, as injury might be caused by its being performed
in a careless or unskilful manner. A gum elastic pipe should be always
used instead of the hard ivory tube. Having smeared this over with
lard, and placed the infant on its left side, with its knees bent up in
the lap of the nurse, it is to be passed a couple of inches into the
bowel, in a direction not parallel to the axis of the body, but rather
inclined to the left. The latter circumstance should never be
neglected, for if not attended to, there will be difficulty in
administering the injection. The fluid must then be propelled very
gradually, or it will be instantly rejected; on the whole being thrown
up (the pipe carefully and slowly withdrawn), the child must be kept
quietly reposing on its nurse's lap, and in the same posture for some
little time.

THE APERIENT LINIMENT.

A liniment to be rubbed on the stomach is another resource in cases of
habitual costiveness, and will frequently be attended with great
success when repeated purgatives have been resisted.

Olive or castor oil may be used for this purpose; they must be warmed
and rubbed over the abdomen night and morning, for five or ten minutes.
Perhaps the best form of liniment that can be made use of is the
following:--

Compound soap liniment, one ounce;
Compound tincture of aloes, half an ounce.

Sect. II.--CALOMEL.

Calomel is one of the most useful medicines we possess; but though
powerful for good, it is by no means powerless for mischief, and pages
might be written upon the evil effects which have resulted from its
indiscriminate use in the nursery; medical men are daily and hourly
witnessing this fact. It is particularly eligible in the diseases of
children; but then it is quite impossible for unprofessional persons to
judge when it may be appropriately exhibited. And it cannot be too
generally known, that the effect of this medicine upon the evacuations
is always to make them appear unnatural. From ignorance of this fact,
calomel is often repeated again and again to relieve that very
condition which it has itself produced, causing, but too frequently, a
degree of irritation in the delicate lining membrane of the bowel,
which it may be very difficult for a medical man to remove, and perhaps
a source of misery to the child as long as it lives.

Its frequent exhibition has also another evil attending it, for "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."[FN#20]

[FN#20]  Bell on the Teeth.

In the diseases of childhood it is often administered by the mother or
nurse with a degree of careless excess which ultimately, if not
immediately, produces severe and irremediable injury. I have met with
such cases; but Mr. Bell details a remarkable instance in point: "A
child, about three years of age, was brought to me, having a most
extensive ulceration in the gum of the lower jaw, by which the alveolar
process (that portion of the jaw which forms the sockets of the teeth)
was partially denuded. The account given by the mother was, that the
child had some time previously been the subject of measles, for which a
chemist, whom she consulted, gave her white powders, one of which was
ordered to be taken every four hours. It appears by the result, that
this must have been calomel; for, after taking it for two or three
days, profuse salivation was produced, with swollen tongue, inflamed
gums, etc., followed by ulceration of the gum, lips, and cheek. On
examining the denuded alveolar process, I found that a considerable
necrosis (death of the bone) had taken place, including the whole
anterior arch of the jaw from the first double tooth on the left side
to the eye-tooth on the right. By degrees the dead portion of bone was
raised, and became loose, when I found that the mischief was not
confined to the alveolar process, but comprised the whole substance of
the bone within the space just mentioned," etc. Surely the knowledge of
such a case as this would induce every prudent mother to exclude
calomel from her list of domestic nursery medicines.

Sect. III.--OPIATES.

This class of medicine is often kept in the nursery, in the forms of
laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's
cordial.

The object with which they are generally given is to allay pain by
producing sleep; they are, therefore, remedies of great convenience to
the nurse; and I am sorry to be obliged to add, that, so exhibited,
they are but too often fatal to the little patient.

The fact is, that in the hands of the physician, there is no medicine
the administration of which requires greater caution and judgment than
opiates, both from the susceptibility of infants to their narcotic
influence, and their varying capability of bearing it; the danger,
therefore, with which their use is fraught in the hands of a nurse
should for ever exclude them from the list of domestic nursery
medicines.

Dalby's carminative and Godfrey's cordial are, perhaps, more
frequently used than any other forms; and some striking cases,
illustrative of the fatal results of exhibiting them indiscriminately,
and without medical sanction, are on record.[FN#21] The late Dr.
Clark, in his "Commentaries," mentions a case which he saw, where
"forty drops of Dolly's carminative destroyed an infant." Dr. Merriman
gives the following in a note in Underwood, "On the Diseases of
Children:"--

[FN#21]  Two or three fatal cases, and upon which coroners' inquests
were held, have occurred within the last two years.

"A woman, living near Fitzroy Square, thinking her child not quite
well, gave it a dose of Godfrey's cordial, which she purchased at a
chemist's in the neighbourhood. In a very short time after taking it
the child fell into convulsions, and soon died. In less than a month
the child of another woman in the same house was found to be ill with
disordered bowels. The first woman, not at all suspecting that the
Godfrey's cordial had produced the convulsions in her infant, persuaded
her friend to give the same medicine to her child. A dose from the same
bottle was given, and this child was likewise attacked almost
immediately with convulsions, and also died."

Convulsions and epilepsy, without such fatal results as the foregoing,
are not uncommon as the effect of a single dose of an opiate given
unadvisedly; and by their continued and habitual use (and the form of
syrup of poppies is but too often administered by an indiscreet and
lazy nurse, unknown by the parent), a low, irritative, febrile state is
produced, gradually followed by loss of flesh, the countenance becoming
pallid, sallow, and sunken, the eyes red and swollen, and the
expression stupid and heavy, and the powers of the constitution at last
becoming completely undermined. Such an object is to be seen daily
among the poorer classes,--the miniature of a sickly aged person: death
soon follows here.

Sect. IV.--LEECHING.

Difficulty sometimes arises in putting a stop to the bleeding from
leech-bites; a matter of considerable importance in the case of a
delicate infant. The following measures may be resorted to for this
purpose:--

1. Expose the surface of the part to the external air, so that a
coagulum of blood may form at the orifice: this simple mode will
frequently arrest it.

2. If this fail, make compression upon the part: this is one of the
most effectual means of restraining haemorrhage. It is to be effected
by taking a piece of lint folded three or four thicknesses, and the
size of the finger-nail, to be steadily pressed upon the open orifice
with the point of the finger until the blood has ceased to flow. The
pledget of lint, however, must not be removed for some hours
afterwards, or the bleeding will break out afresh.

3. If the compression fails in stopping the bleeding, or from the
situation of the leech-bites it cannot be adopted, because there is no
firm point of resistance upon which to make pressure, the part may be
dusted with starch or gum arabic powder, or, if this is of no avail,
the wound may be touched with lunar caustic.

If none of these measures are successful, the assistance of the
medical attendant must be obtained; and if firm pressure be made upon
the part, no serious loss of blood can ensue before his arrival.

Leeches should never be resorted to by a parent for any of the
diseases of infancy, without medical direction.

Sect. V.--BLISTERS AND POULTICES.

A blister should never be applied for any infantile disease, except
when ordered by a medical man, as its injudicious use might greatly
aggravate the complaint.

There are also one or two precautions in reference to the mode of the
application of a blister, which it is always right for a parent to
attend to. From the great irritability of the skin, it should never be
allowed to remain on longer than from two to four hours. At the
expiration of this time, the surface will usually become red and
inflamed; and, if the blister is removed, and the part dressed with
fresh spermaceti ointment spread on lint, or with a soft bread and
water poultice, a full blister will soon be raised: the little patient
is thus saved much suffering, and a very troublesome sore prevented. A
piece of tissue or silver paper, interposed between the blister and the
skin, will answer the same purpose; the blister will act well, and the
evils before alluded to will be prevented.

After a blister has been two or three hours applied, its edge should
be carefully raised, to ascertain the effect produced; and if the
surface be much inflamed, more particularly if little points of