Chapter I (3)

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

CASTOR OIL

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

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

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

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

Under one year, one small tea-spoonful.

Under three years, two ditto.

Under six years, three ditto.

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

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

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

MANNA.

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

MAGNESIA AND RHUBARB.

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

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

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

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

Powdered rhubarb, half a drachm;

Magnesia, two scruples;

Compound spirits of ammonia, twenty drops;

Dill water, two ounces;

Simple syrup, two drachms.

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

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

THE LAVEMENT.

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

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

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

THE APERIENT LINIMENT.

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

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

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

Sect. II.--CALOMEL.

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

Its frequent exhibition has also another evil attending it, for "the immoderate use of mercury in early infancy produces more, perhaps, than any other similar cause, that universal tendency to decay, which, in many instances, destroys almost every tooth at an early age."[FN#20]

[FN#20] Bell on the Teeth.

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

Sect. III.--OPIATES.

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

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

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

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

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

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

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

Sect. IV.--LEECHING.

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

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

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

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

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

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

Sect. V.--BLISTERS AND POULTICES.

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

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

After a blister has been two or three hours applied, its edge should be carefully raised, to ascertain the effect produced; and if the surface be much inflamed, more particularly if little points of vesication (watery bladders) are present, it should be removed, and the above directions attended to.

Mustard poultices are invaluable in some of the diseases of infancy and childhood, and therefore frequently ordered.

A mustard poultice is made by mixing two thirds of mustard flour and one third of wheaten flour with warm water or vinegar, in sufficient quantity to render the powder of the consistence of paste. It is then spread on linen from the size of a half-crown to that of the palm of the hand, according to the effect intended, and placed on the skin. How long it is to be kept on will depend upon the individual sensibility of the skin of the child; but, in general, from fifteen to twenty minutes will be found amply sufficient. The application, however, must at all times be carefully watched; for if it remain on too long, ulceration, and death of the part, might ensue; therefore, directly the skin is found tolerably red, the poultice should be removed. After its removal, the part may be exposed, or, if very painful, smeared over with fresh cream or common cerate.

A bread and water poultice, although one of the commonest applications in use, is rarely well made or properly applied. It thus becomes injurious rather than useful; adding to the inflammation or irritation of the part, instead of soothing and allaying it. Nothing, however, is more simple than the mode of its preparation.

Cut slices of stale bread of sufficient quantity, scald out a bason, put the bread into it, pour upon it boiling water, cover it over, and let it stand for ten minutes; next strain the water oft, gently squeeze the saturated bread in a thin cloth, so that the poultice shall not be too moist, and then spread it upon a cloth so that it shall be in thickness half an inch, and of a size large enough to cover the whole of the inflamed part, and a little more. Apply it just warm enough to be borne, and cover it well with oiled silk. A poultice thus made, will act as a local tepid bath to the inflamed part; and the oiled silk preventing evaporation, it will be found, when taken off, as moist as the first moment that it was put on.

Sect. VI.--BATHS.

Baths are much resorted to during infancy and childhood, both in health and in disease. In the former state, they constitute an important measure of hygeiene (this has been briefly alluded to under the section "Bathing"), and in the latter, a valuable remedial agent. Their indiscriminate use, however, might be followed by serious consequences; it is therefore important to point out a few rules for their judicious employment.

THE COLD WATER PLUNGE BATH.

It consists of water in its natural degree of heat; its temperature varying, according to the season of the year or other circumstances, from 30 degrees to 60 degrees.

The phenomena produced upon a strong and healthy boy plunging into this bath will be as follows:--He will first experience a sensation of cold, followed by slight shuddering, and, if the immersion has been sudden, a peculiar impression in the nervous system, called a shock. Almost immediately after the shock, the feeling of cold will vanish, and give place to a sensation of warmth, speedily diffusing itself over the whole frame. If the boy leaves the bath at this time, or, at all events, before the warmth of the body goes off, and quickly dresses himself, a renewal of the reaction which had followed the shock of immersion will be experienced; he will be in a most delightful glow,-- there will be a general feeling of enjoyment, accompanied by a sensible increase of animal power, and invigoration of the whole system. But, on the other hand, if the boy greatly prolong his stay in the water, no reaction will ensue, and he will become chilly, which will gradually increase to a strong and general shivering;--his feet and legs will become benumbed, and the whole body will soon be languid, exhausted, and powerless. The same result will happen to the young and delicate infant, if plunged into this bath; the same sensations will be produced; except that here the shock is scarcely followed by any reaction, and therefore from the first moment of the immersion, the shivering and consequent train of sensations occur. This arises from the infant at birth having less power of producing heat than when further advanced in age.

From the foregoing remarks, then, it will be seen, that, in early infancy, the cold bath is inadmissible, and water of a higher temperature than that which feels cool to the hand of the nurse should always be used at this age. But that, as the child grows older,--if of a healthy and vigorous constitution,--the cold bath is unquestionably most desirable; and, if used in a proper manner, will be found to act as a most powerful tonic to the system. The summer is of course the only period of the year when the cold plunging bath can be resorted to for the child.

SEA BATHING.

When sea bathing can be obtained, it is even more conducive to the health of the child than the fresh water plunge bath; for the sea water is more tonic, stimulant, and bracing, than fresh. The period of the year best adapted for sea bathing is the summer and autumn. The best time of the day for bathing is two or three hours after breakfast; except in very hot weather, when an earlier hour must be chosen. Exercise is always useful previously to the bath; but it must be gentle, so as not to induce fatigue or much perspiration, Then the bath must be entered suddenly, with a plunge, inasmuch as an instantaneous immersion produces a greater reaction than a gradual immersion.[FN#22] The length of time of remaining in will depend upon circumstances. One dip only is enough at the first bath. Subsequently the time of remaining in the water may be prolonged, but this must be increased gradually; the positive necessity of leaving the bath while there still remains sufficient power of reaction being always kept in mind. Exercise in the water, particularly that of swimming, is highly useful. The body should be speedily and well dried, immediately upon coming out; a rough jack towel is an excellent means of accomplishing this purpose, while at the same time it insures considerable friction of the surface of the skin. If the boy is in sound health, he may bathe daily.

[FN#22] It is a matter of importance in bathing children, that they should not be terrified by the immersion, and every precaution should be taken to prevent this.

As a remedy, sea bathing is highly serviceable. Its employment, however, requires much caution, and great mischief is sometimes committed by its indiscriminate use.

The child of a strumous habit may be greatly benefited by sea bathing, united with a few years' residence on the coast. Indeed, by carefully following up a course of sea bathing, a suitable diet, and a judicious mode of living, the very temperament of the individual may be all but changed, and a power and activity imparted to the system, productive eventually of comparatively strong and robust health. A parent will do wisely, therefore, to send a child of such a habit to a school on the coast. Great caution, however, must be observed when bathing is commenced, lest the shock be too powerful for the energies of the system, and be not followed by the necessary degree of reaction. It will be prudent to begin with the tepid bath (85 degrees to 92 degrees), and gradually reduce the temperature until the open sea can be resorted to without fear. The measures already mentioned for promoting reaction--exercise previous to immersion; the immersion at first only momentary, and followed by strong friction--must be diligently regarded in such a case.

In the child of a delicate and feeble habit, much out of health, whose general debility is dependent on some organic disease, sea bathing is not only improper, but dangerous. Instead of being strengthened, such a child will be rendered more weak and debilitated. On the other hand, when the child is of a weak and relaxed habit, but free from organic disease, the cold bath will be highly useful, provided sufficient power of reaction exist in the system. In this case the skin and flesh of the child is relaxed and flabby; there is a great tendency to warm perspirations in bed, capricious appetite, confined or relaxed bowels, indisposition to exertion, and weariness from the slightest effort.

THE SHOWER BATH.

The effects of the shower bath are, on the whole, similar to those of the plunge bath of the same degree of temperature, except that the immediate shock of the shower bath is in general felt to be greater than that from simple immersion. This, however, may be met by putting warm water into the bottom of the bath in sufficient quantity to cover the ankles of the individual taking the bath, which tends at once to lessen the shock, and to increase the reaction.

The apprehension and alarm experienced by young children in entering this kind of bath is easily overcome, by using at first a modification of it, lately brought into use. It consists of a tin vessel in the form of a large bottle, pierced at the bottom like a colander, and terminating in the upper part in a narrow tube, with an open mouth. When put into water it becomes filled, which is retained by closing the mouth of the tube with the finger; on removing which the water flows gradually out of the sieve-like bottom in a gentle shower. This may be used to the youngest child. At first the quantity of water employed should be small, and its temperature warm; as, however, the child grows older and accustomed to the bath, the former may be increased, and the latter lowered. Its tonic effect may be augmented by the addition ofbay salt, and by much active rubbing.

As the child gets older the common form of shower bath may be used, and throughout the year, if he enjoy robust health; during the winter season, however, the water should be made tepid. This bath should be taken immediately upon rising from bed.

ABLUTION, OR SPONGING.

By ablution is meant the process of applying water to the surface of the body by means of a sponge or towel. It is one of the best substitutes for the cold bath; and if done quickly and thoroughly, produces a glow and invigoration of frame almost equal to the former. It is also the surest preventive against catching cold.

Every child in health ought to be obliged, every morning of its life (when other means of bathing cannot be obtained), upon rising, and while the body still retains all the warmth of the bed, to sponge the whole body. If too young to do it for himself, it must be done for him. Salt or vinegar should be added to the water; and if the boy be robust, cold water may be used throughout the year; if not, in the winter season it must be made tepid.

As a remedy, cold water sponging, and the application of ice and iced water, are often ordered under certain states of disease by the medical attendant, and frequently followed by delightful results. But it is necessary that they should be properly applied to do good.

Cold water sponging is a convenient and grateful method of moderating febrile heat of the surface, provided undoubted powers of reaction be present in the system. It is frequently ordered, therefore, to be employed in eruptive fevers, as measles, scarlet fever, smallpox, and other fevers; and also in some local inflammations, particularly of the brain. Vinegar may be added to the water under these circumstances with advantage. It should at first be used tepid or cool, but afterwards cold. As a general rule, the more dry and parched the heat of the surface, the more urgent the necessity for the application of the cold, and the more frequently and fearlessly ought it to be renewed,--every hour or half-hour not being too often. Should the child fall asleep during the process, and begin to perspire, it must be intermitted, but resumed again on a recurrence of the parching heat.

Ice and iced water are most frequently employed in affections of the brain. The former is most conveniently applied in a well-cleaned pig's bladder, which should be half filled with broken fragments of the ice. The bladder prevents moisture about the clothes, and, from its smooth and pliant nature, readily accommodates itself to every part of the child's head. If iced water is used, care must be taken that the cloths are sufficiently large to cover the whole of the head, and they should be doubled to prevent their getting rapidly warm. Indeed, in applying cold locally, as in inflammation of the brain, one rule it is of the utmost importance to observe, viz. that the application of the cold shall be continuous; therefore a second set of cold cloths or bags of ice should be applied before the former has become warm. This plan, especially pursued during the night, along with judicious internal treatment, will save many children from perishing under the most insidious and fatal disease of childhood--water on the brain.

If neither water of a sufficiently low temperature, nor ice, can be procured, then recourse may be had to refrigerating mixtures, of which the following is a good form:--

Common water, five pints; Vinegar, two pints; Nitre, eight ounces; Sal ammoniac, four ounces.

THE WARM BATH.

The warm bath judiciously prescribed is one of the most valuable remedial agents we possess; but although powerful for good, when misapplied, it is equally powerful for mischief. For instance, in active inflammatory affections, before the loss of blood, the use of the warm bath would greatly aggravate the disease; and yet, for an infant with active inflammation of the respiratory organs, it is continually resorted to. Again, nothing is more common than for a child, when attacked with convulsions, to be put immediately in the warm bath; and, generally speaking, it is extremely beneficial in this class of diseases; but it is sometimes no less prejudicial, when applied without due examination of the peculiarities of individual cases. For, in plethoric and gross children, the local abstraction of blood from the head, and the complete unloading of the alimentary canal, are often necessary to render such a measure beneficial, or even free from danger. In convulsions, however, and particularly when arising from teething, a parent may, without hesitation, at any time immerse the feet of the infant in water as warm as can be borne, at the same time that cloths wet with cold water are applied to the head and temples.

As a preventive, where there is a tendency to disease, the warm bath may be employed without scruple, and will be found most serviceable. Its value in this point of view is very great, and it is to be regretted that it is not sufficiently appreciated and used. For example, a severe cold has been taken, and inflammation of the air- tubes is threatened: only put the child into a warm bath, and, with the common domestic remedies, a very serious attack may be warded off. Again, in the commencement of a diarrhoea, a warm bath, and discontinuing the cause of the attack, will alone suffice to cure; and, more-over, in the protracted diarrhoea attendant upon teething, where, after various remedies have been tried in vain, the child has lost flesh and strength to an apparently hopeless degree, Recovery has been brought about by the simple use of the warm bath.

In the treatment of scrofulous children, warm and tepid bathing is of great value. In such cases, a course of warm sea bathing, with active friction over the whole surface after each bath, will at once relieve that abdominal fulness which is generally present, improve the functions of the skin, and give tone and vigour to the whole system. Towards the termination of such a course of baths, their temperature must be gradually reduced till they become tepid (85 degrees to 92 degrees).

The opinion that warm baths generally relax is erroneous: they are, no doubt, debilitating when used by persons of a weak and relaxed constitution, or when continued too long; but, on the contrary, they invariably give tone when employed in the cases to which they are properly applicable.

A partial warm bath, such as the foot-bath, is of much service in warding off many complaints. If a child get the feet wet, plunging them into warm water will often prevent any ill consequences; and even when the first chill and slight shiverings which usher in colds, fevers, and other inflammatory complaints, have been complained of, the disease may be cut short by the use of a foot-bath, continued till free perspiration occurs.

RULES FOR THE USE OF THE WARM BATH.

TEMPERATURE OF THE WATER.--When the warm bath is used as a measure of hygeiene, as a general rule, any degree of temperature may be chosen between 92 degrees and 98 degrees, which appears to be most agreeable to the child; but on no account must 98 degrees be exceeded. When ordered as a remedial measure, the temperature will of course be fixed by the medical attendant.

The same degree of temperature must be kept up during the whole period of immersion. For this purpose the thermometer must be kept in the bath, and additions of warm water made as the temperature is found to decrease. These additions of warm water, however, must be regulated by the indications of the thermometer, and not by the feelings of the child.

PERIOD OF REMAINING IN THE BATH.--This must depend upon circumstances. As a measure of hygeiene, it must be varied according to the age of the child. For the first four or five weeks, the infant should not be kept in beyond three or four minutes; and the duration must afterwards be gradually prolonged as the child advances in age, until it extends to a quarter of an hour, a period which may be allowed after it has attained the age of four years.

When the bath is employed as a remedial agent, the time of immersion must be prolonged; this will be determined by the medical adviser. Speaking generally, a quarter of an hour may be said to be the shortest period, an hour the longest, and half an hour the medium.

When in the bath, care must be taken that the child's body is immersed up to the shoulders or neck, otherwise that part of the body which is out of the bath (the shoulders, arms, and chest), being exposed to the cooler temperature of the air, will be chilled.

When the infant or child is taken out of the bath, the general surface, especially the feet, must be carefully rubbed dry with towels previously warmed; and when one of the objects of the bath is to excite much perspiration, the child should be immediately wrapped in flannel and put to bed. When, however, the object is not to excite perspiration, the child may be dressed in his ordinary clothing, but should not be allowed to expose himself to the open air for at least an hour.

TIME OF USING THE BATH.--When resorted to for sudden illness, the bath must of course be employed at any time needed. When used for any complaint of long standing, or a measure of hygeiene, as a general rule, it should be taken between breakfast and dinner, about two hours after the former, or an hour and a half before the latter. This implies that the infant should never be put into the bath after having been freely nourished at the breast. Neither should it ever be used when the child is in a state of free perspiration from exercise, or on awaking from sleep.

Chap. III.

OF TEETHING, AND HINTS ON THE PERMANENT OR ADULT TEETH.

The infant at birth has no teeth visible: the mouth is toothless. It possesses, however, hidden in the jaw, the rudiments of two sets. The first of these which makes its appearance, are called the Temporary or Milk Teeth; the second, the Permanent or Adult Teeth, and these come up as the former fall out, and so gradually replace them.

Sect. I.--ON TEETHING.

THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set of teeth, or milk-teeth as they are called, are twenty in number; they usually appear in pairs, and those of the lower jaw generally precede the corresponding ones of the upper. The first of the milk-teeth is generally cut about the sixth or seventh month, and the last of the set at various periods from the twentieth to the thirtieth months. Thus the whole period occupied by the first dentition may be estimated at from a year and a half to two years. The process varies, however, in different individuals, both as to its whole duration, and as to the periods and order in which the teeth make their appearance. It is unnecessary, however, to add more upon this point.

Their developement is a natural process. It is too frequently, however, rendered a painful and difficult one, by errors in the management of the regimen and health of the infant, previously to the coming of the teeth, and during the process itself.

Thus, chiefly in consequence of injudicious management, it is made the most critical period of childhood. Not that I believe the extent of mortality fairly traceable to it, is by any means so great as has been stated; for it is rated as high as one sixth of all the children who undergo it. Still, no one doubts that first dentition is frequently a period of great danger to the infant. It therefore becomes a very important question to an anxious and affectionate mother, how the dangers and difficulties of teething can in any degree be diminished, or, if possible, altogether prevented. A few hints upon this subject, then, may be useful. I shall consider, first, the management of the infant, when teething is accomplished without difficulty;--and, secondly, the management of the infant when it is attended with difficulty.

MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.

In the child of a healthy constitution, which has been properly, that is, naturally, fed, upon the milk of its mother alone, the symptoms attending teething will be of the mildest kind, and the management of the infant most simple and easy.

SYMPTOMS.--The symptoms of natural dentition (which this may be fairly called) are, an increased flow of saliva, with swelling and heat of the gums, and occasionally flushing of the cheeks. The child frequently thrusts its fingers, or any thing within its grasp, into its mouth. Its thirst is increased, and it takes the breast more frequently, though, from the tender state of the gums, for shorter periods than usual. It is fretful and restless; and sudden fits of crying and occasional starting from sleep, with a slight tendency to vomiting, and even looseness of the bowels, are not uncommon. Many of these symptoms often precede the appearance of the tooth by several weeks, and indicate that what is called "breeding the teeth" is going on. In such cases, the symptoms disappear in a few days, to recur again when the tooth approaches the surface of the gum.

TREATMENT.--The management of the infant in this case is very simple, and seldom calls for the interference of the medical attendant. The child ought to be much in the open air, and well exercised: the bowels should be kept freely open with castor oil; and be always gently relaxed at this time. Cold sponging employed daily, and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear; friction being very useful. The breast should be given often, but not for long at a time; the thirst will thus be allayed, the gums kept moist and relaxed, and their irritation soothed, without the stomach being overloaded. The mother must also carefully attend, at this time, to her own health and diet, and avoid all stimulant food or drinks.

From the moment dentition begins, pressure on the gums will be found to be agreeable to the child, by numbing the sensibility and dulling the pain. For this purpose coral is usually employed, or a piece of orris-root, or scraped liquorice root; a flat ivory ring, however, is far safer and better, for there is no danger of its being thrust into the eyes or nose. Gentle friction of the gums, also, by the finger of the nurse, is pleasing to the infant; and, as it seems to have some effect in allaying irritation, may be frequently resorted to. In France, and in this country also, it is very much the practice to dip the liquorice-root, and other substances, into honey, or powdered sugar-candy; and in Germany, a small bag, containing a mixture of sugar and spices, is given to the infant to suck, whenever it is fretful and uneasy during teething. The constant use, however, of sweet and stimulating ingredients must do injury to the stomach, and renders their employment very objectionable.

THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.

In the child which has been partly or altogether brought up by hand, or who is of a feeble and delicate constitution, or imbued with any hereditary taint, the process of dentition will be attended with more or less difficulty, and not unfrequendy with danger.

SYMPTOMS.--The symptoms of difficult dentition are of a much more aggravated description than those which attend the former case; and it is right that a mother should, to a certain extent, be acquainted with their character, that she may early request that medical aid, which, if judiciously applied, will mitigate, and generally quickly remove them.

Difficult dentition will be attended with painful inflammation and swelling of the gum, which is hotter, of a deeper red, than natural, and intolerant of the slightest pressure. There is often great determination of blood to the head, which a mother may recognise by the cheeks being red, hot, and swollen; the eyes red, irritable, and watery; and the saliva running from the mouth profusely. The fever is great, and the thirst extreme. The child is at one time restless and irritable, and at another heavy and oppressed: the sleep will be broken, and the infant frequently awake suddenly and in alarm from its short slumbers. Such are the chief symptoms of difficult teething, and which will be present to a greater or less degree.

TREATMENT.--As most of the above symptoms are induced by the painful tension of the gum, it would seem that the most rational mode of attempting their relief is by freely lancing the swollen part. Great prejudices, however, still exist in the minds of some parents against this operation. They think it gives great pain, and, if the tooth is not very near, makes its coming through the gum subsequently the more difficult.

With regard to the first objection, the lancet is carried through the gum so quickly, that this is hardly possible; and the fact that the infant will often smile in your face after it is done, although previously crying from pain, is sufficient evidence that it is not a very painful operation. In reference to the second, that the scar which ensues, opposes, by its hardness, the subsequent progress of the tooth, it is quite groundless; for cicatrices, like all other new-formed parts, are much more easily absorbed than the original structure.

Of the practical utility and perfect safety of this operation we have ample proof in its daily performance with impunity, and in the instant relief which it often affords to all the symptoms.

Mere scarifying the gums is sometimes all that is required, and will afford great relief. This operation, therefore, should not be opposed by the mother. She, at the same time, should be acquainted with its precise object, lest the speedy return of the symptoms, and the non- appearance of the expected tooth, might tend to bring the operation of lancing the gums into disrepute.

The parental management of the infant, then, and by which much of the pain and difficulty of teething may be removed or alleviated, consists in attending to the following directions:--

FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of the mother's duty to pay especial attention; and, by so doing, she will save her child much suffering. The condition of the mouth should be carefully inspected from time to time; and should a swollen gum be discovered, it should immediately be attended to, not waiting till constitutional symptoms appear before she employs proper aid for her child. For this purpose the mother should make herself familiar with the appearances of the gum under distention and inflammation; a matter of no difficulty, accompanied, as this condition usually is, by a profuse secretion of saliva, heat of mouth, and at a time when the age of the child justifies the supposition that it is about to cut its first tooth, or, if it have some teeth, that others are about to appear.

SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it should always have its quantity of nourishment diminished. If it is being fed, as well as nursed at the breast, at the time, the former should be immediately withheld: if it is being fed alone, the only kind of food that should be allowed is milk and water. These cases are much aggravated by the not uncommon habit of parents giving the infant food whenever it cries from the irritation attending upon the process; and thus a slightly difficult dentition is converted into serious disease.

THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched, that they may not become confined; it being necessary that they should be gently relaxed at this time. If a slight diarrhoea is present, it must not be checked; if it pass beyond this, however, medicine must be had recourse to, and great benefit will also arise from putting the child into a warm hip-bath, and warmly clothing the body, but keeping the head cool.

FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold water night and morning, and no other covering than that which nature has provided should be put upon it when within doors or asleep; and on no occasion should warm felt or velvet hats be worn during mild or warm weather, straw or white hats being much lighter and cooler. The child should be much in the open air.

The sponging of the infant's body daily, either with cold or tepid water, must depend upon the season of the year and constitution of the child, as well as upon other circumstances. Sponging the head with cold water night and morning is almost invariably atttended with great benefit, and may be resorted to in every case without fear; and now and then the use of the warm hip-bath, for several days together, will be ordered by the physician, which, by acting upon the skin, diminishes the determination of blood to the head, and thus forms an important source of relief.

FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not unfrequently excited by difficult teething, and then give great alarm to the parent, relief will be afforded by immersing the hips, legs, and feet of the infant in water as warm as can be borne, and at the same time applying over the head and temples a piece of flannel wet with cold water. I have also often cut the fit short by sprinkling cold water in the child's face while in the bath. The gums should always be looked to, and if they appear swollen, and painful, at once lanced. I have known the most formidable convulsions to cease immediately after this operation.

SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses to administer narcotics to quiet infants while teething. It is not only objectionable, but, from the uncertain effects of sedatives upon infants, a very dangerous practice, and they ought never to be given, except at the suggestion of a medical man. It is far better, if the child is restless at night, to have it frequently taken out of its cot, and carried about in an airy room; for the cool air, and change of posture, will do much to allay the feverishness and restlessness of the child.

From these few hints, it must have been seen how much the sufferings from teething may be mitigated by judicious management. That, if the parent is able to support her infant upon the breast alone, teething will be found comparatively an easy process, and unattended with danger; the mother thus reaping a delightful reward for all the anxieties and privations nursing necessarily involves. That the child brought up partially, or entirely, by hand will always pass through dentition with more or less of pain and difficulty; but that even here, if the diet has been properly regulated, much less suffering and inconvenience will arise than when less attention has been paid to it. And, lastly, that, when teething is difficult, how highly important it is to call in proper aid at an early period, and to carry out fully the directions of the medical attendant, allowing no foolish prejudices to interfere with his prescriptions and management.

If I stood in need of any argument to impress upon the mind of a parent the importance of attending to the last injunction, I would simply state, that its neglect is but too frequently the cause of disease of the brain, terminating in death, or a state of idiotcy far worse than death, of which I know more than one living instance.

It may be as well to add, that eruptions about the ears, head, face, and various parts of the body, very frequently appear during the process of the first teething.[FN#23] If they are slight, they should be left alone, being rather useful than otherwise; if they are troublesome, they must receive that kind of attention from the parent which will be pointed out under the chapter on diseases. The same remark applies to enlargements of the glands of the neck, which frequently appear at this time.

[FN#23] In some infants a rash always precedes the cutting a tooth. Sometimes it appears in the form of hard elevated pimples as large as peas; in other instances in the form of red patches, of the size of a shilling, upon the arms, shoulders, and back of the neck. They are always harmless, require no particular attention, and prevent, I doubt not, more serious complaints.

SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.

Parents are not sufficiently alive to the importance of attending to the condition of the mouth of their children at the period of changing the first for the second set of teeth; they do not seem to be aware how much the comfort, appearance, and future health of the child depends upon it. Nor do they subsequently impress upon the minds of their children how necessary, on their part, is the observance of certain rules for the preservation of the teeth, and how distressing are the effects which result from their neglect. It is proposed, here, to say a few words for the information and guidance of the parent upon this subject.

THE MANNER IN WHICH THEY APPEAR.

The change of the temporary for the permanent or adult teeth commences, in the majority of instances, at about seven years of age; occasionally it occurs as early as five, and as late as eight years and a half. The necessity which exists for this change, and the mode by which it is effected, are striking and beautiful; it is, however, not our object to enter fully upon its consideration here.