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by this circumstance. It may be laid down as a very general truth, that whatever causes a diversion of the blood towards the former organ will induce a diminution in the secretion of the latter.
But not only is the quantity of the secretion diminished; it is almost invariably altered in quality. Hence, in nineteen out of twenty cases, where the nurse is apt to be unwell during suckling, the infant will suffer griping pains in the bowels, purging, sometimes fits, &c.-all which symptoms clearly shew that they are attributable to the food that is administered. We know, indeed, that some women will tell us that their baby does not seem to be at all affected by the cause now mentioned; but the medical man may rest assured that such is very rarely the case, and that in by far the majority of instances the very reverse holds true.
Let it not, however, be supposed that we should recommend a nurse to discontinue suckling altogether for this cause alone; but we do say that the less the child takes the breast under such circumstances the better, and that it should be fed chiefly by hand, as long as the menstrual discharge continues.
The inference we draw from these considerations is, that it will be prudent, even under the most favourable circumstances, not to trust to the breast alone in the rearing of a child; but to give occasionally such light food as may be a convenient substitute for the milk. Like the wise general, who will never commence a campaign, or even enter upon a single action, without providing a safe mode of retreat for his troops-knowing full well how some casualty, which no sagacity could foresee, may occur to baffle his most confident hopes-the physician will not be willing to trust all to the contingent health of the nurse, which is apt to suffer from such a variety of uncontrollable events. It is not because the infant, for the first four or six months of its life, has need of more nourishment than what a healthy nurse can supply, that we recommend the early use of other food at the same time;-but only that it may not suffer from the sudden change of diet which many circumstances may render necessary. And has not beneficent Nature herself suggested a useful lesson to us on this very point, in the working of those instincts that she has implanted in the lower animals to guide them in all their doings? How soon does the lamb begin to crop the herbage by the side of the ewe! and do we not see the pup and kitten trying to lap food, before they can well hold themselves erect upon their legs? We may be assured that we shall seldom err, if we but follow the promptings of Nature's directions on this as well as on a variety of other topics connected with the preservation of health.
We proceed now to another question
How often should the Child be fed in twenty-fours?
This is unquestionably one of the most important rules of all, in the management of infants, to be rightly determined; and we are glad to find that Drs. Bull and Donné entirely agree with each other in the precepts which they give under this head. The former says—
"At the expiration of a week or so it is essentially necessary, and with some children this may be done with safety from the first day of suckling, to nurse
the infant at regular intervals of three or four hours, day and night. This allows sufficient time for each meal to be digested, and tends to keep the bowels of the child in order. Such regularity, moreover, will do much to obviate fretfulness, and that constant cry, which seems as if it could be allayed only by constantly putting the child to the breast." 8.
He afterwards adds, " in reference to night-nursing, I would suggest suckling the babe as late as ten o'clock p. m., and not putting it to the breast again until five o'clock the next morning. Many mothers have adopted this hint, with great advantage to their own health, and without the slightest detriment to that of the child. With the latter it soon becomes a habit; to induce it, however, it must be taught early."
M. Donné suggests that, during the first few weeks, the breast may be given every two hours or so, unless indeed the child sleeps a great deal, and then it requires to be applied less frequently: afterwards, once every three or four hours is amply sufficient. He very justly remarks that, as a matter of course, no exact or mathematical rules can be laid down on such a subject, and that a good deal must always be left to the discretion of the nurse. He expressly condemns the foolish practice of applying a child to the breast, whenever it begins to cry, and points out with great good sense the importance of having regular and stated hours for feeding. As we expressed our own opinions on this subject in a late Numbervide Medico-Chirurgical Review for October, 1842, p. 566—we shall not do more at present than offer two or three remarks on some of the evils of overfeeding.
By far the greater number of infantile ailments arise from some disorder of the bowels, occasioning griping pains, vomiting, feverish restlessness, and not unfrequently inward fits' and convulsions. These symptoms are almost invariably owing either to the unwholesome quality, or to an excessive quantity, of the food administered. The evils of stuffing (to use a phrase more expressive than elegant) a child are soon sufficiently apparent. Often, as is well known, does Nature get rid of the excess by inducing vomiting of the superfluity; and mothers will sometimes pride themselves as being capital nurses when their infants give this most satisfactory sign of not being stinted of their allowance. Unfortunately the practice has much greater inconveniences than its unseemliness. The digestion of the food that is retained is almost always more or less interfered with, when the stomach has been once too full. It (the food) is not so readily exposed to the action of the gastric juice—the great agent in the process of digestion-nor does it favourably undergo those changes, which are necessary to fit it to become absorbed into the system and assimilated with the blood. This is not the only evil that is apt to follow; for the food, when imperfectly digested, will inevitably cause irritation of the bowels, as it passes along their highly sensitive surface, giving rise to griping pains, inward fits, and purging. Every nurse knows well that the alvine motions often exhibit portions of the curd of the milk quite unchanged. Is not this a most convincing proof that the child has swallowed more than it has been able to digest?* Diarrhoea in infants is the result as
We may here mention one very simple, but most valuable, means of judging of the wholesomeness of food, especially in the case of children. Whenever any
often of over-feeding, as of the unwholesome quality of the milk or other food that has been given. Nature acts the part of the kind physician; she sets up an action to get rid of what is offending the bowels; and often little more is required to check the complaint than merely to restrict the suckling to certain intervals of time.
The Sleeping of Infants.
Ought an infant to sleep with the nurse? is a question very intimately connected with the one of which we have just been treating. All medical men will, as a matter of course, disapprove of the too common practice of a child being put to the breast four, five, or six times during the course of a night; and yet this practice cannot well be avoided, if the little creature sleeps with its nurse. The mere smell, arising from the mamma constantly near it, provokes a most unnecessary frequency of returning appetite; and if there was no other reason against it, this alone would be a sufficient one to condemn the practice of the mother and child sleeping together. For the first month or six weeks, while the young infant has but comparatively a feeble power of maintaining its own heat-a fact that has been so beautifully proved by the researches of Edwards-this may be proper; but after that time, it should be accustomed to sleep in a little bed or cot by the nurse's side. It is of more consequence to women in humble life than to those in more easy circumstances to attend to this advice, as it is of especial importance to the former that their sleep should not be unnecessarily disturbed. No woman can be a good nurse, who has not from six to eight hours good sound sleep every night. She may indeed wake once, or twice at most, to give suck to her infant during this time; but even this may be unnecessary after the second or third month, as a child will often rest quietly itself without requiring food from eleven at night to five or six next morning-provided it has been accustomed to be fed only at stated intervals, and to sleep by itself. M. Donné has some very sensible remarks on the inconveniences of accustoming children to fall asleep in the arms or on the knees of their nurse; the earlier that they are reconciled to the use of the cradle, assuredly the better.
So much for Food and Sleep; and now a few words on
Air and Exercise.
There are certain months of the year in this climate in which it is wiser, as a general rule, to keep infants within doors than expose them to the inclemencies and vicissitudes of the weather. It is to be remembered, as we have already mentioned, that their bodies have a much feebler power of generating heat than those of grown-up persons; and the circumstance moreover of their being merely passive creatures, incapable of taking such
substance, or portion of it, passes through the bowels unchanged, we may be assured that it is indigestible, and should be prohibited. Hence cheese, the white of hard-boiled eggs, dried currants, &c. are certainly among the worst articles that can be given to a child. Many of the most dangerous cases of the slow, or remittent, fever of children are owing to an accumulation-which has been going on for a length of time-of such matters, along with the depraved secretion of the bile and the intestinal mucus in the bowels.
exercise as may stimulate the muscular and circulatory systems, renders them the more obnoxious to the injurious effects of undue exposure. If kept within doors, the nursery room should be large, lofty and cheerful; and, whenever the weather will permit, the windows may be thrown open. It is impossible to lay down any specific directions applicable to all cases, as much will depend upon a variety of circumstances touching the age of the child, its vigour and healthfulness, &c. &c.; but a well-instructed medical man can never experience any difficulty in advising what should be done. Unquestionably as a general rule, young children cannot be too much in the open air, whenever the weather is favourable; it is almost as necessary to them, as a means of vigorous health, as a due supply of wholesome food. Let us take a hint from what we observe in our daily walks.
Observe how all young creatures delight in the cool air of an open field, and how they pine when cribbed up in a cage or any close place within doors. It is just the same with our own infants; they cannot express, except by dumb signs, their satisfaction; but whoever is in the habit of watching their movements, from the earliest period of life, must have often observed the pleasure which they seem to feel in being exposed to the refreshing breath of a Summer's breeze. Their skin, it should be remembered, is greatly more sensitive to the action of the air, and indeed to all outward impressions, than that of an adult. From its being very much thinner, and also exceedingly vascular, the circulation on the surface of the body has been thought by many to undergo a change somewhat similar to that which takes place in the lungs; the blood thus becoming more highly oxygenated in the superficial vessels, and all the energies of the system being thereby greatly increased.
However this may be, it is quite certain that young children suffer much more from confinement in a close atmosphere than grown-up persons; and it can, therefore, require no further argument to prove the great importance of the precept we have been endeavouring to inculcate.
Independently of these direct advantages to an infant from being much out in the open air, there are others which, though not so immediate and obvious, are well worthy of notice. Often, very often, it will be found that, when all means have failed within doors of lulling a child asleep during the day, the nurse has only to walk up and down a garden or field with it for a few minutes, and the object is at once gained. Who has not experienced the influence of Nature's sounds in soothing the mind, and inducing slumber, when this best balm' had been chased from the pillow?
And let it not be imagined that the infant is not as much affected by them as we are in after-life. It is probably much more so; and for this very simple reason, that the mind is not yet developed; the young creature is a being merely of sensation and perception, easily influenced by all outward impressions, and especially by those which act upon the senses of touch and hearing. The cool breezy air, the rustling of the trees, the hum of the insect, the chirrup of the bird, are all, we may be assured, perceived by the young being long before it can give any utterance to its joy, even by inarticulate sounds; and the wise nurse will therefore often
gladly avail herself of these sweet provocatives of sleep, rather than always trust to the rocking of the cradle, and the hush-hush droning of her own sweet voice.
There are, perhaps, even higher considerations than those of mere regard for health, that should induce mothers to have their children as much as possible in the open air. We know not, indeed, when the infant begins to notice the objects which it sees and hears, or how soon the impressions of good and evil, of love and hate, of sadness and joy are made upon its mind; but there cannot be a reasonable doubt, we think, that it is an observing, a remembering, perhaps even a reasoning, being long before it is generally imagined to be so. Hence the importance of surrounding children as frequently as possible with objects that, while they soothe, animate, while they gladden, elevate the mind; and where shall we find such objects so well as in the open fields and quiet woods?
But we must now draw our remarks on the Hygiene of early life to a close, and turn to the consideration of a few of the most important diseases to which children are exposed. We therefore take leave of the works of Dr. Bull and M. Donné-both of which are excellent guides in their way, and deserve to be generally known-and substitute for our text-books those of Mr. Rees and Dr. Stewart.
The first subject we shall notice, is the application of Auscultationusing this term in its widest acceptation-to the diagnosis of chest diseases in childhood.
Let us hear what our authors say.
According to Mr. Rees' experience-and our own is entirely in accordance with it-Percussion is of subordinate and only occasional use.
"It will not always yield that information in infants that it does in adults. A considerable portion of the lung may be rendered solid from inflammation in the former, and the chest not sound decidedly dull; and in cases where, after death, the lungs have been crowded with tubercles, I have failed to perceive any dulness on percussion. Nevertheless where hepatization is limited, as it mostly is, to the lower or upper lobes of one lung, percussion, if carefully performed, will detect it, even in infants, and with the auscultatory signs decide the diagnosis. In older children percussion is at times very valuable, for in them, as in adults, latent pneumonia proceeding to hepatization of a large portion of one lung is not uncommon; and in many cases, where the general symptoms have been vague and undefined, the breathing little affected, and the cough trifling, percussion of the chest has led to the detection of hepatization of the lung, and directed to the treatment likely to prove successful." Rees, 90.
As an instance of the uncertainty of any one means of diagnosis, taken by itself, he alludes to an interesting case of pleuritic effusion in a child, three years of age, where the chest on percussion gave out a tympanitic resonance, while no respiratory murmur was perceptible: death ensued in the course of a day or two. On dissection, the lung was found to be quite solidified; but the cavity of the pleura-which was much thickened from false membrane-was perfectly empty, shreds of lymph passing across. "In this case," says our author, "the effusion must have been very considerable, and have been rapidly absorbed, before the thorax had contracted from the dilated size to which the fluid had expanded it."
With respect even to Auscultation, the young physician must not expect