The maternal management of children, in health and disease

by Thomas Bull

SECT. III.—OTHER CIRCUMSTANCES WHICH WILL ASSIST IN THE EARLY DETECTION OF DISEASE.

1. THE INFLUENCE OF THE SEASONS IN PRODUCING PARTICULAR FORMS OF DISORDER.—The recollection of the fact, that at the different seasons of the year some diseases are more prevalent than at other periods, will greatly aid a judicious parent in the early detection of the presence of disorder, and its kind, in her child.

Thus, in the early part of the winter, what is called catarrh, viz. an increased secretion of mucus from the membranes of the nose, fauces, and air-tubes, with fever, and attended with sneezing and cough, thirst, lassitude, and want of appetite, is generally prevalent.

As the winter advances, the air-tubes of the lungs, and the lungs themselves, are liable to become the seat of disorder; and those signs will present themselves, which have been pointed out in the previous section as characteristic of such attacks.

In the spring, we have still the same diseases prevalent, and in addition, measles, scarlet fever, small-pox, and chicken pox, which increase in liability towards the close of this season, and with the first weeks of summer.

In the summer, disease is less prevalent than at any other period of the year; but towards its middle and close, and through the whole of the autumnal months, bowel complaints may be expected, in the forms of diarrhoea, cholera, and dysentery.

2. THE INFLUENCE OF A HEREDITARY PREDISPOSITION TO CERTAIN DISEASES.— Without entering into this subject at large, still it may be useful to remark, that in some families there is a predisposition to some diseases, which, occurring in the first child, will, as each succeeding child is born, attack at the same age. Amongst other diseases of this class are, croup, hooping-cough, and water in the head.

This observation should not only lead a mother to be alive to the possibility of the successional occurrence of these diseases in her family, and so early note their appearance, and seek medical advice, but should at the same time make her most anxious, on the one hand, to shield her child from all their exciting causes, and on the other, to adopt those measures which may contribute indirectly to overcome the constitutional predisposition to them.

Of the scrofulous constitution, I will merely mention here, that it is of the greatest importance, where a predisposition to this disease exists in a family, that a mother should immediately attend to any alteration in the gait or contour of her child, and give prompt attention also to any complaint made of swelling about a joint, although it may be unattended with pain. The importance of this remark will be seen by contrasting the result of the following cases which occurred in children of the same family.

Case I.

A. B., a female child, having blue eyes, light hair, and a fair complexion, in the early part of the year 1838, being then two years of age, had an enlargement of the left knee joint. For some weeks previous to this time, there had been a degree of heat about the part; but as no pain apparently existed, it was not regarded as of any consequence, and nothing was done. The child, living in the neighbourhood of London, was afterwards placed under medical treatment. Two or three months having elapsed, it was brought to town, and shown to me, in consequence of a slight tumefaction over the lower part of the spine. This soon disappeared under the measures employed, and eventually the disease of the knee (evidently scrofulous) was arrested, so that now the case promises to be cured; but the joint will for ever be stiff, and the limb thus affected shorter than the other.

Case II.

G. B., the brother of the above, a handsome boy, with light hair, fine blue eyes,—indeed, very much like his little sister,—in the year 1836, had enlargements of the glands in his neck, which were relieved by the treatment resorted to.

In April, 1839, being then eight years old, he was observed by his mother to limp slightly in walking, but complained of little or no pain. From the caution, however, which had been given to the parent at the time I was consulted about the previous case, to notice at an early period any symptom of this nature in her children, the fact was immediately attended to. The affection was evidently in the hip; there was imperfection in the gait, and pain upon pressing over the joint. A blister was applied, perfect rest to the limb enjoined, and steel medicines ordered; and in a fortnight the motions of the joint were restrained more effectually by the application of strips of soap plaster and a bandage. In three months the child was ordered to the sea- side, and eventually was able to walk without the slightest limp or pain, and may be said to be quite well.

I would not say that in the first case, if the disease had been discovered early, and at that time met by judicious medical treatment, a stiff knee and shortened limb would have been prevented, although this is my belief; but in reference to the latter case, I have no hesitation in saying, that without the disease had been early detected by the mother, and as promptly attended to by her, the remedial measures might have failed,—certainly the result would not have been so highly satisfactory as it was.

Chap. V.

ON WHAT CONSTITUTES THE MATERNAL MANAGEMENT OF THE DISEASES OF CHILDREN.

The especial province of the mother is the prevention of disease, not its cure. To the establishment and carrying out of this principle, every word contained in the preceding pages has directly or indirectly tended.

This, however, is not all. When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.

Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to; and will most assuredly fail altogether, if counteracted by the erroneous prejudices of ignorant attendants. But to the affections of infancy and childhood, this remark applies with great force; since, at this period, disease is generally so sudden in its assaults, and rapid in its progress, that unless the measures prescribed are rigidly and promptly administered, their exhibition is soon rendered altogether fruitless.

The amount of suffering, too, may be greatly lessened by the thoughtful and discerning attentions of the mother. The wants and necessities of the young child must be anticipated; the fretfulness produced by disease, soothed by kind and affectionate persuasion; and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct, carefully provided against.

Again, not only is a firm and strict compliance with medical directions in the administration of remedies, of regimen, and general measures, necessary, but an unbiased, faithful, and full report of symptoms to the physician, when he visits his little patient, is of the first importance. An ignorant servant or nurse, unless great caution be exercised by the medical attendant, may, by an unintentional but erroneous report of symptoms, produce a very wrong impression upon his mind, as to the actual state of the disease. His judgment may, as a consequence, be biased in a wrong direction, and the result prove seriously injurious to the welldoing of the patient. The medical man cannot sit hour after hour watching symptoms; hence the great importance of their being faithfully reported. This can alone be done by the mother, or some person equally competent.

There are other weighty considerations which might be adduced here, proving how much depends upon efficient maternal management in the time of sickness; but they will be severally dwelt upon, when the diseases with which they are more particularly connected are spoken of.

Sect. 1.—ACCIDENTS AND DISEASES WHICH MAY OCCUR TO THE INFANT AT
BIRTH, OR SOON AFTER.

STILL-BORN.

Sometimes the child comes into the world apparently dead, and, unless the most active exertions are made by the attendants, is lost. The superintendence of the means used devolves upon the medical man; but it would be often well if his assistants were already acquainted with the measures pursued under these circumstances, for they would be more likely to be carried into effect with promptitude and success, than they now frequently are. And again, the still-born child is frequently in this state from having been born very rapidly, and before the medical man can have arrived, it will be more especially useful in such a case, that the attendants in the lying-in-room should know how to proceed.

The various causes producing this condition it is unnecessary to mention.

The condition itself may exist in a greater or less degree: the infant may be completely stillborn, with no indication of life, except, perhaps, the pulsation of the cord, or a feeble action of the heart;—or it may make ineffectual efforts at breathing, or even cry faintly, and yet subsequently perish for want of strength to establish perfectly the process of respiration. Under all these circumstances, a good deal can often be effected by art. In every instance, therefore, in which we have not positive evidence of the child being dead, in the existence of putrefaction, or of such malformation as is incompatible with life, it is our duty to give a fair trial to the means for restoring suspended animation; and as long as the slightest attempt at motion of the respiratory organs is evinced, or the least pulsation of the heart continues, we have good grounds for persevering and hoping for ultimate success.

The measures to be employed to restore a still-born child will be a little modified by the circumstances present.

IF THERE IS NO PULSATION—NO BEATING IN THE CORD, when the child comes into the world, it may at once be separated from the mother. This is to be effected by first tying the navel-string with common sewing thread (three or four times doubled), about two inches from the body of the child, and again two inches from the former ligature, and then dividing the cord with a pair of scissors between the two. And now the means for its restoration are to be made use of, which are detailed below, viz. inflation of the lungs, and perhaps the warm bath. If, with the above circumstances, the child's face be livid and swollen, some drops of blood should previously be allowed to escape before the ligature is applied to that part of the navel-string which is now only attached to the child.

IF THERE IS PULSATION IN THE CORD, BUT RESPIRATION IS NOT FULLY ESTABLISHED, it must not be divided; and as long as pulsation continues, and the child does not breathe perfectly and regularly, no ligature should be applied. The first thing to be done here, is to pass the finger, covered with the fold of a handkerchief or soft napkin, to the back of the child's mouth, to remove any mucus which might obstruct the passage of air into the lungs, and at the same time to tickle those parts, and thereby excite respiratory movements. The chest should then be rubbed by the hand, and a gentle shock given to the body by slapping the back. If these means fail, the chest and soles of the feet must next be rubbed with spirits, the nostrils and back of the throat irritated with a feather previously dipped in spirits of wine, and ammonia or hartshorn may be held to the nose.

INFLATION OF THE LUNGS.—These means not having been successful, and the pulsation in the cord having ceased, the infant must be separated, and inflation of the lungs resorted to. This is to be effected gently and cautiously as follows:—

The child, wrapped in flannel, is to be laid on its back upon a table placed near the fire. Its head is to be slightly extended, and the nostrils held between the fingers and thumb of one hand, whilst with the fingers of the other slight pressure is to be made upon the pit of the stomach, so as to prevent the air from passing into that organ. The lungs of the child are now to be filled with air, by the operator applying his own lips—with a fold of silk or muslin intervening, for the sake of cleanliness—to those of the child, and then simply blowing in its mouth, he is to propel the air from his own chest into that of the infant. Previously, however, to his doing this, he should make several deep and rapid inspirations, and, finally, a full inspiration, in order to obtain greater purity of air in his own lungs.

When the chest of the child has been thus distended, it is to be compressed gently with the hand, so as to empty the lungs; and then the inflation, with the alternately compressing the chest, must be repeated again and again, until either the commencement of natural respiration is announced by a sneeze or deep sigh, or until after long-continued, steady, persevering, but unavailing, efforts to effect this object shall have removed all ground of hope for a successful issue.

Whilst these efforts are being made, some other individual must endeavour to maintain or restore the warmth of the infant's body, by gently but constantly pressing and rubbing its limbs between his warm hands. And after respiration is established, the face must still be freely exposed to the air, whilst the warmth of the limbs and body is carefully sustained.

It will sometimes happen—and to this circumstance the operator should be fully alive—that when the child begins to manifest symptoms of returning animation, its tongue will be drawn backwards and upwards against the roof of the mouth, filling up the passage to the throat, and preventing further inflation of the lungs. This is to be remedied by the introduction of the fore-finger to the upper and back part of the child's tongue, and gently pressing it downwards and forwards, by which the difficulty will be removed, and the air again passes.

THE WARM BATH.—More reliance may be placed upon the above measure to restore animation, than upon the warm bath. Still this is sometimes useful, and therefore must not be neglected. Whilst inflation is going on, the bath may be got ready, then resorted to, and if unsuccessful, inflation may and ought again to be followed up.[FN#28] If the bath is useful at all, it will be so immediately upon putting the infant into it; respiration will be excited, followed by a cry; and if this does not occur at once, it would be wrong to keep the child longer in the bath, as it would be only losing valuable time which ought to be devoted to other efforts. The temperature of the bath should be about 100 degrees; and if, upon plunging the infant into it, it fortunately excite the respiratory effort, it should then be taken out, rubbed with dry but hot flannels, and, when breathing is fully established, laid in a warm bed, or, what is still better, in its mother's bosom; letting it, however, have plenty of air.

[FN#28] We should not relinquish our endeavours at resuscitation under two or three hours, or even longer; and if ultimately successful, the state of the infant should be carefully watched for two or three days.