MISCELLANY No 14
MRS BEETON: THE VICTORIAN BABY
PART 2: FEEDING, WEANING, DRESSING, WASHING, TEETHING
THE MILK.
2472. As Nature has placed in the bosom of the mother the natural food of her offspring, it must be self-evident to every reflecting woman, that it becomes her duty to study, as far as lies in her power, to keep that reservoir of nourishment in as pure and invigorating a condition as possible; for she must remember that the quantity is no proof of the quality of this aliment.2473. The mother, while suckling, as a general rule, should avoid all sedentary occupations, take regular exercise, keep her mind as lively and pleasingly occupied as possible, especially by music and singing. Her diet should be light and nutritious, with a proper sufficiency of animal food, and of that kind which yields the largest amount of nourishment; and, unless the digestion is naturally strong, vegetables and fruit should form a very small proportion of the general dietary, and such preparations as broths, gruels, arrowroot, &c., still less. Tapioca, or ground-rice pudding, made with several eggs, may be taken freely; but all slops and thin potations, such as that delusion called chicken-broth, should be avoided, as yielding a very small amount of nutriment, and a large proportion of flatulence. All purely stimulants should be avoided as much as possible, especially spirits, unless taken for some special object, and that medicinally; but as a part of the dietary they should be carefully shunned. Lactation is always an exhausting process, and as the child increases in size and strength, the drain upon the mother becomes great and depressing. Then something more even than an abundant diet is required to keep the mind and body up to a standard sufficiently healthy to admit of a constant and nutritious secretion being performed without detriment to the physical integrity of the mother, or injury to the child who imbibes it; and as stimulants are inadmissible, if not positively injurious, the substitute required is to be found in malt liquor. To the lady accustomed to her Madeira and sherry, this may appear a very vulgar potation for a delicate young mother to take instead of the more subtle and condensed elegance of wine; but as we are writing from experience, and with the avowed object of imparting useful facts and beneficial remedies to our readers, we allow no social distinctions to interfere with our legitimate object.
2474. We have already said that the suckling mother should avoid stimulants, especially spirituous ones; and though something of this sort is absolutely necessary to support her strength during the exhausting process, it should be rather of a tonic than of a stimulating character; and as all wines contain a large percentage of brandy, they are on that account less beneficial than the pure juice of the fermented grape might be. But there is another consideration to be taken into account on this subject; the mother has not only to think of herself, but also of her infant. Now wines, especially port wine, very often—indeed, most frequently—affect the baby's bowels, and what might have been grateful to the mother becomes thus a source of pain and irritation to the child afterwards. Sherry is less open to this objection than other wines, yet still it very frequently does influence the second participator, or the child whose mother has taken it.
2475. The nine or twelve months a woman usually suckles must be, to some extent, to most mothers, a period of privation and penance, and unless she is deaf to the cries of her baby, and insensible to its kicks and plunges, and will not see in such muscular evidences the griping pains that rack her child, she will avoid every article that can remotely affect the little being who draws its sustenance from her. She will see that the babe is acutely affected by all that in any way influences her, and willingly curtail her own enjoyments, rather than see her infant rendered feverish, irritable, and uncomfortable. As the best tonic, then, and the most efficacious indirect stimulant that a mother can take at such times, there is no potation equal to porter and stout, or, what is better still, an equal part of porter and stout. Ale, except for a few constitutions, is too subtle and too sweet, generally causing acidity or heartburn, and stout alone is too potent to admit of a full draught, from its proneness to affect the head; and quantity, as well as moderate strength, is required to make the draught effectual; the equal mixture, therefore, of stout and porter yields all the properties desired or desirable as a medicinal agent for this purpose.
2476. Independently of its invigorating influence on the constitution, porter exerts a marked and specific effect on the secretion of milk; more powerful in exciting an abundant supply of that fluid than any other article within the range of the physician's art; and, in cases of deficient quantity, is the most certain, speedy, and the healthiest means that can be employed to insure a quick and abundant flow. In cases where malt liquor produces flatulency, a few grains of the "carbonate of soda" may advantageously be added to each glass immediately before drinking, which will have the effect of neutralizing any acidity that may be in the porter at the time, and will also prevent its after-disagreement with the stomach. The quantity to be taken must depend upon the natural strength of the mother, the age and demand made by the infant on the parent, and other causes; but the amount should vary from one to two pints a day, never taking less than half a pint at a time, which should be repeated three or four times a day.
2477. We have said that the period of suckling is a season of penance to the mother, but this is not invariably the case; and, as so much must depend upon the natural strength of the stomach, and its power of assimilating all kinds of food into healthy chyle, it is impossible to define exceptions. Where a woman feels she can eat any kind of food, without inconvenience or detriment, she should live during her suckling as she did before; but, as a general rule, we are bound to advise all mothers to abstain from such articles as pickles, fruits, cucumbers, and all acid and slowly digestible foods, unless they wish for restless nights and crying infants.
2478. As regards exercise and amusement, we would certainly neither prohibit a mother's dancing, going to a theatre, nor even from attending an assembly. The first, however, is the best indoor recreation she can take, and a young mother will do well to often amuse herself in the nursery with this most excellent means of healthful circulation. The only precaution necessary is to avoid letting the child suck the milk that has lain long in the breast, or is heated by excessive action.
2479. Every mother who can, should be provided with a breast-pump, or glass tube, to draw off the superabundance that has been accumulating in her absence from the child, or the first gush excited by undue exertion: the subsequent supply of milk will be secreted under the invigorating influence of a previous healthy stimulus.
2480. As the first milk that is secreted contains a large amount of the saline elements, and is thin and innutritious, it is most admirably adapted for the purpose Nature designed it to fulfil,—that of an aperient; but which, unfortunately, it is seldom permitted, in our artificial mode of living, to perform.
2481. So opposed are we to the objectionable plan of physicking new-born children, that, unless for positive illness, we would much rather advise that medicine should be administered through the mother for the first eight or ten weeks of its existence. This practice, which few mothers will object to, is easily effected by the parent, when such a course is necessary for the child, taking either a dose of castor-oil, half an ounce of tasteless salts (the phosphate of soda), one or two teaspoonfuls of magnesia, a dose of lenitive electuary, manna, or any mild and simple aperient, which, almost before it can have taken effect on herself, will exhibit its action on her child.
2482. One of the most common errors that mothers fall into while suckling their children, is that of fancying they are always hungry, and consequently overfeeding them; and with this, the great mistake of applying the child to the breast on every occasion of its crying, without investigating the cause of its complaint, and, under the belief that it wants food, putting the nipple into its crying mouth, until the infant turns in revulsion and petulance from what it should accept with eagerness and joy. At such times, a few teaspoonfuls of water, slightly chilled, will often instantly pacify a crying and restless child, who has turned in loathing from the offered breast; or, after imbibing a few drops, and finding it not what nature craved, throws back its head in disgust, and cries more petulantly than before. In such a case as this, the young mother, grieved at her baby's rejection of the tempting present, and distressed at its cries, and in terror of some injury, over and over ransacks its clothes, believing some insecure pin can alone be the cause of such sharp complaining, an accident that, from her own care in dressing, however, is seldom or ever the case.
2483. These abrupt cries of the child, if they do not proceed from thirst, which a little water will relieve, not unfrequently occur from some unequal pressure, a fold or twist in the "roller," or some constriction round the tender body. If this is suspected, the mother must not be content with merely slackening the strings; the child should be undressed, and the creases and folds of the hot skin, especially those about the thighs and groins, examined, to see that no powder has caked, and, becoming hard, irritated the parts. The violet powder should be dusted freely over all, to cool the skin, and everything put on fresh and smooth. If such precautions have not afforded relief, and, in addition to the crying, the child plunges or draws up its legs, the mother may be assured some cause of irritation exists in the stomach or bowels,—either acidity in the latter or distension from overfeeding in the former; but, from whichever cause, the child should be "opened" before the fire, and a heated napkin applied all over the abdomen, the infant being occasionally elevated to a sitting position, and while gently jolted on the knee, the back should be lightly patted with the hand.
2484. Should the mother have any reason to apprehend that the cause of inconvenience proceeds from the bladder—a not unfrequent source of pain,—the napkin is to be dipped in hot water, squeezed out, and immediately applied over the part, and repeated every eight or ten minutes, for several times in succession, either till the natural relief is afforded, or a cessation of pain allows of its discontinuance. The pain that young infants often suffer, and the crying that results from it, is, as we have already said, frequently caused by the mother inconsiderately overfeeding her child, and is produced by the pain of distension, and the mechanical pressure of a larger quantity of fluid in the stomach than the gastric juice can convert into cheese and digest.
2485. Some children are stronger in the enduring power of the stomach than others, and get rid of the excess by vomiting, concluding every process of suckling by an emission of milk and curd. Such children are called by nurses "thriving children;" and generally they are so, simply because their digestion is good, and they have the power of expelling with impunity that superabundance of aliment which in others is a source of distension, flatulence, and pain.
2486. The length of time an infant should be suckled must depend much on the health and strength of the child, and the health of the mother, and the quantity and quality of her milk; though, when all circumstances are favourable, it should never be less than nine, nor exceed fifteen months; but perhaps the true time will be found in the medium between both. But of this we may be sure, that Nature never ordained a child to live on suction after having endowed it with teeth to bite and to grind; and nothing is more out of place and unseemly than to hear a child, with a set of twenty teeth, ask for "the breast."
2487. The practice of protracted wet-nursing is hurtful to the mother, by keeping up an uncalled-for, and, after the proper time, an unhealthy drain on her system, while the child either derives no benefit from what it no longer requires, or it produces a positive injury on its constitution. After the period when Nature has ordained the child shall live by other means, the secretion of milk becomes thin and deteriorated, showing in the flabby flesh and puny features of the child both its loss of nutritious properties and the want of more stimulating aliment.
2488. Though we have said that twelve months is about the medium time a baby should be suckled, we by no means wish to imply that a child should be fed exclusively on milk for its first year; quite the reverse; the infant can hardly be too soon made independent of the mother. Thus, should illness assail her, her milk fail, or any domestic cause abruptly cut off the natural supply, the child having been annealed to an artificial diet, its life might be safely carried on without seeking for a wet-nurse, and without the slightest danger to its system.
2489. The advantage to the mother of early accustoming the child to artificial food is as considerable to herself as beneficial to her infant; the demand on her physical strength in the first instance will be less severe and exhausting, the child will sleep longer on a less rapidly digestible aliment, and yield to both more quiet nights, and the mother will be more at liberty to go out for business or pleasure, another means of sustenance being at hand till her return. Besides these advantages, by a judicious blending of the two systems of feeding, the infant will acquire greater constitutional strength, so that, if attacked by sickness or disease, it will have a much greater chance of resisting its virulence than if dependent alone on the mother, whose milk, affected by fatigue and the natural anxiety of the parent for her offspring, is at such a time neither good in its properties nor likely to be beneficial to the patient.
2490. All that we have further to say on suckling is an advice to mothers, that if they wish to keep a sound and unchapped nipple, and possibly avoid what is called a "broken breast," never to put it up with a wet nipple, but always to have a soft handkerchief in readiness, and the moment that delicate part is drawn from the child's mouth, to dry it carefully of the milk and saliva that moisten it; and, further, to make a practice of suckling from each breast alternately.
Dress and Dressing,
Washing, &c.
2492. In these days of intelligence, there are few ladies who have not, in all probability, seen the manner in which the Indian squaw, the aborigines of Polynesia, and even the Lapp and Esquimaux, strap down their baby on a board, and by means of a loop suspend it to the bough of a tree, hang it up to the rafters of the hut, or on travel, dangle it on their backs, outside the domestic implements, which, as the slave of her master, man, the wronged but uncomplaining woman carries, in order that her lord may march in unhampered freedom. Cruel and confining as this system of "backboard" dressing may seem to our modern notions of freedom and exercise, it is positively less irksome, less confining, and infinitely less prejudicial to health, than the mummying of children by our grandmothers a hundred, ay, fifty years ago: for what with chin-stays, back-stays, body-stays, forehead-cloths, rollers, bandages, &c., an infant had as many girths and strings, to keep head, limbs, and body in one exact position, as a ship has halyards.
2493. Much of this—indeed we may say all—has been abolished; but still the child is far from being dressed loosely enough; and we shall never be satisfied till the abominable use of the pin is avoided in toto in an infant's dressing, and a texture made for all the under garments of a child of a cool and elastic material.
2494. The manner in which an infant is encircled in a bandage called the "roller," as if it had fractured ribs, compressing those organs—that, living on suction, must be, for the health of the child, to a certain degree distended, to obtain sufficient aliment from the fluid imbibed—is perfectly preposterous. Our humanity, as well as our duty, calls upon us at once to abrogate and discountenance by every means in our power. Instead of the process of washing and dressing being made, as with the adult, a refreshment and comfort, it is, by the dawdling manner in which it is performed, the multiplicity of things used, and the perpetual change of position of the infant to adjust its complicated clothing, rendered an operation of positive irritation and annoyance. We, therefore, entreat all mothers to regard this subject in its true light, and study to the utmost, simplicity in dress, and dispatch in the process.
2495. Children do not so much cry from the washing as from the irritation caused by the frequent change of position in which they are placed, the number of times they are turned on their face, on their back, and on their side, by the manipulations demanded by the multiplicity of articles to be fitted, tacked, and carefully adjusted on their bodies. What mother ever found her girl of six or seven stand quiet while she was curling her hair? How many times nightly has she not to reprove her for not standing still during the process! It is the same with the unconscious infant, who cannot bear to be moved about, and who has no sooner grown reconciled to one position than it is forced reluctantly into another. It is true, in one instance the child has intelligence to guide it, and in the other not; but the motitory nerves, in both instances, resent coercion, and a child cannot be too little handled.
2496. On this account alone, and, for the moment, setting health and comfort out of the question, we beg mothers to simplify their baby's dress as much as possible; and not only to put on as little as is absolutely necessary, but to make that as simple in its contrivance and adjustment as it will admit of; to avoid belly-bands, rollers, girths, and everything that can impede or confine the natural expansion of the digestive organs, on the due performance of whose functions the child lives, thrives, and develops its physical being.
REARING BY HAND.
Articles necessary, and how to use them,—Preparation of Foods.—Baths.—Advantages of Rearing by Hand.
2497. As we do not for a moment wish to be thought an advocate for an artificial, in preference to the natural course of rearing children, we beg our renders to understand us perfectly on this head; all we desire to prove is the fact that a child can be brought up as well on a spoon dietary as the best example to be found of those reared on the breast; having more strength, indeed, from the more nutritious food on which it lives. It will be thus less liable to infectious diseases, and more capable of resisting the virulence of any danger that may attack it; and without in any way depreciating the nutriment of its natural food, we wish to impress on the mother's mind that there are many cases of infantine debility which might eventuate in rickets, curvature of the spine, or mesenteric disease, where the addition to, or total substitution of, an artificial and more stimulating aliment, would not only give tone and strength to the constitution, but at the same time render the employment of mechanical means totally unnecessary. And, finally, though we would never—where the mother had the strength to suckle her child—supersede the breast, we would insist on making it a rule to accustom the child as early as possible to the use of an artificial diet, not only that it may acquire more vigour to help it over the ills of childhood, but that, in the absence of the mother, it might not miss the maternal sustenance; and also for the parent's sake, that, should the milk, from any cause, become vitiated, or suddenly cease, the child can be made over to the bottle and the spoon without the slightest apprehension of hurtful consequences.
2498. To those persons unacquainted with the system, or who may have been erroneously informed on the matter, the rearing of a child by hand may seem surrounded by innumerable difficulties, and a large amount of personal trouble and anxiety to the nurse or mother who undertakes the duty. This, however, is a fallacy in every respect, except as regards the fact of preparing the food; but even this extra amount of work, by adopting the course we shall lay down, may be reduced to a very small sum of inconvenience; and as respects anxiety, the only thing calling for care is the display of judgment in the preparation of the food. The articles required for the purpose of feeding an infant are a night-lamp, with its pan and lid, to keep the food warm; a nursing-bottle, with a prepared teat; and a small pap saucepan, for use by day. Of the lamp we need hardly speak, most mothers being acquainted with its operation: but to those to whom it is unknown we may observe, that the flame from the floating rushlight heats the water in the reservoir above, in which the covered pan that contains the food floats, keeping it at such a heat that, when thinned by milk, it will be of a temperature suitable for immediate use. Though many kinds of nursing-bottles have been lately invented, and some mounted with India-rubber nipples, the common glass bottle, with the calf's teat, is equal in cleanliness and utility to any; besides, the nipple put into the child's mouth is so white and natural in appearance, that no child taken from the breast will refuse it. The black artificial ones of caoutchouc or gutta-percha are unnatural. The prepared teats can be obtained at any chemist's, and as they are kept in spirits, they will require a little soaking in warm water, and gentle washing, before being tied securely, by means of fine twine, round the neck of the bottle, just sufficient being left projecting for the child to grasp freely in its lips; for if left the full length, or over long, it will be drawn too far into the mouth, and possibly make the infant heave. When once properly adjusted, the nipple need never be removed till replaced by a new one, which will hardly be necessary oftener than once a fortnight, though with care one will last for several weeks. The nursing-bottle should be thoroughly washed and cleaned every day, and always rinsed out before and after using it, the warm water being squeezed through the nipple, to wash out any particles of food that might lodge in the aperture, and become sour. The teat can always be kept white and soft by turning the end of the bottle, when not in use, into a narrow jug containing water, taking care to dry it first, and then to warm it by drawing the food through before putting it into the child's mouth.
Food, and its
Preparation.
2499. The articles generally employed as food
for infants consist of arrowroot, bread, flour, baked flour, prepared groats,
farinaceous food, biscuit-powder, biscuits, tops-and-bottoms, and semolina, or
manna croup, as it is otherwise called, which, like tapioca, is the prepared
pith of certain vegetable substances. Of this list the least efficacious,
though, perhaps, the most believed in, is arrowroot, which only as a mere
agent, for change, and then only for a very short time, should ever be employed
as a means of diet to infancy or childhood. It is a thin, flatulent, and
innutritious food, and incapable of supporting infantine life with energy.
Bread, though the universal régime with the labouring poor, where the
infant's stomach and digestive powers are a reflex, in miniature, of the
father's, should never be given to an infant under three months, and, even
then, however finely beaten up and smoothly made, is a very questionable diet.
Flour, when well boiled, though infinitely better than arrowroot, is still only
a kind of fermentative paste, that counteracts its own good by after-acidity
and flatulence.2500. Baked flour, when cooked into a pale brown mass, and finely powdered, makes a far superior food to the others, and may be considered as a very useful diet, especially for a change. Prepared groats may be classed with arrowroot and raw flour, as being innutritious. The articles that now follow in our list are all good, and such as we could, with conscience and safety, trust to for the health and development of any child whatever.
2501. We may observe in this place, that an occasional change in the character of the food is highly desirable, both as regards the health and benefit of the child; and though the interruption should only last for a day, the change will be advantageous.
2502. The packets sold as farinaceous food are unquestionably the best aliment that can be given from the first to a baby, and may be continued, with the exception of an occasional change, without alteration of the material, till the child is able to take its regular meals of animal and vegetable food. Some infants are so constituted as to require a frequent and total change in their system of living, seeming to thrive for a certain time on any food given to them, but if persevered in too long, declining in bulk and appearance as rapidly as they had previously progressed. In such cases the food should be immediately changed, and when that which appeared to agree best with the child is resumed, it should be altered in its quality, and perhaps in its consistency.
2503. For the farinaceous food there are directions with each packet, containing instructions for the making; but, whatever the food employed is, enough should be made at once to last the day and night; at first, about a pint basinful, but, as the child advances, a quart will hardly be too much. In all cases, let the food boil a sufficient time, constantly stirring, and taking every precaution that it does not get burnt, in which case it is on no account to be used.
2504. The food should always be made with water, the whole sweetened at once, and of such a consistency that, when poured out, and it has had time to cool, it will cut with the firmness of a pudding or custard. One or two spoonfuls are to be put into the pap saucepan and stood on the hob till the heat has softened it, when enough milk is to be added, and carefully mixed with the food, till the whole has the consistency of ordinary cream; it is then to be poured into the nursing-bottle, and the food having been drawn through to warm the nipple, it is to be placed in the child's mouth. For the first month or more, half a bottleful will be quite enough to give the infant at one time; but, as the child grows, it will be necessary not only to increase the quantity given at each time, but also gradually to make its food more consistent, and, after the third month, to add an egg to every pint basin of food made. At night the mother puts the food into the covered pan of her lamp, instead of the saucepan—that is, enough for one supply, and, having lighted the rush, she will find, on the waking of her child, the food sufficiently hot to bear the cooling addition of the milk. But, whether night or day, the same food should never be heated twice, and what the child leaves should be thrown away.
2505. The biscuit powder is used in the same manner as the farinaceous food, and both prepared much after the fashion of making starch. But when tops-and-bottoms, or the whole biscuit, are employed, they require soaking in cold water for some time previous to boiling. The biscuit or biscuits are then to be slowly boiled in as much water as will, when thoroughly soft, allow of their being beaten by a three-pronged fork into a fine, smooth, and even pulp, and which, when poured into a basin and become cold, will cut out like a custard. If two large biscuits have been so treated, and the child is six or seven months old, beat up two eggs, sufficient sugar to properly sweeten it, and about a pint of skim milk. Pour this on the beaten biscuit in the saucepan, stirring constantly; boil for about five minutes, pour into a basin, and use, when cold, in the same manner as the other.
2506. This makes an admirable food, at once nutritious and strengthening. When tops-and-bottoms or rusks are used, the quantity of the egg may be reduced, or altogether omitted.
2507. Semolina, or manna croup, being in little hard grains, like a fine millet-seed, must be boiled for some time, and the milk, sugar, and egg added to it on the fire, and boiled for a few minutes longer, and, when cold, used as the other preparations.
2508. Many persons entertain a belief that cow's milk is hurtful to infants, and, consequently, refrain from giving it; but this is a very great mistake, for both sugar and milk should form a large portion of every meal an infant takes.
TEETHING AND CONVULSIONS.
Fits, &c., the consequence of Dentition, and how to be treated.—The number and order of the Teeth, and manner in which they are cut.—First and Second Set.2509. About three months after birth, the infant's troubles may be said to begin; teeth commence forming in the gums, causing pain and irritation in the mouth, and which, but for the saliva it causes to flow so abundantly, would be attended with very serious consequences. At the same time the mother frequently relaxes in the punctuality of the regimen imposed on her, and, taking some unusual or different food, excites diarrhoea or irritation in her child's stomach, which not unfrequently results in a rash on the skin, or slight febrile symptoms, which, if not subdued in their outset, superinduce some more serious form of infantine disease. But, as a general rule, the teeth are the primary cause of much of the child's sufferings, in consequence of the state of nervous and functional irritation into which the system is thrown by their formation and progress out of the jaw and through the gums. We propose beginning this branch of our subject with that most fertile source of an infant's suffering—
Teething.
2510. That this subject may he better understood by the nurse and mother, and the reason of the constitutional disturbance that, to a greater or less degree, is experienced by all infants, may be made intelligible to those who have the care of children, we shall commence by giving a brief account of the formation of the teeth, the age at which they appear in the mouth, and the order in which they pierce the gums. The organs of mastication in the adult consist of 32 distinct teeth, 16 in either jaw; being, in fact, a double set. The teeth are divided into 4 incisors, 2 canine, 4 first and second grinders, and 6 molars; but in childhood the complement or first set consists of only twenty, and these only make their appearance as the development of the frame indicates the requirement of a different kind of food for the support of the system. At birth some of the first-cut teeth are found in the cavities of the jaw, in a very small and rudimentary form; but this is by no means universal. About the third month, the jaws, which are hollow and divided into separate cells, begin to expand, making room for the slowly developing teeth, which, arranged for beauty and economy of space lengthwise, gradually turn their tops upwards, piercing the gum by their edges, which, being sharp, assist in cutting a passage through the soft parts. There is no particular period at which children cut their teeth, some being remarkably early, and others equally late. The earliest age that we have ever ourselves known as a reliable fact was, six weeks. Such peculiarities are generally hereditary, and, as in this case, common to a whole family. The two extremes are probably represented by six and sixteen months. Pain and drivelling are the usual, but by no means the general, indications of teething.
2511. About the sixth month the gums become tense and swollen, presenting a red, shiny appearance, while the salivary glands pour out an unusual quantity of saliva. After a time, a white line or round spot is observed on the top of one part of the gums, and the sharp edge of the tooth may be felt beneath if the finger is gently pressed on the part. Through these white spots the teeth burst their way in the following order:—
2512. Two incisors in the lower jaw are first cut, though, in general, some weeks elapse between the appearance of the first and the advent of the second. The next teeth cut are the four incisors of the upper jaw. The next in order are the remaining two incisors of the bottom, one on each side, then two top and two bottom on each side, but not joining the incisors; and lastly, about the eighteenth or twentieth month, the four eye teeth, filling up the space left between the side teeth and the incisors; thus completing the infant's set of sixteen. Sometimes at the same period, but more frequently some months later, four more double teeth slowly make their appearance, one on each side of each jaw, completing the entire series of the child's first set of twenty teeth. It is asserted that a child, while cutting its teeth, should either dribble excessively, vomit after every meal, or be greatly relaxed. Though one or other, or all of these at once, may attend a case of teething, it by no means follows that any one of them should accompany this process of nature, though there can be no doubt that where the pain consequent on the unyielding state of the gums, and the firmness of the skin that covers the tooth, is severe, a copious discharge of saliva acts beneficially in saving the head, and also in guarding the child from those dangerous attacks of fits to which many children in their teething are liable.
2513. The Symptoms that generally indicate the cutting of teeth, in addition to the inflamed and swollen state of the gums, and increased flow of saliva, are the restless and peevish state of the child, the hands being thrust into the mouth, and the evident pleasure imparted by rubbing the finger or nail gently along the gum; the lips are often excoriated, and the functions of the stomach or bowels are out of order. In severe cases, occurring in unhealthy or scrofulous children, there are, from the first, considerable fever, disturbed sleep, fretfulness, diarrhoea, rolling of the eyes, convulsive startings, laborious breathing, coma, or unnatural sleep, ending, unless the head is quickly relieved, in death.
2514. The Treatment in all cases of painful teething is remarkably simple, and consists in keeping the body cool by mild aperient medicines, allaying the irritation in the gums by friction with a rough ivory ring or a stale crust of broad, and when the head, lungs, or any organ is overloaded or unduly excited, to use the hot bath, and by throwing the body into a perspiration, equalize the circulation, and relieve the system from the danger of a fatal termination.
2515. Besides these, there is another means, but that must be employed by a medical man; namely, scarifying the gums—an operation always safe, and which, when judiciously performed, and at a critical opportunity, will often snatch the child from the grasp of death.
2516. There are few subjects on which mothers have often formed such strong and mistaken opinions as on that of lancing an infant's gums, some rather seeing their child go into fits—and by the unrelieved irritation endangering inflammation of the brain, water on the head, rickets, and other lingering affections—than permit the surgeon to afford instant relief by cutting through the hard skin, which, like a bladder over the stopper of a bottle, effectually confines the tooth to the socket, and prevents it piercing the soft, spongy substance of the gum. This prejudice is a great error, as we shall presently show; for, so far from hurting the child, there is nothing that will so soon convert an infant's tears into smiles as scarifying the gums in painful teething; that is, if effectually done, and the skin of the tooth be divided.
2517. Though teething is a natural function, and to an infant in perfect health should be unproductive of pain, yet in general it is not only a fertile cause of suffering, but often a source of alarm and danger; the former, from irritation in the stomach and bowels, deranging the whole economy of the system, and the latter, from coma and fits, that may excite alarm in severe cases; and the danger, that eventuates in some instances, from organic disease of the head or spinal marrow.
2518. We shall say nothing in this place of "rickets," or "water on the head," which are frequent results of dental irritation, but proceed to finish our remarks on the treatment of teething. Though strongly advocating the lancing of the gums in teething, and when there are any severe head-symptoms, yet it should never be needlessly done, or before being satisfied that the tooth is fully formed, and is out of the socket, and under the gum. When assured on these points, the gum should be cut lengthwise, and from the top of the gum downwards to the tooth, in an horizontal direction, thus——, and for about half an inch in length. The operation is then to be repeated in a transverse direction, cutting across the gum, in the centre of the first incision, and forming a cross, thus +. The object of this double incision is to insure a retraction of the cut parts, and leave an open way for the tooth to start from—an advantage not to be obtained when only one incision is made; for unless the tooth immediately follows the lancing, the opening reunites, and the operation has to be repeated. That this operation is very little or not at all painful, is evidenced by the suddenness with which the infant falls asleep after the lancing, and awakes in apparently perfect health, though immediately before the use of the gum-lancet, the child may have been shrieking or in convulsions.
Convulsions, or
Infantine Fits.
2519. From their birth till after teething,
infants are more or less subject or liable to sudden fits, which often, without
any assignable cause, will attack the child in a moment, and while in the
mother's arms; and which, according to their frequency, and the age and
strength of the infant, are either slight or dangerous.2520. Whatever may have been the remote cause, the immediate one is some irritation of the nervous system, causing convulsions, or an effusion to the head, inducing coma. In the first instance, the infant cries out with a quick, short scream, rolls up its eyes, arches its body backwards, its arms become bent and fixed, and the fingers parted; the lips and eyelids assume a dusky leaden colour, while the face remains pale, and the eyes open, glassy, or staring. This condition may or may not be attended with muscular twitchings of the mouth, and convulsive plunges of the arms. The fit generally lasts from one to three minutes, when the child recovers with a sigh, and the relaxation of the body. In the other case, the infant is attacked at once with total insensibility and relaxation of the limbs, coldness of the body and suppressed breathing; the eyes, when open, being dilated, and presenting a dim glistening appearance; the infant appearing, for the moment, to be dead.
2521. Treatment.-The first step in either case is, to immerse the child in a hot bath up to the chin; or if sufficient hot water cannot be procured to cover the body, make a hip-bath of what can be obtained; and, while the left hand supports the child in a sitting or recumbent position, with the right scoop up the water, and run it over the chest of the patient. When sufficient water can be obtained, the spine should be briskly rubbed while in the bath; when this cannot be done, lay the child on the knees, and with the fingers dipped in brandy, rub the whole length of the spine vigorously for two or three minutes, and when restored to consciousness, give occasionally a teaspoonful of weak brandy and water or wine and water.
2522. An hour after the bath, it may be necessary to give an aperient powder, possibly also to repeat the dose for once or twice every three hours; in which case the following prescription is to be employed. Take of
Powdered scammony 6 grains.
Grey powder 6 grains.
Antimonial powder 4 grains.
Lump sugar 20 grains.
Mix thoroughly, and divide into three powders, which are to be taken as advised for an infant one year old; for younger or weakly infants, divide into four powders, and give as the other. For thirst and febrile symptoms, give drinks of barley-water, or cold water, and every three hours put ten to fifteen drops of spirits of sweet nitre in a dessert-spoonful of either beverage.
