The Maternal Management Of Children, In Health And Disease Part 17

MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.

As must have been already seen, the maternal treatment chiefly consists in the removal of the cause of the disorder; medicine may occasionally be exhibited by the mother, but its use in her hands must be very limited indeed.

Unfortunately the general resource and only remedy of most mothers in affections of the stomach and bowels is an aperient, and a combination containing calomel is the one too frequently selected. The primary cause of the disorder is undetected, and consequently no measures taken for its removal, but purgative powder after purgative powder is given, the evil being supposed to rest in the bowels alone, and that such means must eventually get rid of it. The mother is not aware all this time that the real source of the derangement is probably in the diet itself; that there is some error here, and that unless this is corrected, the remedies must be worse than useless. The consequence of such a plan of proceeding is usually very sad; a confirmed and obstinate diarrhoea but too commonly ensues, and the infant is sometimes reduced to the last extremity.

The removal of the cause of the disorder, then, in a large number of instances of derangement of the stomach and bowels, if effected early, will cure the disease, and without further remedy. But it will be asked, by what method is this cause to be detected? In this way. In all human probability the primary cause of the disorder is connected with the diet; this is the case in ninety-nine instances out of a hundred.

Well, then, is the sick child at the breast? If so, ascertain whether the breast-milk is healthy and wholesome, or whether any circ.u.mstances exist which have rendered it otherwise? If nothing faulty is found here, the next question would naturally be, whether the rules and regulations laid down for suckling have been strictly adhered to? Or, whether the infant is sufficiently old to render it at all probable that a tooth may be irritating the gum?

Perhaps the child is being weaned; well, is there any error here? Is the change being attempted too early? or too suddenly and abruptly? If this is not the case, then, has the child been overfed, or is the food given of the proper description?

Is the child being brought up by hand? Then, there is every reason to suspect, either that the quality of the food given is not the most suitable, or, that the quant.i.ty exhibited is too great; in fact, that the rules laid down for "artificial feeding" have not been strictly acted upon.

By a mode of investigation like this, any defect or error in the dietetic management of the infant producing the disorder will be easily detected by a careful mother; and its correction alone will, in very many instances, be all that is necessary to remove the symptoms.

For example, if flatulence and griping, followed by diarrhoea, occur to an infant at the breast; if at the same time it becomes pale, its flesh flabby, its disposition fretful, always crying until it is put to the breast, the nipple of which it grasps eagerly, sucking eagerly, yet never satisfied, for its hunger continues, it is not nourished; if, too, the more it sucks, the more the stomach and bowels are deranged, the more it vomits and is purged; depend upon it the cause of all the evil will be found to be unwholesome milk. No medicine will avail any thing here; the cause must be removed; the best medicine, and the only remedy, is a breast of healthy milk. And if this is not procured early, there will be great danger of a diarrhoea setting in, which may probably prove fatal to the child.

Again; if there is simply vomiting of the breast-milk almost immediately after the child has been suckled, the milk coming up pure and unchanged, and discharged without any apparent effort, and the moment after the child is cheerful and happy, this will be found to depend upon repletion, and not upon unwholesome milk; in fact, the stomach has received too much. This must be prevented in future, not by giving medicine, but simply by removing the infant from the nipple immediately it ceases to draw strongly, the moment it begins to dally with the breast.

Again; if flatulence and griping occur to the child brought up by handy this derangement will generally be found to result from overfeeding: abstinence and diminution of the quant.i.ty of the food will generally be all that is necessary here. It will be well, however, for the mother in this case, and she may do it with the utmost safety, to unload the bowels of their indigestible contents by the exhibition of a tea-spoonful of castor oil. A dose or two of this medicine will effectually clear them out, without increasing the irritation, or weakening the child, whilst it will in most instances altogether remove the symptoms. If the flatulence, however, should continue, four or five grains of magnesia may be mixed with the last meal at night, and a little warm water thrown up into the bowel as an injection the next morning.

Diarrhoea occurring in a child brought up by hand, if it be not the result of overfeeding, will very frequently be found to arise from unsuitable diet, the food given not being of a kind suited to the infant's stomach; for what will agree with one child often disagrees with another. Alteration of diet will sometimes alone suffice in these cases to cure, if this alteration is only made early enough, before any considerable irritation of the stomach and bowels has been induced.

Thin arrow-root made with water (prepared very carefully, or the child will refuse it,) should be given for five or six days; the warm bath used every night for the same period, a new flannel bandage rolled round the body, and the child cautiously protected from a damp atmosphere. The arrow-root, upon the cessation of the diarrhoea, may have cows' milk added to it, if milk is not found to disagree: when this is the case, chicken or weak mutton broth, free from fat, or beef- tea, thickened with farinaceous food, with a little salt added, are the best subst.i.tutes. Should not the diarrhoea yield to the foregoing measures, and that readily, medical aid ought to be sought. Diarrhoea is very frequent from the time of weaning to the third year of age, and certainly in its effects forms so important a disease, that, unless in the slight form noticed above, a mother is not justified in attempting its relief.

In conclusion, I would observe, that I do not think a mother justified in attempting more than what has been laid down here for her guidance.

It is believed that the few and plain common-sense directions given, if followed, will do much to prevent disease, and even to relieve it in its milder forms; they will not, however, cure disease itself when really established: and again I would repeat, let the mother recollect that to prevent disease is her province--to cure it, is the physician's.

Sect. III.--COSTIVENESS.

1. IN INFANCY.

The principle to act upon in the management of the infant's bowels is this,--that they should be kept free, and by the mildest and least irritating means.

If therefore they become accidentally confined (less than two stools in the four-and-twenty hours), and the infant is suckled, the mother may ascertain whether an aperient taken by herself will render her milk of a sufficiently purgative quality to act upon the bowels of her child. This is the mildest mode of all.

If, however, this does not answer, or is not practicable from the child being fed artificially, then the mildest aperient medicines must be chosen to accomplish this purpose. The kind of medicine to be selected, and the doses in which to be adminstered, will be found in the section on "Aperient Medicine."[FN#39]

[FN#39] See page 97.

If, however, the bowels of the infant are disposed to be habitually confined, it should be ascertained whether this may not be dependent upon its diet. The same food that agrees perfectly well with one child will frequently cause costiveness in another. An intelligent and observing mother will soon discover whether this is the source of the mischief, or not. Boiled milk, for instance, will invariably cause confined bowels in some children; the same result will follow sago boiled in beef tea, with others; whilst, on the other hand, the bowels may frequently be brought into regular order, and their confined state overcome, by changing the food to Leman's tops and bottoms steeped in hot water, and a small quant.i.ty of unboiled milk added; or prepared barley, mixed in warm water and unboiled milk, will have the same effect.

Sometimes children are const.i.tutionally costive, that is, the bowels are relieved every third or fourth day, not oftener, and yet perfect health is enjoyed. This occasionally will happen in large families, all the children, though perfectly healthy and robust, being similarly affected. When such is found by a mother to be really the habit of her child, it would be very unwise, because injurious to its health, to attempt by purgatives to obtain more frequent relief. At the same time it will be prudent and necessary for her to watch that the regular time is not exceeded. This condition seldom occurs to the very young infant.

2. IN CHILDHOOD.

Children of sound health, who are judiciously fed, and have sufficient exercise, very seldom need aperient medicine. Errors in diet, a want of proper attention to the state of the skin, insufficiency of air and exercise, in fine, a neglect of those general principles which have been laid down for the management of health, and upon the observance of which the due and healthy performance of every function of the body depends, are the sources of bowel derangements, and particularly, at this age, of costiveness.

I feel a.s.sured, however, that some children are more troubled with costiveness than others, from the simple but important circ.u.mstance of their not being early taught the habit of relieving the bowels daily, and at a certain hour. There is a natural tendency to this periodical relief of the system, and it exists at the earliest age. And if the mother only cause this habit to be fairly established in infancy, she will do much towards promoting regularity of her child's bowels throughout life. The recollection of this fact, and the mother's acting upon it, is of the greatest importance to the future health and comfort of her children.

If the bowels are accidentally confined at this age, castor oil is certainly the best aperient that can be given: it acts mildly but efficiently, clearing out the bowels without irritating them. The dose must be regulated by the age, as also by the effect that aperients generally have upon the individual. Great care must in future be taken to avoid the cause or accidental circ.u.mstance which produced the irregularity.

When the bowels are habitually costive, much care and judgment is necessary for their relief and future management. Fortunately this condition is very rare in youth. The activity and exposure to the air, usual at this period of life, render purgatives unnecessary, unless, indeed (as just mentioned), some error in diet, or some unusual circ.u.mstance, render them accidentally confined. Should, however, the foregoing state exist, medicine alone will avail little; there are certain general measures which must also be acted up to, and most strictly, if the end is to be accomplished. They consist, princ.i.p.ally, in an observance of great regularity with respect to the time of taking food, its quality, quant.i.ty, and due mastication; regular and sufficient exercise, horse exercise being particularly serviceable; the shower-bath, or daily ablution; early rising (the indulgence in the habit of lying in bed always predisposing to constipation); and, lastly, the patient habituating himself to evacuate the bowels at a certain hour of the day. After breakfast appears to be the time when the bowels are more disposed to act than at any other part of the day; this is the time, then, that should be chosen.

All these points must be sedulously observed, and upon the principles laid down in the various chapters upon these subjects, if habitual costiveness is expected to be overcome.

SECT. IV.--WORMS.

NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF MISCHIEF.--Almost all diseases have been, at one time or other, attributed to the generation of worms in the intestines. And at the present day it is not at all an uncommon occurrence for medical men to be called in to prescribe for children, to whom the strongest purgative quack medicines have been previously exhibited by parents, for the removal of symptoms which, upon investigation, are found in no way connected with or produced by worms. The results of such errors are always, more or less, mischievous, and sometimes of so serious a nature as to lay the foundation of disease which ultimately proves fatal. This observation, moreover, it behoves a mother carefully to regard, since the symptoms, popularly supposed to indicate the existence of worms, are so deceptive, (and none more so than that which is usually so much depended upon--the picking of the nose,) that it may be positively a.s.serted to be impossible for an unprofessional person to form a correct and sound opinion in any of these cases.

It was at one time imagined, and the idea is still popularly current, that worms were the occasion of a troublesome and lingering species of fever, which was therefore designated worm-fever. This notion is now entirely exploded; for if worms be present under such circ.u.mstances, it is a mere accidental complication; the fever referred to being generally of a remitting character, and neither caused by or causing the generation of worms. The symptoms of this fever, however, have led and continue to lead very many astray. This is not surprising, since they so closely resemble those which characterise the presence of worms, that an unprofessional person is almost sure to be misled by them. Amongst other symptoms, there is the picking of the nose and lips, offensive breath, occasional vomiting, deranged bowels, pain in the head and belly, with a tumid and swollen condition of the latter, a short dry cough, wasting of the flesh, etc.; symptoms continually attendant upon the disorder now under consideration. These cases have hitherto been perpetually looked upon by mothers as worm-cases, and after having been treated by them as such, by the use of the popular worm-powders of the day, have, as perpetually, presented themselves to the physician greatly and grievously aggravated by such injudicious treatment. It is folly, at any time, for an unprofessional person to prescribe for a case where worms are actually known to exist: surely where there is any doubt upon the latter point it must be greater folly still.

The infant at the breast is seldom, if ever, the subject of this disorder, whilst an artificial diet, or bringing up by hand, predisposes to it. Worms most frequently occur, however, during childhood; much more so at this epoch than in adult age. They do not invariably occasion indisposition, for they are now and then pa.s.sed without pain or distress by children who are in the enjoyment of perfect health, and in whom previously there was not the slightest suspicion of their existence. The idea, formerly so prevalent, of their being attended with danger, is without foundation; for unless the case be mismanaged, they rarely give rise to serious consequences.

HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not very easy to explain; at the same time it is very certain that some known circ.u.mstances favour their production.

If the general health of a child be enfeebled, particularly if the child be strumous, such a condition will favour the generation of these animals. The protracted use of unwholesome and innutritious articles of food, or a deficient supply of salt (the most necessary stimulant to the digestive organs), or other condiments, predisposes to worms. This observation is strikingly ill.u.s.trated by an occurrence which formerly took place in Holland, where an ancient law existed forbidding salt in the bread of certain criminals; they were in consequence horribly infested with worms, and quickly died. Sugar, too, whilst a necessary condiment for the food of children, if given in the form of sweetmeats, and their indulgence, long persisted in, may so enfeeble the organs of digestion as to cause worms. And, lastly, (though many other causes might be referred to) the injudicious means occasionally employed to effect the removal of these animals, by the debility produced in the intestinal ca.n.a.l, favours not only their re-appearance but their increase.

These, then, are so many causes which may occasion worms in the child, and of course the best and most effectual method to prevent their production is their avoidance. A mother, therefore, should at all times be careful in the regulation of the diet and general management of her child's habits and health, even if no stronger obligations existed than the dread of this disorder; and she must be more than ordinarily vigilant on this head, when the slightest disposition to such disorder is manifested. Again; she must not forget that the symptoms so commonly ascribed as characteristic of worms are much more frequently caused by other diseases; that at no time, therefore, is she justified in giving worm powders, or strong doses of medicine for such symptoms; for if they do exist, their use is always attended with risk, and if they do not, the debility which they occasion in the stomach and bowels may itself become the source of their production.

Sect. V. SCARLET FEVER.

There are several varieties of this disease; it will be more perspicuous, however, for our purpose to speak of it under the two following forms:--