The Book of Household Management

by Mrs. Beeton

TEETHING AND CONVULSIONS.

Fits, &c., the consequence of Dentition, and how to be treated.—The number and order of the Teeth, and manner in which they are cut.—First and Second Set.

2509. About three months after birth, the infant's troubles may be said to begin; teeth commence forming in the gums, causing pain and irritation in the mouth, and which, but for the saliva it causes to flow so abundantly, would be attended with very serious consequences. At the same time the mother frequently relaxes in the punctuality of the regimen imposed on her, and, taking some unusual or different food, excites diarrhoea or irritation in her child's stomach, which not unfrequently results in a rash on the skin, or slight febrile symptoms, which, if not subdued in their outset, superinduce some more serious form of infantine disease. But, as a general rule, the teeth are the primary cause of much of the child's sufferings, in consequence of the state of nervous and functional irritation into which the system is thrown by their formation and progress out of the jaw and through the gums. We propose beginning this branch of our subject with that most fertile source of an infant's suffering—

Teething.

2510. That this subject may he better understood by the nurse and mother, and the reason of the constitutional disturbance that, to a greater or less degree, is experienced by all infants, may be made intelligible to those who have the care of children, we shall commence by giving a brief account of the formation of the teeth, the age at which they appear in the mouth, and the order in which they pierce the gums. The organs of mastication in the adult consist of 32 distinct teeth, 16 in either jaw; being, in fact, a double set. The teeth are divided into 4 incisors, 2 canine, 4 first and second grinders, and 6 molars; but in childhood the complement or first set consists of only twenty, and these only make their appearance as the development of the frame indicates the requirement of a different kind of food for the support of the system. At birth some of the first-cut teeth are found in the cavities of the jaw, in a very small and rudimentary form; but this is by no means universal. About the third month, the jaws, which are hollow and divided into separate cells, begin to expand, making room for the slowly developing teeth, which, arranged for beauty and economy of space lengthwise, gradually turn their tops upwards, piercing the gum by their edges, which, being sharp, assist in cutting a passage through the soft parts. There is no particular period at which children cut their teeth, some being remarkably early, and others equally late. The earliest age that we have ever ourselves known as a reliable fact was, six weeks. Such peculiarities are generally hereditary, and, as in this case, common to a whole family. The two extremes are probably represented by six and sixteen months. Pain and drivelling are the usual, but by no means the general, indications of teething.

2511. About the sixth month the gums become tense and swollen, presenting a red, shiny appearance, while the salivary glands pour out an unusual quantity of saliva. After a time, a white line or round spot is observed on the top of one part of the gums, and the sharp edge of the tooth may be felt beneath if the finger is gently pressed on the part. Through these white spots the teeth burst their way in the following order:—

2512. Two incisors in the lower jaw are first cut, though, in general, some weeks elapse between the appearance of the first and the advent of the second. The next teeth cut are the four incisors of the upper jaw. The next in order are the remaining two incisors of the bottom, one on each side, then two top and two bottom on each side, but not joining the incisors; and lastly, about the eighteenth or twentieth month, the four eye teeth, filling up the space left between the side teeth and the incisors; thus completing the infant's set of sixteen. Sometimes at the same period, but more frequently some months later, four more double teeth slowly make their appearance, one on each side of each jaw, completing the entire series of the child's first set of twenty teeth. It is asserted that a child, while cutting its teeth, should either dribble excessively, vomit after every meal, or be greatly relaxed. Though one or other, or all of these at once, may attend a case of teething, it by no means follows that any one of them should accompany this process of nature, though there can be no doubt that where the pain consequent on the unyielding state of the gums, and the firmness of the skin that covers the tooth, is severe, a copious discharge of saliva acts beneficially in saving the head, and also in guarding the child from those dangerous attacks of fits to which many children in their teething are liable.

2513. The Symptoms that generally indicate the cutting of teeth, in addition to the inflamed and swollen state of the gums, and increased flow of saliva, are the restless and peevish state of the child, the hands being thrust into the mouth, and the evident pleasure imparted by rubbing the finger or nail gently along the gum; the lips are often excoriated, and the functions of the stomach or bowels are out of order. In severe cases, occurring in unhealthy or scrofulous children, there are, from the first, considerable fever, disturbed sleep, fretfulness, diarrhoea, rolling of the eyes, convulsive startings, laborious breathing, coma, or unnatural sleep, ending, unless the head is quickly relieved, in death.

2514. The Treatment in all cases of painful teething is remarkably simple, and consists in keeping the body cool by mild aperient medicines, allaying the irritation in the gums by friction with a rough ivory ring or a stale crust of broad, and when the head, lungs, or any organ is overloaded or unduly excited, to use the hot bath, and by throwing the body into a perspiration, equalize the circulation, and relieve the system from the danger of a fatal termination.

2515. Besides these, there is another means, but that must be employed by a medical man; namely, scarifying the gums—an operation always safe, and which, when judiciously performed, and at a critical opportunity, will often snatch the child from the grasp of death.

2516. There are few subjects on which mothers have often formed such strong and mistaken opinions as on that of lancing an infant's gums, some rather seeing their child go into fits—and by the unrelieved irritation endangering inflammation of the brain, water on the head, rickets, and other lingering affections—than permit the surgeon to afford instant relief by cutting through the hard skin, which, like a bladder over the stopper of a bottle, effectually confines the tooth to the socket, and prevents it piercing the soft, spongy substance of the gum. This prejudice is a great error, as we shall presently show; for, so far from hurting the child, there is nothing that will so soon convert an infant's tears into smiles as scarifying the gums in painful teething; that is, if effectually done, and the skin of the tooth be divided.

2517. Though teething is a natural function, and to an infant in perfect health should be unproductive of pain, yet in general it is not only a fertile cause of suffering, but often a source of alarm and danger; the former, from irritation in the stomach and bowels, deranging the whole economy of the system, and the latter, from coma and fits, that may excite alarm in severe cases; and the danger, that eventuates in some instances, from organic disease of the head or spinal marrow.

2518. We shall say nothing in this place of "rickets," or "water on the head," which are frequent results of dental irritation, but proceed to finish our remarks on the treatment of teething. Though strongly advocating the lancing of the gums in teething, and when there are any severe head-symptoms, yet it should never be needlessly done, or before being satisfied that the tooth is fully formed, and is out of the socket, and under the gum. When assured on these points, the gum should be cut lengthwise, and from the top of the gum downwards to the tooth, in an horizontal direction, thus——, and for about half an inch in length. The operation is then to be repeated in a transverse direction, cutting across the gum, in the centre of the first incision, and forming a cross, thus +. The object of this double incision is to insure a retraction of the cut parts, and leave an open way for the tooth to start from—an advantage not to be obtained when only one incision is made; for unless the tooth immediately follows the lancing, the opening reunites, and the operation has to be repeated. That this operation is very little or not at all painful, is evidenced by the suddenness with which the infant falls asleep after the lancing, and awakes in apparently perfect health, though immediately before the use of the gum-lancet, the child may have been shrieking or in convulsions.

Convulsions, or Infantine Fits.

2519. From their birth till after teething, infants are more or less subject or liable to sudden fits, which often, without any assignable cause, will attack the child in a moment, and while in the mother's arms; and which, according to their frequency, and the age and strength of the infant, are either slight or dangerous.

2520. Whatever may have been the remote cause, the immediate one is some irritation of the nervous system, causing convulsions, or an effusion to the head, inducing coma. In the first instance, the infant cries out with a quick, short scream, rolls up its eyes, arches its body backwards, its arms become bent and fixed, and the fingers parted; the lips and eyelids assume a dusky leaden colour, while the face remains pale, and the eyes open, glassy, or staring. This condition may or may not be attended with muscular twitchings of the mouth, and convulsive plunges of the arms. The fit generally lasts from one to three minutes, when the child recovers with a sigh, and the relaxation of the body. In the other case, the infant is attacked at once with total insensibility and relaxation of the limbs, coldness of the body and suppressed breathing; the eyes, when open, being dilated, and presenting a dim glistening appearance; the infant appearing, for the moment, to be dead.

2521. Treatment.-The first step in either case is, to immerse the child in a hot bath up to the chin; or if sufficient hot water cannot be procured to cover the body, make a hip-bath of what can be obtained; and, while the left hand supports the child in a sitting or recumbent position, with the right scoop up the water, and run it over the chest of the patient. When sufficient water can be obtained, the spine should be briskly rubbed while in the bath; when this cannot be done, lay the child on the knees, and with the fingers dipped in brandy, rub the whole length of the spine vigorously for two or three minutes, and when restored to consciousness, give occasionally a teaspoonful of weak brandy and water or wine and water.

2522. An hour after the bath, it may be necessary to give an aperient powder, possibly also to repeat the dose for once or twice every three hours; in which case the following prescription is to be employed. Take of

Powdered scammony 6 grains.
Grey powder 6 grains.
Antimonial powder 4 grains.
Lump sugar 20 grains.

Mix thoroughly, and divide into three powders, which are to be taken as advised for an infant one year old; for younger or weakly infants, divide into four powders, and give as the other. For thirst and febrile symptoms, give drinks of barley-water, or cold water, and every three hours put ten to fifteen drops of spirits of sweet nitre in a dessert-spoonful of either beverage.