Chapter III: Part I: Infancy (2)

Very little sugar should be used in the food, as much sugar weakens the digestion. A small pinch of table-salt ought to be added to whatever food is given, as "the best savour is salt." Salt is most wholesome--it strengthens and assists digestion, prevents the formation of worms, and, in small quantities, may with advantage be given (if artificial food be used) to the youngest baby.

35. _Where it is found to be absolutely necessary to give an infant artificial food_ WHILST SUCKLING, _how often ought he to be fed_?

Not oftener than twice during the twenty four hours, and then only in _small_ quantities at a time, as the stomach requires rest, and at the same time, can manage to digest a little food better than it can a great deal. Let me again urge upon you the importance, if it be at all practicable, of keeping the child _entirely_ to the breast for the first five or six months of his existence. Remember there is no _real_ substitute for a mother's milk, there is no food so well adapted to his stomach, there is no diet equal to it in developing muscle, in making bone, or in producing that beautiful plump rounded contour of the limbs, there is nothing like a mother's milk _alone_ in making a child contented and happy, in laying the foundation of a healthy constitution, in preparing the body for a long life, in giving him tone to resist disease, or in causing him to cut his teeth easily and well, in short, _the mothers milk is the greatest temporal blessing an infant can possess_.

As a general rule, therefore, when the child and the mother are tolerably strong, he is better _without artificial_ food until he have attained the age of three or four months, then, it will usually be necessary to feed him with _The Milk-water-and-sugar-of milk Food_ (see p 19) twice a day, so as gradually to prepare him to be weaned (if possible) at the end of nine months. The food mentioned in the foregoing Conversation will, when he is six or seven months old, be the best for him.

36. _When the mother is not able to suckle her infant herself, what ought to be done_?

It must first be ascertained, _beyond all doubt_, that a mother is not able to suckle her own child Many delicate ladies do suckle their infants with advantage, not only to their offspring, but to themselves. "I will maintain," says Steele, "that the mother grows stronger by it, and will have her health better than she would have otherwise She will find it the greatest cure, and preservative for the vapours [nervousness] and future miscarriages, much beyond any other remedy whatsoever Her children will be like giants, whereas otherwise they are but living shadows, and like unripe fruit, and certainly if a woman is strong enough to bring forth a child, she is beyond all doubt strong enough to nurse it afterwards."

Many mothers are never so well as when they are nursing, besides, suckling prevents a lady from becoming pregnant so frequently as she otherwise would. This, if she be delicate, is an important consideration, and more especially if she be subject to miscarry. The effects of miscarriage are far more weakening than those of suckling.

A hireling, let her be ever so well inclined, can never have the affection and unceasing assiduity of a mother, and, therefore, cannot perform the duties of suckling with equal advantage to the baby.

The number of children who die under five years of age is enormous--many of them from the want of the mother's milk. There is a regular "parental baby-slaughter"--"a massacre of the innocents"-- constantly going on in England, in consequence of infants being thus deprived of their proper nutriment and just dues! The mortality from this cause is frightful, chiefly occurring among rich people who are either too grand, or, from luxury, too delicate to perform such duties; poor married women, as a rule, nurse their own children, and, in consequence reap their reward.

If it be ascertained, _past all doubt_, that a mother cannot suckle her child, then, if the circumstances of the parents will allow--and they ought to strain a point to accomplish it--a healthy wet-nurse should be procured, as, of course, the food which nature has supplied is far, very far superior to any invented by art. Never bring up a baby, then, if you can possibly avoid it, on _artificial_ food. Remember, as I proved in a former Conversation, there is in early infancy no _real_ substitute for either a mother's or a wet-nurse's milk. It is impossible to imitate the admirable and subtle chemistry of nature. The law of nature is, that a baby, for the first few months of his existence, shall be brought up by the breast, and nature's law cannot be broken with impunity. [Footnote: For further reasons why artificial food is not desirable, at an early period of infancy, see answer to 35th question, page 26.] It will be imperatively necessary then--

"To give to nature what is nature's due."

Again, in case of a severe illness occurring during the first nine months of a child's life, what a comfort either the mother's or the wet-nurse's milk is to him! It often determines whether he shall live or die. But if a wet-nurse cannot fill the place of a mother, then asses' milk will be found the best substitute, as it approaches nearer, in composition, than any other animal's, to human milk; but it is both difficult and expensive to obtain. The next best substitute is goats' milk. Either the one or the other ought to be milked fresh and fresh, when wanted, and should be given by means of a feeding-bottle. Asses' milk is more suitable for a _delicate_ infant, and goats' milk for a _strong_ one.

If neither asses' milk nor goats' milk can be procured, then the following _Milk-water-salt-and-sugar Food_, from the very commencement, should be given; and as I was the author of the formula, [Footnote: It first appeared in print in the 4th edition of _Advice to a Mother_, 1852.] I beg to designate it as--_Rye Chavasse's Milk Food_:--

New milk, the produce of ONE _healthy_ cow;
Warm water, of each, equal parts;
Table salt, a few grains--a small pinch;
Lump sugar, a sufficient quantity, to slightly sweeten it.

The milk itself ought not to be heated over the fire, [Footnote: It now and then happens that if the milk be not boiled, the motions of an infant are offensive; _when such is the case_, let the milk be boiled, but not otherwise.] but should, as above directed, be warmed by the water; it must, morning and evening, be had fresh and fresh. The milk and water should be of the same temperature as the mother's milk, that is to say, at about ninety degrees Fahrenheit. It ought to be given by means of either Morgan's, or Maw's, or Mather's feeding-bottle, [Footnote: See answer to Question 24, page 24.] and care must be taken to _scald_ the bottle out twice a day, for if attention be not paid to this point, the delicate stomach of an infant is soon disordered. The milk should, as he grows older, be gradually increased and the water decreased, until two-thirds of milk and one-third of water be used; but remember, that either _much_ or _little_ water must _always_ be given with the milk.

The above is my old form, and which I have for many years used with great success. Where the above food does not agree (and no food except a healthy mother's own milk does _invariably_ agree) I occasionally substitute sugar-of milt for the lump sugar, in the proportion of a tea spoonful of sugar-of milk to every half pint of food.

If your child bring up his food, and if the ejected matter be sour-smelling, I should advise you to leave out the sugar-of milk altogether, and simply to let the child live, for a few days, on milk and water alone, the milk being of _one_ cow, and in the proportion of two-thirds to one-third of _warm_ water--not _hot_ water, the milk should not be scalded with _hot_ water, as it injures its properties, besides, it is only necessary to give the child his food with the chill just off. The above food, where the stomach is disordered, is an admirable one, and will often set the child to rights without giving him any medicine whatever. Moreover, there is plenty of nourishment in it to make the babe thrive, for after all it is the milk that is the important ingredient in all the foods of infants, they can live on it, and on it alone, and thrive amazingly.

Mothers sometimes say to me, that farinaceous food makes their babes flatulent, and that my food (_Pye Chavasse's Milk Food_) has not that effect.

The reason of farinaceous food making babes, until they have _commenced_ cutting their teeth, "windy" is, that the starch of the farinaceous food (and all farinaceous foods contain more or less of starch) is not digested, and is not, as it ought to be, converted by the saliva into sugar [Footnote: See Pye Chavasse's _Counsel to a Mother_, 3d edition.] hence "wind" is generated, and pain and convulsions often follow in the train.

The great desideratum, in devising an infant's formula for food, is to make it, until he be nine months old, to resemble as much as possible, a mother's own milk, and which my formula, as nearly as is practicable, does resemble hence its success and popularity.

As soon as a child begins to cut his teeth the case is altered, and _farinaceous food, with milk and with water_, becomes an absolute necessity.

I wish, then, to call your especial attention to the following-facts, for they are facts--Farinaceous foods, _of all kinds_, before a child _commences_ cutting his teeth (which is when he is about six or seven months old) are worse than useless--they are, positively, injurious, they are, during the early period of infant life, perfectly indigestible, and may bring on--which they frequently do-- convulsions. A babe fed on farinaceous food alone would certainly die of starvation, for, "up to six or seven months of age, infants have not the power of digesting farinaceous or fibrinous substances"--Dr Letheby on _Food_.

A babe's salivary glands, until he be six or seven months old, does not secrete its proper fluid--namely, ptyalin, and consequently the starch of the farinaceous food--and all farinaceous food contains starch--is not converted into dextrine and grape-sugar, and is, therefore, perfectly indigestible and useless--nay, injurious to an infant, and may bring on pain and convulsions, and even death, hence, the giving of farinaceous food, until a child be six or seven months old, is one and the principal cause of the frightful infant mortality at the present time existing in England, and which is a disgrace to any civilized land!

In passing, allow me to urge you never to stuff a babe--never to overload his little stomach with food, it is far more desirable to give him a little not enough, than to give him a little too much. Many a poor child has been, like a young bird, killed with stuffing. If a child be at the breast, and at the breast alone, there is no fear of his taking too much, but if he be brought up on artificial food, there is great fear of his over loading his stomach. Stuffing a child brings on vomiting and bowel-complaints, and a host of other diseases which now it would be tedious to enumerate. Let me, then, urge you on no account, to over load the stomach of a little child.

There will, then, in many cases, be quite sufficient nourishment in the above. I have known some robust infants brought up on it, and on it along, without a particle of farinaceous food, or of any other food, in any shape or form whatever. But if it should not agree with the child, or if there should not be sufficient nourishment in it, then the food recommended in answer to No. 34 question ought to be given, with this only difference--a little new milk must from the beginning be added, and should be gradually increased, until nearly all milk be used.

The milk, as a general rule, ought to be _unboiled_; but if it purge violently, or if it cause offensive motions--which it sometimes does--then it must be boiled. The moment the milk boils up, it should be taken off the fire.

Food ought for the first month to be given about every two hours; for the second month, about every three hours; lengthening the space of time as the baby advances in age. A mother must be careful not to over-feed a child, as over-feeding is a prolific source of disease.

Let it be thoroughly understood, and let there be no mistake about it, that a babe during the first nine months of his life, MUST have--it is absolutely necessary for his very existence--milk of some kind, as the staple and principal article of his diet, either mother's, wet-nurse's, or asses', or goats', or cow's milk.

37. _How would you choose a wet-nurse_?

I would inquire particularly into the state of her health; whether she be of a healthy family, of a consumptive habit, or if she or any of her family have laboured under "king's evil;" ascertaining if there be any seams or swellings about her neck; any eruptions or blotches upon her skin; if she has a plentiful breast of milk, and if it be of good quality [Footnote: "It should be thin, and of a bluish-white colour, sweet to the taste, and when allowed to stand, should throw up a considerable quantity of cream,"--_Maxell and Evenson on the Diseases of Children_.] (which may readily be ascertained by milking a little into a glass); if she has good nipples, sufficiently long for the baby to hold; that they be not sore; and if her own child be of the same, or nearly of the same age, as the one you wish her to nurse. Ascertain, whether she menstruate during suckling; if she does, the milk is not so good and nourishing, and you had better decline taking her. [Footnote: Sir Charles Locock considers that a woman who menstruates during lactation is objectionable as a wet-nurse, and "that as a mother with her first child is more liable to that objection, that a second or third child's mother is more eligible than a first"--_Letter to the Author_.] Assure yourself that her own babe is strong and healthy that he be free from a sore mouth, and from a "breaking-out" of the skin. Indeed, if it be possible to procure such a wet-nurse, she ought to be from the country, of ruddy complexion, of clear skin, and of between twenty and five-and-twenty years of age, an the milk will then be fresh, pure, and nourishing.

I consider it to be of great importance that the infant of the wet-nurse should be, as nearly as possible, of the same age as your own, as the milk varies in quality according to the age of the child. For instance, during the commencement of suckling, the milk is thick and creamy, similar to the biestings of a cow, which, if given to a babe of a few months old, would cause derangement of the stomach and bowels. After the first few days, the appearance of the milk changes; it becomes of a bluish-white colour, and contains less nourishment. The milk gradually becomes more and more nourishing as the infant becomes older and requires more support.

In selecting a wet-nurse for a very small and feeble babe, you must carefully ascertain that the nipples of the wet-nurse are good and soft, and yet not very large. If they be very large, the child's mouth being very small, he may not be able to hold them. You must note, too, whether the milk flows readily from the nipple into the child's mouth; if it does not, he may not have strength to draw it, and he would soon die of starvation. The only way of ascertaining whether the infant really draws the milk from the nipple, can be done by examining the mouth of the child _immediately_ after his taking the breast, and seeing for yourself whether there be actually milk, or not, in his mouth.

Very feeble new-born babes sometimes cannot take the bosom, be the nipples and the breasts ever so good, and although Maw's nipple-shield and glass tube had been tried. In such a case, cow's milk-water-sugar-and-salt, as recommended at page 29, must be given in small quantities at a time--from two to four tea-spoonfuls--but frequently; if the child be awake, every hour, or every half hour, both night and day, until he be able to take the breast. If, then, a puny, feeble babe is only able to take but little at a time, and that little by tea-spoonfuls, he must have little and often, in order that "many a little might make a mickle."

I have known many puny, delicate children who had not strength to hold the nipple in their mouths, but who could take milk and water (as above recommended) by tea-spoonfuls only at a time, with steady perseverance, and giving it every half hour or hour (according to the quantity swallowed), at length be able to take the breast, and eventually become strong and hearty children; but such cases require unwearied watching, perseverance, and care. Bear in mind, then, that the smaller the quantity of the milk and water given at a time, the oftener must it be administered, as, of course, the babe must have a certain quantity of food to sustain life.

38. _What ought to be the diet either of a wet-nurse, or of a mother, who is suckling_?

It is a common practice to cram a wet-nurse with food, and to give her strong ale to drink, to make good nourishment and plentiful milk! This practice is absurd; for it either, by making the nurse feverish, makes the milk more sparing than usual, or it causes the milk to be gross and unwholesome. On the other hand, we must not run into an opposite extreme. The mother, or the wet-nurse, by using those means most conducive to her own health, will best advance the interest of her little charge.

A wet-nurse, ought to live somewhat in the following way:--Let her for breakfast have black tea, with one or two slices of cold meat, if her appetite demand it, but not otherwise. It is customary for a wet-nurse to make a hearty luncheon; of this I do not approve. If she feel either faint or low at eleven o'clock, let her have either a tumbler of porter, or of mild fresh ale, with a piece of dry toast soaked in it. She ought not to dine later than half-past one or two o'clock; she should eat, for dinner, either mutton or beef, with either mealy potatoes, or asparagus, or French beans, or secale, or turnips, or broccoli, or cauliflower, and stale bread. Rich pastry, soups, gravies, high-seasoned dishes, salted meats, greens, and cabbage, must one and all be carefully avoided; as they only tend to disorder the stomach, and thus to deteriorate the milk.

It is a common remark, that "a mother who is suckling may eat anything." I do not agree with this opinion. Can impure or improper food make pure and proper milk, or can impure and improper milk make good blood for an infant, and thus good health?

The wet-nurse ought to take with her dinner a moderate quantity of either sound porter, or of mild (but not old or strong) ale. Tea should be taken at half past five or six o'clock; supper at nine, which should consist either of a slice or two of cold meat, or of cheese if she prefer it, with half a pint of porter or of mild ale; occasionally a basin of gruel may with advantage be substituted. Hot and late suppers are prejudicial to the mother, or to the wet-nurse, and, consequently, to the child. The wet-nurse ought to be in bed every night by ten o'clock.

It might be said, that I have been too minute and particular in my rules for a wet-nurse; but when it is considered of what importance good milk is to the well-doing of an infant, in making him strong and robust, not only now, but as he grows up to manhood, I shall, I trust, be excused for my prolixity.

39. _Have you any more hints to offer with regard to the management of a wet-nurse_?

A wet-nurse is frequently allowed to remain in bed until a late hour in the morning, and during the day to continue in the house, as if she were a fixture! How is it possible that any one, under such treatment, can continue healthy! A wet nurse ought to rise early, and, if the weather and season will permit, take a walk, which will give her an appetite for breakfast, and will make a good meal for her little charge. This, of course, cannot, during the winter mouths, be done; but even then, she ought, some part of the day, to take every opportunity of walking out; indeed, in the summer time she should live half the day in the open air.

She ought strictly to avoid crowded rooms; her mind should be kept calm and unruffled, as nothing disorders the milk so much as passion, and other violent emotions of the mind; a fretful temper is very injurious, on which account you should, in choosing your wet-nurse, endeavour to procure one of a mild, calm, and placid disposition. [Footnote: "'The child is poisoned.'

'Poisoned! by whom?'

'By you. You have been fretting.'

'Nay, indeed, mother. How can I help fretting!'

'Don't tell me, Margaret. A nursing mother has no business to fret. She must turn her mind away from her grief to the comfort that lies in her lap. Know you not that the child pines if the mother vexes herself?'"--_The Cloister and the Hearth_. By Charles Reade.]

A wet-nurse ought never to be allowed to dose her little charge either with Godfrey's Cordial, or with Dalby's Carminative, or with Syrup of White Poppies, or with medicine of any kind whatever. Let her thoroughly understand this, and let there be no mistake in the matter. Do not for one moment allow your children's health to be tampered and trifled with. A baby's health is too precious to be doctored, to be experimented upon, and to be ruined by an ignorant person.

40. _Have the goodness to state at what age a child ought to be weaned_?

This, of course, must depend both upon the strength of the child, and upon the health of the parent; on an average, nine months is the proper time. If the mother be delicate, it may be found necessary to wean the infant at six months; or if he be weak, or labouring under any disease, it may be well to continue suckling him for twelve months; but after that time, the breast will do him more harm than good, and will, moreover, injure the mother's health, and may, if she be so predisposed, excite consumption.

41. _How would you recommend a mother to act when, she weans her child_?

She ought, as the word signifies, do it gradually--that is to say, she should, by degrees, give him less and less of the breast, and more and more of artificial food; at length, she must only suckle him at night; and lastly, it would be well for the mother either to send him away, or to leave him at home, and, for a few days, to go away herself.

A good plan is, for the nurse-maid to have a half-pint bottle of new milk--which has been previously boiled [Footnote: The previous boiling of the milk will prevent the warmth of the bed turning the milk sour, which it otherwise would do.]--in the bed, so as to give a little to him in lieu of the breast. The warmth of the body will keep the milk of a proper temperature, and will supersede the use of lamps, of candle-frames, and of other troublesome contrivances.

42. _While a mother is weaning her infant, and after she have weaned him, what ought to be his diet_?

Any one of the foods recommended in answer to question 34.

43. _If a child be suffering severely from "wind," is there any objection to the addition of a small quantity either of gin or of peppermint to his food to disperse it_?

It is a murderous practice to add either gin or peppermint of the shops (which is oil of peppermint dissolved in spirits) to his food. Many children have, by such a practice, been made puny and delicate, and have gradually dropped into an untimely grave. An infant who is kept, for the first five or six months, _entirely_ to the breast--more especially if the mother be careful in her own diet--seldom suffers from "wind;" those, on the contrary, who have much or improper food, [Footnote: For the first five or six months never, if you can possibly avoid it, give artificial food to an infant who is sucking. There is nothing, in the generality of cases, that agrees, for the first few months, like the mother's milk _alone_.] suffer severely.

Care in feeding, then, is the grand preventative of "wind;" but if, notwithstanding all your precautions, the child be troubled with flatulence, the remedies recommended under the head of Flatulence will generally answer the purpose.

44. _Have you any remarks to make on sugar for sweetening a baby's food_?

A _small_ quantity of sugar in an infant's food is requisite, sugar being nourishing and fattening, and making cow's milk to resemble somewhat, in its properties human milk; but, bear in mind, _it must be used sparingly._ _Much_ sugar cloys the stomach, weakens the digestion, produces acidity, sour belchings, and wind:--

"Things sweet to taste, prove in digestion sour."

_Shakspeare._

If a babe's bowels be either regular or relaxed, _lump_ sugar is the best for the purpose of sweetening his food; if his bowels are inclined to be costive, _raw_ sugar ought to be substituted for lump sugar, as _raw_ sugar acts on a young babe as an aperient, and, in the generality of cases, is far preferable to physicking him with opening medicine. An infant's bowels, whenever it be practicable (and it generally is), ought to be regulated by a judicious dietary rather than by physic.

VACCINATION AND RE-VACCINATION.

45. _Are you an advocate for vaccination_?

Certainly. I consider it to be one of the greatest blessings ever conferred upon mankind. Small-pox, before vaccination was adopted, ravaged the country like a plague, and carried off thousands annually; and those who did escape with their lives were frequently made loathsome and disgusting objects by it. Even inoculation (which is cutting for the small-pox) was attended with danger, more especially to the unprotected--as it caused the disease to spread like wildfire, and thus it carried off immense numbers.

Vaccination is one, and an important cause of our increasing population; small-pox, in olden times, decimated the country.

46. _But vaccination does not always protect a child from, small-pox_?

I grant you that it does not _always_ protect him, _neither does inoculation_; but when he is vaccinated, if he take the infection, he is seldom pitted, and very rarely dies, and the disease assumes a comparatively mild form. There are a few, very few fatal cases recorded after vaccination, and these may be considered as only exceptions to the general rule; and, possibly, some of these may be traced to the arm, when the child was vaccinated, not having taken proper effect.

If children, and adults were _re-vaccinated_,--say every seven years after the first vaccination,--depend upon it, even these rare cases would not occur, and in a short time small-pox would be known only by name.

47. _Do you consider it, then, the imperative duty of a mother, in every case, to have, after the lapse of every seven years, her children re-vaccinated_?

I decidedly do: it would be an excellent plan for _every_ person, once every seven years to be re-vaccinated, and even oftener, if small-pox be rife in the neighbourhood. Vaccination, however frequently performed, can never do the slightest harm, and might do inestimable good. Small-pox is both a pest and a disgrace, and ought to be constantly fought and battled with, until it be banished (which it may readily be) the kingdom.

I say that small-pox is a pest; it is worse than the plague, for if not kept in subjection, it is more general--sparing neither young nor old, rich nor poor, and commits greater ravages than the plague ever did. Small-pox is a disgrace: it is a disgrace to any civilised land, as there is no necessity for its presence, if cow-pox were properly and frequently performed, small-pox would be unknown. Cow-pox is a weapon to conquer small-pox and to drive it ignominiously from the field.

My firm belief, then, is, that if _every_ person were, _every seven years_, duly and properly vaccinated, small-pox might be utterly exterminated; but as long as there are such lax notions on the subject, and such gross negligence, the disease will always be rampant, for the poison of small-pox never slumbers nor sleeps, but requires the utmost diligence to eradicate it. The great Dr Jenner, the discoverer of cow-pox as a preventative of small-pox, strongly advocated the absolute necessity of _every_ person being re-vaccinated once every seven years, or even, oftener, if there was an epidemic of small-pox in the neighbourhood.

48. _Are you not likely to catch not only the cow-pox, but any other disease that the child has from whom the matter is taken_?

The same objection holds good in cutting for small pox (inoculation)--only in a ten-fold degree--small-pox being such a disgusting complaint. Inoculated small-pox frequently produced and left behind inveterate "breakings-out," scars, cicatrices, and indentations of the skin, sore eyes, blindness, loss of eyelashes, scrofula, deafness--indeed, a long catalogue of loathsome diseases. A medical man, of course, will be careful to take the cow-pox matter from a healthy child.

49. _Would it not be well to take the matter direct from the cow_?

If a doctor be careful--which, of course, he will be--to take the matter from a healthy child, and from a well-formed vesicle, I consider it better than taking it _direct_ from the cow, for the following reasons:--The cow-pox lymph, taken direct from the cow, produces much more violent symptoms than after it has passed through several persons; indeed, in some cases, it has produced effects as severe as cutting for the small-pox, besides, it has caused, in many cases, violent inflammation and even sloughing of the arm. There are also several kinds of _spurious_ cow-pox to which the cow is subject, and which would be likely to be mistaken for the _real_ lymph. Again, if even the _genuine_ matter were not taken from the cow _exactly_ at the proper time, it would he deprived of its protecting power.

50. _At what age do you recommend an infant to be first vaccinated_?

When he is two months old, as the sooner he is protected the better. Moreover, the older he is the greater will be the difficulty in making him submit to the operation, and in preventing his arm from being rubbed, thus endangering the breaking of the vesicles, and thereby interfering with its effects. If small-pox be prevalent in the neighbourhood, he may, with perfect safety, be vaccinated at the month's end; indeed if the small-pox be near at hand, he _must_ be vaccinated, regardless of his age, and regardless of everything else, for small-pox spares neither the young nor the old, and if a new-born babe should unfortunately catch the disease, he will most likely die, as at his tender age he would not have strength to battle with such a formidable enemy. "A case, in the General Lying-in-Hospital, Lambeth, of small-pox occurred in a woman a few days after her admission, and the birth of her child. Her own child was vaccinated when only four days old, and all the other infants in the house varying from one day to a fortnight and more. All took the vaccination; and the woman's own child, which suckled her and slept with her; and all escaped the small pox." [Footnote: Communicated by Sir Charles Locock to the Author.]

51. _Do you consider that taking of matter from a child's arm weakens the effect of vaccination on the system_?

Certainly not, provided it has taken effect in more than one place. The arm is frequently much inflamed, and vaccinating other children from it abates the inflammation, and thus affords relief. _It is always well to leave one vesicle undisturbed_.

52. _If the infant have any "breaking out" upon the skin, ought that to be a reason for deferring the vaccination_?

It should, as two skin diseases cannot well go on together; hence the cow-pox might not take, or, if it did, might not have its proper effect in preventing small-pox. "It is essential that the vaccine bud or germ have a congenial soil, uncontaminated by another poison, which, like a weed, might choke its healthy growth."--_Dendy_. The moment the skin be free from the breaking-out, he must be vaccinated. A trifling skin affection, like red gum, unless it be severe, ought not, at the proper age to prevent vaccination. If small-pox be rife in the neighbourhood, the child _must_ be vaccinated, regardless of any "breaking-out" on the skin.

53. _Does vaccination make a child poorly_?

At about the fifth day after vaccination, and for three or four days, he is generally a little feverish; the mouth is slightly hot, and he delights to have the nipple in his mouth. He does not rest so well at night; he is rather cross and irritable; and, sometimes, has a slight bowel-complaint. The arm, about the ninth or tenth day, is usually much inflamed--that is to say it is, for an inch or two or more around the vesicles, red, hot, swollen, and continues in this state for a day or two, at the end of which time the inflammation gradually subsides. It might be well to state that the above slight symptoms are desirable, as it proves that the vaccination has had a proper effect on his system, and that, consequently, he is more likely to be thoroughly protected from any risk of catching small-pox.

54. _Do you approve, either during or after vaccination, of giving medicine, more especially if he be a little feverish_?

No, as it would be likely to work off some of its effects, and thus would rob the cow-pox of its efficacy on the system. I do not like to interfere with vaccination _in any way whatever_ (except, at the proper time, to take a little matter from the arm), but to allow the pock to have full power upon his constitution.

What do you give the medicine for? If the matter that is put into the arm be healthy, what need is there of physic! And if the matter be not of good quality, I am quite sure that no physic will make it so! Look, therefore, at the case in whatever way you like, physic after vaccination is _not_ necessary; but, on the contrary, hurtful. If the vaccination produce slight feverish attack, it will, without the administration of a particle of medicine, subside in two or three days.

55. _Have you any directions to give respecting the arm AFTER vaccination_?

The only precaution necessary is to take care that the arm be not rubbed; otherwise the vesicles may be prematurely broken, and the efficacy of the vaccination may be lessened. The sleeve, in vaccination, ought to be large and soft, and should not be tied up. The tying up of a sleeve makes it hard, and is much more likely to rub the vesicles than if it were put on the usual way.

56. _If the arm, AFTER vaccination, be much inflamed, what ought to be done_?

Smear frequently, by means of a feather or a camel's hair brush, a little cream on the inflamed part. This simple remedy will afford great comfort and relief.

57. _Have the goodness to describe the proper appearance, after the falling-off of the scab of the arm_?

It might be well to remark, that the scabs ought always to be allowed to fall off of themselves. They must not, on any account, be picked or meddled with. With regard to the proper appearance of the arm, after the falling-off of the scab, "a perfect vaccine scar should be of small size, circular, and marked with radiations and indentations."-- _Gregory_.

DENTITION

58. _At what time does dentition commence_?

The period at which it commences is uncertain. It may, as a rule, be said that a babe begins to cut his teeth at seven months old. Some have cut teeth at three months; indeed, there are instances on record of infants having been born with teeth. King Richard the Third is said to have been an example. Shakspeare notices it thus:--

"YORK.--Marry, they say my uncle grew so fast,
That he could gnaw a crust at two hours old.
'Twas full two years ere I could get a tooth,
Grandam, this would have been a biting jest."

When a babe is born with teeth, they generally drop out. On the other hand, teething, in some children does not commence until they are a year and a half or two years old, and, in rare cases, not until they are three years old. There are cases recorded of adults who have never cut any teeth. An instance of the kind came under my own observation.

Dentition has been known to occur in old age. A case is recorded by M. Carre, in the _Gazette Medicale de Paris_ (Sept 15, 1860), of an old lady, aged eighty-five, who cut several teeth after attaining that age!

59. _What is the number of the FIRST set of teeth, and in what order do they generally appear_?

The first or temporary set consists of twenty. The first set of teeth are usually cut in pairs. "I may say that nearly invariably the order is--1st, the lower front incissors [cutting teeth], then the upper front, then the _upper_ two lateral incissors, and that not uncommonly a double tooth is cut before the two _lower_ laterals; but at all events the lower laterals come 7th and 8th, and, not 5th and 6th, as nearly all books on the subject testify." [Footnote: Sir Charles Locock in a _Letter_ to the Author.] Then the first grinders, in the lower jaw, afterwards the first upper grinders, then the lower corner-pointed or canine teeth, after which the upper corner or eye-teeth, then the second grinders in the lower jaw, and lastly, the second grinders of the upper jaw. They do not, of course, always appear in this rotation. Nothing is more uncertain than the order of teething. A child seldom cuts his second grinders until after he is two years old. _He is, usually, from the time they first appear, two years in cutting the first set of teeth_. As a rule, therefore, a child of two years old has sixteen, and one of two years and a half old, twenty teeth.

60. _If an infant be feverish or irritable, or otherwise poorly, and if the gums be hot, swollen, and tender, are you an advocate for their being lanced_?

Certainly; by doing so he will, in the generality of instances, be almost instantly relieved.

61. _But it has been stated that lancing the gums hardens them_?

This is a mistake--it has a contrary effect. It is a well-known fact, that a part which has been divided gives way much more readily than one which has not been cut. Again, the tooth is bound down by a tight membrane, which, if not released by lancing, frequently brings on convulsions. If the symptoms be urgent, it may be necessary from time to time to repeat the lancing. It would, of course, be the height of folly to lance the gums unless they be hot and swollen, and unless the tooth, or the teeth, be near at hand. It is not to be considered a panacea for every baby's ill, although, in those cases where the lancing of the gums is indicated, the beneficial effect is sometimes almost magical.

62. _How ought the lancing of a child's gums to be performed_?

The proper person, of course, to lance his gums is a medical man. But if, perchance, you should be miles away and be out of the reach of one, it would be well for you to know how the operation ought to be performed. Well, then, let him lie on the nurse's lap upon his back, and let the nurse take hold of his hands in order that he may not interfere with the operation.

Then, _if it be the upper gum_ that requires lancing, you ought to go to the head of the child, looking over, as it were, and into his mouth, and should steady the gum with the index finger of your left hand; then, you should take hold of the gum-lancet with your right hand--holding as if it were a table-knife at dinner--and cut firmly along the inflamed and swollen gum and down to the tooth, until the edge of the gum-lancet grates on the tooth. Each incision ought to extend along the ridge of the gum to about the extent of each expected tooth.

_If it be the lower gum_ that requires lancing, you must go to the side of the child, and should steady the outside of the jaw with the fingers of the left hand, and the gum with the left thumb, and then you should perform the operation as before directed.

Although the lancing of the gums, to make it intelligible to a non-professional person, requires a long description, it is, in point of fact, a simple affair, is soon performed, and gives but little pain.

63. _If teething cause convulsions, what ought to be done_?

The first thing to be done (after sending for a medical man) is to freely dash water upon the face, and to sponge the head with cold water, and as soon as warm water can be procured, to put him into a warm bath [Footnote: For the precautions to be used in putting a child into a warm bath, see the answer to question on "Warm Baths."] of 98 degrees Fahrenheit. If a thermometer be not at hand, [Footnote: No family, where there are young children, should be without Fahrenheit's thermometer.] you must plunge your own elbow into the water: a comfortable heat for your elbow will be the proper heat for the infant. He must remain in the bath for a quarter of an hour, or until the fit be at an end. The body must, after coming out of the bath, be wiped with warm and dry and coarse towels; he ought then to be placed in a warm blanket. The gums must be lanced, and cold water should be applied to the head. An enema, composed of table salt, of olive oil, and warm oatmeal gruel--in the proportion of one table-spoonful of salt, of one of oil, and a tea-cupful of gruel--ought then to be administered, and should, until the bowels have been well opened, be repeated every quarter of an hour; as soon as he comes to himself a dose of aperient medicine ought to be given.

It may be well, for the comfort of a mother, to state that a child in convulsions is perfectly insensible to all pain whatever; indeed, a return to consciousness speedily puts convulsions to the rout.

64. _A nurse is in the habit of giving a child, who is teething, either coral, or ivory, to bite: do you approve of the plan_?

I think it a bad practice to give him any hard, unyielding substance, as it tends to harden the gums, and, by so doing, causes the teeth to come through with greater difficulty. I have found softer substances, such as either a piece of wax taper, or an India-rubber ring, or a piece of the best bridle leather, or a crust of bread, of great service. If a piece of crust be given as a gum-stick, he must, while biting it, be well watched, or by accident he might loosen a large piece of it, which might choke him. The pressure of any of these excites a more rapid absorption of the gum, and thus causes the tooth to come through more easily and quickly.

65. _Have you any objection to my baby, when he is cutting his teeth, sucking his thumb_?

Certainly not: the thumb is the best gum-stick in the world:--it is convenient; it is handy (in every sense of the word): it is of the right size, and of the proper consistence, neither too hard nor too soft; there is no danger, as of some artificial gum-sticks, of its being swallowed, and thus of its choking the child. The sucking of the thumb causes the salivary glands to pour out their contents, and thus not only to moisten the dry mouth, but assist the digestion; the pressure of the thumb eases, while the teeth are "breeding," the pain and irritation of the gums, and helps, when the teeth are sufficiently advanced, to bring them through the gums. Sucking of the thumb will often make a cross infant contended and happy, and will frequently induce a restless babe to fall into a sweet refreshing sleep. Truly may the thumb be called a baby's comfort. By all means, then, let your child suck his thumb whenever he likes, and as long as he chooses to do so.

There is a charming, bewitching little picture of a babe sucking his thumb in Kingsley's _Water Babies_, which I heartily commend to your favourable notice and study.

66. _But if an infant be allowed to suck his thumb, will it not be likely to become a habit, and stick to him for years--until, indeed, he become a big boy_?

After he have cut the whole of his first set of teeth, that is to say, when he is about two years and a half old, he might, if it be likely to become a habit, be readily cured by the following method, namely, by making a paste of aloes and water, and smearing it upon his thumb. One or two dressings will suffice as after just tasting the bitter aloes he will take a disgust to his former enjoyment, and the habit will at once be broken.

Many persons I know have an objection to children sucking their thumbs, as for instance,--

"Perhaps it's as well to keep children from plums,
And from pears in the season, and sucking their thumbs." [Footnote:
_Ingoldsby Legends_.]

My reply is,--

P'rhaps 'tis as well to keep children from pears;
The pain they might cause, is oft follow'd by tears;
'Tis certainly well to keep them from plums;
But certainly not from sucking their thumbs!
If a babe suck his thumb
'Tis an ease to his gum;
A comfort; a boon; a calmer of grief;
A friend in his need--affording relief;
A solace; a good; a soother of pain;
A composer to sleep; a charm; and a gain.

'Tis handy, at once, to his sweet mouth to glide;
When done with, drops gently down by his side;
'Tis fix'd, like an anchor, while the babe sleeps.
And the mother, with joy, her still vigil keeps.

67. _A child who is teething dribbles, and thereby wets his chest, which frequently causes him to catch cold; what had better be done_?

Have in readiness to put on several _flannel_ dribbling bibs, so that they may be changed as often as they become wet; or, if he dribble _very much_, the oiled silk dribbling-bibs, instead of the flannel ones, may be used, and which may be procured at any baby-linen ware house.

68. _Do you approve of giving a child, during teething, much fruit_?

No; unless it be a few ripe strawberries or raspberries, or a roasted apple, or the juice of five or six grapes--taking care that he does not swallow either the seeds or the skin--or the insides of ripe gooseberries, or an orange. Such fruits, if the bowels be in a costive state, will be particularly useful.

All stone fruit, _raw_ apples or pears, ought to be carefully avoided, as they not only disorder the stomach and the bowels,--causing convulsions, gripings, &c.,--but they have the effect of weakening the bowels, and thus of engendering worms.

69. _Is a child, during teething, more subject to disease, and, if so, to what complaints, and in what manner may they be prevented_?

The teeth are a fruitful source of suffering and of disease; and are, with truth, styled "our first and our last plagues." Dentition is the most important period of a child's life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching. When we consider how the teeth elongate and enlarge in his gums, pressing on the nerves and on the surrounding parts, and thus how frequently they produce pain, irritation, and inflammation; when we further contemplate what sympathy there is in the nervous system, and how susceptible the young are to pain, no surprise can be felt, at the immense disturbance, and the consequent suffering and danger frequently experienced by children while cutting their _first_ set of teeth. The complaints or the diseases induced by dentition are numberless, affecting almost every organ of the body,--the _brain_, occasioning convulsions, water on the brain, &c.; the _lungs_, producing congestion, inflammation, cough, &c.; the _stomach_, exciting sickness, flatulence, acidity, &c,; the _bowels_, inducing griping, at one time costiveness, and at another time purging; the _skin_, causing "breakings-out."

To prevent these diseases, means ought to be used to invigorate a child's constitution by plain, wholesome food, as recommended under the article of diet; by exercise and fresh air; [Footnote: The young of animals seldom suffer from cutting their teeth--and what is the reason? Because they live in the open air, and take plenty of exercise; while children are frequently cooped up in close rooms, and are not allowed the free use of their limbs. The value of fresh air is well exemplified in the Registrar-General's Report for 1843; he says that in 1,000,000 deaths, from all diseases, 616 occur in the town from teething while 120 only take place in the country from the same cause.] by allowing him, weather permitting, to be out of doors a great part of every day; by lancing the gums when they get red, hot, and swollen; by attention to the bowels, and if he suffer more than usual, by keeping them rather in a relaxed state by any simple aperient, such as either castor oil, or magnesia and rhubarb, &c.; and, let me add, by attention to his temper: many children are made feverish and ill by petting and spoiling them. On this subject I cannot do better than refer you to an excellent little work entitled Abbot's _Mother of Home_, wherein the author proves the great importance of _early_ training.

70. _Have the goodness to describe the symptoms and the treatment of Painful Dentition_?

Painful dentition may be divided into two forms--(1) the Mild; and (2) the Severe. In the _mild_ form the child is peevish and fretful, and puts his fingers, and everything within reach, to his mouth, he likes to have his gums rubbed, and takes the breast with avidity, indeed it seems a greater comfort to him than ever. There is generally a considerable flow of saliva, and he has frequently a more loose state of bowels than is his wont.

Now, with regard to the more _severe_ form of painful dentition--The gums are red, swollen, and hot, and he cannot without expressing pain bear to have them touched, hence, if he be at the breast, he is constantly loosing the nipple. There is dryness of the mouth, although before there had been a great flow of saliva. He is feverish, restless, and starts in his sleep. His face is flashed. His head is heavy and hot. He is sometimes convulsed. [Footnote: See answer to Question 63.] He is frequently violently griped and purged, and suffers severely from flatulence. He is predisposed to many and severe diseases.