The maternal management of children, in health and disease

by Thomas Bull

MATERNAL TREATMENT OF THE DISORDERS OF THE STOMACH AND BOWELS.

As must have been already seen, the maternal treatment chiefly consists in the removal of the cause of the disorder; medicine may occasionally be exhibited by the mother, but its use in her hands must be very limited indeed.

Unfortunately the general resource and only remedy of most mothers in affections of the stomach and bowels is an aperient, and a combination containing calomel is the one too frequently selected. The primary cause of the disorder is undetected, and consequently no measures taken for its removal, but purgative powder after purgative powder is given, the evil being supposed to rest in the bowels alone, and that such means must eventually get rid of it. The mother is not aware all this time that the real source of the derangement is probably in the diet itself; that there is some error here, and that unless this is corrected, the remedies must be worse than useless. The consequence of such a plan of proceeding is usually very sad; a confirmed and obstinate diarrhoea but too commonly ensues, and the infant is sometimes reduced to the last extremity.

The removal of the cause of the disorder, then, in a large number of instances of derangement of the stomach and bowels, if effected early, will cure the disease, and without further remedy. But it will be asked, by what method is this cause to be detected? In this way. In all human probability the primary cause of the disorder is connected with the diet; this is the case in ninety-nine instances out of a hundred. Well, then, is the sick child at the breast? If so, ascertain whether the breast-milk is healthy and wholesome, or whether any circumstances exist which have rendered it otherwise? If nothing faulty is found here, the next question would naturally be, whether the rules and regulations laid down for suckling have been strictly adhered to? Or, whether the infant is sufficiently old to render it at all probable that a tooth may be irritating the gum?

Perhaps the child is being weaned; well, is there any error here? Is the change being attempted too early? or too suddenly and abruptly? If this is not the case, then, has the child been overfed, or is the food given of the proper description?

Is the child being brought up by hand? Then, there is every reason to suspect, either that the quality of the food given is not the most suitable, or, that the quantity exhibited is too great; in fact, that the rules laid down for "artificial feeding" have not been strictly acted upon.

By a mode of investigation like this, any defect or error in the dietetic management of the infant producing the disorder will be easily detected by a careful mother; and its correction alone will, in very many instances, be all that is necessary to remove the symptoms.

For example, if flatulence and griping, followed by diarrhoea, occur to an infant at the breast; if at the same time it becomes pale, its flesh flabby, its disposition fretful, always crying until it is put to the breast, the nipple of which it grasps eagerly, sucking eagerly, yet never satisfied, for its hunger continues, it is not nourished; if, too, the more it sucks, the more the stomach and bowels are deranged, the more it vomits and is purged; depend upon it the cause of all the evil will be found to be unwholesome milk. No medicine will avail any thing here; the cause must be removed; the best medicine, and the only remedy, is a breast of healthy milk. And if this is not procured early, there will be great danger of a diarrhoea setting in, which may probably prove fatal to the child.

Again; if there is simply vomiting of the breast-milk almost immediately after the child has been suckled, the milk coming up pure and unchanged, and discharged without any apparent effort, and the moment after the child is cheerful and happy, this will be found to depend upon repletion, and not upon unwholesome milk; in fact, the stomach has received too much. This must be prevented in future, not by giving medicine, but simply by removing the infant from the nipple immediately it ceases to draw strongly, the moment it begins to dally with the breast.

Again; if flatulence and griping occur to the child brought up by handy this derangement will generally be found to result from overfeeding: abstinence and diminution of the quantity of the food will generally be all that is necessary here. It will be well, however, for the mother in this case, and she may do it with the utmost safety, to unload the bowels of their indigestible contents by the exhibition of a tea-spoonful of castor oil. A dose or two of this medicine will effectually clear them out, without increasing the irritation, or weakening the child, whilst it will in most instances altogether remove the symptoms. If the flatulence, however, should continue, four or five grains of magnesia may be mixed with the last meal at night, and a little warm water thrown up into the bowel as an injection the next morning.

Diarrhoea occurring in a child brought up by hand, if it be not the result of overfeeding, will very frequently be found to arise from unsuitable diet, the food given not being of a kind suited to the infant's stomach; for what will agree with one child often disagrees with another. Alteration of diet will sometimes alone suffice in these cases to cure, if this alteration is only made early enough, before any considerable irritation of the stomach and bowels has been induced. Thin arrow-root made with water (prepared very carefully, or the child will refuse it,) should be given for five or six days; the warm bath used every night for the same period, a new flannel bandage rolled round the body, and the child cautiously protected from a damp atmosphere. The arrow-root, upon the cessation of the diarrhoea, may have cows' milk added to it, if milk is not found to disagree: when this is the case, chicken or weak mutton broth, free from fat, or beef- tea, thickened with farinaceous food, with a little salt added, are the best substitutes. Should not the diarrhoea yield to the foregoing measures, and that readily, medical aid ought to be sought. Diarrhoea is very frequent from the time of weaning to the third year of age, and certainly in its effects forms so important a disease, that, unless in the slight form noticed above, a mother is not justified in attempting its relief.

In conclusion, I would observe, that I do not think a mother justified in attempting more than what has been laid down here for her guidance. It is believed that the few and plain common-sense directions given, if followed, will do much to prevent disease, and even to relieve it in its milder forms; they will not, however, cure disease itself when really established: and again I would repeat, let the mother recollect that to prevent disease is her province—to cure it, is the physician's.

Sect. III.—COSTIVENESS.