APPENDIX

TO THE

SECOND PART OF THE MEDICAL GUIDE.

THE MANAGEMENT OF CHILDREN.

Ir appears by the annual bills of mortality, that no less than one half of the children born in this country die before they attain the age of eight years. * Of late years the causes of this mortality, peculiar to the human race, have been so far investigated, that many of the vulgar errors in nursing, handed down from time immemorial, have been abandoned, and nature and reason begin to predominate over prejudice and ignorance. The calamity is, doubtless, in a great measure to be attributed to improper feeding and clothing. That the method of nursing has been wrong, needs no other proof than the frequent miscarriages which have attended it, the death of many, and the deformities and ill health of those that have survived. The mortality of infants is, in some degree, a natural evil; but the majority of instances may certainly be ascribed to neglect or officiousness; for the brute creation, guided by instinct, or the dictates of nature, seldom perish until they have run their natural course; while man, the child of art and refinement, proud of his superior mental attainments, is very liable to err. †

OF THE CLOTHING OF CHILDREN. The first great mistake arises from the prejudice of nurses, in overloading and binding children with flannels, swathes, stays, &c. which render a healthy child so tender and chilly, that it cannot bear the external air‡:

*The average of the bills of mortality for ten successive years, in London and its environs, demonstrates that more than one half of the children born within their limits die under seven years of age. In Manchester and Birming ham the proportion is nearly the same, but throughout the country very considerably less. Some have estimated the death of children in London to be at least double that in the country.

Whatever may be the advantages of modern refinement to society, the life of man is certainly abridged by it; for uncultivated man is not only exempt from a number of diseases to which the civilized world is subject, but rarely dies till he has arrived to the limited period of his existence.

The clothes of children should, in all cases, be proportioned to the climate and temperature of the atmosphere.

and if by accident it should be exposed to a refreshing breeze, the consequence is frequently a serious inflammatory affection of the lungs or bowels; or if the child should survive the first month, it is then sent into the country, to be reared in a house that admits wind and air from every quarter! Now, a new-born infant, being naturally warmer than an adult, requires in proportion less clothing, which should be put on so loose, that the bowels may have room, and the limbs liberty to act and exert themselves, that the circulation of blood, through the superficial vessels may not be impeded, or malformation or unnatural swellings be produced by partial compression. To the latter are doubtless attributable the many distortions and deformities*, particularly among females, who suffer more in this respect than males. The great pleasure a child manifests on being divested of this superfluity of dress, by all its powers of expression, one would suppose sufficient to convince nurses, were they capable of making just observations, that the free use of its muscles is more agreeable to its feelings, as well as necessary for its growth and strength.

A flannel waistcoat, without sleeves, made to fit the body, and tie loosely behind, with a petticoat †, and over this a kind of gown-both of the same thin, light and flimsy materials — (the petticoat should not be quite so long as the child, the gown a few inches longer) with one cap only on the head, and the linen as usual, I think abundantly sufficient for the day, laying aside all swathes, bandages, stays, and the contrivances that are most ridiculously used to close and keep the bones of the head

The negro children in the West Indies are suffered to lie and tumble about on the floor from their earliest infancy in a naked state; and notwithstanding the hardships they undergo at every period of life, there is scarcely a deformed negro to be seen amongst them: a convincing proof that the pressure of clothes is a means of producing deformity, when we see on the other hand so many victims to it in this country.

In putting on the petticoat, great care should be taken not to confine the motion of the ribs. The structure of the bones of the chest are very delicate, and the least pressure will produce distortion. The bowels of a child after two years of age, and some at an earlier period, require to be gently supported, and for this purpose a fine thin flannel waistcoat will answer best. It should be made to lace behind from the bottom upwards. The intention of this waistcoat is merely to support the bowels, so as to prevent the relaxation and obstruction of the viscera, which often take place in weakly children, and predispose them to rickets and bowel complaints. Beneath the laced part there' should be a slip of flannel to defend the skin, which at the same time will support the back-bone.

It sometimes happens that a portion of intestine protrudes at the navel, through violent crying: in which case, a plaster of diachylon, of the size of a dollar, may be applied to the part, and over it a soft broad piece of thin flannel, in the form of a roller. If the bandage be applied tight, it may not only hurt the bowels, but produce rupture at the lower part of the belly.

in their place; the latter of which, by confining and compressing the brain, have no doubt been productive of very serious mischief to that organ, and by keeping up irritation in it, may often produce that formidable disease commonly called Watery Head. Shoes and stockings are likewise unnecessary incumbrances; the latter keep the legs wet and dirty, if they are not changed two or three times a day, and the former too often cramp and hurt the feet, so as to prevent the child learning to walk. Children in this simple dress would be perfectly easy, and enjoy the free use of their limbs and faculties. They should be put into it as soon as they are born, and continued in it till they are three years old, when it may be left off for any other more genteel and fashionable. They ought to be changed at least every day, to keep them free from sourness, which is prejudicial to the tender state of infancy. The night-dress should be only a loose flannel shirt, and less in quantity than that which is worn during the day, otherwise the child will be very liable to be affected with cold and complaints of the bowels. Tape should be used instead of pins in putting on their napkins.

OF THE FEEDING OF CHILDREN. In the feeding of children, great care should be taken that their food be wholesome and good, and that it be given in such quantity only as the body requires for its support and growth. In the business of nursing, as in physic, we should endeavour to follow the dictates of nature. When a child is born, it is full of blood and excrement; and it requires some intermediate time of abstinence and rest to compose and recover it from the effects of the pressure it may have sustained in the birth; as well as the slight fever arising from the revolutions it undergoes after delivery. If the child has sustained no injury, it will soon fall into a sound sleep of six or seven hours, when it will awake refreshed and hungry. It should then be put to suckt: if there be no milk, the sucking of the

The unnatural custom of confining the limbs of a child during night cannot be too much reprobated or guarded against by parents: a simple contrivance to confine the hands, in order to prevent the child from rubbing or scratching its eyes, is often necessary; but the confinement of the legs should on no account be allowed.

If the nipples of the mother be short, which is generally the case with the first child, they should be first drawn out by the nurse; and in case of being tender, it will be proper to wash them with a little brandy instead of the poisonous preparation of lead, recommended by quacks and officious nurses. If the mother has small, tender, or ulcerated nipples, the prepared nipples (the teats of calves) will enable her to give suck with great comfort. I have, in many instances, found them to answer when the mother, through ulceration or total deficiency of nipple, could not otherwise have suckled her infant. The ease and advantages they afford are so very considerable and important, that it is much to be regretted that they are not better known to the faculty.

infant will in a few hours infallibly bring it; and if nothing else be given, the child will grow strong, and the mother perfectly recover in a few days. The general practice of forcing down a child's throat, as soon as it is born, a lump of butter and sugar, or a little oil and syrup, with a view to cleanse the bowels, is exceedingly pernicious. The mother's first milk is of a purga

tive nature, and cleanses a child of its excrements, without griping or disordering the stomach or bowels; indeed, such is its gentle aperient property, that no child can be deprived of it without manifest injury. + By degrees, the milk becomes less purgative, and more nourishing, and is unquestionably the best and only food the child likes, or ought to have, for at least three months. The call of nature should be waited for, to feed it with any thing more substantial; and the appetite always precedes the food, not only with regard to the daily meals, but those changes of diet which increasing life requires.

I am well convinced that nine in ten of the diseases of children may justly be imputed to the mistakes of nurses, both in the quality and quantity of food. With respect to quantity, it is a most ridiculous error to suppose, that whenever a child cries, it wants victuals, and thus to feed it twelve or more times in the course of a day and night. If the child's wants and motions be diligently and judiciously attended to, it will be found that it seldom, if ever, cries but from pain. Children, no doubt, suffer very acute pain from spasms, in consequence of over-distention of the stomach by food; the nurse, notwithstanding, in order to pacify it, will persist in forcing down its throat fresh quantities; or otherwise, with the same view, it is put to suck, which will often relieve it

Another frequent obstacle to suckling is inflammation of the gland of the breast, to which young mothers are very subject. The object in the treatment of this often very painful affection is to prevent suppuration or the formation of matter, by the application of leeches to the part, and the discutient lotion, No. 102 (without camphor), and the occasional use of an aperient dose of jalap or castor oil. The milk should be drawn off very gently by the nurse or child. In consequence of the increased determination of blood to the breast, and the irritation kept up in it by its office of secreting milk, the inflammation generally advances to suppuration, in spite of all our efforts to prevent it. When this is the case, a poultice of linseed powder should be applied and continued till the part has healed. After the abscess has broken, the inflamed skin may be washed with spirit of wine or brandy twice a day, and the ulcer or opening covered with lint. Ointment is seldom necessary.

A lady of respectability in the city of London had nearly lost her infant through the nurse giving it, soon after it was born, a table-spoonful of wate, in which the end of a red-hot poker had been put for a few minutes: this was done, as she stated, to prevent the thrush.

If the infant has been deprived of the first milk by any untoward occurrence, a little oil of almond or fresh castor-oil may be given for the purpose of emptying the bowels.

by producing vomiting. If the stomach be frequently supplied with food, or be overloaded, it is impossible the whole can be properly digested; and hence, by undergoing fermentation, a quantity of air is disengaged, and acidity generated, which, by producing spasms and irritation in the stomach and intestines, give rise to inward fits, convulsions, and not unfrequently inflammation of the bowels. The sensation of hunger being unattended with pain, a very young child will make other signs of its wants before it will cry for food. If it be healthy and quite easy in its dress, it will very rarely cry at all. Children that are fed only four or five times in twenty-four hours, are more healthy, active, and cheerful, than those who are never suffered to be hungry. The great fault in the quality of the food is its not being simple enough. The addition of spices and wine to their pap, gruel, or panada, is unnecessary; they were first only introduced by luxury, to the great destruction of the health of mankind. Å child should not be kept entirely on vegetable food, on account of its tendency to fermentation in the stomach, and to the consequent production of an acid and air which are the exciting causes of many diseases. Man being partly carnivorous, his offspring should not be entirely deprived of animal food, which corrects the acescent quality of vegetables. The mother's milk, when good, appears to be a mixture of vegetable and animal properties; in the due proportion of which consists that salubrity of aliment our nature seems to require. I would advise, therefore, that one-fourth of their diet be thin and light broth, free from fat, with a little arrow-root, bread, or rice-flour. The admixture of animal jelly with that of the arrow-root, recommended under the head of arrow-root, is likewise an excellent combination for weakly children. If this combination should prove too heavy, or if the child should refuse thick food, asses' milk may be substituted for it. (See ARROW-ROOT, p. 155.) The other part of children's diet may be a little toasted bread, or tops and bottoms, boiled with a little water, almost dry, and then mixed with fresh milk, not boiled, the properties of the milk and its taste being much changed by heat. This, without spices, or any other pretended amendment whatever, will be perfectly light and wholesome. A sucking child may be fed twice a day at first, and not oftener; once with the broth, and once with the milk thus prepared, in quantity just to satisfy its hunger. Children should

*

* When this acid corruption of food predominates, which is obvious from crude, white, or green stools, gripes and purging, a little magnesia, or limewater (see Antacids, p. 6), in mint-water, will prove the best remedy; but if attended with much pain in the bowels, known by the child's kicking and drawing up its legs, the absorbent mixture will prove more serviceable than magnesia alone.