THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN.
Not long ago a pretty little girl of ten was brought to me from a long distance to get my advice as to a slight paralysis of one leg. The trouble had existed for several years. I soon saw that the child was irritable, sensitive, and positive, and I was, therefore, careful to approach her gently. The moment it was proposed to show me the leg, she broke into a fury of rage, and no inducement I could offer enabled me to effect my purpose. An appeal to the parents, and from them to force, ended in a distressing battle. She bit, scratched, kicked, and at last won a victory, and was left sullen and sobbing on the floor. Next day the same scene was repeated. It is true that at length they were able to undress her, but neither threats nor persuasion would keep her quiet long enough to enable me to apply the simplest tests. The case was obscure, and demanded the most careful study. Their time was limited, so that at length they were obliged to take her home in despair, without any guiding opinion from me, and with no advice, except as to her moral education, concerning which I was sufficiently explicit. I have seen many such illustrations of a common evil, and have watched the growth to adult life of some of these cases of wrecked character, and observed the unpleasant results which came as they grew older. I have used an extreme case as a text, because I desire to fix attention on the error which parents and some doctors are apt to commit in cases of chronic ailments in children.
As to the miserable sufferers who pass through long illness to death I have little to say. We naturally yield to their whims, pet and indulge them, moved by pitiful desire to give them all they want of the little which life affords them. In acute illness, with long convalescence, I am pretty sure that the tender mother does no real good by over-indulgence; but the subject is difficult, and hard to handle with justice and charity without calling down upon me the indignation of the unthoughtful. It is so easy and pleasant to yield to the caprices of those we love, when they are in pain or helpless from illness,—so doubly hard at such times to say no. Yet, if in the case of a long convalescence, such as follows, perhaps, a typhoid or scarlet fever, we balance for the little one the too-easily yielded joy of to-day against the inevitable stringency of discipline, which, with recovered health, must teach the then doubly difficult lesson of self-restraint, we shall see, I think, that, on the whole, we do not add to the sum of happiness to which the child is entitled.
The mother at the sick-bed of her young child is, however, a being quite often as difficult to manage as her child. All her instinctive maternity is up in arms. Deep in the heart of many mothers there is an unconfessed and half-smothered sense of wrath at the attack which sickness has made on her dear one. Then nothing is too much to give; no sacrifice of herself or others too great to grant or demand. The irritability and feebleness of convalescence makes claims upon her love of self-sacrifice, and her prodigality of tenderness as positive and yet more baneful. That in most cases she may and does go too far, and loses for her child what it is hard to recover in health, is a thing likely enough, yet to talk to her at such times of the wrong she does the child is almost to insult her. Nevertheless the unwisdom of a course of reckless yielding to all a child's whims is plain enough, for if the little one be long ill or weak, it learns with sad swiftness to exact more and more, and to yield less and less, so that it becomes increasingly hard to do for it the many little unpleasant things which sickness demands. Character comes strongly out in the maladies of the child, as it does even less distinctly in the sickness of the adult. The spoiled, over-indulged child is a doubly unmanageable invalid, and when in illness the foolish petting of the mother continues, the doctor, at least, is to be pitied.
The ductility of childhood has its dangerous side. This is seen very well in cases which, fortunately, are rather rare, and, for some reason, are less frequent in girls than in boys. These little ones observe sharply the faces and obvious motives of those about their sick-beds, and more readily than adults are led to humor the doubts they hear expressed by the doctor or their elders as to their capacity to do this or that. Too frequent queries as to their feelings are perilously suggestive, and out of it all arises, in children of nervous or imaginative temperaments, an inexplicable tendency to fulfil the predictions they have heard, or actively to humor the ideas they acquire as to their own ailments and disabilities.
There is something profoundly human in this. With careless, unthoughtful people, who have trained a child to know that illness means absolute indulgence, and who pour out unguardedly their own fears and expectations at the bedside, the result for the child is in some cases past belief. The little one gets worse and worse. It accepts automatically the situation, with all the bribes to do so made larger by feebleness, and at last gains that extreme belief in its own inability to rise or move about which absolute convictions of this nature impose on child or man.
There is a further and worse stage possible. The child's claims increase. Its complaints gather force, and alarm those about it. Gratified in all its whims, it develops perverted tastes, or refuses all food but what it fancies. At last it becomes violent if opposed, and rules at will a scared circle of over-affectionate relatives. When all else fails, it exaggerates or invents symptoms, and so goes on, until some resolute physician sees the truth and opens the eyes of an amazed family.
Certain physicians explain these cases as due to hysteria, and in a small number of instances there are signs which justify such an explanation. But in the larger proportion the mode of origin is complex, and depends on the coincidence of a variety of evils, none of which are of hysterical character. I am not here concerned so much with the exact nature of these troubles as I am with the avoidable errors in the management of sick childhood. If I can make the mother more thoughtfully alert, less disposed to terror and exaggeration, less liable to be led by her emotions, I shall have fulfilled my purpose without such discussion as is out of place in essays like these.
To make clear, however, the possibility of the disasters I have briefly described, an illustration may answer better than any length of generalized statements. A little fellow of nine once came under my care, and was said to have inflammation of the coverings of the brain. There was a long story, which I may sum up in a few sentences. An only child; feeble in youth; indulgence to almost any degree; at the age of eight, a fall, not at all grave, but followed by some days of headache; long rest in bed, by order of a physician; much pity; many questions; half-whispered, anxious discussions at the bedside; yet more excessive indulgence, because every denial seemed to increase or cause headache. At last the slightest annoyance became cause for tears, and finally for blame, all of which a gentle, fearful mother bore as if it were part of the natural trials of disease. It took but a few months of complete non-restraint to make of a shrewd, bright, half-educated, spoiled boy a little brute, as to whose sanity there seemed to be some doubt. He was easily made well, and has lived to thank the sternness which won back the health of mind and body his parents had so foolishly helped to lose for him.
A single example may suffice, nor have I any fear that it may lead any one, least of all nature's gentlest creation, a mother, to be more severe than is reasonable. She it is who is really most responsible. She is ever beside the child when the little actor is off guard. She may have the cleverness to see through the deceit or she may not. The physician comes and goes, and must take for granted much that he has no chance to see, and for which he has to trust the more constant attendant. Moreover, the rarity of these cases is apt to help to deceive him quite as much as does the mother's affectionate trust. Nevertheless, it is his fault if soon or late he fail to see the truth; but he may well be careful how he states his doubt. The mother at the sick-bed but too often resents as a wrong any hint at the true state of the case.
Children are singularly imitative, and more or less prone to suffer from this tendency. Hence the curious cases in which a child simulates, I do not say dissimulates, the malady it sees constantly before it, as when one child has attacks of false epilepsy, owing to having seen the real attack in a sister or brother, or when St. Vitus's dance runs through a school or an asylum.
To sum up, we credit these little ones with a simplicity of moral organization which forbids us to believe that the causes which are active for mischief in their elders are not as potent for evil in them. The popular and reasonable creed of moral education, which teaches us to ask from a well child self-control, self-restraint, truth of statement, reasonable endurance of the unavoidable, good temper, is not too lightly or too entirely to be laid aside when sickness softens the rule of health and all our hearts go out in pity to the little sufferer.
Certain of the nervous and other maladies of children sometimes keep them a long while under treatments which are annoying, painful, or disabling. They often end by leaving them as strong as their fellows, but crippled, lame, disfigured, or with troubles that attract remark, or, at least, notice. Thus, a child may have hip-disease, and, after years of treatment, get well, and although vigorous enough to do all that is required in life, be more or less lame. In another case, there is disease of the bones of the spine. After a wearying treatment, it is well, but the little one has a distorted spine,—is humpbacked. Again, we have the common malady, palsy of childhood, and here, too, most probably, there is left a residue of disability, or, at all events, some loss of power.
In each case there are years of troublesome treatment, all sorts of unpleasant limitations, pain it may be, and certainly, at the best, a variety of discomforts. The joy and little pleasures of youth are gone. It makes one sorrowful to think of such cases, even when all that competent means can do to help them is at their disposal, and still more to reflect on those who have to battle for health with no more resource than is left to the needy. What shall we not do for them! The woman's whole tendency is to give them all of herself and all else that she can control. Indulgence becomes inevitable, or seems to become so, and the mother is rare who does not insist that they shall have what they desire, and that her other children shall yield to them in all things. Her answer to herself and others is, "They have so little; let them at least have what they can." As rare as the reasonable mother is the sick child who can stand this treatment and survive with those traits of character which it above all others requires to make its crippled life happy, not to say useful. The child thus unrestrained and foolishly indulged must needs become ill-tempered. It loses self-control, and yet no one will need it more. It learns to expect no disappointments, and life is to hold for it less than for others. Disease has crippled its body and the mother has crippled its character.
I have no belief that long illness is good for the mass of people, but the character of the adult sufferer is in his or her own hands to make, mar, or mend. In childhood the mother is in large measure responsible for the ductile being in her care. If she believes that unrestraint is her duty, she is laying up for the invalid a retribution which soon or late will bitterly visit on the child the sin or, if you like, the mistakes of the parent. It is her business and duty, no matter how hard may be to her the trial, to see that this child, above all others, shall be taught patience, gentleness, good temper, and self-control in all its varieties, nor should she fail to point out, as health returns and years go by, that it is not all of life to be straight and uncrippled. I need not dwell on this. Every wise woman will understand me, and be able to put in practice better than I can here state what I might more fully say.
I do not wish, however, to be understood as urging that all children long ill or crippled grow to be unamiable and spoiled. I do not quite know why it is, but, after all, children are less apt to suffer morally from long illness than adults, and very often, despite careless or thoughtless usage, these young sufferers come out as wholesome in mind and heart as if they had known no trial, or, perhaps, because of it. It is in a measure a matter of original temperament. In other words, what the sick child was as to character modified results, and this is especially true as concerns the peculiarities which attract unpleasant notice. One person who has twitching of the muscles of the face is made miserable by the attention it invites; another is indifferent.
The cases of Lord Byron and Walter Scott are to the point. The former was sensitive and morbid about his deformity. I cannot help thinking that had his mother been other than she was, he would have been brought up to more wholesome views as to what was after all no very great calamity. Walter Scott suffered from a like trouble, but healthy moral surroundings and a cheerful nature saved him from the consequences which fell so heavily upon his brother poet.
Epilepsy is a malady but too common in childhood, and as to which a few words apart are needed. Usually a child epileptic for some years will carry the disease with it for a time, the length of which no man can set. The disease may be such as to ruin mind and body, or the attacks may be rare, and not prevent courageous and resolute natures from leading useful lives. All intermediate degrees are possible. As a rule, no children need so inflexible a discipline as epileptics. Indulgence as regards them is only another name for ruin. Do as we may, they are apt to become morally perverted, and require the utmost firmness, and the most matured and educated intelligence, to train them wisely. Difficult epileptics and most idiots are best looked after, and certainly happiest, in some one of the competent training-schools for feeble-minded children.
Even the milder epileptic cases are hard to manage. I rarely see one which has been intelligently dealt with. Few mothers are able or willing to use a rule as stern, as enduring, as unyielding as they require.
As to education, I am satisfied that these children are the better for it, and yet almost invariably I find that in the cases referred to me some physician has, with too little thought, recommended entire abandonment or avoidance of mental training. I have neither space nor desire to go into my reasons for a different belief. I am, however, sure that education limited as to time, education of mind, and especially of the hands, has for these cases distinct utility, while to them also, as to the other children crippled in mind or body, all that I have already urged applies with equal force.
As to the management of sick or crippled childhood, I have said far more than I had at first meant to say, and chiefly because I have been made to feel, as I thought the matter over, how far more difficult it is in practice than in theory. But this applies to all moral lessons, and the moralist must be credited by the thoughtful mother with a full perception of the embarrassments which lie in her path.