# Mrs. Beeton's Book of Household Management/Chapter LXXII

THE NURSERY
CHAPTER LXXII
Nursery Management, the Duties of Mother, Governess, and Nursery Servants; the Rearing and Management of Children, Diseases of Infancy and Childhood and their Remedies
THE MOTHER
A mother's responsibilities are the greatest that a woman can have, for with her rests not only the care for the daily needs of food, clothing and the like of her children, but, what is even more important, their moral training. No matter what good nurses and attendants she may be able to engage for her little ones, what pleasures, changes of air, model nurseries, toys and books she may afford for their benefit, she should still devote some part of her time to them at any rate; should be with them often, should know their individual childish tastes and faults, and strive by her influence, precepts and example to make them what she hopes they may be in the future.
A mother's influence with children is greater than any other; it is easier for her than any one else to train them all right if she be a good and loving mother, and the little ones will rather obey her commands than those of nurse or governess, no matter how kind these may be to those under their charge. Some women of fashion, moving constantly in society, deny that they have time to give to their little ones. Their visits to schoolroom or nursery are few and far between. They have everything beautifully appointed in the children's quarters, and first-rate nurses and governesses, and they cannot take time from gaiety and pleasure to devote to what they think can be obtained from hired service. This is a mistake, for no nurse, however excellent, can supply a mother's place.
The children's hour should be an institution in every household. To the young folks it is (or should be) the happiest time in the day, while to the attendants it is a rest and a great relief. Let the children bring their little troubles and sorrows to mother, to be set right and comforted; let praise be given for little tasks well done, disputes be settled, help and suggestions given for either work or play, and let a game or tale (the latter told, not read) conclude the happy hour. Should this, as it often happens, be just the time generally given to afternoon tea, let the little ones bring this to their mother and wait upon her as children love to do. She will not find an hour wasted in this way, even if it be one hard to spare.
​Children's Amusements.—In spite of the fact that children have far more, and more beautiful, toys with every advancing year, we venture to assert that it is just as difficult to amuse them now as ever it was. A magnificently-dressed wax doll often seems to afford no more delight than a shabbily-dressed old one, and the most complete and perfect of expensive toys, be it what it may, lasts no longer than a shilling one in destructive little hands. The truth is, modern children are often surfeited with playthings. They are allowed to use them all whenever they like, and so they mix them up, and soon lose their appreciation, however beautiful the toys may be. The best plan is to let children have but one plaything at a time, and directly they weary of it to make them put it away. If it be anything that they can improve or add to, encourage them to do so; if it be a broken toy, help them to mend it; if it be a doll, let the owner be often making something fresh to add to its wardrobe. Modern playthings are often too complete when given to children. Dolls are dressed, boats are fully rigged, horses are harnessed, dolls' houses are as well fitted as real ones, so that there is nothing left to be done by the little ones, to whom making and contriving are pleasures in themselves, and, at the same time, develop their constructive faculties.
Games for children should be provided out of doors as much as possible whenever the weather will allow. Running and playing come more natural to children than walking, and in these days of high-pressure education it is most essential that when released from the schoolroom they should find healthy, active exercise, and games which try the muscles instead of the brains.
Children's Clothing should be a matter of care and thought with the mother—without which, indeed, it is impossible to have the little ones always properly clothed. We do not mean by this the mere consideration of prettiness and effect, but whether their clothing is just what it should be for the season and the health of each individual child. People are apt to think that what is good for one must be good for another; whereas, although all children feel the effects of heat and cold more than we do (although they may not always show it), they are as different in temperament as ourselves, and clothing that is amply sufficient for one child is quite inadequate to the wants of another. The main requirements of children's clothing are lightness, freedom and warmth. Children should never be encumbered with their clothes, nor, on the other hand, should they ever be allowed to feel cold. In winter, flannel or merino may be worn next the skin by all children, and in summer by many, while night-dresses of the same materials are fit for either season. The best kind of night garments for young children who are apt to throw off their bed clothing, are pyjamas. Light woollen materials are the best for the ordinary wear of young children; the garments should be easy and loose, so that their limbs are free. An overall of some washing material will be found most serviceable for wearing during play hours. ​Children's Food should be nourishing rather than stimulating. They do not need much meat, nor require several courses to make a meal. The meals' should be served regularly at the same hour daily, and irregular eating of sweets, cake, biscuits, fruit, etc., between meals should not be permitted. A minimum of 3 hours is necessary for the digestion and assimilation of the simplest meal, and meal times should be so arranged that an interval of 3 to 4 hours elapses between each. The stomach then has time to digest its contents, and pass these on to the small intestine before it again receives food, and has also time to rest (for it requires rest as much as any other organ if its work is to be done properly). Eating between meals, therefore, is harmful in two ways: first, undigested food enters the stomach and mixes with the partly digested food present, which is hindered in its passage onward to the small intestine till the whole has been digested; second, no time is allowed for rest, the stomach is over-worked, it ceases to perform its functions efficiently, and indigestion ensues. These remarks apply to all foods taken at irregular times, but starchy foods (cakes, biscuits) and sweets are especially harmful in this respect. When sugar is taken in excess, the walls of the stomach secrete large quantities of mucus; this is poured out or mixed with the food, and the gastric juice is thus prevented from reaching it. In other words, "catarrh of the stomach" is produced, a common precursor, of indigestion. The most important thing is to vary the food given; for children, like ourselves, need change of diet. A good dinner from a joint one day may be followed the next by one of macaroni boiled in milk. When the children are young, soup or fish makes a pleasant change; while puddings should be not only frequent, but more varied in flavour than those usually given to children. We are, of course, now only speaking generally, but all children cannot eat the same things, and the mother who values her children's health must study, without pampering, their individual tastes. Plenty of milk should be given to young children, for it is their best and most natural food.
THE NURSERY GOVERNESS
The position of a good Nursery Governess in a household should be that of a lady, and not, as it too often happens, a situation in which the duties of a governess and of a nurse are expected to be performed by one person at a salary far below the wages of a servant. Speaking generally, there is scarcely any class so badly paid as nursery governesses, but the fault does not lie entirely with the employers. Too often the girls themselves are, by their social position and education, totally unfitted for the training of children, and really not worth the wages of a good servant, whose place they would be too proud to take. A nursery governess should be, as she is sometimes termed, "a mother's help," and as such the mistress of the household should endeavour to choose her from her own rank. No one expects the daughters of the ​aristocracy to take situations as nursery governesses, but there are now many well-educated, lady-like girls to be found a little lower in the social scale who have qualified themselves by special training to earn their living in this manner.
Treatment of Nursery Governess.—To the mistress of a household she should be, as we have said, a mother's help, and treated accordingly. In many cases she has to perform the duties that might fall to the eldest daughter, or the mistress herself; and anything which they themselves would shrink from should not be pressed upon her. She should not have to feel ashamed of her position in the household, or suffer the lack of kindness or companionship, while her pay should be adequate. Kindly encouragement, it need hardly be mentioned, should always be given to the nursery governess who honestly and faithfully fulfils her duties; while, should she be an orphan with no near relatives to whom to turn for advice, she should be able to find, in the mistress of the household, a friend from whom she can seek help and sympathy.
The qualifications most necessary for a nursery governess are a love for children and a good temper. With these she can soon win the hearts of the little ones under her care, and keep them happy while in her company. It must be bad for both governess and children when these qualifications are lacking, or even one of them; and it would be far better to seek another post more congenial than one into which she cannot put heart, as well as hands and brain. But, independent of these two qualities, a good nursery governess must also have a good system of training children, a thorough knowledge of all she undertakes to teach, and be a good manager. That she should be clean, neat, and refined in manner and speech goes without saying. Good early teaching and example in such matters as speaking correctly, eating in a proper manner, politeness, and so on, is of the utmost importance, for children are ready copyists, quick to pick up and use words or ways of those around them, especially those it is most desirable they should avoid; and they are also quick to notice the injustice of being children for a fault that they see passed in their elders without comment. For this reason it is unwise to select for nursery governess a girl who has had the disadvantage of an inferior moral and social training.
A knowledge of needlework is also essential. It is not always stipulated that the nursery governess makes the clothing for the children, but it is always understood that she repairs it and keeps it in order, and to do this she must work neatly, and, if the children be old enough, give them some instruction in the rudiments of needlework. To be able to renovate and renew little garments, to trim hats or bonnets, and to suggest or design pretty and inexpensive little costumes, should be a pleasure to one who takes an interest in the children for whom she works; while if she is able to undertake to entirely clothe them, her value to her employer will be considerably greater, and her salary should, in consequence, be higher.
​Duties of the Nursery Governess.—Where a nurse and nursemaid are kept, these would chiefly consist in teaching, needlework and superintendence; very probably walking out with the little ones, and having those old enough to come to table in charge during meals; but where there are no nurses, and the general care of the little ones devolves upon her (generally the case when a nursery governess is engaged), her duties are more numerous and varied. Should there be a baby besides several other children in such a household, it is not expected that the nursery governess will do more for it than to take it occasionally in her charge and do a little needlework for it when necessary, the mother washing, dressing and looking after the infant herself. The governess's work chiefly lies with the other children. She washes and dresses them, has them under her charge at their meals, takes them out walking, gives them instruction according to their ages, looks after their clothes, and puts them to bed. It should be part of her duty also to amuse and interest the little ones while they are with her, and to be on the watch for, and to correct, all that is wrong or ill-mannered in their ways.
Incidental duties, such as a little help given to the mistress of the house, dusting the drawing-room, arranging the flowers, and many other little tasks, should be willingly performed if there be time to spare from that which must be devoted to the children. None of these tasks, however, would be asked by a mistress who looked upon the governess she employed in the right light (unless she had engaged her to do them) except as an assistance to herself; requested and rendered as such, they should be the means of creating mutual sympathy and friendship.
UPPER AND UNDER NURSEMAIDS
The Nursery should be a bright, cheerful room, sunny and airy, and if at the top of the house, not exposed to the extremes of heat and cold. Children suffer sooner than adults if the hygienic arrangements are not perfect, and as in some houses it happens that, with perhaps the exception of a short half-hour now and then, they spend all their time at home in the one room, it ought to be kept at an even temperature, and made as pleasant as possible for its inmates. The walls should be covered with sanitary paper of some cheerful pattern, and varnished. The windows should be air-tight and free from draughts. Ventilators should be inserted near the ceiling (the importance of fresh air for the life and well-being of children cannot be over-estimated). The fireplace must be provided with a substantial and efficient guard. The greatest cleanliness is needed in a nursery, for the children cannot thrive if they are not well kept, and a room so constantly used as the day nursery by little folks, needs more cleaning than ordinary sitting-rooms. The floor of the night nursery should not be covered with carpet, and it is better that each child should have its own little bed or crib, with sufficient, but not too much, clothing.
​Duties of the Head Nurse.—The nursery is of great importance in every family; and in families of distinction, where there are several young children, it is an establishment kept apart from the rest of the family, under the charge of an upper nurse, assisted by under nursery-maids proportioned to the work to be done. The responsible duties of upper nursemaid commence with the weaning of the child. It must now be separated from the mother or wet-nurse, at least for a time, and the cares of the nurse, which have hitherto been only occasionally put in requisition, are now to be entirely devoted to the infant. She washes, dresses, and feeds it; walks out with it; supplies and regulates all its wants; and, even at this early age, many good qualities are requisite to perform these duties in a satisfactory manner. Patience and good temper are indispensable; truthfulness, purity of manners, minute cleanliness, and docility and obedience are almost as essential. The nurse ought also to be acquainted with the art of ironing and getting up small fine things, and be handy with her needle.
Carrying Infants.—There is a considerable art in carrying an infant with comfort to itself and to the nursemaid. If it is carried always seated upright on her arm and pressed too closely against her chest, the stomach of the child is apt to get compressed, and the back fatigued. For her own comfort, a good nurse will frequently vary this position by changing the child from one arm to the other, and sometimes by laying it across both, raising the head a little. When teaching it to walk, and guiding it by the hand, she should change the hand from time to time, to avoid raising one shoulder higher than the other. This is the only way in which a child should be taught to walk; leading-strings and other foolish inventions, which force an infant to make efforts, with its shoulders and head forward, before it knows how to use its limbs, will only render it feeble, and retard its progress.
Bad Habits.—Most children have some bad habit, of which they must be broken; but this is never accomplished by harshness without developing worse evils. Kindness, perseverance, and patience in the nurse, are here of the utmost importance. When finger-sucking is one of these habits, the fingers should be rubbed with bitter aloes, or some equally disagreeable substance. Others have dirty habits, which are only to be changed by patience, perseverance, and, above all, by regularity in the nurse. She should never be permitted to inflict punishment on these occasions, or, indeed, on any occasion. But, if punishment is prohibited, it is still more necessary that all kinds of indulgence and flattery be equally forbidden. To yield to all the whims of a child—to pick up its toys when thrown away in mere wantonness, etc., is extremely foolish. A child should never be led to think others inferior to it, to beat a dog or even the stone against which it has fallen, as some children are taught to do by silly nurses. Neither should the nurse affect or show alarm at any of the little accidents must inevitably happen; if a child fall, treat the incident as a ​trifle, otherwise a spirit of cowardice and timidity is encouraged. But she must take care that such accidents are not of frequent occurrence, or the result of neglect. The nurse should keep the child as clean as possible, training it, in particular, in cleanly habits, so that it feels uncomfortable when not clean; and she must watch especially that it does not soil itself in eating. At the same time, vanity in its personal appearance is not to be encouraged by over-care in this direction, or by too tight lacing or buttoning of dresses, nor a small foot cultivated by the use of tight shoes.
Nursemaids would do well to repeat to the parents faithfully and accurately the defects they observe in the dispositions of very young children. If properly checked in time, evil propensities may be eradicated; but this should not extend to anything but serious defects; otherwise, the intuitive perceptions which all children possess will construe the act into "spying" and "informing," which should never be resorted to in the case of children, nor, indeed, in any case. Such are the cares which devolve upon the nurse, and it is her duty to fulfil them personally. In large establishments she will have assistance proportioned to the number of children of which she has the care. The under nursemaid lights the fires, sweeps, scours, and dusts the rooms, and makes the beds, empties slops and carries up water, brings up and removes the nursery meals, washes and dresses all the children, except the infant, and assists in mending. Where there is a nursery girl to assist, she does the rougher part of the cleaning; and all take their meals in the nursery together, after the children of the family have finished. In higher families the upper nurse is usually permitted to sup or dine occasionally at the housekeeper's table by way of relaxation, when the children are all well, and her subordinates trustworthy.
The Single Nursemaid.—In smaller families, where only one nurse-maid is kept, she is assisted by the housemaid or general servant, who will do the rougher part of the work and carry up the nursery meals. In such circumstances she will be more immediately under the eye of her mistress, who will probably relieve her from some of the cares of the infant.
Baths for children should be given according to age and constitution. Some require warm baths and suffer from the effect of cold water, while with other children the cold agrees perfectly. A tepid bath is the one most generally suitable. Young children should have their bath in the morning, and if they are under two years may take it after their first meal. A child should never be given a hot bath in a very cold room, and thorough drying after bathing is of great importance.
Children's Complaints.—Where the nurse has the entire charge of the nursery, and the mother is too much occupied to do more than pay a daily visit, it is desirable that the nurse should be an observant woman, possessing some acquaintance with the diseases incident to ​childhood, and with the simple remedies that may be useful before a medical attendant can be procured, or when such attendance is considered unnecessary. All these little ailments are preceded by symptoms so minute as to be only perceptible to close observation; such as twitching of the brows, restless sleep, and grinding of the gums; in some inflammatory diseases the child even abstains from crying from fear of the increased pain produced by the movement. Dentition, or cutting of the teeth, is attended with many of these symptoms. Measles, thrush, scarlatina, croup, whooping-cough, and other childish complaints, all of which are preceded by well-known symptoms, may be alleviated and rendered less virulent by simple remedies instantaneously applied.
Cleanliness, fresh air, clean utensils, and frequent washing of the person, both of nurse and children, are even more necessary in the nursery than in either drawing-room or sick-room, inasmuch as the delicate organs of childhood are more susceptible of injury from smells and vapours than adults. It may not be out of place if we conclude this brief notice of the duties of a nursemaid by an extract from Florence Nightingale's admirable Notes on Nursing. Referring to children, she says—
"They are much more susceptible than grown people to all noxious influences. They are affected by the same things, but much more quickly and seriously; by want of fresh air, of proper warmth; want of cleanliness in house, clothes, bedding, or body; by improper food, want of punctuality, by dulness, by want of light, by too much or too little covering in bed or when up." And all this in health; and then she quotes a passage from a lecture on sudden deaths in infancy, to show the importance of careful nursing of children: "In the great majority of instances, when death suddenly befalls the infant or young child it is an accident; it is not a necessary, inevitable result of any disease. That which is known to injure children most seriously is foul air; keeping the rooms where they sleep closely shut up is destruction to them; and, if the child's breathing be disordered by disease, a few hours only of such foul air may endanger its life, even where no inconvenience is felt by grown-up persons in the room." "Don't treat your children like sick," she sums up; "don't dose them with tea. Let them eat meat and drink milk." "Give them fresh, light, sunny, and open rooms, cool bedrooms, plenty of out-door exercise, facing even the cold, and wind, and weather, in sufficiently warm clothes, and with sufficient exercise; plenty of amusements and play; more liberty, and less schooling and cramming and training; more attention to food, and less to physic."
THE MONTHLY NURSE
The doctor will, in most cases, be best able to recommend a suitable and trustworthy nurse. It is of the utmost importance to engage ​the monthly nurse in good time, as, if she be competent and clever, her services will be sought months beforehand, a good nurse having seldom much of her time disengaged. There are some qualifications which it is evident the nurse should possess: she should be scrupulously clean and tidy in her person; honest, sober and noiseless in her movements; should possess a natural love for children, and have a strong nerve in case of emergencies.
Receiving, as she often will, instructions from the doctor, she should bear these in mind, and carefully carry them out. In those instances where she does not feel herself sufficiently informed, she should ask advice from the medical man, and not take upon herself to administer medicines, etc., without his knowledge. The advantages of employing a nurse who has gone through a systematic course of instruction at one of the recognized lying-in hospitals are obvious.
A monthly nurse should be between 30 and 50 years of age, sufficiently old to have had a little experience, and yet not too old or infirm to be able to perform various duties requiring strength and bodily vigour. She should be able to wake the moment she is called—at any hour of the night—that the mother or child may have their wants immediately attended to. Good temper, united to a kind and gentle disposition, is indispensable; and, although the nurse will frequently have much to endure from the whims and caprices of the invalid, she should make allowances for these, and command her temper, at the same time exerting her authority when it is necessary.
The duties of the monthly nurse in the way of cleaning and dusting the sick-room depend entirely on the establishment that is kept. Where there are plenty of servants, the nurse, of course, has nothing to do but attend on her patient, and ring the bell for anything she may require. Where the number of domestics is limited, she should not mind keeping her room in order; that is to say, sweeping and dusting it every morning. (But if fires are necessary, the housemaid should always clean the grate, and do all that is wanted in that way, as this dirty work would soil the nurse's dress and unfit her to approach the bed, or take the infant without soiling its clothes.) In small establishments, too, the nurse should herself fetch things she may require, and not ring for everything she wants. She must not leave her charge, of course, unless she sees everything is comfortable; and then only for a few minutes. When downstairs, and in company with the other servants, the nurse should not repeat what she may have heard in the sick-room, as much mischief may be done by a gossiping nurse. As in most houses the monthly nurse is usually sent for a few days before her services may be required, she should see that all is in readiness, so that there shall be no bustle and hurry at the time the confinement takes place. She should keep two pairs of sheets, thoroughly aired, as well as night-dresses, flannels, etc., etc. All the things which will be required to dress the baby the first time should be laid in the basket ​in readiness, in the order in which they are to put on; as well as scissors, thread, a few pieces of soft linen rag, and two or three flannel squares. If a berceaunette is to be used immediately, the nurse should ascertain that the mattresses, pillow, etc., are all well aired; and if not already completed before she arrives, she should assist in covering and trimming it, ready for the little occupant. A monthly nurse should be handy at her needle, as, if she is in the house some time before the baby is born, she will require some work of this sort to occupy her time.
Cleanliness and Neatness. A nurse should endeavour to keep the sick-room as cheerful as possible, and always see that it is clean and tidy. All utensils must be taken away and emptied as soon as used. Soiled baby's napkins must be rolled up and taken away, and put into a pan, when they should be washed out every morning and hung out to dry; they are then in a fit state to be sent to the laundress; on no account must they be left dirty, but dealt with every morning in this way. The bedroom should be kept of a regular temperature, well ventilated, free from draughts, and free also from unpleasant smells every cause of offence being removed at once.
The infant during the month must not be exposed to strong light, or much air; and in carrying it about the passages, stairs, etc., the nurse should always have its head flannel on, to protect the eyes and ears from the currents of air. A good nurse should understand the symptoms of ailments incident to this period, as, in all cases, prevention is better than cure. As young mothers with their first baby are very often much troubled at first with their breasts, the nurse should understand how to deal with retracted nipples, and the prevention of cracked nipples by carefully washing them and drying with a soft linen rag after the infant has fed, and then anointing them with a little glycerine of borax.
The importance of preventing sore or cracked nipples by cleanliness in this respect is emphasized by the fact that abscess of the breast is almost always due to septic organisms entering the breast by way of these cracks, or less commonly along the milk ducts.
THE WET NURSE
Duty of the Mother.—Unless prevented by illness or inability, a mother should nurse her child herself. A woman with health, strength, and time to devote to her child, should not shrink from performing this most natural of maternal functions, no matter to what rank she belongs, for by not doing so she certainly risks the child's health, and perhaps her own. If, however, she is unable to nurse her child, it is usual to bring it up on some preparation of cow's milk, which has been so altered as to correspond in its composition to human milk, many children thriving as well on this as on their natural food. It is seldom that doctors think it necessary in these days to advise the employment ​of a wet nurse; but as in some cases it is absolutely necessary, some hints on the choice and diet of the " foster-mother " may be useful.
The Wet Nurse.—Her age, if possible, should not be less than twenty nor exceed thirty years. Preference is to be given to the woman who has already had one or two children of her own, for the reason that the milk is richer and more nourishing in those who have already borne children, and she is likely to be more experienced. It is necessary that the ages of the children should nearly correspond; where there is any great disproportion, as when the age of one child is a few weeks, while that of the other is six or seven months, the woman should be rejected. Her health should be sound in every respect, and her body free from all eruptive disease or local blemish. The best evidence of a sound state of health will be found in the woman's clear, open countenance, the ruddy hue of the skin, the full, round and elestic state of the breasts, and especially in the erectile, firm condition of the nipple, which, in all unhealthy states of the body, is flabby and relaxed; in which case, the milk is sure to be imperfect in its organization, and, consequently, deficient in its nutrient qualities. Appetite is another indication of health in the suckling nurse or foster-mother, for it is impossible that a woman can feed her child properly unless she has a good appetite herself; and though inordinate craving for food is neither desirable nor necessary, a healthy zest at the proper hours is very essential. It is very important also that something should be known of the moral fibre of the wet nurse, as unless she is a woman of principle the child may suffer by her selfish indulgence in some favourite but forbidden article of diet, such as pickles, etc., or by her secret use of narcotics to secure a quiet night.
The ultimate choice of the wet nurse should of course, in all cases, be left to the doctor. Disregard in this respect may bring about the direst consequences. He alone is capable of deciding whether a woman may or may not nurse another woman's child. He will not do it until he has examined both foster-mother and her child, for if the latter is not thriving and healthy on its own mother's milk, it is extremely improbable that a stranger's child will benefit by it.
The conscientiousness and good faith that would prevent a nurse so acting are, unfortunately, very rare; and many nurses, rather than forego the enjoyment of a favourite dish, though morally certain of the effect it will have on the child, will, on the first opportunity, feed with avidity on fried meats, cabbage, cucumbers, pickles, or other crude and injurious aliments, in defiance of all orders given or confidence reposed in their word, good sense, and humanity. Then when the infant is racked with pain, a night of disquiet alarms the mother, and the doctor is sent for, the nurse covers her dereliction by a falsehood, the consequence of her gluttony is treated as a disease, and the poor infant is dosed for some days with medicines that can do it but little if any good, and, in all probability, materially retard its physical ​development. The selfish nurse, in her ignorance, believes, too, that as long as she experiences no admonitory symptoms herself, the child cannot suffer; and is satisfied that, whatever the cause of its screams and plunges, neither she, nor what she had eaten, had anything to do with it; with which nattering assurance at her heart, she watches her opportunity, and has another luxurious feast off the proscribed dainties, till the increasing disturbance in the child's health, or treachery from the kitchen, opens the eyes of mother and doctor to the nurse's unprincipled conduct. In all such cases the infant should be spared the infliction of medicine, and, as a wholesome corrective to herself, and relief to her charge, a good sound dose administered to the nurse.
The Diet of the Wet Nurse.—The first point of importance is to fix early and definite hours for every meal; and the mother should see that no cause is ever allowed to interfere with their punctuality. The food itself should be light, easy of digestion, and simple. Boiled or roast meat, with bread and potatoes, and occasionally some sago, rice, or tapioca pudding, should constitute the dinner, the only meal that requires special comment; broths, green vegetables, and all acid or salt foods must be avoided. Fresh fish, once or twice a week, may be taken; but it is hardly sufficiently nutritious to be often used as a meal. If the dinner is taken early—at one o'clock—there will be no occasion for luncheon, which too often, to the injury of the child, is made an excuse for a first dinner. A glass of milk and a biscuit at eleven o'clock will be abundantly sufficient between breakfast at eight and a good dinner at one o'clock. Supper may be taken about eight o'clock, and should consist of some light farinaceous pudding, porridge and milk, etc. Animal food once in twenty-four hours is quite sufficient. All spirits, unless in extreme cases, should be avoided; and wine is still more seldom needed. With a due quantity of plain, digestible food, with early hours and regularity, the nurse will not only be strong and healthy herself, but fully capable of rearing a child in health and strength. The large quantities of stout or porter which were formerly ordered are not essential; one pint during the day is an ample allowance, or milk may be substituted altogether. Two points are of importance in maintaining the nurse in good health: (1) The diet should not be too rich at the commencement of her duties. A change from a poor, insufficient diet, to which she may have been accustomed, to a rich, full one, is likely to cause indigestion; (2) Exercise daily in the open air is absolutely essential to her well-being.
There are two cautions which all mothers who are obliged to employ wet nurses should remember. The first is, never to allow a wet nurse to give medicine to the infant on her own authority; many have such an infatuated idea of the healing excellence of castor-oil, that they would administer a dose of this unpleasant grease twice a week, and think they had done a useful service to the child. The next point is, to be careful that to insure a night's sleep for herself, she does not dose the ​infant with syrup of poppies, or some narcotic potion, to insure tranquillity to the child and give the opportunity of sleep to herself. The fact that it used to be the common practice of wet nurses to keep secret bottles of these dangerous syrups and to use them to a terrible extent, is notorious; and too great care cannot be taken by any employer of a wet nurse to-day to guard her child against the possibility of such ignorant or unprincipled treatment, remembering in all cases to consult a medical man for her infant, in preference to following the counsel of her nurse.
THE REARING AND MANAGEMENT OF INFANTS AND CHILDREN
The knowledge of the management of infants, like the mother's love for her offspring, seems to be born with the child, and to be a direct intelligence of Nature. It may thus, at first sight, appear as inconsistent and presumptuous to tell a woman how to rear her infant as to instruct her in the manner of loving it. Yet, though Nature is unquestionably the best nurse, Art makes so admirable a foster-mother, that no sensible woman, in her novitiate of parent, would refuse the admonitions of art, or the teachings of experience, to consummate her duties of nurse. It is true that, in a civilized state of society, few young wives reach the epoch that makes them mothers without some insight, traditional or practical, into the management of infants; consequently, the cases wherein a woman is left to her own unaided intelligence, or what, in such a case, may be called instinct, and obliged to trust to the promptings of Nature alone for the well-being of her child, are very rare indeed. Again, every woman is not gifted with the same physical ability for the harassing duties of a mother; and though Nature, as a general rule, has endowed all female creation with the attributes necessary to that most beautiful, and, at the same time, holiest function—the healthy rearing of their offspring, the cases are sufficiently numerous to establish the exception, where the mother is either physically or socially incapacitated from undertaking these duties herself, and where, consequently, she is compelled to trust to adventitious aid for those natural benefits which are at once the mother's pride and delight to render to her child.
The Lungs.—Respiration.—The first effect of air on the infant is a slight tremor about the lips and angles of the mouth, increasing to twitchings, and finally to a convulsion of the lips and cheeks, the consequence of sudden cold to the nerves of the face. This spasmodic action produces a gasp, causing the air to rush through the mouth and nostrils and enter the windpipe and upper portion of the flat and contracted lungs, which immediately expand. This is succeeded by a few faint sobs or pants, by which larger volumes of air are drawn into the chest, till, after a few seconds, and when a greater bulk of the lungs has become ​inflated, the breast-bone and ribs rise, the chest expands, and, with a sudden start, the infant gives utterance to a succession of loud, sharp cries, which have the effect of completely filling the lungs with air.
At the same instant that the air rushes into the lungs, the valve, or door between the two sides of the heart—and through which the blood has previously passed—is closed, and the blood taking a new course, bounds into the lungs now expanded with air, where it becomes oxygenated and made fit to nourish the different organs of the body.
What the key is to the mechanical watch, air is to the physical man. Once admit air into the mouth and nostrils and the lungs expand, the blood rushes to the remotest part of the body; the mouth secretes saliva, to soften and macerate the food; the liver forms its bile, to separate the nutriment from the digested aliment; the kidneys perform their office; the eye elaborates its tears, to facilitate motion and impart that glistening to the orb on which depends so much of its beauty; and a dewy moisture exudes from the skin, protecting the body from the extremes of heat and cold, and sharpening the perception of touch and feeling. At the same instant, and in every part, the arteries are everywhere laying down layers of muscle, bones, teeth, and, in fact, like the coral zoophyte, building up a continent of life and matter; while the veins, equally busy, are carrying away the debris and refuse collected from where the zoophyte arteries are building; this refuse, in its turn, being conveyed to the kidneys, is then excreted and leaves the body as urine.
All these—and they are but a few of the vital actions constantly taking place—are the instant result of one gasp of life-giving air. No subject can be fraught with greater interest than watching the changes which are wrought upon the living baby the moment the external air acts upon it.
The Stomach.—Digestion.—Next to respiration, digestion is the chief function in the economy of life, as, without the digestion and absorption of food, there would be nothing to supply the immense and constantly recurring waste of the system, caused by the activity of the vital processes, especially during infancy and growth.
In infancy (the period of which our present subject treats), the series of parts engaged in the process of digestion may be reduced simply to the stomach and intestines, and the liver, or rather its secretion, the bile.
The stomach is a thick muscular bag, connected above with the gullet, and, at its lower extremity, with the commencement of the small intestines. The duty or function of the stomach is to secrete a sharp, acid liquid, called the gastric juice, which, with a due mixture of saliva, softens, dissolves, and gradually digests the food or contents of the stomach, reducing the whole to a soft pulpy mass, the chyme. This passes into the first part of the small intestines, where it comes in contact with the bile from the gall-bladder and the pancreatic juice ​from the pancreas, being converted into a white, creamy fluid called chyle, which is taken up by proper vessels called lacteals, and conveyed to the blood to enrich it and fit it for supplying the various organs of the body with nutriment.
Now, as Nature has ordained that infantile life shall be supported on liquid aliment, and as without digestion the body would perish, some provision was necessary to meet this difficulty, and that provision was found in the nature of the liquid itself, or, in other words, the milk.
The process of making cheese, or fresh curds and whey, is familiar to most persons; but, as it is necessary to the elucidation of our subject, we will briefly repeat it. The internal membrane, or the lining coat of a calf's stomach, having been removed from the organ, is hung up, like a bladder, to dry; when required, a piece is cut off, put in a jug, a little warm water poured upon it, and after a few hours it is fit for use; the liquid so made being called rennet. A little of this rennet, poured into a basin of warm milk, at once coagulates the greater part, and separates a quantity of thin liquor called whey.
This is precisely the action which takes place in the infant's stomach, immediately converting the milk into a soft cheese. It is gastric juice, adhering to the calf's stomach, and drawn out by the water, forming rennet, that makes the curds in the basin. The cheesy substance, being a solid, at once undergoes the process of digestion, is converted into chyle, and goes to form new blood and so to build up the various tissues of the body. This is the simple process of a baby's digestion; milk converted into cheese, cheese into chyle, chyle into blood, and blood into flesh and bone.
The Infant.—We have already described the phenomena produced on the new-born child by the contact of air, which, after a succession of muscular twitchings, becomes endowed with voice, and heralds its advent by a loud but brief succession of cries. But though this is the general rule, it sometimes happens (from causes it is unnecessary here to explain) that the infant does not cry, or give utterance to any audible sound, or if it does, they are exceedingly faint, and indicate that life, as yet, to the new visitor, is neither a boon nor a blessing: the infant being in fact in a state of suspended or imperfect vitality. As soon as this state of things is discovered, the child should be turned on its right side, and the spine rubbed with the fingers of the right hand, sharply and quickly till heat is evoked, and till the loud and sharp cries of the child have thoroughly expanded the lungs and satisfactorily established its life.
Another method that is frequently adopted to bring children, born in this condition of suspended or feeble animation, round, is to take a basin of very hot water (but not hot enough to scald), and another of quite cold water, and, placing them upon the floor, to immerse the child for a moment first in the one and then in the other. If this has ​the desired effect, and the child begins to cry lustily, it should be at once taken out and dried, but if not, it may be slapped rather smartly a few times on the chest, back and buttocks.
Should these efforts prove ineffectual, recourse must be had to artificial respiration. This may be performed as follows: the hands of the infant are seized by the attendant and raised from the side until they are lifted above its head as far as they will go, by doing which the act of inspiration or drawing of air into the chest is imitated, after which the hands and arms are to be depressed until they are brought to the side again, by which the air will be driven from the chest, and the act of expiration be thus imitated.
Washing and Dressing.—Provided there is nothing to hinder it, so soon as the child has been removed, in a flannel receiver, the process of washing and dressing may be at once begun. The various articles of clothing which are to be put on the child should have been hung upon a chair at the commencement of labour, in proximity to the fire.
The child is generally washed upon the nurse's knee, the basin with soap and water being placed upon the floor, but it is better, if it can be done, to use an oval wooden bath, having a place scooped out at one end to allow of the child's head being supported during the process.
The bath should be sufficiently filled with warm water to cover the body, by which means it will not be exposed to the influence of the atmosphere till ready to be dried. The soap that is employed should be of the most non-irritating kind, and great care must be taken that none is allowed to enter the infant's eyes. Many of the inflammatory affections of the eyes occurring in infants may be traced to carelessness in this respect.
If there is much cheesy-looking substance on the body it may be removed with a little sweet oil, and then well soaped with a soft flannel.
When the process of washing is over, the infant should be laid upon the nurse's knee, on a pillow covered with warm cloths, and dried by means of warm soft towels. The buttocks, between the legs, armpits, etc., should be powdered carefully after each washing with refined fuller's-earth. The baby's eyes should be most carefully washed out with a little boracic acid lotion, or corrosive sublimate solution (1 part to 4,000 of water). Neglect of this precaution often results in inflammation, ulceration and subsequent blindness.
A piece of soft old linen should then be taken and a hole cut in the centre. Through this the umbilical cord should be drawn, and the lower part of the linen folded up against the other, so as to be brought in contact with the child's abdomen. The cord will thus lie between the two folds of linen, and is to be maintained in position by means of the flannel binder, which should now be applied. The binder is on no account to be too tight.
Next to the flannel binder is placed a shirt, which preferably should be made of wool, as it will afford greater protection against cold. Above ​this the petticoat is placed, and then the infant's frock or slip. A shawl or piece of flannel should also be provided to throw over the shoulders. The head is better left without any covering A linen diaper is next applied, and the process of dressing is complete.
Nursing.—It should be regarded as a part of every mother's duty to bring up her child at the breast, unless, of course, there are obstacles in the way which prevent her doing so. The only consideration that ought to weigh with a mother should be the welfare of her child; if it is her intention of nursing, the allurements of pleasure should not be allowed to interfere with the discharge of her duty. If the breasts are large and the nipples depressed they must be drawn out by suction. The breast, before the infant is applied, should be sponged with tepid water and dried, and this should be again done when the child has finished suckling. The child's mouth should also be wiped out with a clean linen rag moistened with water or boracic lotion. Those who ought not to suckle are women who are consumptive, women who are very nervous and excitable, and those whose nipples are so depressed that they are obliged to give up all attempts at nursing. The diet of the nursing mother should be wholesome and nourishing, while at the same time easy of digestion. Stimulants are quite unnecessary, and will, in the majority of cases, do more harm than good. Cheerful occupation and exercise in the open air have a beneficial effect upon the milk. Personal cleanliness should be attended to, and the clothing should be warm and permit of the most perfect freedom of movement.
The Milk.—It has been already pointed out that if nothing in the mother's condition prevents her suckling her infant, it is her duty to do so; but certain conditions must be complied with in order that it may be beneficial to the child and not hurtful to the mother.
During the first few days, until the milk comes to the breasts, the infant should not be applied more frequently than once in every six hours, but may have a little cow's milk, well diluted with boiling water and sweetened with loaf sugar, given occasionally instead, at a temperature of 96° F.
When the milk has come to the breasts all artificial nourishment must cease, and the child be put to the breast regularly. The frequency with which this should be done during the first month is once every two hours during the day, and once every three or four hours during the night.
The best time to give the child the breast is when it awakes out of sleep; when its hunger is appeased it will generally fall asleep again without further trouble.
After the first month the breast should not be given more frequently than once every two and a half or three hours during the day, and during the night once every three or four hours. As the child grows older, the time which is allowed to intervene between each meal should be increased,
​Till the appearance of the first or milk teeth, the child should be fed exclusively on the breast milk; after that, which is Nature's indication that the stomach has become fit to digest other substances, the child may be given rusks, Mellin's food, Robb's biscuits, or Robinson's groats.
About the ninth or tenth month the mother should begin to wean her child. The artificial feeding begun on the appearance of the teeth should now be increased in frequency, while the breast should be at the same time gradually withdrawn.
It is difficult to determine the quantity of food to be given at any one time, but it may be laid down, as a rule, that not more than about three ounces of fluid shall be given at any one time. When larger quantities are given the stomach is apt to become overloaded and the digestive powers impaired.
Should the breast become swollen after weaning, gentle saline medicines should be administered, such as Friedrichshall water, a seidlitz powder, or a little Epsom salts, and the breasts be bathed with a lotion of eau-de-Cologne and water.
If it is found advisable that the mother should not suckle her infant, and the breasts become full and painful, relief may be obtained by drawing off the milk with a breast-pump, and checking the secretion applying belladonna plasters to the breasts. The mother should also very much limit the amount of fluid nourishment she is taking, with these precautions the breasts will soon run dry.
The Wet Nurse.—For reasons that have been already stated, it may be found necessary to obtain the services of a wet nurse, the choice, qualifications and duties of whom have been fully dealt with in the previous section.
Rearing by Hand.—When from one or other of the causes already mentioned the mother is unable to nurse her child, and when, as frequently happens, especially among the working classes and the poor, the services of a wet nurse cannot be had, nothing remains but to bring the child up artificially, or "by hand," as it is called.
This is the most difficult kind of bringing up to accomplish satisfactorily, and many more hand-fed children die than those brought up at the breast.
There are three kinds of milk, any one of which may serve as a substitute for the breast milk. These are, the milk of the ass, the goat and the cow, in the order given. Cow's milk is the substitute generally adopted, but in order to make it more closely resemble human breast milk, it must be diluted with water, sweetened with sugar, and cream added.
The milk should be boiled and given at a temperature of 96° F., which is that of the human breast milk. The quantity given at a time will have to be increased with the growth of the child, but after the first few days are over it may be laid down, as a rule, that three or ​four ounces are sufficient at each meal. Of course, when the teeth begin to appear, other articles of food require to be given as well.
A regular method of feeding should be practised from the first, and a sufficient interval must be allowed to elapse between one meal and another, in order that the act of digestion may be completed.
For the first month the child may be fed every two and a half or three hours during the day, and every four hours during the night, as in the case of a breast-fed child. From this time onwards the child should be fed at regular intervals of three hours, from five in the morning till eleven at night. It should not be fed between 11 p.m. and 5 a.m. For the first month 1 part of boiled milk to 2 parts of boiled water should be given, gradually increasing the proportion of milk till at the beginning of the ninth month the infant is taking equal parts of boiled milk and water.
A teaspoonful of cream should be added to each feed, and one lump sugar.
In feeding infants at birth and during the first few weeks of their existence, it is necessary to know the size of the infant's stomach in order that the amount given at each meal is not greater than the infant can digest. At birth the stomach holds about three tablespoonfuls, and its capacity gradually increases as the child grows. At eight months the capacity is five times as great.
There are two methods that may be employed in this artificial system of feeding—the one is to give the child its meals from a spoon, the other is to allow it to suck from a bottle. Of these the latter is preferable.
It is most essential to the success of this method of feeding that the bottle or bottles be kept scrupulously clean, as dirty bottles frequently give rise to "thrush." The best form of bottle to use is the boat-shaped one, with a rubber nipple fixed to the end or neck. No bottles with rubber tubes should be used, since milk sticks to the inside of the tube, and cannot be removed. This milk when decomposed will set up diarrhœa. The bottle and teat must be scalded after each meal in hot water and soda, the teat turned inside out, and both rinsed in cold water. They then should be allowed to stand in cold water in which a little boracic acid has been dissolved.
No more food should be made than will serve for one time.
When the teeth begin to appear, which is usually about the sixth or seventh month, the diet requires alteration, but milk must still constitute the chief item of food. In addition, the child may have Mellin's food, some of Allen and Hanbury's prepared foods, Robb's biscuits, Robinson's groats, etc.
When the larger double teeth make their appearance, it is regarded as a sign that a further change in the diet is now become necessary. Milk should continue to form a large part of the child's food, but, in addition, some beef-tea, chicken-tea or mutton broth may be given ​once a day in the forenoon. As a change, a little meat gravy with a mealy potato mashed up in it may be given. An egg lightly boiled, or one that has been placed for two minutes in boiling water, forms a very useful article of diet for young children, and one that is very nourishing. A little piece of some ripe fruit will not prove hurtful to most children, and so may be given sparingly, care being taken to remove all stones. Nuts and other husk fruits, which are difficult of digestion, should be avoided.
Children should not be allowed to eat between meals.
DISEASES OF INFANCY AND CHILDHOOD
Chicken-Pox.—This is a contagious but harmless disease of childhood attended by slight constitutional disturbance, as a rule, and after running its course for a few days ends in complete recovery. Often several children of the same family have it, one after the other. It effects both sexes alike and all classes indiscriminately. After a period of incubation of about a fortnight, a number of little red points suddenly appear on the skin, and in the course of 24 hours each has become a small blister, or vesicle, raised above the surface and surrounded by a pink areola or zone. The next day more red spots appear, which also form blisters, and so on for about 3 or 4 days fresh crops appear, the previous ones attaining a maturer stage. The eruption is most abundant on the back and front of the body. In about a week the vesicles begin to wither and dry up, and in a week or 10 days longer the scabs fall off, leaving as a rule no scar.
Treatment.—The child should be put to bed when the spots appear and prevented from scratching the pox by the use of fingerless gloves. Diet should be plain and simple, chiefly of milk and farinaceous foods. Medicine is not necessary. It should not be allowed to mix with other children till the scabs have fallen off; occasionally the little patient is restless and feverish, but in most cases it will play as cheerfully as usual and appear to have nothing the matter with it.
It is well to have medical advice in cases of suspected chicken-pox, as the resemblance between this disease and small-pox is so great. Also in many places chicken-pox is one of the diseases cases of which have to be notified to the local sanitary authorities.
Chilblains are most irritating to children. Common factors in their causation are wet boots and imperfectly fitting boots, which compress the feet and retard the circulation. Special attention should be paid to these points in the prevention of chilblains. Wet boots should be changed immediately on returning from a walk. The following is an excellent remedy for unbroken chilblains: hydrochloric acid, diluted, ¼ of an ounce, hydrocyanic acid, diluted, 30 drops; camphor water, 6 ounces. This chilblain lotion cures mild cases by one application. It is deadly poison, and should be kept under lock and key. A ​responsible person should apply it to the feet of children. This must not be applied to broken chilblains.
Convulsions.—Some children are much more liable to suffer from convulsions than others, owing to their nervous system being more impressionable.
Causes.—Difficulty in teething is a very frequent cause, the irritation of the gums affecting the brain; and when the cause of irritation is removed the convulsions disappear. Indigestible articles of food are another very frequent cause; fright may occasion convulsions, and anything profoundly affecting the mother, such as anger, terror, grief, may so act upon her when nursing as to give rise to convulsions in the infact from indigestion.
Symptoms.—Sometimes the convulsions are partial; thus an arm may twitch or certain portions of the face. The writer recollects being called to a child suffering from partial convulsions, whose mother, recognizing, from the inflamed condition of the gums, that the teething was at fault, took out her penknife and scratched the surface, which was really just what was required. Again, the convulsion may be general, when the muscles of the face, eyes, eyelids and limbs are in a violent state of rapid contraction alternating with relaxation. Froth may appear at the mouth, which, if the tongue has been bitten, will be tinged with blood. The head is generally thrown back, and the thumbs pressed in upon the palms of the hands.
Treatment.—If the teeth are plainly at fault, the gums must be scarified with a piece of lump sugar or lanced with a gum lancet, and 3 grains of bromide of potassium may be given in a little water. If due to some indigestible article of diet, it must be got rid of as soon as possible. A safe emetic is a teaspoonful of ipecacuanha wine in tepid water; drinks of tepid water being afterwards given. This, of course, is only to be given if it is thought that some indigestible article of food has given rise to the convulsions, and if too long a time has not elapsed since it was swallowed. If some hours have elapsed, it will be better to give a teaspoonful of castor-oil. The following mixture will be found useful, and may be given to children from 1 to 3 years old: bromide of potassium, 2 drachms; iodide of potassium, half a drachm; syrup of orange peel, 1 ounce; water to make 4 ounces. A teaspoonful every 3 hours, till all tendency to twitching of the muscles has passed away. Another very useful item of treatment is a warm bath or a pack. A sheet should be wrung out of hot water and wrapped round the child from the neck downwards, and over this one or two blankets. The child should remain in this for 1 hour, after which time it may be taken out and dried with warm towels. Or the child may be immersed in a warm bath up to the neck, or put in a hip-bath with as much water as can be got into it, so as to cover as much of the body as possible. A tablespoonful of mustard added to the water will, by acting as a counter irritant, increase the efficacy of the bath. It should ​remain in this for about 15 minutes, during which cold cloths may be applied to the head, and then be put to bed.
Croup.—Croup means obstruction to inspiration associated with noisy breathing. It is a very common symptom of diphtheria when it has invaded the larynx; in fact, this disease was formerly known as membranous croup. Medical assistance should be summoned without delay. Croup is, however, very frequently the result of simple congestion of the larynx, or of merely spasmodic contraction; in which cases it is of far less serious import than when diphtheria is the cause.
Symptoms.—Croup is attended by very noisy inspiration, on account of the narrowed condition of the glottis preventing the free entrance of air into the lungs. The child feels as if it were about to be choked, and makes violent efforts with the muscles of the chest to increase the supply of air within.
Treatment.—Croup is a condition in which no delay should take place in treatment, as imminent danger may ensue from suffocation. Give the child a hot bath at once, then put it to bed between hot blankets. Wring sponges out of hot water, and apply them constantly to the throat. A bronchitis or other kettle should be kept boiling in the room, as the steam from this often has a very beneficial effect on the dyspnœa, or breathing trouble. Vomiting should be induced by doses of ipecacuanha wine as prescribed in "What to Do in Case of Accident."
After an attack care should be taken not to expose the child to draughts; flannel should be worn next to the skin, and the feet kept warm and dry.
’Diarrhœa.'—The causes of diarrhoea in children being very varied, it is necessary, as far as possible, to determine what it is in each case; thus, for instance, teething is a very frequent cause when it is difficult and accompanied by a good deal of irritation. When the tooth is cut, the irritation ceases, and the diarrhœa passes away. Again, cold may give rise to diarrhœa, from the impression made upon the nerves of the skin. This is frequently seen in children who toss the bed-clothes off during sleep. Fright may also give rise to diarrhœa, and of course, the eating of indigestible articles of food will do the same. A frequent cause of diarrhœa in infants is an overloaded condition of the stomach, or the giving of unsuitable articles of diet.
Treatment.—Diarrhœa in children ought never to be neglected, as, if allowed to run on from day to day, it weakens the child, and may pass into inflammation of the bowels, a much more serious disorder. If the diet appear to be at fault, it must be corrected. Suppose, for instance, that the child, previous to the cutting of the teeth, has been given solid food; the probability is that this has disagreed and set up irritation in the bowels, causing the diarrhœa. In such a case nothing but milk should be given for food, to which a little lime-water may be added with advantage, and a dose of castor-oil administered.
If the diarrhœa has continued for any length of time it is necessary ​to check it at once. For this purpose a little chalk mixture may be given—half to 1 teaspoonful every 4 hours to a child two or three years old. This may be combined with a little opium, as follows: laudanum, 4 drops; tincture of catechu, 2 drachms; chalk mixture to make 2 ounces; 1 teaspoonful to be given every 4 hours.
Diphtheria.—This disease is characterized by sore throat and fever, which begins insidiously, and by enlargement and tenderness of the glands under the angle of the jaw. Examination of the throat will show the uvula red and swollen, and the tonsils much inflamed, with greyish patches of membrane on them. There may be croupous breathing, from the larynx being involved in the disease. Medical assistance must be called in immediately, as the recovery or death of the patient may be determined by the quickness with which treatment is applied.
Treatment consists in the injection of an antitoxin serum, painting of the throat with an antiseptic—lactic acid 1 part to 7 of water is a good application—and suitable stimulating medicines.
In view of the infectiousness of the disease, the patient must be isolated, a carbolized sheet being hung over the room door; a carbolic spray should be frequently used about the room, and the attendants must be careful not to inhale the patient's breath. As a precautionary measure, they may use an antiseptic gargle or mouthwash themselves, remembering that being careful does not argue being cowardly. A steam kettle is useful, in keeping the atmosphere of the room moist and warm.
Measles.—This is an infectious febrile disorder. It is nearly always more or less prevalent in this country; but at times it spreads with great rapidity, and sometimes causes death. As a rule, children and young people are attacked, but the general exemption of adults is probably due only to the fact that most of them have had the disease in childhood. Second attacks are not unknown.
Symptoms.—Before the appearance of the rash there are some precursory symptoms; the patient feels languid and hot, there is shivering, followed by a rise of temperature, a quick pulse, thirst, loss of appetite, and sickness. The eyes become red and watery, and give the patient the appearance of having cried; the membrane which lines the nose, throat, larynx and trachea is red and swollen, and pours forth a watery secretion; thus the affected person appears to have a severe cold, with running from the eyes and nose. There is generally much sneezing with a slightly sore throat and a dry, harsh cough. Convulsions occasionally occur in children. After these symptoms have lasted 3 or 4 days the rash appears. It begins in very small papules or minute red pimples, which rapidly multiply, and these run together into patches which have a tendency to a horse-shoe, or crescent, shape, while the portions of skin between are of a natural colour. Commencing on the face and neck, the blotches spread to the arms, then the trunk of the ​body, and gradually reach the lower extremities. When the eruption has disappeared the part of the skin affected is covered with a dry scurf.
Complications are liable to occur. Convulsions at the commencement are usually without danger; if they come on at the end of the disease they may lead to a fatal issue. Inflammation of the lungs and bronchitis, which may prove fatal to young children, may ensue if the patient is allowed to take a chill. The eruptions turning of a dark purple colour is a symptom of danger.
Treatment.—The child must be kept in bed. The room should be airy and well ventilated, but the patient must not be exposed to draughts. All discharges should be removed at once, and dirty linen taken away and disinfected. A fire should be kept burning, and the temperature of the room maintained about 60° or 65° F. The blinds should be kept down on account of the patient's eyes, and the bed should be turned so that he lies with his back to the light. In all cases it is advisable to give the patient a hot bath at the very onset of the disease; then dry the surface of the body, and put to bed directly. All sources of annoyance and irritation and all noises should be avoided. The food should be of the simplest nature: milk, milk and water, chicken broth, beef-tea, and toast and water. When the fever subsides a small piece of chicken or fried sole may be eaten, with toast or bread and butter; a fresh egg may also be given. As the tongue cleans and the appetite returns, the patient may be allowed to resume his ordinary diet. Although children generally recover rapidly, yet there are times when much debility ensues, and the general health becomes impaired, although the fever has quite left. Children who are in bad health are liable to lumps or glandular swellings of the neck and under the jaws, or they may remain weak for a long time. In these cases chemical food may be used with advantage; Parrish's Syrup is another name for this. It may be given in doses of 5 to 10 drops 3 times a day in a little water, to children 2 or 3 years old. Fellow's Syrup of the Hypophosphites is a very useful preparation in such cases, and may be given in doses of 5 drops largely diluted with water, 3 times a day, immediately after food. The following mixture is useful: steel drops, 1 drachm; solution of chloride of calcium, 3 drachms; glycerine, half an ounce; add water to 4 ounces. 1 teaspoonful for a child from 3 to 5 years old in water 3 times a day. A visit to the seaside is very beneficial.
Mumps is a very infectious febrile disease, accompanied by swelling of the parotid salivary gland in front of and beneath the ears. The patient complains of slight malaise for a day or two, and then the swelling appears, at first on one side, generally commencing beneath the ear, and coming forwards on to the cheek, followed in a day or so by a similar swelling on the other side of the face. Sometimes both the swellings appear simultaneously; sometimes only one side is affected. The swelling is usually painful, especially during deglutition. ​Treatment.—If there is much pain, hot fomentations with poppy-heads should be applied, but if not it will be sufficient simply to keep the head tied up in flannel. Very occasionally an abscess may form on one side or other. This will require energetic medical treatment. Usually no medicine will be required, except a simple aperient at the commencement of the attack, and during convalescence the following prescription: tincture of steel, 1 drachm; glycerine, 4 drachms; water to 6 ozs: give 1 tablespoonful 3 times a day for a child of ten. While there is fever the patient should be kept in bed; and cold must be avoided throughout the course of the disease.
Night Terrors.—The sudden awakenings of children apparently suffering from some dreadful delusion, and screaming, generally occur during the period of second dentition, and are found associated with some error of diet and indigestion. They will soon disappear if attention is paid to the digestion, and any errors of feeding corrected. Mild purgation is advisable.
Rickets generally makes its first appearance between the ages of 6 months and 2 years. The causes are unsuitable food and unhealthy conditions of life, while hereditary influences may have some effect in producing the disease. The early symptoms are restlessness at night, and free perspiration in the head while sleeping. These are followed by enlargement of the ends of the bones of the arms and legs at the wrists, knees and ankles. The head also enlarges, and the fontanelles do not close, the forehead becoming square and prominent. The long bones soften and bend, the limbs becoming crooked, and the chest "pigeon breasted." The health becomes poor, the patient showing undue susceptibility to chills, and disorders of the nervous system.
Treatment consists primarily in removing the cause of the trouble. Nourishing and digestible food should be given, with a due supply of animal broths, fish and meat, according to the age of the child. The ventilation of the bedroom and day-room should be free, and any sanitary defects remedied. Daily tepid, or still better, if they can be borne, cold baths are advisable. Warm clothing should be worn, and as much open air and sunshine as possible obtained. The tendency to bandy legs must be corrected by splints, and by keeping the child off its legs. The only medicine of use is cod-liver oil, which should be taken in as large doses as can be digested.
Ringworm.—This disease is caused by the growth in the skin of a low form of vegetable life allied to ordinary mould. When some of the scales of a hair affected with ringworm are placed in liquid, and magnified about 300 times, the spores or seeds, and the mycelium or thread of the fungus, can readily be seen.
Ringworm of the scalp is sometimes a most intractable disease, especially when it has been existent for some time before its discovery; and its cure will tax the resources of the most experienced doctors to their utmost. Therefore prompt and vigorous treatment is essential. ​It shows itself as a dry scurfy or scaly condition of some portion of the scalp, generally in separate patches more or less circular, on which the hairs are broken off, and the surface presents a dirty appearance, with some redness beneath.
On the face, body or limbs the disease appears in the form of rings of various sizes, generally pretty round and of a reddish colour; they commence as minute points, and increase in size somewhat rapidly, healing in the centre as the disease progresses centrifugally. As the disease is contagious, children suffering from it must not go to school or play with others till they are cured.
Treatment.—The daily application of dilute nitrate of mercury ointment or ammoniated mercury ointment is generally sufficient to effect a cure. Amongst the popular remedies are ink and vinegar. Strong acetic acid is a useful preparation. It should be used once and well rubbed in; after that ammoniated mercury ointment may be used daily. The liniment of iodine is also a most useful preparation. It should be applied by means of a camel-hair brush or feather, and repeated in a few days if necessary. Great cleanliness is essential in this affection, and if the disease is situated on the scalp, the hair must be cut away for some little distance round the diseased patch before applying the remedy.
Teething.—The period of teething is one which is looked upon by many mothers with dread. Owing to the greater irritability of the system usually found to exist at that time, children are more susceptible to certain diseases; and in order that everything may be done on the mother's part to guard against these, it is well that she should be familiar with the usual time of appearance of the teeth, and with a few hints that may be of service in maintaining the health of the child during this period.
The first, or temporary, teeth, 20 in all, generally begin to make their appearance between the fifth and eighth months in the following order: the 2 central front teeth of the lower jaw, called central incisors; the corresponding teeth in the upper jaw; 2 lower and 2 upper lateral incisors; the 4 first molars; the 4 canines (the 2 upper of which are popularly called eye-teeth); and, lastly, the 4 second molars.
The symptoms of troublesome teething are most perceptible to the mother: the child sucks feebly, and its gums are hot, inflamed and swollen. In this case, relief is yielded by rubbing the gums with the finger or a teething ring from time to time. Selfish and thoughtless nurses, and mothers too sometimes, give cordials and sleeping-draughts, the effects of which are too well known.
During the cutting of the temporary teeth, the infant's head should be kept cool, and its feet and hands warm. The body clothing should be light but warm. The apartments occupied by the child should be rather cool at this time. If the bowels are confined, the diet should be altered, and a little calcined magnesia given in milk. ​Weak and improper food is often the cause of tardy teething. Children should be washed daily, and always kept sweet and clean.
Thrush.—This is a common affection in infants. It may be seen in the mouth as small white specks on the lining membrane. The malady is due to the Saccharomycetes albicans, and is often due to mal-nutrition and bad feeding, especially to dirty bottles or teats, and sour milk. The swallowing of food becomes difficult, there is thirst, and the water is scanty and high-coloured.
Treatment.—If the infant is bottle-fed, see that everything is scrupulously clean. If breast-fed, a nipple shield should be used, otherwise the nipple will become irritated. Give a little lime-water in the milk, in the proportion of 1 to 4 parts. Paint the mouth frequently with glycerine and borax, or honey and borax, using a feather or small camel-hair brush; or dissolve some powdered borax in water (4 grains borax to 1 ounce of water), and apply in the same way. Should this fail, wipe the mouth out thoroughly with a soft wet rag, and then rub some flowers of sulphur on the white patches with the finger. Great attention must be paid to the diet, and any errors must at once be corrected. If the stomach is disordered and the motions offensive, benefit may be derived by giving the child one of the following powders twice a day: grey powder, 6 grains; bicarbonate of soda, 18 grains; powdered rhubarb, 8 grains. Mix and divide into 6 powders; 1 twice a day to a child a year old. Change of air when the child is getting better will often work wonders.
Whooping-Cough.—This is an infectious disease of great frequency in childhood, and a large proportion of infant mortality is due to this cause.
Symptoms.—The earliest symptom is a common cold or catarrh, accompanied by a cough; there is also a slight amount of fever, restlessness, and sometimes running at the eyes and nose. The cough in a few days becomes most troublesome; in a week or 10 days, but often later, the child will begin to have the characteristic whoop; the cough comes on in paroxysms, more frequently by night than by day; each paroxysm begins with a deep and loud inspiration, followed by a succession of short and sharp expirations, again followed by a deep inspiration, and the repeated expirations; this may go on several times, and last 1 or 2 minutes, according to the severity of the case. Just before each attack comes on, the child clings to its nurse or mother. During the paroxysm it sits in an erect position, the face is flushed, the veins in the head and face prominent, the eyes suffused and watery, and generally there is some glairy fluid expelled from the mouth, or vomiting may come on. After the paroxysm the child will rest for a time, and appear pretty well until the next attack. These symptoms last for 3 or 4 weeks, and then the cough abates in severity and frequency, and finally ceases altogether. If it comes on during the winter the cough may last six or seven weeks, unless extra care is taken. In ​most cases there is some bronchitis attending this complaint, shown by the hurried breathing and rise of temperature, and by the rattling noises over the chest.
Treatment.—In all cases it is best for the child to be kept in the house as soon as the malady has declared itself; in a very mild case it need not be kept in bed, but it should be in a room of warm and even temperature, and protected from draught; it can then be allowed to play about as it likes. If there is any lung affection, it must be put to bed and treated according to the requirements of the case. Other children must not be allowed to come near it, unless they have had an attack previously, in order that its spreading may be prevented. The child must be fed in the usual way, but solid food should be given sparingly, and the stomach must not be over-loaded, as vomiting is often a symptom. Steel wine is very valuable in cases of whooping-cough, and more especially when there is no fever and during convalescence; it may also stop the diarrhœa, which is now and then present. Numberless remedies have been tried for whooping-cough, but as many of them are powerful and require careful watching, they ought only to be given under medical direction. Some sweet mucilaginous fluid may be given, such as the mucilage of gum acacia mixed with glycerine, in the proportion of 1 teaspoonful of the latter to 1 tablespoonful of the former; a teaspoonful of this being given to a child 3 or 4 years old 3 or 4 times a day. A cresolene lamp has often a good effect, or a little pure carbolic acid may be put in a saucer over a nightlight. Warm clothing should be worn; and during convalescence a nourishing diet, moderate exercise in the open air when fine, a tepid bath in the morning, and a tonic, such as steel wine or cod-liver oil, are enjoined. A visit to the seaside, seven weeks from the onset, will frequently complete a cure.
Worms principally affecting children are of two kinds the small threadworms, usually seen in large numbers, and causing great irritation, and the larger round worm, generally seen singly, and which is of about the same size and shape as the common earthworm.
Worms are the torment of some children; the symptoms are an unnatural craving for food, even after a full meal; costiveness, suddenly followed by looseness; fetid breath, a livid circle under the eyes, enlarged abdomen, and picking the nose; for which the remedies must be prescribed by the doctor, but sugar preserves and green vegetables must be avoided in the diet.
| Disease. | Infection after an attack ceases. | Quarantine required after latest exposure to infection. |
| Chicken Pox | When every scab has fallen off. | Twenty days. |
| Diphtheria | Four weeks after the commencement of attack, if no complications. | Twelve days. |
| German Measles. | Ten days after appearance of the rash. | Twenty days. |
| Measles | Two weeks after appearance of the rash. | Sixteen days. |
| Mumps | Three weeks, or one week after disappearance of the swelling. | Twenty-four days. |
| Ringworm | When examination shows no broken hairs, and no spores. |
| Scarlet Fever | Six weeks, or when sore throat, albuminuria and desquamation have disappeared. | Ten days. |
| Small Pox | When every scab has fallen off. | Sixteen days. |
| Typhus Fever | Four weeks | Fourteen days. |
| Whooping Cough | Five weeks, or two weeks after cough and whooping have disappeared. | Twenty-one days. |
| | N.B.—In each case the number of weeks mentioned represents the shortest time. |
This table accords with the Code of Rules laid down by the Association of Medical Officers of Schools.