Advice to a Mother on the Management of Her Children

by Pye Henry Chavasse

CLOTHING.

21. Is it necessary to have a flannel cap in readiness to put on as soon as the babe is born?

Sir Charles Locock considers that a flannel cap is not necessary, and asserts that all his best nurses have long discarded flannel caps. Sir Charles states that since the discontinuance of flannel caps infants have not been more liable to inflammation of the eyes. Such authority is, in my opinion, conclusive. My advice, therefore, to you is, discontinue by all means the use of flannel caps.

22. What kind of a belly-band do you recommend—a flannel or a calico one?

I prefer flannel, for two reasons—first, on account of its keeping the child's bowels comfortably warm; and secondly, because of its not chilling him (and thus endangering cold, &c.) when he wets himself. The belly-band ought to be moderately, but not tightly applied, as, if tightly applied, it would interfere with the necessary movement of the bowels.

23. When should the belly-band be discontinued?

When the child is two or three months old. The best way of leaving it off is to tear a strip off daily for a few mornings, and then to leave it off altogether. "Nurses who take charge of an infant when the monthly nurse leaves, are frequently in the habit of at once leaving off the belly-band, which often leads to ruptures when the child cries or strains. It is far wiser to retain it too long than too short a time; and when a child catches whooping-cough, whilst still very young, it is safer to resume the belly-band." [Footnote: Communicated by Sir Charles Locock to the Author.]

24. Have you any remarks to make on the clothing of on infant?

A babe's clothing ought to be light, warm, loose, and free from pins. (1.) It should be light, without being too airy. Many infant's clothes are both too long and too cumbersome. It is really painful to see how some poor little babies are weighed down with a weight of clothes. They may be said to "bear the burden," and that a heavy one, from the very commencement of their lives! How absurd, too, the practice of making them wear long clothes. Clothes to cover a child's feet, and even a little beyond, may be desirable; but for clothes, when the infant is carried about, to reach to the ground, is foolish and cruel in the extreme. I have seen a delicate baby almost ready to faint under the infliction. (2.) It should be warm, without being too warm. The parts that ought to be kept warm are the chest, the bowels, and the feet. If the infant be delicate, especially if he be subject to inflammation of the lungs, he ought to wear a fine flannel, instead of his usual shirts, which should be changed as frequently. (3.) The dress should be loose, so as to prevent any pressure upon the blood-vessels, which would otherwise impede the circulation, and thus hinder a proper development of the parts. It ought to be loose about the chest and waist, so that the lungs and the heart may have free play. It should be loose about the stomach, so that digestion may not be impeded; it ought to be loose about the bowels, in order that the spiral motion of the intestines may not be interfered with—hence the importance of putting on a belly-band moderately slack; it should be loose about the sleeves, so that the blood may course, without let or hindrance, through the arteries and veins; it ought to be loose, then, everywhere, for nature delights in freedom from restraint, and will resent, sooner or later, any interference. Oh, that a mother would take common sense, and not custom, as her guide! (4.) As few pins should be used in the dressing of a baby as possible. Inattention to this advice has caused many a little sufferer to be thrown into convulsions.

The generality of mothers use no pins in the dressing of their children; they tack every part that requires fastening with a needle and thread. They do not even use pins to fasten the baby's diapers. They make the diapers with loops and tapes, and thus altogether supersede the use of pins in the dressing of an infant. The plan is a good one, takes very little extra time, and deserves to be universally adopted. If pins be used for the diapers, they ought to be the Patent Safety Pins.

25. Is there any necessity for a nurse being particular in airing an infant's clothes before they are put on? If she were less particular, would it not make him more hardy?

A nurse cannot be too particular on this head. A babe's clothes ought to be well aired the day before they are put on, as they should not be put on warm from the fire. It is well, where it can be done, to let him have clean clothes daily. Where this cannot be afforded, the clothes, as soon as they are taken off at night, ought to be well aired, so as to free them from the perspiration, and that they may be ready to put on the following morning. It is truly nonsensical to endeavour to harden a child, or any one else, by putting on damp clothes!

26. What is your opinion of caps for an infant?

The head ought to be kept cool; caps, therefore, are unnecessary. If caps be used at all, they should only be worn for the first month in summer, or for the first two or three months in winter. If a babe take to caps, it requires care in leaving them off, or he will catch cold. When you are about discontinuing them, put a thinner and a thinner one on, every time they are changed, until you leave them off altogether.

But remember, my opinion is, that a child is better without caps; they only heat his head, cause undue perspiration, and thus make him more liable to catch cold.

If a babe does not wear a cap in the day, it is not at all necessary that he should wear one at night. He will sleep more comfortably without one, and it will be better for his health. Moreover, night-caps injure both the thickness and beauty of the hair.

27. Have you any remarks to make on the clothing of an infant, when, in the winter time, he is sent out for exercise?

Be sure that he is well wrapped up. He ought to have under his cloak a knitted worsted spencer, which should button behind, and if the weather be very cold, a shawl over all, and, provided it be dry above, and the wind be not in the east or in the north-east, he may then brave the weather. He will then come from his walk refreshed and strengthened, for cold air is an invigorating tonic. In a subsequent Conversation I will indicate the proper age at which a child should be first sent out to take exercise in the open air.

28. At what age ought an infant "to be shortened?"

This, of course, will depend upon the season. In the summer, the right time "for shortening a babe," as it is called, is at the end of two months, in the winter, at the end of three months. But if the right time for "shortening" a child should happen to be in the spring, let it be deferred until the end of May. The English springs are very trying and treacherous, and sometimes, in April the weather is almost as cold, and the wind as biting as in winter. It is treacherous, for the sun is hot, and the wind, which is at this time of the year frequently easterly, is keen and cutting I should far prefer "to shorten" a child in the winter than in the early spring.

DIET

29. Are you an advocate for putting a baby to the breast soon after birth, or for waiting, as many do, until the third day?

The infant ought to be put to the bosom soon after birth, the interest, both of the mother and of the child demands it. It will be advisable to wait three or four hours, that the mother may recover from her fatigue, and, then, the babe must be put to the breast. If this be done, he will generally take the nipple with avidity.

It might be said, at so early a period that there is no milk in the bosom; but such is not usually the case. There generally is a little from the very beginning, which acts on the baby's bowels like a dose of purgative medicine, and appears to be intended by nature to cleanse the system. But, provided there be no milk at first, the very act of sucking not only gives the child a notion, but, at the same time, causes a draught (as it is usually called) in the breast, and enables the milk to flow easily.

Of course, if there be no milk in the bosom—the babe having been applied once or twice to determine the fact—then you must wait for a few hours before applying him again to the nipple, that is to say, until the milk be secreted.

An infant, who, for two or three days, is kept from the breast, and who is fed upon gruel, generally becomes feeble, and frequently, at the end of that time, will not take the nipple at all. Besides, there is a thick cream (similar to the biestings of a cow), which, if not drawn out by the child, may cause inflammation and gathering of the bosom, and, consequently, great suffering to the mother. Moreover, placing him early to the breast, moderates the severity of the mother's after pains, and lessens the risk of her flooding. A new-born babe must not have gruel given to him, as it disorders the bowels, causes a disinclination to suck, and thus makes him feeble.

30. If an infant show any disinclination to suck, or if he appear unable to apply his tongue to the nipple, what ought to be done?

Immediately call the attention of the medical man to the fact, in order that he may ascertain whether he be tongue-tied. If he be, the simple operation of dividing the bridle of the tongue will remedy the defect, and will cause him to take the nipple with ease and comfort.

31. Provided there be not milk AT FIRST, what ought then to be done?

Wait with patience; the child (if the mother have no milk) will not, for at least twelve hours, require artificial food. In the generality of instances, then, artificial food is not at all necessary; but if it should be needed, one-third of new milk and two-thirds of warm water, slightly sweetened with loaf sugar (or with brown sugar, if the babe's bowels have not been opened), should be given, in small quantities at a time, every four hours, until the milk be secreted, and then it must be discontinued. The infant ought to be put to the nipple every four hours, but not oftener, until he be able to find nourishment.

If after the application of the child for a few times, he is unable to find nourishment, then it will be necessary to wait until the milk be secreted. As soon as it is secreted, he must be applied with great regularity, alternately to each breast.

I say alternately to each breast. This is most important advice. Sometimes a child, for some inexplicable reason, prefers one breast to the other, and the mother, to save a little contention, concedes the point, and allows him to have his own way. And what is frequently the consequence?—a gathered breast!

We frequently hear of a babe having no notion of sucking. This "no notion" may generally be traced to bad management, to stuffing him with food, and thus giving him a disinclination to take the nipple at all.

32. How often should a mother suckle her infant?

A mother generally suckles her baby too often, having him almost constantly at the breast. This practice is injurious both to parent and to child. The stomach requires repose as much as any other part of the body; and how can it have if it be constantly loaded with breast-milk? For the first month, he ought to be suckled, about every hour and a half; for the second month, every two hours,—gradually increasing, as he becomes older, the distance of time between, until at length he has it about every four hours.

If a baby were suckled at stated periods, he would only look for the bosom at those times, and be satisfied. A mother is frequently in the habit of giving the child the breast every time he cries, regardless of the cause. The cause too frequently is that he has been too often suckled—his stomach has been overloaded, the little fellow is consequently in pain, and he gives utterance to it by cries. How absurd is such a practice! We may as well endeavour to put out a fire by feeding it with fuel. An infant ought to be accustomed to regularity in everything, in times for sucking, for sleeping, &c. No children thrive so well as those who are thus early taught.

33. Where the mother is MODERATELY strong, do you advise that the infant should have any other food than the breast?

Artificial food must not, for the first five or six months, be given, if the parent be moderately strong, of course, if she be feeble, a little food will be necessary. Many delicate women enjoy better health whilst ambling than at any other period of their lives.

It may be well, where artificial food, in addition to the mother's own milk, is needed, and before giving any farinaceous food whatever (for farinaceous food until a child is six or seven months old is injurious), to give, through a feeding bottle, every night and morning, in addition to the mother's breast of milk, the following Milk-Water-and Sugar-of Milk Food—

Fresh milk, from ONE cow,
Warm water, of each a quarter of a pint,
Sugar of milk one tea spoonful

The sugar of milk should first be dissolved in the warm water, and then the fresh milk unboiled should be mixed with it. The sweetening of the above food with sugar-of-milk, instead of with lump sugar, makes the food more to resemble the mother's own milk. The infant will not, probably, at first take more than half of the above quantity at a time, even if he does so much as that but still the above are the proper proportions, and as he grows older, he will require the whole of it at a meal.

34. What food, when a babe is six or seven months old, is the best substitute for a mother's milk?

The food that suits one infant will not agree with another. (1) The one that I have found the most generally useful, is made as follows—Boil the crumb of bread for two hours in water, taking particular care that it does not burn, then add only a little lump-sugar (or brown sugar, if the bowels be costive), to make it palatable. When he is six or seven months old, mix a little new milk—the milk of ONE cow—with it gradually as he becomes older, increasing the quantity until it be nearly all milk, there being only enough water to boil the bread, the milk should be poured boiling hot on the bread. Sometimes the two milks—the mother's and the cow's milk—do not agree, when such is the case, let the milk be left out, both in this and in the foods following, and let the food be made with water, instead of with milk and water. In other respects, until the child is weaned, let it be made as above directed, when he is weaned, good fresh cow's milk MUST, as previously recommended, be used. (2) Or cut thin slices of bread into a basin, cover the bread with cold water, place it in an oven for two hours to bake, take it out, beat the bread up with a fork, and then slightly sweeten it. This is an excellent food. (3) If the above should not agree with the infant (although, if properly made, they almost invariably do), "tous les-mois" may be given. [Footnote: "Tous les mois" is the starch obtained from the tuberous roots of various species of canna, and is imported from the West Indies. It is very similar to arrow root. I suppose it is called "tous les-mois," as it is good to be eaten all the year round.](4) Or Robb's Biscuits, as it is "among the best bread compounds made out of wheat-flour, and is almost always readily digested."—Routh.

(5) Another good food is the following—Take about a pound of flour put it in a cloth, tie it up tightly, place it a saucepanful of water, and let it boil for four or five hours, then take it out, peel off the outer rind, and the inside will be found quite dry, which grate. (6) Another way of preparing an infant's food, is to bake flour—biscuit flour—in a slow oven, until it be of a light fawn colour. Baked flour ought after it is baked, to be reduced, by means of a rolling pin, to a fine powder, and should then be kept in a covered tin, ready for use. (7) An excellent food for a baby is baked crumbs of bread. The manner of preparing it is as follows—Crumb some bread on a plate, put it a little distance from the fire to dry. When dry, rub the crumbs in a mortar, and reduce them to a fine powder, then pass them through a sieve. Having done which, put the crumbs of bread into a slow oven, and let them bake until they be of a light fawn colour. A small quantity either of the boiled, or of the baked flour, or of the baked crumb of bread, ought to be made into food, in the same way as gruel is made, and should then be slightly sweetened, according to the state of the bowels, either with lump or with brown sugar.

(8) Baked flour sometimes produces constipation, when such is the case, Mr. Appleton, of Budleigh Salterton, Devon, wisely recommends a mixture of baked flour, and prepared oatmeal, [Footnote: If there is any difficulty in obtaining prepared oatmeal, Robinson's Scotch Oatmeal will answer equally as well.] in the proportion of two of the former and one of the latter. He says—"To avoid the constipating effects, I have always had mixed, before baking, one part of prepared oatmeal with two parts of flour, this compound I have found both nourishing, and regulating to the bowels. One table-spoonful of it, mixed with a quarter of a pint of milk, or milk and water, when well boiled, flavoured and sweetened with white sugar, produces a thick, nourishing, and delicious food for infants or invalids." He goes on to remark—"I know of no food, after repeated trials, that can be so strongly recommended by the profession to all mothers in the rearing of their infants, without or with the aid of the breasts, at the same time relieving them of much draining and dragging whilst nursing with an insufficiency of milk, as baked flour and oatmeal." [Footnote: British Medical Journal, Dec 18, 1858]

(9) A ninth food may be made with "Farinaceous Food for Infants, prepared by Hards of Dartford". If Hard's Farinaceous food produces costiveness—as it sometimes does—let it be mixed either with equal parts or with one third of Robinson's Scotch Oatmeal. The mixture of the two together makes a splendid food for a baby. (10) A tenth, and an excellent one, may be made with rusks, boiled for an hour in water, which ought then to be well beaten up, by means of a fork, and slightly sweetened with lump sugar. Great care should be taken to select good rusks, as few articles vary so much in quality. (11) An eleventh is—the top crust of a baker's loaf, boiled for an hour in water, and then moderately sweetened with lump sugar. If, at any time, the child's bowels should be costive, raw must be substituted for lump sugar. (12) Another capital food for an infant is that made by Lemann's Biscuit Powder. [Footnote: Lemann's Biscuit Powder cannot be too strongly recommended—It is of the finest quality, and may be obtained of Lemann, Threadneedle Street, London. An extended and an extensive experience confirms me still more in the good opinion I have of this food.] (13) Or, Brown and Polson's Patent Corn Flour will be found suitable. Francatelli, the Queen's cook, in his recent valuable work, gives the following formula for making it—"To one dessert-spoonful of Brown and Polson, mixed with a wineglassful of cold water, add half a pint of boiling water, stir over the fire for five minutes, sweeten lightly, and feed the baby, but if the infant is being brought up by the hand, this food should then be mixed with milk—not otherwise." (14) A fourteenth is Neaves' Farinaceous Food for Infants, which is a really good article of diet for a babe, it is not so binding to the bowels as many of the farinaceous foods are, which is a great recommendation.

(15) The following is a good and nourishing food for a baby:—Soak for an hour, some best rice in cold water; strain, and add fresh water to the rice; then let it simmer till it will pulp through a sieve; put the pulp and the water in a saucepan, with a lump or two of sugar, and again let it simmer for a quarter of an hour; a portion of this should be mixed with one-third of fresh milk, so as to make it of the consistence of good cream. This is an excellent food for weak bowels.

When the baby is six or seven months old, new milk should be added to any of the above articles of food, in a similar way to that recommended for boiled bread.

(16.) For a delicate infant, lentil powder, better known as Du Barry's "Ravalenta Arabica," is invaluable. It ought to be made into food, with new milk, in the same way that arrow-root is made, and should be moderately sweetened with loaf-sugar. Whatever food is selected ought to be given by means of a nursing bottle.

If a child's bowels be relaxed and weak, or if the motions be offensive, the milk must be boiled, but not otherwise. The following (17) is a good food when an infant's bowels are weak and relaxed:—"Into five large spoonfuls of the purest water, rub smooth one dessert-spoonful of fine flour. Set over the fire five spoonfuls of new milk, and put two bits of sugar into it; the moment it boils, pour it into the flour and water, and stir it over a slow fire twenty minutes."

Where there is much emaciation, I have found (18) genuine arrow-root [Footnote: Genuine arrow-root, of first-rate quality, and at a reasonable price, may be obtained of H. M. Plumbe, arrow-root merchant, 8 Alie Place. Great Alie Street. Aldgate, London, E.] a very valuable article of food for an infant, as it contains a great deal of starch, which starch helps to form fat and to evolve caloric (heat)—both of which a poor emaciated chilly child stands so much in need of. It must be made with equal parts of water and of good fresh milk, and ought to be slightly sweetened with loaf sugar; a small pinch of table salt should be added to it.

Arrow-root will not, as milk will, give bone and muscle; but it will give—what is very needful to a delicate child—fat and warmth. Arrow-root, as it is principally composed of starch, comes under the same category as cream, butter, sugar, oil, and fat. Arrowroot, then, should always be given with new milk (mixed with one-half of water); it will then fulfil, to perfection, the exigencies of nourishing, of warming, and fattening the child's body.

New milk, composed in due proportions as it is, of cream and of skim milk—the very acme of perfection—is the only food, which of itself alone, will nourish and warm and fatten. It is, for a child, par excellence, the food of foods!

Arrow-root, and all other farinaceous foods are, for a child, only supplemental to milk—new milk being, for the young, the staple food of all other kinds of foods whatever.

But bear in mind, and let there be no mistake about it, that farinaceous food, be it what it may, until the child be six or seven months old, until, indeed, he begin to cut his teeth, is not suitable for a child; until then, The Milk-water-salt-and-sugar Food (see page 29) is usually, if he be a dry-nursed child, the best artificial food for him.

I have given you a large and well-tried infant's dietary to chose from, as it is sometimes difficult to fix on one that will suit; but, remember, if you find one of the above to agree, keep to it, as a babe requires a simplicity in food—a child a greater variety.

Let me, in this place, insist upon the necessity of great care and attention being observed in the preparation of any of the above articles of diet. A babe's stomach is very delicate, and will revolt at either ill-made, or lumpy, or burnt food. Great care ought to be observed as to the cleanliness of the cooking utensils. The above directions require the strict supervision of the mother.

Broths have been recommended, but, for my own part, I think that, for a young infant, they are objectionable; they are apt to turn acid on the stomach, and to cause flatulence and sickness, they, sometimes, disorder the bowels and induce griping and purging.

Whatever artificial food is used ought to be given by means of a bottle, not only as it is a more natural way than any other of feeding a baby, as it causes him to suck as though he were drawing it from the mother's breasts, but as the act of sucking causes the salivary glands to press out their contents, which materially assist digestion. Moreover, it seems to satisfy and comfort him more than it otherwise would do.

One of the best, if not the best feeding bottle I have yet seen, is that made by Morgan Brothers, 21 Bow Lane, London. It is called "The Anglo-French Feeding Bottle" S Maw, of 11 Aldersgate Street, London, has also brought out an excellent one—"The Fountain Infant's Feeding Bottle" Another good one is "Mather's Infant's Feeding Bottle" Either of these three will answer the purpose admirably. I cannot speak in terms too highly of these valuable inventions.

The food ought to be of the consistence of good cream, and should be made fresh and fresh. It ought to be given milk warm. Attention must be paid to the cleanliness of the vessel, and care should be taken that the milk be that of ONE cow, [Footnote: I consider it to be of immense importance to the infant, that the milk be had from ONE cow. A writer in the Medical Times and Gazette speaking on this subject, makes the following sensible remarks—"I do not know if a practice common among French ladies when they do not nurse, has obtained the attention among ourselves which it seems to me to deserve. When the infant is to be fed with cow milk that from various cows is submitted to examination by the medical man and if possible, tried on some child, and when the milk of any cow has been chosen, no other milk is ever suffered to enter the child's lips for a French lady would as soon offer to her infant's mouth the breasts of half a dozen wet-nurses in the day, as mix together the milk of various cows, which must differ, even as the animals themselves, in its constituent qualities. Great attention is also paid to the pasture, or other food of the cow thus appropriated.">[ and that it be new and of good quality, for if not it will turn acid and sour, and disorder the stomach, and will thus cause either flatulence or looseness of the bowels, or perhaps convulsions. The only way to be sure of having it from one cow, is (if you have not a cow of your own), to have the milk from a respectable cow keeper, and to have it brought to your house in a can of your own (the London milk cans being the best for the purpose). The better plan is to have two cans, and to have the milk fresh and fresh every night and morning. The cans, after each time of using, ought to be scalded out, and, once a week the can should be filled with cold water, and the water should be allowed to remain in it until the can be again required.

Very little sugar should be used in the food, as much sugar weakens the digestion. A small pinch of table-salt ought to be added to whatever food is given, as "the best savour is salt." Salt is most wholesome—it strengthens and assists digestion, prevents the formation of worms, and, in small quantities, may with advantage be given (if artificial food be used) to the youngest baby.

35. Where it is found to be absolutely necessary to give an infant artificial food WHILST SUCKLING, how often ought he to be fed?

Not oftener than twice during the twenty four hours, and then only in small quantities at a time, as the stomach requires rest, and at the same time, can manage to digest a little food better than it can a great deal. Let me again urge upon you the importance, if it be at all practicable, of keeping the child entirely to the breast for the first five or six months of his existence. Remember there is no real substitute for a mother's milk, there is no food so well adapted to his stomach, there is no diet equal to it in developing muscle, in making bone, or in producing that beautiful plump rounded contour of the limbs, there is nothing like a mother's milk alone in making a child contented and happy, in laying the foundation of a healthy constitution, in preparing the body for a long life, in giving him tone to resist disease, or in causing him to cut his teeth easily and well, in short, the mothers milk is the greatest temporal blessing an infant can possess.

As a general rule, therefore, when the child and the mother are tolerably strong, he is better without artificial food until he have attained the age of three or four months, then, it will usually be necessary to feed him with The Milk-water-and-sugar-of milk Food (see p 19) twice a day, so as gradually to prepare him to be weaned (if possible) at the end of nine months. The food mentioned in the foregoing Conversation will, when he is six or seven months old, be the best for him.

36. When the mother is not able to suckle her infant herself, what ought to be done?

It must first be ascertained, beyond all doubt, that a mother is not able to suckle her own child Many delicate ladies do suckle their infants with advantage, not only to their offspring, but to themselves. "I will maintain," says Steele, "that the mother grows stronger by it, and will have her health better than she would have otherwise She will find it the greatest cure, and preservative for the vapours [nervousness] and future miscarriages, much beyond any other remedy whatsoever Her children will be like giants, whereas otherwise they are but living shadows, and like unripe fruit, and certainly if a woman is strong enough to bring forth a child, she is beyond all doubt strong enough to nurse it afterwards."

Many mothers are never so well as when they are nursing, besides, suckling prevents a lady from becoming pregnant so frequently as she otherwise would. This, if she be delicate, is an important consideration, and more especially if she be subject to miscarry. The effects of miscarriage are far more weakening than those of suckling.

A hireling, let her be ever so well inclined, can never have the affection and unceasing assiduity of a mother, and, therefore, cannot perform the duties of suckling with equal advantage to the baby.

The number of children who die under five years of age is enormous—many of them from the want of the mother's milk. There is a regular "parental baby-slaughter"—"a massacre of the innocents"— constantly going on in England, in consequence of infants being thus deprived of their proper nutriment and just dues! The mortality from this cause is frightful, chiefly occurring among rich people who are either too grand, or, from luxury, too delicate to perform such duties; poor married women, as a rule, nurse their own children, and, in consequence reap their reward.

If it be ascertained, past all doubt, that a mother cannot suckle her child, then, if the circumstances of the parents will allow—and they ought to strain a point to accomplish it—a healthy wet-nurse should be procured, as, of course, the food which nature has supplied is far, very far superior to any invented by art. Never bring up a baby, then, if you can possibly avoid it, on artificial food. Remember, as I proved in a former Conversation, there is in early infancy no real substitute for either a mother's or a wet-nurse's milk. It is impossible to imitate the admirable and subtle chemistry of nature. The law of nature is, that a baby, for the first few months of his existence, shall be brought up by the breast, and nature's law cannot be broken with impunity. [Footnote: For further reasons why artificial food is not desirable, at an early period of infancy, see answer to 35th question, page 26.] It will be imperatively necessary then—

"To give to nature what is nature's due."

Again, in case of a severe illness occurring during the first nine months of a child's life, what a comfort either the mother's or the wet-nurse's milk is to him! It often determines whether he shall live or die. But if a wet-nurse cannot fill the place of a mother, then asses' milk will be found the best substitute, as it approaches nearer, in composition, than any other animal's, to human milk; but it is both difficult and expensive to obtain. The next best substitute is goats' milk. Either the one or the other ought to be milked fresh and fresh, when wanted, and should be given by means of a feeding-bottle. Asses' milk is more suitable for a delicate infant, and goats' milk for a strong one.

If neither asses' milk nor goats' milk can be procured, then the following Milk-water-salt-and-sugar Food, from the very commencement, should be given; and as I was the author of the formula, [Footnote: It first appeared in print in the 4th edition of Advice to a Mother, 1852.] I beg to designate it as—Rye Chavasse's Milk Food:—

New milk, the produce of ONE healthy cow;
Warm water, of each, equal parts;
Table salt, a few grains—a small pinch;
Lump sugar, a sufficient quantity, to slightly sweeten it.

The milk itself ought not to be heated over the fire, [Footnote: It now and then happens that if the milk be not boiled, the motions of an infant are offensive; when such is the case, let the milk be boiled, but not otherwise.] but should, as above directed, be warmed by the water; it must, morning and evening, be had fresh and fresh. The milk and water should be of the same temperature as the mother's milk, that is to say, at about ninety degrees Fahrenheit. It ought to be given by means of either Morgan's, or Maw's, or Mather's feeding-bottle, [Footnote: See answer to Question 24, page 24.] and care must be taken to scald the bottle out twice a day, for if attention be not paid to this point, the delicate stomach of an infant is soon disordered. The milk should, as he grows older, be gradually increased and the water decreased, until two-thirds of milk and one-third of water be used; but remember, that either much or little water must always be given with the milk.

The above is my old form, and which I have for many years used with great success. Where the above food does not agree (and no food except a healthy mother's own milk does invariably agree) I occasionally substitute sugar-of milt for the lump sugar, in the proportion of a tea spoonful of sugar-of milk to every half pint of food.

If your child bring up his food, and if the ejected matter be sour-smelling, I should advise you to leave out the sugar-of milk altogether, and simply to let the child live, for a few days, on milk and water alone, the milk being of one cow, and in the proportion of two-thirds to one-third of warm water—not hot water, the milk should not be scalded with hot water, as it injures its properties, besides, it is only necessary to give the child his food with the chill just off. The above food, where the stomach is disordered, is an admirable one, and will often set the child to rights without giving him any medicine whatever. Moreover, there is plenty of nourishment in it to make the babe thrive, for after all it is the milk that is the important ingredient in all the foods of infants, they can live on it, and on it alone, and thrive amazingly.

Mothers sometimes say to me, that farinaceous food makes their babes flatulent, and that my food (Pye Chavasse's Milk Food) has not that effect.

The reason of farinaceous food making babes, until they have commenced cutting their teeth, "windy" is, that the starch of the farinaceous food (and all farinaceous foods contain more or less of starch) is not digested, and is not, as it ought to be, converted by the saliva into sugar [Footnote: See Pye Chavasse's Counsel to a Mother, 3d edition.] hence "wind" is generated, and pain and convulsions often follow in the train.

The great desideratum, in devising an infant's formula for food, is to make it, until he be nine months old, to resemble as much as possible, a mother's own milk, and which my formula, as nearly as is practicable, does resemble hence its success and popularity.

As soon as a child begins to cut his teeth the case is altered, and farinaceous food, with milk and with water, becomes an absolute necessity.

I wish, then, to call your especial attention to the following-facts, for they are facts—Farinaceous foods, of all kinds, before a child commences cutting his teeth (which is when he is about six or seven months old) are worse than useless—they are, positively, injurious, they are, during the early period of infant life, perfectly indigestible, and may bring on—which they frequently do— convulsions. A babe fed on farinaceous food alone would certainly die of starvation, for, "up to six or seven months of age, infants have not the power of digesting farinaceous or fibrinous substances"—Dr Letheby on Food.

A babe's salivary glands, until he be six or seven months old, does not secrete its proper fluid—namely, ptyalin, and consequently the starch of the farinaceous food—and all farinaceous food contains starch—is not converted into dextrine and grape-sugar, and is, therefore, perfectly indigestible and useless—nay, injurious to an infant, and may bring on pain and convulsions, and even death, hence, the giving of farinaceous food, until a child be six or seven months old, is one and the principal cause of the frightful infant mortality at the present time existing in England, and which is a disgrace to any civilized land!

In passing, allow me to urge you never to stuff a babe—never to overload his little stomach with food, it is far more desirable to give him a little not enough, than to give him a little too much. Many a poor child has been, like a young bird, killed with stuffing. If a child be at the breast, and at the breast alone, there is no fear of his taking too much, but if he be brought up on artificial food, there is great fear of his over loading his stomach. Stuffing a child brings on vomiting and bowel-complaints, and a host of other diseases which now it would be tedious to enumerate. Let me, then, urge you on no account, to over load the stomach of a little child.

There will, then, in many cases, be quite sufficient nourishment in the above. I have known some robust infants brought up on it, and on it along, without a particle of farinaceous food, or of any other food, in any shape or form whatever. But if it should not agree with the child, or if there should not be sufficient nourishment in it, then the food recommended in answer to No. 34 question ought to be given, with this only difference—a little new milk must from the beginning be added, and should be gradually increased, until nearly all milk be used.

The milk, as a general rule, ought to be unboiled; but if it purge violently, or if it cause offensive motions—which it sometimes does—then it must be boiled. The moment the milk boils up, it should be taken off the fire.

Food ought for the first month to be given about every two hours; for the second month, about every three hours; lengthening the space of time as the baby advances in age. A mother must be careful not to over-feed a child, as over-feeding is a prolific source of disease.

Let it be thoroughly understood, and let there be no mistake about it, that a babe during the first nine months of his life, MUST have—it is absolutely necessary for his very existence—milk of some kind, as the staple and principal article of his diet, either mother's, wet-nurse's, or asses', or goats', or cow's milk.

37. How would you choose a wet-nurse?

I would inquire particularly into the state of her health; whether she be of a healthy family, of a consumptive habit, or if she or any of her family have laboured under "king's evil;" ascertaining if there be any seams or swellings about her neck; any eruptions or blotches upon her skin; if she has a plentiful breast of milk, and if it be of good quality [Footnote: "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,"—Maxell and Evenson on the Diseases of Children.] (which may readily be ascertained by milking a little into a glass); if she has good nipples, sufficiently long for the baby to hold; that they be not sore; and if her own child be of the same, or nearly of the same age, as the one you wish her to nurse. Ascertain, whether she menstruate during suckling; if she does, the milk is not so good and nourishing, and you had better decline taking her. [Footnote: Sir Charles Locock considers that a woman who menstruates during lactation is objectionable as a wet-nurse, and "that as a mother with her first child is more liable to that objection, that a second or third child's mother is more eligible than a first"—Letter to the Author.] Assure yourself that her own babe is strong and healthy that he be free from a sore mouth, and from a "breaking-out" of the skin. Indeed, if it be possible to procure such a wet-nurse, she ought to be from the country, of ruddy complexion, of clear skin, and of between twenty and five-and-twenty years of age, an the milk will then be fresh, pure, and nourishing.

I consider it to be of great importance that the infant of the wet-nurse should be, as nearly as possible, of the same age as your own, as the milk varies in quality according to the age of the child. For instance, during the commencement of suckling, the milk is thick and creamy, similar to the biestings of a cow, which, if given to a babe of a few months old, would cause derangement of the stomach and bowels. After the first few days, the appearance of the milk changes; it becomes of a bluish-white colour, and contains less nourishment. The milk gradually becomes more and more nourishing as the infant becomes older and requires more support.

In selecting a wet-nurse for a very small and feeble babe, you must carefully ascertain that the nipples of the wet-nurse are good and soft, and yet not very large. If they be very large, the child's mouth being very small, he may not be able to hold them. You must note, too, whether the milk flows readily from the nipple into the child's mouth; if it does not, he may not have strength to draw it, and he would soon die of starvation. The only way of ascertaining whether the infant really draws the milk from the nipple, can be done by examining the mouth of the child immediately after his taking the breast, and seeing for yourself whether there be actually milk, or not, in his mouth.

Very feeble new-born babes sometimes cannot take the bosom, be the nipples and the breasts ever so good, and although Maw's nipple-shield and glass tube had been tried. In such a case, cow's milk-water-sugar-and-salt, as recommended at page 29, must be given in small quantities at a time—from two to four tea-spoonfuls—but frequently; if the child be awake, every hour, or every half hour, both night and day, until he be able to take the breast. If, then, a puny, feeble babe is only able to take but little at a time, and that little by tea-spoonfuls, he must have little and often, in order that "many a little might make a mickle."

I have known many puny, delicate children who had not strength to hold the nipple in their mouths, but who could take milk and water (as above recommended) by tea-spoonfuls only at a time, with steady perseverance, and giving it every half hour or hour (according to the quantity swallowed), at length be able to take the breast, and eventually become strong and hearty children; but such cases require unwearied watching, perseverance, and care. Bear in mind, then, that the smaller the quantity of the milk and water given at a time, the oftener must it be administered, as, of course, the babe must have a certain quantity of food to sustain life.

38. What ought to be the diet either of a wet-nurse, or of a mother, who is suckling?

It is a common practice to cram a wet-nurse with food, and to give her strong ale to drink, to make good nourishment and plentiful milk! This practice is absurd; for it either, by making the nurse feverish, makes the milk more sparing than usual, or it causes the milk to be gross and unwholesome. On the other hand, we must not run into an opposite extreme. The mother, or the wet-nurse, by using those means most conducive to her own health, will best advance the interest of her little charge.

A wet-nurse, ought to live somewhat in the following way:—Let her for breakfast have black tea, with one or two slices of cold meat, if her appetite demand it, but not otherwise. It is customary for a wet-nurse to make a hearty luncheon; of this I do not approve. If she feel either faint or low at eleven o'clock, let her have either a tumbler of porter, or of mild fresh ale, with a piece of dry toast soaked in it. She ought not to dine later than half-past one or two o'clock; she should eat, for dinner, either mutton or beef, with either mealy potatoes, or asparagus, or French beans, or secale, or turnips, or broccoli, or cauliflower, and stale bread. Rich pastry, soups, gravies, high-seasoned dishes, salted meats, greens, and cabbage, must one and all be carefully avoided; as they only tend to disorder the stomach, and thus to deteriorate the milk.

It is a common remark, that "a mother who is suckling may eat anything." I do not agree with this opinion. Can impure or improper food make pure and proper milk, or can impure and improper milk make good blood for an infant, and thus good health?

The wet-nurse ought to take with her dinner a moderate quantity of either sound porter, or of mild (but not old or strong) ale. Tea should be taken at half past five or six o'clock; supper at nine, which should consist either of a slice or two of cold meat, or of cheese if she prefer it, with half a pint of porter or of mild ale; occasionally a basin of gruel may with advantage be substituted. Hot and late suppers are prejudicial to the mother, or to the wet-nurse, and, consequently, to the child. The wet-nurse ought to be in bed every night by ten o'clock.

It might be said, that I have been too minute and particular in my rules for a wet-nurse; but when it is considered of what importance good milk is to the well-doing of an infant, in making him strong and robust, not only now, but as he grows up to manhood, I shall, I trust, be excused for my prolixity.

39. Have you any more hints to offer with regard to the management of a wet-nurse?

A wet-nurse is frequently allowed to remain in bed until a late hour in the morning, and during the day to continue in the house, as if she were a fixture! How is it possible that any one, under such treatment, can continue healthy! A wet nurse ought to rise early, and, if the weather and season will permit, take a walk, which will give her an appetite for breakfast, and will make a good meal for her little charge. This, of course, cannot, during the winter mouths, be done; but even then, she ought, some part of the day, to take every opportunity of walking out; indeed, in the summer time she should live half the day in the open air.

She ought strictly to avoid crowded rooms; her mind should be kept calm and unruffled, as nothing disorders the milk so much as passion, and other violent emotions of the mind; a fretful temper is very injurious, on which account you should, in choosing your wet-nurse, endeavour to procure one of a mild, calm, and placid disposition. [Footnote: "'The child is poisoned.'

'Poisoned! by whom?'

'By you. You have been fretting.'

'Nay, indeed, mother. How can I help fretting!'

'Don't tell me, Margaret. A nursing mother has no business to fret. She must turn her mind away from her grief to the comfort that lies in her lap. Know you not that the child pines if the mother vexes herself?'"—The Cloister and the Hearth. By Charles Reade.]

A wet-nurse ought never to be allowed to dose her little charge either with Godfrey's Cordial, or with Dalby's Carminative, or with Syrup of White Poppies, or with medicine of any kind whatever. Let her thoroughly understand this, and let there be no mistake in the matter. Do not for one moment allow your children's health to be tampered and trifled with. A baby's health is too precious to be doctored, to be experimented upon, and to be ruined by an ignorant person.

40. Have the goodness to state at what age a child ought to be weaned?

This, of course, must depend both upon the strength of the child, and upon the health of the parent; on an average, nine months is the proper time. If the mother be delicate, it may be found necessary to wean the infant at six months; or if he be weak, or labouring under any disease, it may be well to continue suckling him for twelve months; but after that time, the breast will do him more harm than good, and will, moreover, injure the mother's health, and may, if she be so predisposed, excite consumption.

41. How would you recommend a mother to act when, she weans her child?

She ought, as the word signifies, do it gradually—that is to say, she should, by degrees, give him less and less of the breast, and more and more of artificial food; at length, she must only suckle him at night; and lastly, it would be well for the mother either to send him away, or to leave him at home, and, for a few days, to go away herself.

A good plan is, for the nurse-maid to have a half-pint bottle of new milk—which has been previously boiled [Footnote: The previous boiling of the milk will prevent the warmth of the bed turning the milk sour, which it otherwise would do.]—in the bed, so as to give a little to him in lieu of the breast. The warmth of the body will keep the milk of a proper temperature, and will supersede the use of lamps, of candle-frames, and of other troublesome contrivances.

42. While a mother is weaning her infant, and after she have weaned him, what ought to be his diet?

Any one of the foods recommended in answer to question 34.

43. If a child be suffering severely from "wind," is there any objection to the addition of a small quantity either of gin or of peppermint to his food to disperse it?

It is a murderous practice to add either gin or peppermint of the shops (which is oil of peppermint dissolved in spirits) to his food. Many children have, by such a practice, been made puny and delicate, and have gradually dropped into an untimely grave. An infant who is kept, for the first five or six months, entirely to the breast—more especially if the mother be careful in her own diet—seldom suffers from "wind;" those, on the contrary, who have much or improper food, [Footnote: For the first five or six months never, if you can possibly avoid it, give artificial food to an infant who is sucking. There is nothing, in the generality of cases, that agrees, for the first few months, like the mother's milk alone.] suffer severely.

Care in feeding, then, is the grand preventative of "wind;" but if, notwithstanding all your precautions, the child be troubled with flatulence, the remedies recommended under the head of Flatulence will generally answer the purpose.

44. Have you any remarks to make on sugar for sweetening a baby's food?

A small quantity of sugar in an infant's food is requisite, sugar being nourishing and fattening, and making cow's milk to resemble somewhat, in its properties human milk; but, bear in mind, it must be used sparingly. Much sugar cloys the stomach, weakens the digestion, produces acidity, sour belchings, and wind:—

"Things sweet to taste, prove in digestion sour."

Shakspeare.

If a babe's bowels be either regular or relaxed, lump sugar is the best for the purpose of sweetening his food; if his bowels are inclined to be costive, raw sugar ought to be substituted for lump sugar, as raw sugar acts on a young babe as an aperient, and, in the generality of cases, is far preferable to physicking him with opening medicine. An infant's bowels, whenever it be practicable (and it generally is), ought to be regulated by a judicious dietary rather than by physic.

VACCINATION AND RE-VACCINATION.

45. Are you an advocate for vaccination?

Certainly. I consider it to be one of the greatest blessings ever conferred upon mankind. Small-pox, before vaccination was adopted, ravaged the country like a plague, and carried off thousands annually; and those who did escape with their lives were frequently made loathsome and disgusting objects by it. Even inoculation (which is cutting for the small-pox) was attended with danger, more especially to the unprotected—as it caused the disease to spread like wildfire, and thus it carried off immense numbers.

Vaccination is one, and an important cause of our increasing population; small-pox, in olden times, decimated the country.

46. But vaccination does not always protect a child from, small-pox?

I grant you that it does not always protect him, neither does inoculation; but when he is vaccinated, if he take the infection, he is seldom pitted, and very rarely dies, and the disease assumes a comparatively mild form. There are a few, very few fatal cases recorded after vaccination, and these may be considered as only exceptions to the general rule; and, possibly, some of these may be traced to the arm, when the child was vaccinated, not having taken proper effect.

If children, and adults were re-vaccinated,—say every seven years after the first vaccination,—depend upon it, even these rare cases would not occur, and in a short time small-pox would be known only by name.

47. Do you consider it, then, the imperative duty of a mother, in every case, to have, after the lapse of every seven years, her children re-vaccinated?

I decidedly do: it would be an excellent plan for every person, once every seven years to be re-vaccinated, and even oftener, if small-pox be rife in the neighbourhood. Vaccination, however frequently performed, can never do the slightest harm, and might do inestimable good. Small-pox is both a pest and a disgrace, and ought to be constantly fought and battled with, until it be banished (which it may readily be) the kingdom.

I say that small-pox is a pest; it is worse than the plague, for if not kept in subjection, it is more general—sparing neither young nor old, rich nor poor, and commits greater ravages than the plague ever did. Small-pox is a disgrace: it is a disgrace to any civilised land, as there is no necessity for its presence, if cow-pox were properly and frequently performed, small-pox would be unknown. Cow-pox is a weapon to conquer small-pox and to drive it ignominiously from the field.

My firm belief, then, is, that if every person were, every seven years, duly and properly vaccinated, small-pox might be utterly exterminated; but as long as there are such lax notions on the subject, and such gross negligence, the disease will always be rampant, for the poison of small-pox never slumbers nor sleeps, but requires the utmost diligence to eradicate it. The great Dr Jenner, the discoverer of cow-pox as a preventative of small-pox, strongly advocated the absolute necessity of every person being re-vaccinated once every seven years, or even, oftener, if there was an epidemic of small-pox in the neighbourhood.

48. Are you not likely to catch not only the cow-pox, but any other disease that the child has from whom the matter is taken?

The same objection holds good in cutting for small pox (inoculation)—only in a ten-fold degree—small-pox being such a disgusting complaint. Inoculated small-pox frequently produced and left behind inveterate "breakings-out," scars, cicatrices, and indentations of the skin, sore eyes, blindness, loss of eyelashes, scrofula, deafness—indeed, a long catalogue of loathsome diseases. A medical man, of course, will be careful to take the cow-pox matter from a healthy child.

49. Would it not be well to take the matter direct from the cow?

If a doctor be careful—which, of course, he will be—to take the matter from a healthy child, and from a well-formed vesicle, I consider it better than taking it direct from the cow, for the following reasons:—The cow-pox lymph, taken direct from the cow, produces much more violent symptoms than after it has passed through several persons; indeed, in some cases, it has produced effects as severe as cutting for the small-pox, besides, it has caused, in many cases, violent inflammation and even sloughing of the arm. There are also several kinds of spurious cow-pox to which the cow is subject, and which would be likely to be mistaken for the real lymph. Again, if even the genuine matter were not taken from the cow exactly at the proper time, it would he deprived of its protecting power.

50. At what age do you recommend an infant to be first vaccinated?

When he is two months old, as the sooner he is protected the better. Moreover, the older he is the greater will be the difficulty in making him submit to the operation, and in preventing his arm from being rubbed, thus endangering the breaking of the vesicles, and thereby interfering with its effects. If small-pox be prevalent in the neighbourhood, he may, with perfect safety, be vaccinated at the month's end; indeed if the small-pox be near at hand, he must be vaccinated, regardless of his age, and regardless of everything else, for small-pox spares neither the young nor the old, and if a new-born babe should unfortunately catch the disease, he will most likely die, as at his tender age he would not have strength to battle with such a formidable enemy. "A case, in the General Lying-in-Hospital, Lambeth, of small-pox occurred in a woman a few days after her admission, and the birth of her child. Her own child was vaccinated when only four days old, and all the other infants in the house varying from one day to a fortnight and more. All took the vaccination; and the woman's own child, which suckled her and slept with her; and all escaped the small pox." [Footnote: Communicated by Sir Charles Locock to the Author.]

51. Do you consider that taking of matter from a child's arm weakens the effect of vaccination on the system?

Certainly not, provided it has taken effect in more than one place. The arm is frequently much inflamed, and vaccinating other children from it abates the inflammation, and thus affords relief. It is always well to leave one vesicle undisturbed.

52. If the infant have any "breaking out" upon the skin, ought that to be a reason for deferring the vaccination?

It should, as two skin diseases cannot well go on together; hence the cow-pox might not take, or, if it did, might not have its proper effect in preventing small-pox. "It is essential that the vaccine bud or germ have a congenial soil, uncontaminated by another poison, which, like a weed, might choke its healthy growth."—Dendy. The moment the skin be free from the breaking-out, he must be vaccinated. A trifling skin affection, like red gum, unless it be severe, ought not, at the proper age to prevent vaccination. If small-pox be rife in the neighbourhood, the child must be vaccinated, regardless of any "breaking-out" on the skin.

53. Does vaccination make a child poorly?

At about the fifth day after vaccination, and for three or four days, he is generally a little feverish; the mouth is slightly hot, and he delights to have the nipple in his mouth. He does not rest so well at night; he is rather cross and irritable; and, sometimes, has a slight bowel-complaint. The arm, about the ninth or tenth day, is usually much inflamed—that is to say it is, for an inch or two or more around the vesicles, red, hot, swollen, and continues in this state for a day or two, at the end of which time the inflammation gradually subsides. It might be well to state that the above slight symptoms are desirable, as it proves that the vaccination has had a proper effect on his system, and that, consequently, he is more likely to be thoroughly protected from any risk of catching small-pox.

54. Do you approve, either during or after vaccination, of giving medicine, more especially if he be a little feverish?

No, as it would be likely to work off some of its effects, and thus would rob the cow-pox of its efficacy on the system. I do not like to interfere with vaccination in any way whatever (except, at the proper time, to take a little matter from the arm), but to allow the pock to have full power upon his constitution.

What do you give the medicine for? If the matter that is put into the arm be healthy, what need is there of physic! And if the matter be not of good quality, I am quite sure that no physic will make it so! Look, therefore, at the case in whatever way you like, physic after vaccination is not necessary; but, on the contrary, hurtful. If the vaccination produce slight feverish attack, it will, without the administration of a particle of medicine, subside in two or three days.

55. Have you any directions to give respecting the arm AFTER vaccination?

The only precaution necessary is to take care that the arm be not rubbed; otherwise the vesicles may be prematurely broken, and the efficacy of the vaccination may be lessened. The sleeve, in vaccination, ought to be large and soft, and should not be tied up. The tying up of a sleeve makes it hard, and is much more likely to rub the vesicles than if it were put on the usual way.

56. If the arm, AFTER vaccination, be much inflamed, what ought to be done?

Smear frequently, by means of a feather or a camel's hair brush, a little cream on the inflamed part. This simple remedy will afford great comfort and relief.

57. Have the goodness to describe the proper appearance, after the falling-off of the scab of the arm?

It might be well to remark, that the scabs ought always to be allowed to fall off of themselves. They must not, on any account, be picked or meddled with. With regard to the proper appearance of the arm, after the falling-off of the scab, "a perfect vaccine scar should be of small size, circular, and marked with radiations and indentations."— Gregory.

DENTITION

58. At what time does dentition commence?

The period at which it commences is uncertain. It may, as a rule, be said that a babe begins to cut his teeth at seven months old. Some have cut teeth at three months; indeed, there are instances on record of infants having been born with teeth. King Richard the Third is said to have been an example. Shakspeare notices it thus:—

"YORK.—Marry, they say my uncle grew so fast,
That he could gnaw a crust at two hours old.
'Twas full two years ere I could get a tooth,
Grandam, this would have been a biting jest."

When a babe is born with teeth, they generally drop out. On the other hand, teething, in some children does not commence until they are a year and a half or two years old, and, in rare cases, not until they are three years old. There are cases recorded of adults who have never cut any teeth. An instance of the kind came under my own observation.

Dentition has been known to occur in old age. A case is recorded by M. Carre, in the Gazette Medicale de Paris (Sept 15, 1860), of an old lady, aged eighty-five, who cut several teeth after attaining that age!

59. What is the number of the FIRST set of teeth, and in what order do they generally appear?

The first or temporary set consists of twenty. The first set of teeth are usually cut in pairs. "I may say that nearly invariably the order is—1st, the lower front incissors [cutting teeth], then the upper front, then the upper two lateral incissors, and that not uncommonly a double tooth is cut before the two lower laterals; but at all events the lower laterals come 7th and 8th, and, not 5th and 6th, as nearly all books on the subject testify." [Footnote: Sir Charles Locock in a Letter to the Author.] Then the first grinders, in the lower jaw, afterwards the first upper grinders, then the lower corner-pointed or canine teeth, after which the upper corner or eye-teeth, then the second grinders in the lower jaw, and lastly, the second grinders of the upper jaw. They do not, of course, always appear in this rotation. Nothing is more uncertain than the order of teething. A child seldom cuts his second grinders until after he is two years old. He is, usually, from the time they first appear, two years in cutting the first set of teeth. As a rule, therefore, a child of two years old has sixteen, and one of two years and a half old, twenty teeth.

60. If an infant be feverish or irritable, or otherwise poorly, and if the gums be hot, swollen, and tender, are you an advocate for their being lanced?

Certainly; by doing so he will, in the generality of instances, be almost instantly relieved.

61. But it has been stated that lancing the gums hardens them?

This is a mistake—it has a contrary effect. It is a well-known fact, that a part which has been divided gives way much more readily than one which has not been cut. Again, the tooth is bound down by a tight membrane, which, if not released by lancing, frequently brings on convulsions. If the symptoms be urgent, it may be necessary from time to time to repeat the lancing. It would, of course, be the height of folly to lance the gums unless they be hot and swollen, and unless the tooth, or the teeth, be near at hand. It is not to be considered a panacea for every baby's ill, although, in those cases where the lancing of the gums is indicated, the beneficial effect is sometimes almost magical.

62. How ought the lancing of a child's gums to be performed?

The proper person, of course, to lance his gums is a medical man. But if, perchance, you should be miles away and be out of the reach of one, it would be well for you to know how the operation ought to be performed. Well, then, let him lie on the nurse's lap upon his back, and let the nurse take hold of his hands in order that he may not interfere with the operation.

Then, if it be the upper gum that requires lancing, you ought to go to the head of the child, looking over, as it were, and into his mouth, and should steady the gum with the index finger of your left hand; then, you should take hold of the gum-lancet with your right hand—holding as if it were a table-knife at dinner—and cut firmly along the inflamed and swollen gum and down to the tooth, until the edge of the gum-lancet grates on the tooth. Each incision ought to extend along the ridge of the gum to about the extent of each expected tooth.

If it be the lower gum that requires lancing, you must go to the side of the child, and should steady the outside of the jaw with the fingers of the left hand, and the gum with the left thumb, and then you should perform the operation as before directed.

Although the lancing of the gums, to make it intelligible to a non-professional person, requires a long description, it is, in point of fact, a simple affair, is soon performed, and gives but little pain.

63. If teething cause convulsions, what ought to be done?

The first thing to be done (after sending for a medical man) is to freely dash water upon the face, and to sponge the head with cold water, and as soon as warm water can be procured, to put him into a warm bath [Footnote: For the precautions to be used in putting a child into a warm bath, see the answer to question on "Warm Baths.">[ of 98 degrees Fahrenheit. If a thermometer be not at hand, [Footnote: No family, where there are young children, should be without Fahrenheit's thermometer.] you must plunge your own elbow into the water: a comfortable heat for your elbow will be the proper heat for the infant. He must remain in the bath for a quarter of an hour, or until the fit be at an end. The body must, after coming out of the bath, be wiped with warm and dry and coarse towels; he ought then to be placed in a warm blanket. The gums must be lanced, and cold water should be applied to the head. An enema, composed of table salt, of olive oil, and warm oatmeal gruel—in the proportion of one table-spoonful of salt, of one of oil, and a tea-cupful of gruel—ought then to be administered, and should, until the bowels have been well opened, be repeated every quarter of an hour; as soon as he comes to himself a dose of aperient medicine ought to be given.

It may be well, for the comfort of a mother, to state that a child in convulsions is perfectly insensible to all pain whatever; indeed, a return to consciousness speedily puts convulsions to the rout.

64. A nurse is in the habit of giving a child, who is teething, either coral, or ivory, to bite: do you approve of the plan?

I think it a bad practice to give him any hard, unyielding substance, as it tends to harden the gums, and, by so doing, causes the teeth to come through with greater difficulty. I have found softer substances, such as either a piece of wax taper, or an India-rubber ring, or a piece of the best bridle leather, or a crust of bread, of great service. If a piece of crust be given as a gum-stick, he must, while biting it, be well watched, or by accident he might loosen a large piece of it, which might choke him. The pressure of any of these excites a more rapid absorption of the gum, and thus causes the tooth to come through more easily and quickly.

65. Have you any objection to my baby, when he is cutting his teeth, sucking his thumb?

Certainly not: the thumb is the best gum-stick in the world:—it is convenient; it is handy (in every sense of the word): it is of the right size, and of the proper consistence, neither too hard nor too soft; there is no danger, as of some artificial gum-sticks, of its being swallowed, and thus of its choking the child. The sucking of the thumb causes the salivary glands to pour out their contents, and thus not only to moisten the dry mouth, but assist the digestion; the pressure of the thumb eases, while the teeth are "breeding," the pain and irritation of the gums, and helps, when the teeth are sufficiently advanced, to bring them through the gums. Sucking of the thumb will often make a cross infant contended and happy, and will frequently induce a restless babe to fall into a sweet refreshing sleep. Truly may the thumb be called a baby's comfort. By all means, then, let your child suck his thumb whenever he likes, and as long as he chooses to do so.

There is a charming, bewitching little picture of a babe sucking his thumb in Kingsley's Water Babies, which I heartily commend to your favourable notice and study.

66. But if an infant be allowed to suck his thumb, will it not be likely to become a habit, and stick to him for years—until, indeed, he become a big boy?

After he have cut the whole of his first set of teeth, that is to say, when he is about two years and a half old, he might, if it be likely to become a habit, be readily cured by the following method, namely, by making a paste of aloes and water, and smearing it upon his thumb. One or two dressings will suffice as after just tasting the bitter aloes he will take a disgust to his former enjoyment, and the habit will at once be broken.

Many persons I know have an objection to children sucking their thumbs, as for instance,—

"Perhaps it's as well to keep children from plums, And from pears in the season, and sucking their thumbs." [Footnote: Ingoldsby Legends.]

My reply is,—

P'rhaps 'tis as well to keep children from pears;
The pain they might cause, is oft follow'd by tears;
'Tis certainly well to keep them from plums;
But certainly not from sucking their thumbs!
If a babe suck his thumb
'Tis an ease to his gum;
A comfort; a boon; a calmer of grief;
A friend in his need—affording relief;
A solace; a good; a soother of pain;
A composer to sleep; a charm; and a gain.

'Tis handy, at once, to his sweet mouth to glide;
When done with, drops gently down by his side;
'Tis fix'd, like an anchor, while the babe sleeps.
And the mother, with joy, her still vigil keeps.

67. A child who is teething dribbles, and thereby wets his chest, which frequently causes him to catch cold; what had better be done?

Have in readiness to put on several flannel dribbling bibs, so that they may be changed as often as they become wet; or, if he dribble very much, the oiled silk dribbling-bibs, instead of the flannel ones, may be used, and which may be procured at any baby-linen ware house.

68. Do you approve of giving a child, during teething, much fruit?

No; unless it be a few ripe strawberries or raspberries, or a roasted apple, or the juice of five or six grapes—taking care that he does not swallow either the seeds or the skin—or the insides of ripe gooseberries, or an orange. Such fruits, if the bowels be in a costive state, will be particularly useful.

All stone fruit, raw apples or pears, ought to be carefully avoided, as they not only disorder the stomach and the bowels,—causing convulsions, gripings, &c.,—but they have the effect of weakening the bowels, and thus of engendering worms.

69. Is a child, during teething, more subject to disease, and, if so, to what complaints, and in what manner may they be prevented?

The teeth are a fruitful source of suffering and of disease; and are, with truth, styled "our first and our last plagues." Dentition is the most important period of a child's life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching. When we consider how the teeth elongate and enlarge in his gums, pressing on the nerves and on the surrounding parts, and thus how frequently they produce pain, irritation, and inflammation; when we further contemplate what sympathy there is in the nervous system, and how susceptible the young are to pain, no surprise can be felt, at the immense disturbance, and the consequent suffering and danger frequently experienced by children while cutting their first set of teeth. The complaints or the diseases induced by dentition are numberless, affecting almost every organ of the body,—the brain, occasioning convulsions, water on the brain, &c.; the lungs, producing congestion, inflammation, cough, &c.; the stomach, exciting sickness, flatulence, acidity, &c,; the bowels, inducing griping, at one time costiveness, and at another time purging; the skin, causing "breakings-out."

To prevent these diseases, means ought to be used to invigorate a child's constitution by plain, wholesome food, as recommended under the article of diet; by exercise and fresh air; [Footnote: The young of animals seldom suffer from cutting their teeth—and what is the reason? Because they live in the open air, and take plenty of exercise; while children are frequently cooped up in close rooms, and are not allowed the free use of their limbs. The value of fresh air is well exemplified in the Registrar-General's Report for 1843; he says that in 1,000,000 deaths, from all diseases, 616 occur in the town from teething while 120 only take place in the country from the same cause.] by allowing him, weather permitting, to be out of doors a great part of every day; by lancing the gums when they get red, hot, and swollen; by attention to the bowels, and if he suffer more than usual, by keeping them rather in a relaxed state by any simple aperient, such as either castor oil, or magnesia and rhubarb, &c.; and, let me add, by attention to his temper: many children are made feverish and ill by petting and spoiling them. On this subject I cannot do better than refer you to an excellent little work entitled Abbot's Mother of Home, wherein the author proves the great importance of early training.

70. Have the goodness to describe the symptoms and the treatment of Painful Dentition?

Painful dentition may be divided into two forms—(1) the Mild; and (2) the Severe. In the mild form the child is peevish and fretful, and puts his fingers, and everything within reach, to his mouth, he likes to have his gums rubbed, and takes the breast with avidity, indeed it seems a greater comfort to him than ever. There is generally a considerable flow of saliva, and he has frequently a more loose state of bowels than is his wont.

Now, with regard to the more severe form of painful dentition—The gums are red, swollen, and hot, and he cannot without expressing pain bear to have them touched, hence, if he be at the breast, he is constantly loosing the nipple. There is dryness of the mouth, although before there had been a great flow of saliva. He is feverish, restless, and starts in his sleep. His face is flashed. His head is heavy and hot. He is sometimes convulsed. [Footnote: See answer to Question 63.] He is frequently violently griped and purged, and suffers severely from flatulence. He is predisposed to many and severe diseases.

The treatment, of the mild form, consists of friction, of the gum with the finger, with a little "soothing syrup," as recommended by Sir Charles Locock, [Footnote: Soothing syrup—Some of them probably contain opiates, but a perfectly safe and useful one is a little Nitrate of Potass in syrup of Roses—one scruple to half an ounce.—Communicated by Sir Charles Locock to the Author. This 'soothing syrup' is not intended to be given us a mixture but to be used as an application to rub the gums with. It may be well to state that it is a perfectly harmless remedy even if a little of it were swallowed by mistake.] a tepid bath of about 92 degrees Fahrenheit, every night at bed time, attention to diet and to bowels, fresh air and exercise. For the mild form, the above plan will usually be all that is required. If he dribble, and the bowels be relaxed, so much the better. The flow of saliva and the increased action of the bowels afford relief, and therefore must not be interfered with. In the mild form, lancing of the gums is not desirable. The gums ought not to be lanced, unless the teeth be near at hand, and unless the gums be red, hot, and swollen.

In the severe form a medical man should be consulted early, as more energetic remedies will be demanded; that is to say, the gums will require to be freely lanced, warm baths to be used, and medicines to be given, to ward off mischief from the head, from the chest, and from the stomach.

If you are living in the town, and your baby suffers much from teething, take him into the country. It is wonderful what change of air to the country will often do, in relieving a child who is painfully cutting his teeth. The number of deaths in London, from teething, is frightful; it is in the country comparatively trifling.

71. Should an infant be purged during teething or indeed, during any other time, do you approve of either absorbent or astringent medicines to restrain it?

Certainly not. I should look upon, the relaxation as an effort of nature to relieve itself. A child is never purged without a cause; that cause, in the generality of instances, is the presence of either some undigested food, or acidity, or depraved motions, that want a vent.

The better plan is, in such a case, to give a dose of aperient medicine, such as either castor oil, or magnesia and rhubarb; and thus work it off. IF WE LOCK UP THE BOWELS, WE CONFINE THE ENEMY, AND THUS PRODUCE MISCHIEF. [Footnote: I should put this in capitals, it is so important and is often mistaken.—C. Locock.] If he be purged more than usual, attention should be paid to the diet—if it be absolutely necessary to give him artificial food while suckling—and care must be taken not to overload the stomach.

72. A child is subject to a slight cough during dentition—called by nurses "tooth-cough"—which a parent would not consider of sufficient importance to consult a doctor about: pray tell me, is there any objection to a mother giving her child a small quantity either of syrup of white poppies, or of paregoric, to ease it?

A cough is an effort of nature to bring up any secretion from the lining membrane of the lungs, or from the bronchial tubes, hence it ought not to be interfered with. I have known the administration of syrup of white poppies, or of paregoric, to stop the cough, and thereby to prevent the expulsion of the phlegm, and thus to produce either inflammation of the lungs, or bronchitis. Moreover, both paregoric and syrup of white poppies are, for a young child, dangerous medicines (unless administered by a judicious medical man), and ought never to be given by a mother.

In the month of April 1844, I was sent for, in great haste, to an infant, aged seventeen months, who was labouring under convulsions and extreme drowsiness, from the injudicious administration of paregoric, which had been given to him to ease a cough. By the prompt administration of an emetic he was saved.

73. A child, who is teething, is subject to a "breaking-out," more especially behind the ears—which is most disfiguring, and frequently very annoying what would you recommend?

I would apply no external application to cure it, as I should look upon it as an effort of the constitution to relieve itself, and should expect, if the "breaking-out" were repelled, that either convulsions, or bronchitis, or inflammation of the lungs, or water on the brain, would be the consequence. The only plan I should adopt would be, to be more careful in his diet, to give him less meat (if he be old enough to eat animal food), and to give him, once or twice a week, a few doses of mild aperient medicine, and, if the irritation from the "breaking-out" be great, to bathe it, occasionally, either with a little warm milk and water, or with rose water.