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M.d. Thomas Bull

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This little book has been written for the young and inexperienced mother. It is intended to furnish her with that information which the experience and observation of some years convince the author, young mothers, almost without any exception, do not possess; and yet, from ignorance of which, the constitution of many an infant has received irretrievable injury, and life itself but too frequently fallen a sacrifice.

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M.D. Thomas Bull

The Maternal Management of Children, in Health and Disease

First digital edition 2017 by Anna Ruggieri

PREFACE.

This little book has been written for the young and inexperienced mother. It is intended to furnish her with that information which the experience and observation of some years convince the author, young mothers, almost without any exception, do not possess; and yet, from ignorance of which, the constitution of many an infant has received irretrievable injury, and life itself but too frequently fallen a sacrifice.

In the first chapters, devoted to the general management of the child in health, the author has endeavoured to teach the young mother, that the prevention of disease is her province, not its cure; that to this object all her best efforts must be directed; and, moreover, that to tamper with medicine, when disease has actually commenced, is to hazard the life of her offspring.

In the fourth chapter it has been attempted to point out, how the first symptoms of disease may be early detected by the parent. The subject has been felt to be a difficult one, and to give particular directions quite out of the question; but it is hoped that the suggestions thrown out will, in some measure, answer the purpose intended. On the advantage of an early and prompt application of remedies in the diseases of childhood, generally so active in their progress and severe in their character, it is unnecessary to offer any observation.

The latter part of the work, consisting of the maternal management of disease, the author regards as a subject of high and serious moment. Small as is the attention which has been hitherto paid to it, yet, in the diseases of infancy and childhood, how invaluable is a careful and judicious maternal superintendence to give effect to the measures prescribed by the physician.

The author has endeavoured to arrange the contents of the work in a manner which shall be most easily understood and readily available; and he now publishes it with the desire to supply, in some degree, a deficiency in this important department of knowledge.

Finsbury Place, June, 1840.

Chapter I - ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.

The line of demarcation made between infancy and childhood, both by ancient and modern writers, has always been arbitrary. I would draw the line between the two, at a period of time which appears to me to be the most natural, the most simple, and least likely to lead the reader into the danger of misapplying any part of the practical directions of this, or any future chapter of the work. We will consider, then, that--

Infancy, commencing with birth, extends to about the end of the second year, when the first dentition is completed.

Childhood extends from about the second, to the seventh or eighth year, when the second dentition is commenced.

Sect. I. DIETETICS OF INFANCY.

In the early months of infancy the organs of digestion are unsuited to any other food than that derived from the breast of the mother. So little capable are they, indeed, to digest any other, even of the blandest and most digestible kind, that probably not more than one infant in six or seven ever arrives at the more advanced periods of life when deprived of the kind of nourishment nature intended for this epoch.

It is not every parent, however, who is able to become a nurse; and with many this office would not only be highly injurious to their own health, but materially so to that of their offspring. This may arise from various causes, hereafter to be noticed, but whenever they exist a wet-nurse is demanded.

Again, the latter resource is not always attainable, so that the hazardous experiment of an artificial diet, or bringing up by hand, as it is then termed, is obliged to be resorted to.

Thus, infantile dietetics naturally divides itself into Maternal Nursing, Wet-Nurse Suckling, And Artificial Feeding.

- 1. MATERNAL NURSING.

PLAN OF SUCKLING.

From the first moment the infant is applied to the breast, it must be nursed upon a certain plan. This is necessary to the well-doing of the child, and will contribute essentially to preserve the health of the parent, who will thus be rendered a good nurse, and her duty at the same time will become a pleasure.

This implies, however, a careful attention on the part of the mother to her own health; for that of her child is essentially dependent upon it. Healthy, nourishing, and digestible milk can be procured only from a healthy parent; and it is against common sense to expect that, if a mother impairs her health and digestion by improper diet, neglect of exercise, and impure air, she can, nevertheless, provide as wholesome and uncontaminated a fluid for her child, as if she were diligently attentive to these important points. Every instance of indisposition in the nurse is liable to affect the infant.

And this leads me to observe, that it is a common mistake to suppose that, because a woman is nursing, she ought therefore to live very fully, and to add an allowance of wine, porter, or other fermented liquor, to her usual diet. The only result of this plan is, to cause an unnatural degree of fulness in the system, which places the nurse on the brink of disease, and which of itself frequently puts a stop to the secretion of the milk, instead of increasing it. The right plan of proceeding is plain enough; only let attention be paid to the ordinary laws of health, and the mother, if she have a sound constitution, will make a better nurse than by any foolish deviation founded on ignorance and caprice.

The following case proves the correctness of this statement:--

A young married lady, confined with her first child, left the lying-in- room at the expiration of the third week, a good nurse, and in perfect health. She had had some slight trouble with her nipples, but this was soon overcome.

The porter system was now commenced, and from a pint to a pint and a half of this beverage was taken in the four and twenty hours. This was resorted to, not because there was any deficiency in the supply of milk, for it was ample, and the infant thriving upon it; but because, having become a nurse, she was told that it was usual and necessary, and that without it her milk and strength would ere long fail.

After this plan had been followed for a few days, the mother became drowsy and disposed to sleep in the daytime; and headach, thirst, a hot skin, in fact, fever supervened; the milk diminished in quantity, and, for the first time, the stomach and bowels of the infant became disordered. The porter was ordered to be left off; remedial measures were prescribed; and all symptoms, both in parent and child, were after a while removed, and health restored.

Having been accustomed, prior to becoming a mother, to take a glass or two of wine, and occasionally a tumbler of table beer, she was advised to follow precisely her former dietetic plan, but with the addition of half a pint of barley-milk morning and night. Both parent and child continued in excellent health during the remaining period of suckling, and the latter did not taste artificial food until the ninth month, the parent's milk being all-sufficient for its wants.

No one can doubt that the porter was in this case the source of the mischief. The patient had gone into the lying-in-room in full health, had had a good time, and came out from her chamber (comparatively) as strong as she entered it. Her constitution had not been previously worn down by repeated child-bearing and nursing, she had an ample supply of milk, and was fully capable, therefore, of performing the duties which now devolved upon her, without resorting to any unusual stimulant or support. Her previous habits were totally at variance with the plan which was adopted; her system became too full, disease was produced, and the result experienced was nothing more than what might be expected.

The plan to be followed for the first six months.-Until the breast- milk is fully established, which may not be until the second or third day subsequent to delivery (almost invariably so in a first confinement), the infant must be fed upon a little thin gruel, or upon one third water and two thirds milk, sweetened with loaf sugar.

After this time it must obtain its nourishment from the breast alone, and for a week or ten days the appetite of the infant must be the mother's guide, as to the frequency in offering the breast. The stomach at birth is feeble, and as yet unaccustomed to food; its wants, therefore, are easily satisfied, but they are frequently renewed. An interval, however, sufficient for digesting the little swallowed, is obtained before the appetite again revives, and a fresh supply is demanded.

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. A young mother very frequently runs into a serious error in this particular, considering every expression of uneasiness as an indication of appetite, and whenever the infant cries offering it the breast, although ten minutes may not have elapsed since its last meal. This is an injurious and even dangerous practice, for, by overloading the stomach, the food remains undigested, the child's bowels are always out of order, it soon becomes restless and feverish, and is, perhaps, eventually lost; when, by simply attending to the above rules of nursing, the infant might have become healthy and vigorous.

For the same reason, the infant that sleeps with its parent must not be allowed to have the nipple remaining in its mouth all night. If nursed as suggested, it will be found to awaken, as the hour for its meal approaches, with great regularity. 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.

The foregoing plan, and without variation, must be pursued to the sixth month.

AFTER THE SIXTH MONTH TO THE TIME OF WEANING.--If the parent has a large supply of good and nourishing milk, and her child is healthy and evidently flourishing upon it, no change in its diet ought to be made. If otherwise, however, (and this will but too frequently be the case, even before the sixth month[FN#1],) the child may be fed twice in the course of the day, and that kind of food chosen which, after a little trial, is found to agree best.

Leman's tops and bottoms, steeped in hot water, with the addition of a little fresh milk, and sweetened or not with loaf sugar, is one of the best description.

If the stomach reject this, farinaceous food boiled in water, and mixed with a small quantity of milk, may be employed. Or weak mutton or veal broth, or beef tea, clear and free from fat, and mixed with an equal quantity of farinaceous food.

If this artificial diet is used before the sixth month, it must be given through the sucking-bottle; after this period with a spoon: in either case it must be previously passed through a sieve.

When the large or grinding teeth have appeared, the same food is still to be continued, but need not any longer be expressed through the sieve.

Such is the plan of nursing to be followed by the mother until she wean her infant altogether from the breast. The period when this ought to take place, as also the manner of accomplishing it, are detailed in the section on "Weaning."

The diet from weaning to the termination of infancy is pointed out under "Artificial Feeding."[FN#3]

DEFICIENCY OF MILK.

If this deficiency exist from the earliest weeks after delivery, and it is not quickly remedied by the means presently to be pointed out, a wet-nurse must be obtained. It will be of no avail partially to nurse, and partially to feed the infant at this period and under such circumstances, for if it is not soon lost, it will only live for a few months, or a year at most, and be an object of the greatest anxiety and grief to its parent. This condition arises from the unwholesomeness of the mother's milk, united with the artificial food; for when the milk is deficient from the first, and continues so notwithstanding the means used for its increase, it is invariably unhealthy in its quality.

This deficiency, however, may exist, and even at a very early period after delivery, and yet be removed. This, however, is not to be accomplished by the means too frequently resorted to; for it is the custom with many, two or three weeks after their confinement, if the supply of nourishment for the infant is scanty, to partake largely of malt liquor for its increase. Sooner or later this will be found injurious to the constitution of the mother: but how, then, is this deficiency to be obviated? Let the nurse keep but in good health, and this point gained, the milk, both as to quantity and quality, will be as ample, nutritious, and good, as can be produced by the individual.

I would recommend a plain, generous, and nutritious diet; not one description of food exclusively, but, as is natural, a wholesome, mixed, animal, and vegetable diet, with or without wine or malt liquor, according to former habit; and, occasionally, where malt liquor has never been previously taken, a pint of good sound ale may be taken daily with advantage, if it agree with the stomach. Regular exercise in the open air is of the greatest importance, as it has an extraordinary influence in promoting the secretion of healthy milk. Early after leaving the lying-in room, carriage exercise, where it can be obtained, is to be preferred, to be exchanged, in a week or so, for horse exercise, or the daily walk. The tepid, or cold salt-water shower bath, should be used every morning; but if it cannot be borne, sponging the body withsalt-water must be substituted.

By adopting with perseverance the foregoing plan, a breast of milk will be obtained as ample in quantity, and good in quality, as the constitution of the parent can produce, as the following case proves:

On the 17th September, 1839, I attended a lady twenty-four years of age, a delicate, but healthy woman, in her first confinement. The labour was good. Every thing went on well for the first week, except that, although the breasts became enlarged, and promised a good supply of nourishment for the infant, at its close there was merely a little oozing from the nipple. During the next fortnight a slight, but very gradual increase in quantity took place, so that a dessert spoonful only was obtained about the middle of this period, and perhaps double this quantity at its expiration. In the mean time the child was necessarily fed upon an artificial diet, and as a consequence its bowels became deranged, and a severe diarrhoea followed. A wet-nurse was advised for the child as the only means of saving its life, and change of air for the mother as the most likely expedient (in connection with the general treatment pointed out above) for obtaining a good breast of milk. Accordingly, on the 5th October, the patient, taking with her the infant and a wet-nurse, went a few miles from town.

For three or four days it was a question whether the little one would live, for so greatly had it been reduced by the looseness of the bowels that it had not strength to grasp the nipple of its nurse; the milk, therefore, was obliged to be drawn, and the child fed with it from a spoon. After the lapse of a few days, however, it could obtain the breast-milk for itself; and, to make short of the case, on the 25th of the same month, the mother and child returned home, the former having a very fair proportion of healthy milk in her bosom, and the child perfectly recovered and evidently thriving fast upon it.

Where, however, there has been an early deficiency in the supply of nourishment, it will most frequently happen that, before the sixth or seventh month, the infant's demands will be greater than the mother can meet. The deficiency must be made up by artificial food, which must be of a kind generally employed before the sixth month, and given through the bottle. If, however, this plan of dieting should disagree, the child must, even at this period, have a wet-nurse.

Women who marry comparatively late in life, and bear children, generally have a deficiency of milk after the second or third month: artificial feeding must in part be here resorted to.

THE INJURIOUS EFFECTS TO THE MOTHER AND INFANT OF UNDUE AND PROTRACTED SUCKLING.

UPON THE MOTHER.--The period of suckling is generally one of the most healthy of a woman's life. But there are exceptions to this as a general rule; and nursing, instead of being accompanied by health, may be the cause of its being materially, and even fatally, impaired. This may arise out of one of two causes, either, a parent continuing to suckle too long; or, from the original powers or strength not being equal to the continued drain on the system.

Examples of the first class I am meeting with daily. I refer to poor married women, who, having nursed their infants eighteen months, two years, or even longer than this, from the belief that by so doing they will prevent pregnancy, call to consult me with an exhausted frame and disordered general health, arising solely from protracted nursing, pursued from the above mistaken notion.

I most frequently meet with examples of the second class in the delicate woman, who, having had two or three children in quick succession, her health has given way, so that she has all the symptoms arising from undue suckling, when perhaps the infant at her breast is not more than two or three months old.

Since the health of the mother, then, will suffer materially from this circumstance, she ought not to be ignorant of the fact; so that, when the first symptoms manifest themselves, she may be able to recognise their insidious approach; and tracing them to their real cause, obtain medical advice before her health be seriously impaired.

SYMPTOMS.--The earliest symptom is a dragging sensation in the back when the child is in the act of sucking, and an exhausted feeling of sinking and emptiness at the pit of the stomach afterwards. This is soon followed by loss of appetite, costive bowels, and pain on the left side; then, the head will be more or less affected, sometimes with much throbbing, singing in the ears, and always some degree of giddiness, with great depression of spirits.

Soon the chest becomes affected, and the breathing is short, accompanied by a dry cough and palpitation of the heart upon the slightest exertion. As the disease advances, the countenance becomes very pale, and the flesh wastes, and profuse night perspirations, great debility, swelling of the ankles, and nervousness ensue. It is unnecessary, however, to enter into a more full detail of symptoms.

TREATMENT.--All that it will be useful to say in reference to treatment, is this; that, although much may be done in the first instance by medicine, change of air, cold and sea bathing, yet the quickest and most effectual remedy is to wean the child, and thus remove the cause.

THE ILL EFFECTS UPON THE INFANT.--There is another and equally powerful reason why the child should be weaned, or rather, have a young and healthy wet-nurse, if practicable. The effects upon the infant, suckled under such circumstances, will be most serious. Born in perfect health, it will now begin to fall off in its appearance, for the mother's milk will be no longer competent to afford it due nourishment; it will be inadequate in quantity and quality. Its countenance, therefore, will become pale; its look sickly and aged; the flesh soft and flabby; the limbs emaciated; the belly, in some cases, large, in others, shrunk; and the evacuations fetid and unnatural; and in a very few weeks, the blooming healthy child will be changed into the pale, sickly, peevish, wasted creature, whose life appears hardly desirable.

The only measure that can save the life, and recover an infant from this state, is that which would previously have prevented it a healthy wet-nurse.

If the effects upon the infant should not be so aggravated as those just described, and it subsequently live and thrive, there will be a tendency in such a constitution to scrofula and consumption, to manifest itself at some future period of life, undoubtedly acquired from the parent, and dependent upon the impaired state of her health at the time of its suckling. A wet-nurse early resorted to, will prevent this.

It will be naturally asked, for how long a period a mother ought to perform the office of a nurse? No specific time can be mentioned, and the only way in which the question can be met is this: no woman, with advantage to her own health, can suckle her infant beyond twelve or eighteen months; and at various periods between the third and twelfth month, many women will be obliged partially or entirely to resign the office.

The monthly periods generally reappear from the twelfth to the fourteenth month from delivery; and when established, as the milk is found invariably to diminish in quantity, and also to deteriorate in quality, and the child is but imperfectly nourished, it is positively necessary in such instances at once to wean it.

OF MOTHERS WHO OUGHT NEVER TO SUCKLE.

There are some females who ought never to undertake the office of suckling, both on account of their own health, and also that of their offspring.

THE WOMAN OF A CONSUMPTIVE AND STRUMOUS CONSTITUTION OUGHT NOT.--In the infant born of such a parent there will be a constitutional predisposition to the same disease; and, if it is nourished from her system, this hereditary predisposition will be confirmed.

"No fact in medicine is better established than that which proves the hereditary transmission from parents to children of a constitutional liability to pulmonary disease, and especially to consumption; yet no condition is less attended to in forming matrimonial engagements. The children of scrofulous and consumptive parents are generally precocious, and their minds being early matured, they engage early in the business of life, and often enter the married state before their bodily frame has had time to consolidate. For a few years every thing seems to go on prosperously, and a numerous family gathers around them. All at once, however, even while youth remains, their physical powers begin to give way, and they drop prematurely into the grave, exhausted by consumption, and leaving children behind them, destined, in all probability, either to be cut off as they approach maturity, or to run through the same delusive but fatal career as that of the parents from whom they derived their existence."[FN#5] There is scarcely an individual who reads these facts, to whom memory will not furnish some sad and mournful example of their truth; though they perhaps may have hitherto been in ignorance of the exciting cause.

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

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

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

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

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

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

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

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

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

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

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

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

- 2. WET-NURSE SUCKLING.

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

CHOICE OF A WET-NURSE.

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

IS THE WOMAN IN GOOD HEALTH?--Her general appearance ought to bear the marks of a sound constitution, and ought to be free from all suspicion of a strumous character; her tongue clean, and digestion good; her teeth and gums sound and perfect [...]