Produced by Albert R. Mann Library. 2003. Home Economics Archive:
Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. Mann
Library, Cornell University. http://hearth.library.cornell.edu (Version
January 2003).
THE
MATERNAL MANAGEMENT
OF
CHILDREN,
IN HEALTH AND DISEASE.
By Thomas Bull, M.D.
Physician Accoucheur To The Finsbury Midwifery
Institution, And Lecturer On Midwifery,
And On The Diseases Of Women
And Children;
Author Of "Hints To Mothers On The
Management Of Their Health."
1840.
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.
CONTENTS.
Chapter I.
ON THE GENERAL MANAGEMENT OF INFANCY AND CHILDHOOD.
Sect. - Page
I. On the Dietetics of Infancy - 2
1. Maternal Nursing - 3
Plan of Suckling - 3
Deficiency of Milk - 11
The injurious Effects to Mother and Infant of undue and protracted
Suckling - 15
Mothers who ought never to suckle - 20
2. Wet-nurse Suckling - 27
Choice of a Wet-nurse - 28
Diet and Regimen of a Wet-nurse - 31
3. Artificial Feeding, (bringing up by hand) - 34
The Kind of artificial Food before the sixth Month - 35
The Kind of artificial Food after the sixth Month to the completion of first Dentition - 44
The Kind of artificial Food most suitable under the different
Complaints to which Infants are liable - 48
II. Weaning - 51
The Time when - 51
The Mode - 52
The drying up of the Mother's Milk - 54
III. On the Dietetics of Childhood - 54
General Directions, and of animal Food - 55
Sugar - 60
Salt - 61
Fruits - 62
Water - 63
Wine, Beer, and Spirits - 63
IV. Sleep - 66
During Infancy - 66
During Childhood - 69
V. Bathing and Cleanliness - 72
During Infancy - 72
During Childhood - 75
VI. Clothing - 78
During Infancy - 78
During Childhood - 81
VII. Air and Exercise - 83
In Infancy - 83
In Childhood - 89
Chap. II.
ON THE USE AND ABUSE OF CERTAIN REMEDIES.
I. Aperient Medicine - 97
Castor Oil - 99
Manna - 101
Magnesia and Rhubarb - 102
The Lavement - 105
The Aperient Liniment - 107
II. Calomel - 107
III. Opiates - 110
IV. Leeching - 113
V. Blisters and Poultices - 114
VI. Baths - 117
The Cold-water Plunge Bath - 118
Sea Bathing - 120
The Shower Bath - 123
Ablution, or Sponging - 125
The Warm Bath - 188
Chap. III.
ON TEETHING, AND HINTS UPON THE PERMANENT TEETH.
I. On Teething. - 134
The Manner in which the temporary or milk Teeth appear - 134
The Management of the Infant when Teething is without difficulty - 136
The Management of the Infant in difficult Teething - 139
II. Hints on the permanent or adult Teeth - 148
The Manner in which they appear - 248
Their Value and Importance - 152
Their Management and Preservation - 154
Chap. IV.
HINTS FOR THE EARLY DETECTION OP DISEASE IN THE CHILD BY THE MOTHER.
I. Signs of Health - 163
II. Signs of Disease - 164
Of the Countenance - 165
Of the Gestures - 169
Of the Sleep - 171
Of the Stools - 172
Of the Breathing and Cough - 175
III. Other Circumstances which will assist in the early Detection of
Disease - 178
The Influence of the Seasons in producing particular Forms of Disorder - 178
The Influence of an hereditary Predisposition to certain Diseases - 179
Chap. V.
ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.
I. Accidents and Diseases which may occur to the Infant at Birth, or soon after - 187
1. Still-born - 187
2. Injuries received during Birth - 193
3. Retention of Urine - 194
4. Swelling of the Breasts - 195
5. Inflammation of the Eyes - 196
6. Hare-lip - 199
7. Bleeding from the Navel-string - 201
8. Ulceration or imperfect Healing of the Navel - 20l
9. Bleeding from the Navel - 203
10. Jaundice - 204
11. Tongue-tied - 205
12. Moles and Marks on the Skin, etc. - 206
II. Disorders of the Stomach and Bowels; viz., Indigestion -
Flatulence - Vomiting - Griping and Looseness - 208
1. In the Infant at the Breast - 21O
2. At the period of Weaning - 217
3. In the child brought up by Hand - 221
Maternal Treatment - 222
III. Costiveness - 229
In Infancy - 229
In Childhood - 231
IV. Worms - 234
Not so frequent as popularly supposed; an error productive of mischief - 234
How produced and how best prevented - 237
V. Scarlet Fever - 239
Mild Form - 239
With Sore Throat - 242
Scarlet Fever compared with Measles - 245
Maternal Management - 246
VI. Measles - 253
Description - 253
Compared with Scarlet Fever and Small Pox - 255
Maternal Management - 256
VII. Small-Pox - 262
Natural Small-Pox - 263
Small-Pox in the Vaccinated - 266
Maternal Management - 268
VIII. Hooping Cough - 275
Description - 276
Maternal Management - 279
IX. Croup - 286
Signs of its Approach - 286
Maternal Management - 289
Its prevention - 289
X. Water in the Head - 291
Its Prevention - 292
Maternal Management - 298
THE MATERNAL MANAGEMENT OF CHILDREN.
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.
[FN#1] See Deficiency of Milk, p. 11.
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."[FN#2]
[FN#2] See page 51.
The diet from weaning to the termination of infancy is pointed out under "Artificial Feeding."[FN#3]
[FN#3] See page 34.
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.[FN#4]
[FN#4] See "Weaning," p. 51.
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.
[FN#5] Combe's Principles of Physiology applied to the Preservation of
Health, etc.
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.
[FN#6] See "Choice of a Wet-nurse," p. 28.
[FN#7] One that has been confined about six weeks or two months.
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; her skin free from eruption, and her breath sweet.
WHAT IS THE CONDITION OF THE BREAST?—A good breast should be firm and well formed; its size not dependent upon a large quantity of fat, which will generally take away from its firmness, giving it a flabby appearance, but upon its glandular structure, which conveys to the touch a knotted, irregular, and hard feel; and the nipple must be perfect, of moderate size, but well developed.
WHAT IS THE QUALITY OF THE MILK?—It should be thin, and of a bluish- white colour; sweet to the taste; and when allowed to stand, should throw up a considerable quantity of cream.
WHAT IS ITS AGE?—If the lying-in month of the patient has scarcely expired, the wet-nurse to be hired ought certainly not to have reached her second month. At this time, the nearer the birth of the child, and the delivery of its foster-parent, the better: the reason for which is, that during the first few weeks the milk is thinner and more watery than it afterwards becomes. If, consequently, a new-born infant be provided with a nurse, who has been delivered three or four months, the natural relation between its stomach and the quality of the milk is destroyed, and the infant suffers from the oppression of food too heavy for its digestive power.
On the other hand, if you are seeking a wet-nurse for an infant of four or five months old, it would be very prejudicial to transfer the child to a woman recently delivered; the milk would be too watery for its support, and its health in consequence would give way.
THE NURSE HERSELF SHOULD NOT BE TOO OLD!—A vigorous young woman from twenty-one to thirty admits of no question. And the woman who has had one or two children before is always to be preferred, as she will be likely to have more milk, and may also be supposed to have acquired some experience in the management of infants.
INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?—If so, reject her at once. You will have no difficulty in ascertaining this point; for this class of persons have an idea that their milk is renewed, as they term it, by this circumstance, monthly; and, therefore, that it is a recommendation, rendering their milk fitter for younger children than it would otherwise have been. It produces, however, quite a contrary effect; it much impairs the milk, which will be found to disagree with the child, rendering it at first fretful,—after a time being vomited up, and productive of frequent watery dark green motions.
Last of all, WHAT IS THE CONDITION OF THE CHILD?—It ought to have the sprightly appearance of health, to bear the marks of being well nourished, its flesh firm, its skin clean and free from eruptions. It should be examined in this respect, particularly about the head, neck, and gums.
If a medical man finds that both mother and child answer to the above description, he has no hesitation in recommending the former as likely to prove a good wet-nurse.
DIET AND REGIMEN OF A WET-NURSE.
The regimen of a wet-nurse should not differ much from that to which she has been accustomed; and any change which it may be necessary to make in it should be gradual. It is erroneous to suppose that women when nursing require to be much more highly fed than at other times: a good nurse does not need this, and a bad one will not be the better for it. The quantity which many nurses eat and drink, and the indolent life which they too often lead, have the effect of deranging their digestive organs, and frequently induce a state of febrile excitement, which always diminishes, and even sometimes altogether disperses, the milk.
It will be necessary then to guard against the nurse overloading her stomach with a mass of indigestible food and drink. She should live as much as possible in the manner to which she has been accustomed; she should have a wholesome, mixed, animal and vegetable diet, and a moderate and somewhat extra quantity of malt liquor, provided it agree with her system.
A very prevailing notion exists that porter tends to produce a great flow of milk, and in consequence the wet-nurse is allowed as much as she likes; a large quantity is in this way taken, and after a short time so much febrile action excited in the system, that instead of increasing the flow of milk, it diminishes it greatly. Some parents, however, aware of this fact, will go into an opposite extreme, and refuse the nurse even that which is necessary. Either excess is of course wrong. It is difficult in general terms to say what ought to be considered a proper daily allowance, but some is in general necessary; and whenever a woman has been used to drink malt-liquor, she will rarely make a good wet-nurse if she is denied a reasonable quantity of that beverage. Good sound ale sometimes agrees better than porter. It may be well here to remark, that in London, I frequently meet with severe cases of diarrhoea in infants at the breast, fairly traceable to bad porter, which vitiating the quality of the milk, no medical treatment cures the disease, until this beverage is left off or changed, when it at once disappears.
The nurse should take exercise daily in the open air. Nothing tends more directly to maintain a good supply of healthy milk, than air and exercise; and the best wet-nurse would soon lose her milk, if constantly kept within doors. Sponging the whole body also with cold water with bay-salt in it every morning, should be insisted upon, if possible: it preserves cleanliness, and greatly invigorates the health. United with this, the nurse should rise early, and also be regularly employed during the day in some little portion of duty in the family, an attendance upon the wants of the child not being alone sufficient.
An amiable disposition and good temper are very desirable. A violent fit of passion may exert so peculiar an influence in changing the natural properties of the milk, that a child has been known to be attacked with a fit of convulsions after being suckled by a nurse while labouring under the effects of a fit of anger. The depressing passions frequently drive the milk away altogether. It is hence of no small moment, that a wet-nurse be of a quiet and even temper, and not disposed to mental disturbance.
3. ARTIFICIAL, FEEDING, OR BRINGING UP BY HAND.
Extreme delicacy of constitution, diseased condition of the frame, defective secretion of milk, and other causes, may forbid the mother suckling her child; and unless she can perform this office with safety to herself, and benefit to her infant, she ought not to attempt it. In this case a young and healthy wet-nurse is the best substitute; but even this resource is not always attainable. Under these circumstances, the child must be brought up on an artificial diet "by hand,"—as it is popularly called.
To accomplish this with success requires the most careful attention on the part of the parent, and at all times is attended with risk to the life of the child; for although some children, thus reared, live and have sound health, these are exceptions to the general rule, artificial feeding being in most instances unsuccessful.
THE KIND OF ARTIFICIAL FOOD BEFORE THE SIXTH MONTH.
It should be as like the breast-milk as possible. This is obtained by a mixture of cow's milk, water, and sugar, in the following proportions:—
Fresh cow's milk, two thirds;
Boiling water, or thin barley water, one third;
Loaf sugar, a sufficient quantity to sweeten.
This is the best diet that can be used for the first six months, after which some farinaceous food may be combined.
In early infancy, mothers are too much in the habit of giving thick gruel, panada, biscuit-powder, and such matters, thinking that a diet of a lighter kind will not nourish. This is a mistake; for these preparations are much too solid; they overload the stomach, and cause indigestion, flatulence, and griping. These create a necessity for purgative medicines and carminatives, which again weaken digestion, and, by unnatural irritation, perpetuate the evils which render them necessary. Thus many infants are kept in a continual round of repletion, indigestion, and purging, with the administration of cordials and narcotics, who, if their diet were in quantity and quality suited to their digestive powers, would need no aid from physic or physicians.
In preparing this diet, it is highly important to obtain pure milk, not previously skimmed, or mixed with water; and in warm weather just taken from the cow. It should not be mixed with the water or sugar until wanted, and not more made than will be taken by the child at the time, for it must be prepared fresh at every meal. It is best not to heat the milk over the fire, but let the water be in a boiling state when mixed with it, and thus given to the infant tepid or lukewarm.
As the infant advances in age, the proportion of milk may be gradually increased; this is necessary after the second month, when three parts of milk to one of water may be allowed. But there must be no change in the kind of diet if the health of the child is good, and its appearance perceptibly improving. Nothing is more absurd than the notion, that in early life children require a variety of food; only one kind of food is prepared by nature, and it is impossible to transgress this law without marked injury.
If cow's milk disagree with an infant—and this is sometimes unfortunately the case, even from its birth ass's milk,—diluted with one third its quantity of water, may be given as a substitute. I am now attending a lady in her fourth confinement, who is unable, from defect in her nipples, to suckle her children. The first child had a healthy wet-nurse, and has grown a fine healthy lad. The second, a girl, was unfortunate in her nurse, she being of a strumous and unhealthy constitution, although to a casual observer bearing the appearance of health. The child lived only three months, and the nurse died of a rapid consumption shortly after. This discouraged the mother from adopting wet-nurse suckling for the third child (a great error); and an artificial diet of cow's milk was resorted to. The third day from commencing this plan, flatulence, griping, purging, and vomiting came on, one symptom quickly following the other; the child wasted, and on the sixth day had several convulsive fits. The diet was immediately changed for ass's milk, and in less than twelve hours the sickness and purging ceased; the flatulence was relieved; the motions, from being green, watery, and passed with great violence and pain, became of a healthy consistence and colour, and the screaming ceased. The symptoms did not return, the child thrived, very soon consuming regularly one quart of the ass's milk daily, and is now a fine healthy girl two years old. A fortnight since the parent was confined with a fourth child. Cow's milk was given to it for two or three days (from the difficulty of obtaining that of the ass), the same train of symptoms, precisely, came on with which the third child had been affected, which again gave way upon following up the same plan of diet—the substitution of the ass's milk for that of the cow. The evident conclusion from this is, that the breast-milk of a healthy woman is incomparably the most suitable diet for the infant; but that, if she be not of a healthy constitution, it may be destructive to the child; and that where this cannot be obtained, and cow's milk is found to disagree, ass's milk may sometimes be resorted to with the happiest results.[FN#8]
[FN#8] An infant will generally consume a quart, or a little more, of ass's milk in the four and twenty hours; and as this quantity is nearly as much as the animal will give, it is best to purchase an ass for the express purpose. The foal must be separated from the mother, and the forage of the latter carefully attended to, or the milk will disagree with the child.
Sometimes the mother's breast, and every description of milk, is rejected by the child; in which case recourse must be had to veal or weak mutton broth, or beef tea, clear and free from fat, mixed with a very small quantity of farinaceous food, carefully passed through a sieve before it is poured into the sucking-bottle.
THE MODE OF ADMINISTERING IT.—There are two ways—by the spoon, and by the nursing-bottle. The first ought never to be employed at this period, inasmuch as the power of digestion in infants is very weak, and their food is designed by nature to be taken very slowly into the stomach, being procured from the breast by the act of sucking, in which act a great quantity of saliva is secreted, and being poured into the mouth, mixes with the milk, and is swallowed with it. This process of nature, then, should be emulated as far as possible; and food (for this purpose) should be imbibed by suction from a nursing-bottle: it is thus obtained slowly, and the suction employed secures the mixture of a due quantity of saliva, which has a highly important influence on digestion.
Too much care cannot be taken to keep the bottle perfectly sweet. For this purpose there should always be two in the nursery, to be used alternately; and, if any food remain after a meal, it must be emptied out. The bottle must always be scalded out after use. The flat glass nursing-bottle itself is too well known to need description; it may be well, however, to say a word about the teat that covers its narrow neck, and through which the infant sucks the food. If the artificial or prepared cow's teat is made use of, it should be so attached to the bottle that its extremity does not extend beyond its apex more than half or three quarters of an inch; for if it projects more than this, the child will get the sides of the teat so firmly pressed together between its gums, that there will be no channel for the milk to flow through. This remark applies equally to the teat made of soft wash- leather, which many ladies prefer to that of the cow, and it is a good substitute; but then a fresh piece of leather must be made use of daily, otherwise the food will be tainted, and the child's bowels deranged. It is also necessary that both of these, when used, should have a small conical piece of sponge inclosed.
The most cleanly and convenient apparatus is a cork nipple, upon the plan of M. Darbo, of Paris, fixed in the sucking-bottle.[FN#9] The cork, being of a particularly fine texture, is supple and elastic, yielding to the infant's lips while sucking, and is much more durable than the teats ordinarily used.
[FN#9] Sold by Weiss et Son, 62. Strand,
Whatever kind of bottle or teat is used, however, it must never be forgotten that cleanliness is absolutely essential to the success of this plan of rearing children.
THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.—This must be regulated by the age of the child, and its digestive power. A little experience will soon enable a careful and observing mother to determine this point.—As the child grows older the quantity of course must be increased.
The chief error in rearing the young is overfeeding; and a most serious one it is; but which may be easily avoided by the parent pursuing a systematic plan with regard to the hours of feeding, and then only yielding to the indications of appetite, and administering the food slowly, in small quantities at a time. This is the only way effectually to prevent indigestion, and bowel complaints, and the irritable condition of the nervous system, so common in infancy, and secure to the infant healthy nutrition, and consequent strength of constitution. As has been well observed, "Nature never intended the infant's stomach to be converted into a receptacle for laxatives, carminatives, antacids, stimulants, and astringents; and when these become necessary, we may rest assured that there is something faulty in our management, however perfect it may seem to ourselves."
THE FREQUENCY OF GIVING FOOD.—This must be determined, as a general rule, by allowing such an interval between each meal as will insure the digestion of the previous quantity; and this may be fixed at about every three or four hours. If this rule be departed from, and the child receives a fresh supply of food every hour or so, time will not be given for the digestion of the previous quantity, and as a consequence of this process being interrupted, the food passing on into the bowel undigested, will there ferment and become sour, will inevitably produce cholic and purging, and in no way contribute to the nourishment of the child.
THE POSTURE OF THE CHILD WHEN FED.—It is important to attend to this. It must not receive its meals lying; the head should be raised on the nurse's arm, the most natural position, and one in which there will be no danger of the food going the wrong way, as it is called. After each meal the little one should be put into its cot, or repose on its mother's knee, for at least half an hour. This is essential for the process of digestion, as exercise is important at other times for the promotion of health.
THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION OF FIRST DENTITION.
As soon as the child has got any teeth,—and about this period one or two will make their appearance,—solid farinaceous matter boiled in water, beaten through a sieve, and mixed with a small quantity of milk, may be employed. Or tops and bottoms, steeped in hot water, with the addition of fresh milk and loaf sugar to sweeten. And the child may now, for the first time, be fed with a spoon.
When one or two of the large grinding teeth have appeared, the same food may be continued, but need not be passed through a sieve. Beef tea and chicken broth may occasionally be added; and, as an introduction to the use of a more completely animal diet, a portion, now and then, of a soft boiled egg; by and by a small bread pudding, made with one egg in it, may be taken as the dinner meal.
Nothing is more common than for parents during this period to give their children animal food. This is a great error. "To feed an infant with animal food before it has teeth proper for masticating it, shows a total disregard to the plain indications of nature, in withholding such teeth till the system requires their assistance to masticate solid food. And the method of grating and pounding meat, as a substitute for chewing, may be well suited to the toothless octogenarian, whose stomach is capable of digesting it; but the stomach of a young child is not adapted to the digestion of such food, and will be disordered by it."[FN#10]
[FN#10] Sir James Clarke on Consumption.
"If the principles already laid down be true, it cannot reasonably be maintained that a child's mouth without teeth, and that of an adult, furnished with the teeth of carnivorous and graminivorous animals, are designed by the Creator for the same sort of food. If the mastication of solid food, whether animal or vegetable, and a due admixture of saliva, be necessary for digestion, then solid food cannot be proper, when there is no power of mastication. If it is swallowed in large masses it cannot be masticated at all, and will have but a small chance of being digested; and in an undigested state it will prove injurious to the stomach and to the other organs concerned in digestion, by forming unnatural compounds. The practice of giving solid food to a toothless child, is not less absurd, than to expect corn to be ground where there is no apparatus for grinding it. That which would be considered as an evidence of idiotism or insanity in the last instance, is defended and practised in the former. If, on the other hand, to obviate this evil, the solid matter, whether animal or vegetable, be previously broken into small masses, the infant will instantly swallow it, but it will be unmixed with saliva. Yet in every day's observation it will be seen, that children are so fed in their most tender age; and it is not wonderful that present evils are by this means produced, and the foundation laid for future disease."[FN#11]
[FN#11] Dr. John Clarke's Commentaries.
The diet pointed out, then, is to be continued until the second year. Great care, however, is necessary in its management; for this period of infancy is ushered in by the process of teething, which is commonly connected with more or less of disorder of the system. Any error, therefore, in diet or regimen is now to be most carefully avoided. 'Tis true that the infant, who is of a sound and healthy constitution, in whom, therefore, the powers of life are energetic, and who up to this time has been nursed upon the breast of its parent, and now commences an artificial diet for the first time, disorder is scarcely perceptible, unless from the operation of very efficient causes. Not so, however, with the child who from the first hour of its birth has been nourished upon artificial food. Teething under such circumstances is always attended with more or less of disturbance of the frame, and disease of the most dangerous character but too frequently ensues. It is at this age, too, that all infectious and eruptive fevers are most prevalent; worms often begin to form, and diarrhoea, thrush, rickets, cutaneous eruptions, etc. manifest themselves, and the foundation of strumous disease is originated or developed. A judicious management of diet will prevent some of these complaints, and mitigate the violence of others when they occur.
THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT COMPLAINTS TO WHICH INFANTS ARE LIABLE.
Artificial food, from mismanagement and other causes, will now and then disagree with the infant. The stomach and bowels are thus deranged, and medicine is resorted to, and again and again the same thing occurs.
This is wrong, and but too frequently productive of serious and lasting mischief. Alteration of diet, rather than the exhibition of medicine, should, under these circumstances, be relied on for remedying the evil. Calomel, and such like remedies, "the little powders of the nursery," ought not to be given on every trivial occasion. More mischief has been effected, and more positive disease produced, by the indiscriminate use of the above powerful drug, either alone or in combination with other drastic purgatives, than would be credited. Purgative medicines ought at all times to be exhibited with caution to an infant, for so delicate and susceptible is the structure of its alimentary canal, that disease is but too frequently caused by that which was resorted to in the first instance as a remedy. The bowels should always be kept free; but then it must be by the mildest and least irritating means.
It is a very desirable thing, then, to correct the disordered conditions of the digestive organs of an infant, if possible, without medicine; and much may be done by changing the nature, and sometimes by simply diminishing the quantity, of food.
A diarrhoea, or looseness of the bowels, may frequently be checked by giving, as the diet, sago thoroughly boiled in very weak beef-tea, with the addition of a little milk. The same purpose is frequently to be answered by two thirds of arrow-root with one third of milk, or simply thin arrow-root made with water only; or, if these fail, baked flour, mixed with boiled milk.
Costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in hot water, and a small quantity of milk added, or prepared barley,—mixed in warm water and unboiled milk.
Flatulence and griping generally arise from an undue quantity of food, which passing undigested into the bowels, they are thus irritated and disturbed. This may be cured by abstinence alone. The same state of things may be caused by the food not being prepared fresh at every meal, or even from the nursing-bottle or vessel in which the food is given not having been perfectly clean. In this case weak chicken-broth, or beef-tea freed from fat, and thickened with soft boiled rice or arrow-root, may be given.
Sect. II. WEANING.
THE TIME WHEN TO TAKE PLACE.—The time when weaning is to take place must ever depend upon a variety of circumstances, which will regulate this matter, independently of any general rule that might be laid down. The mother's health may, in one case, oblige her to resort to weaning before the sixth month, and, in another instance, the delicacy of the infant's health, to delay it beyond the twelfth. Nevertheless, as a general rule, both child and parent being in good health, weaning ought never to take place earlier than the ninth (the most usual date), and never delayed beyond the twelfth month.
I should say further, that if child and parent are both in vigorous health, if the infant has cut several of its teeth, and been already accustomed to be partially fed, weaning ought to be gradually accomplished at the ninth month. On the other hand, that if the child is feeble in constitution, the teeth late in appearing, and the mother is healthy, and has a sufficient supply of good milk, especially if it be the autumnal season, it will be far better to prolong the nursing for a few months. In such a case, the fact of the on-appearance of the teeth indicates an unfitness of the system for any other than the natural food from the maternal breast.
And again, if the infant is born of a consumptive parent, and a healthy and vigorous wet-nurse has been provided, weaning should most certainly be deferred beyond the usual time, carefully watching, however, that neither nurse nor child suffer from its continuance.
THE MODE.—It should be effected gradually. From the sixth month most children are fed twice or oftener in the four-and-twenty hours; the infant is in fact, therefore, from this time in the progress of weaning; that is to say, its natural diet is partly changed for an artificial one, so that when the time for complete weaning arrives, it will be easily accomplished, without suffering to the mother, or much denial to the child.
It is, however, of the greatest importance to regulate the quantity and quality of the food at this time. If too much food is given (and this is the great danger) the stomach will be overloaded, the digestive powers destroyed, and if the child is not carried off suddenly by convulsions, its bowels will become obstinately disordered; it will fall away from not being nourished, and perhaps eventually become a sacrifice to the overanxious desire of the parent and its friends to promote its welfare.
The kind of food proper for this period, and the mode of administering it, is detailed in the previous section, on "Artificial Feeding."[FN#12]
[FN#12] The kind of food after the sixth month to the completion of first dentition, p. 44.
Much exercise in the open air (whenever there is no dampness of atmosphere) is highly necessary and beneficial at this time; it tends to invigorate the system, and strengthens the digestive organs, and thus enables the latter to bear without injury the alteration in diet.
THE DRYING UP OF THE MOTHER'S MILK.—This will generally be attended with no difficulty. When the weaning is effected gradually, the milk will usually go away of itself without any measures being resorted to. If, however, the breasts should continue loaded, or indeed painfully distended, a gentle aperient should be taken every morning, so that the bowels are kept slightly relaxed; the diet must be diminished in quantity, and solid nourishment only taken. The breast, if painfully distended, must be occasionally drawn, but only just sufficiently to relieve the distention. In either case they must be rubbed for five or ten minutes, every four or five hours, with the following liniment, previously warmed:—
Compound soap liniment, one ounce and a half;
Laudanum, three drachms.
Sect. III. DIETETICS OF CHILDHOOD.
Childhood, as has been before intimated, extends from about the second to the seventh or eighth year, when the second dentition is commenced.
No precise rules of diet can be laid down for this period, as this requires to be adapted in every case to the particular constitution concerned. There are, however, certain general principles which must be acted upon, and which can be easily modified by a judicious and observant parent, as circumstances and constitution may require.