The Maternal Management Of Children, In Health And Disease Part 2

It is, however, with the mother as a nurse that I have now to do, and I would earnestly advise every one of a consumptive or strumous habit (and if there is any doubt upon this point, the opinion of a medical adviser will at once decide it) never to suckle her offspring; her const.i.tution renders her unfit for the task. And, however painful it may be to her mind at every confinement to debar herself this delightful duty, she must recollect that it will be far better for her own health, and infinitely more so for that of the child, that she should not even attempt it; that her own health would be injured, and her infant's, sooner or later, destroyed by it.

The infant of a consumptive parent, however, must not be brought up by hand. It must have a young, healthy, and vigorous wet-nurse; and in selecting a woman for this important duty very great care must be observed.[FN#6] The child should be nursed until it is twelve or fifteen months old. In some cases it will be right to continue it until the first set of teeth have appeared, when it will be desirable that a fresh wet-nurse should be obtained for the last six months.[FN#7] If the child is partially fed during the latter months (from necessity or any other cause), the food should be of the lightest quality, and const.i.tute but a small proportion of its nutriment.

[FN#6] See "Choice of a Wet-nurse," p. 28.

[FN#7] One that has been confined about six weeks or two months.

But not only must the nourishment of such a child be regarded, but the air it breathes, and the exercise that is given to it; as also, the careful removal of all functional derangements as they occur, by a timely application to the medical attendant, and maintaining, especially, a healthy condition of the digestive organs. All these points must be strictly followed out, if any good is to be effected.

By a rigid attention to these measures the mother adopts the surest antidote, indirectly, to overcome the const.i.tutional predisposition to that disease, the seeds of which, if not inherited from the parent, are but too frequently developed in the infant during the period of nursing; and, at the same time, she takes the best means to engender a sound and healthy const.i.tution in her child. This, surely, is worth any sacrifice.

If the infant derives the disposition to a strumous const.i.tution entirely from the father, and the mother's health be unexceptionable, then I would strongly advise her to suckle her own child.

THE MOTHER OF A HIGHLY SUSCEPTIBLE NERVOUS TEMPERAMENT OUGHT NOT.--There are other women who ought never to become nurses. The mother of a highly nervous temperament, who is alarmed at any accidental change she may happen to notice in her infant's countenance, who is excited and agitated by the ordinary occurrences of the day; such a parent will do her offspring more harm than good by attempting to suckle it. Her milk will be totally unfit for its nourishment: at one time it will be deficient in quant.i.ty, at another, so depraved in its quality, that serious disturbance to the infant's health, will ensue. The young and inexperienced mother, who is a parent for the first time, and altogether ignorant of the duties of her office, and at the same time most anxious to fulfil them faithfully, is but too frequently an instance in point; although at a future period she will generally make a good nurse. The following is an ill.u.s.tration:--

In December, 1838, I attended a young married lady in her first confinement, and in excellent health. She gave birth to a fine, plump, healthy boy. Every thing went on well for three weeks, the mother having an abundant supply of milk, and the infant evidently thriving upon it. About this time, however, the child had frequent fits of crying; the bowels became obstinately costive;--the motions being lumpy, of a mixed colour, quite dry, and pa.s.sed with great pain. It became rapidly thin, and after a while its flesh so wasted, and became so flabby, that it might be said literally to hang on the bones. The fits of crying now increased in frequency and violence, coming on every time after the little one left the breast, when it would commence screaming violently, beat the air with its hands and feet, and nothing that was done could appease it. Having lasted for half an hour or more, it would fall asleep quite exhausted; the fit recurring again, when again it had been to the breast.

It was very evident that the infant's hunger was not satisfied, as it was also but too evident its body was not nourished by the parent's milk, which, although abundant in quant.i.ty (the breast being large and full of milk), was at this time seriously deteriorated in its nutritive quality. This was caused, I believe, from great anxiety of mind. Her nurse became suddenly deranged, and the whole responsibility and care of the child thus devolved upon the mother, of the duties connected with which she was entirely ignorant.

A wet-nurse was obtained. In a very few hours after this change was effected, the screaming ceased, the child had quiet and refres.h.i.+ng sleep, and in twelve hours a healthy motion was pa.s.sed. The child gained flesh almost as quickly as it had previously lost it, and is now as fine and healthy an infant as it promised to be when born.

Whenever there has existed previously any nervous or mental affection in the parent, wet-nurse suckling is always advisable; this, with judicious management of childhood, will do much to counteract the hereditary predisposition.

THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE OUGHT NOT.--The mother who cannot make up her mind exclusively to devote herself to the duties of a nurse, and give up all engagements that would interfere with her health, and so with the formation of healthy milk, and with the regular and stated periods of nursing her infant, ought never to suckle. It is unnecessary to say why; but I think it right, for the child's sake, to add, that if it does not sicken, pine, and die, disease will be generated in its const.i.tution, to manifest itself at some future period.

The child, then, under all the foregoing circ.u.mstances, must be provided with its support from another source, and a wet-nurse is the best.

2. WET-NURSE SUCKLING.

Ill health and many other circ.u.mstances may prevent a parent from suckling her child, and render a wet-nurse necessary. Now, although she will do wisely to leave the choice of one to her medical attendant, still, as some difficulty may attend this, and as most certainly the mother herself ought to be acquainted with the princ.i.p.al points to which his attention is directed in the selection of a good nurse, it will be well to point out in what they consist.

CHOICE OF A WET-NURSE.

The first thing to which a medical man looks, is the general health of the woman; next, the condition of her breast, the quality of her milk its age and her own; whether she is ever unwell while nursing; and, last of all, the condition and health of the child.

IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the marks of a sound const.i.tution, and ought to be free from all suspicion of a strumous character; her tongue clean, and digestion good; her teeth and gums sound and perfect; her skin free from eruption, and her breath sweet.

WHAT IS THE CONDITION OF THE BREAST?--A good breast should be firm and well formed; its size not dependent upon a large quant.i.ty of fat, which will generally take away from its firmness, giving it a flabby appearance, but upon its glandular structure, which conveys to the touch a knotted, irregular, and hard feel; and the nipple must be perfect, of moderate size, but well developed.

WHAT IS THE QUALITY OF THE MILK?--It should be thin, and of a bluish- white colour; sweet to the taste; and when allowed to stand, should throw up a considerable quant.i.ty of cream.

WHAT IS ITS AGE?--If the lying-in month of the patient has scarcely expired, the wet-nurse to be hired ought certainly not to have reached her second month. At this time, the nearer the birth of the child, and the delivery of its foster-parent, the better: the reason for which is, that during the first few weeks the milk is thinner and more watery than it afterwards becomes. If, consequently, a new-born infant be provided with a nurse, who has been delivered three or four months, the natural relation between its stomach and the quality of the milk is destroyed, and the infant suffers from the oppression of food too heavy for its digestive power.

On the other hand, if you are seeking a wet-nurse for an infant of four or five months old, it would be very prejudicial to transfer the child to a woman recently delivered; the milk would be too watery for its support, and its health in consequence would give way.

THE NURSE HERSELF SHOULD NOT BE TOO OLD!--A vigorous young woman from twenty-one to thirty admits of no question. And the woman who has had one or two children before is always to be preferred, as she will be likely to have more milk, and may also be supposed to have acquired some experience in the management of infants.

INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?--If so, reject her at once. You will have no difficulty in ascertaining this point; for this cla.s.s of persons have an idea that their milk is renewed, as they term it, by this circ.u.mstance, monthly; and, therefore, that it is a recommendation, rendering their milk fitter for younger children than it would otherwise have been. It produces, however, quite a contrary effect; it much impairs the milk, which will be found to disagree with the child, rendering it at first fretful,--after a time being vomited up, and productive of frequent watery dark green motions.

Last of all, WHAT IS THE CONDITION OF THE CHILD?--It ought to have the sprightly appearance of health, to bear the marks of being well nourished, its flesh firm, its skin clean and free from eruptions. It should be examined in this respect, particularly about the head, neck, and gums.

If a medical man finds that both mother and child answer to the above description, he has no hesitation in recommending the former as likely to prove a good wet-nurse.

DIET AND REGIMEN OF A WET-NURSE.

The regimen of a wet-nurse should not differ much from that to which she has been accustomed; and any change which it may be necessary to make in it should be gradual. It is erroneous to suppose that women when nursing require to be much more highly fed than at other times: a good nurse does not need this, and a bad one will not be the better for it. The quant.i.ty which many nurses eat and drink, and the indolent life which they too often lead, have the effect of deranging their digestive organs, and frequently induce a state of febrile excitement, which always diminishes, and even sometimes altogether disperses, the milk.

It will be necessary then to guard against the nurse overloading her stomach with a ma.s.s of indigestible food and drink. She should live as much as possible in the manner to which she has been accustomed; she should have a wholesome, mixed, animal and vegetable diet, and a moderate and somewhat extra quant.i.ty of malt liquor, provided it agree with her system.

A very prevailing notion exists that porter tends to produce a great flow of milk, and in consequence the wet-nurse is allowed as much as she likes; a large quant.i.ty is in this way taken, and after a short time so much febrile action excited in the system, that instead of increasing the flow of milk, it diminishes it greatly. Some parents, however, aware of this fact, will go into an opposite extreme, and refuse the nurse even that which is necessary. Either excess is of course wrong. It is difficult in general terms to say what ought to be considered a proper daily allowance, but some is in general necessary; and whenever a woman has been used to drink malt-liquor, she will rarely make a good wet-nurse if she is denied a reasonable quant.i.ty of that beverage. Good sound ale sometimes agrees better than porter. It may be well here to remark, that in London, I frequently meet with severe cases of diarrhoea in infants at the breast, fairly traceable to bad porter, which vitiating the quality of the milk, no medical treatment cures the disease, until this beverage is left off or changed, when it at once disappears.

The nurse should take exercise daily in the open air. Nothing tends more directly to maintain a good supply of healthy milk, than air and exercise; and the best wet-nurse would soon lose her milk, if constantly kept within doors. Sponging the whole body also with cold water with bay-salt in it every morning, should be insisted upon, if possible: it preserves cleanliness, and greatly invigorates the health.

United with this, the nurse should rise early, and also be regularly employed during the day in some little portion of duty in the family, an attendance upon the wants of the child not being alone sufficient.

An amiable disposition and good temper are very desirable. A violent fit of pa.s.sion may exert so peculiar an influence in changing the natural properties of the milk, that a child has been known to be attacked with a fit of convulsions after being suckled by a nurse while labouring under the effects of a fit of anger. The depressing pa.s.sions frequently drive the milk away altogether. It is hence of no small moment, that a wet-nurse be of a quiet and even temper, and not disposed to mental disturbance.

3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.

Extreme delicacy of const.i.tution, diseased condition of the frame, defective secretion of milk, and other causes, may forbid the mother suckling her child; and unless she can perform this office with safety to herself, and benefit to her infant, she ought not to attempt it. In this case a young and healthy wet-nurse is the best subst.i.tute; but even this resource is not always attainable. Under these circ.u.mstances, the child must be brought up on an artificial diet "by hand,"--as it is popularly called.