THE APERIENT LINIMENT.
A liniment to be rubbed on the stomach is another resource in cases of habitual costiveness, and will frequently be attended with great success when repeated purgatives have been resisted.
Olive or castor oil may be used for this purpose; they must be warmed and rubbed over the abdomen night and morning, for five or ten minutes. Perhaps the best form of liniment that can be made use of is the following:—
Compound soap liniment, one ounce;
Compound tincture of aloes, half an ounce.
Sect. II.—CALOMEL.
Calomel is one of the most useful medicines we possess; but though powerful for good, it is by no means powerless for mischief, and pages might be written upon the evil effects which have resulted from its indiscriminate use in the nursery; medical men are daily and hourly witnessing this fact. It is particularly eligible in the diseases of children; but then it is quite impossible for unprofessional persons to judge when it may be appropriately exhibited. And it cannot be too generally known, that the effect of this medicine upon the evacuations is always to make them appear unnatural. From ignorance of this fact, calomel is often repeated again and again to relieve that very condition which it has itself produced, causing, but too frequently, a degree of irritation in the delicate lining membrane of the bowel, which it may be very difficult for a medical man to remove, and perhaps a source of misery to the child as long as it lives.
Its frequent exhibition has also another evil attending it, for "the immoderate use of mercury in early infancy produces more, perhaps, than any other similar cause, that universal tendency to decay, which, in many instances, destroys almost every tooth at an early age."[FN#20]
[FN#20] Bell on the Teeth.
In the diseases of childhood it is often administered by the mother or nurse with a degree of careless excess which ultimately, if not immediately, produces severe and irremediable injury. I have met with such cases; but Mr. Bell details a remarkable instance in point: "A child, about three years of age, was brought to me, having a most extensive ulceration in the gum of the lower jaw, by which the alveolar process (that portion of the jaw which forms the sockets of the teeth) was partially denuded. The account given by the mother was, that the child had some time previously been the subject of measles, for which a chemist, whom she consulted, gave her white powders, one of which was ordered to be taken every four hours. It appears by the result, that this must have been calomel; for, after taking it for two or three days, profuse salivation was produced, with swollen tongue, inflamed gums, etc., followed by ulceration of the gum, lips, and cheek. On examining the denuded alveolar process, I found that a considerable necrosis (death of the bone) had taken place, including the whole anterior arch of the jaw from the first double tooth on the left side to the eye-tooth on the right. By degrees the dead portion of bone was raised, and became loose, when I found that the mischief was not confined to the alveolar process, but comprised the whole substance of the bone within the space just mentioned," etc. Surely the knowledge of such a case as this would induce every prudent mother to exclude calomel from her list of domestic nursery medicines.
Sect. III.—OPIATES.
This class of medicine is often kept in the nursery, in the forms of laudanum, syrup of white poppies, Dalby's carminative, and Godfrey's cordial.
The object with which they are generally given is to allay pain by producing sleep; they are, therefore, remedies of great convenience to the nurse; and I am sorry to be obliged to add, that, so exhibited, they are but too often fatal to the little patient.
The fact is, that in the hands of the physician, there is no medicine the administration of which requires greater caution and judgment than opiates, both from the susceptibility of infants to their narcotic influence, and their varying capability of bearing it; the danger, therefore, with which their use is fraught in the hands of a nurse should for ever exclude them from the list of domestic nursery medicines.
Dalby's carminative and Godfrey's cordial are, perhaps, more frequently used than any other forms; and some striking cases, illustrative of the fatal results of exhibiting them indiscriminately, and without medical sanction, are on record.[FN#21] The late Dr. Clark, in his "Commentaries," mentions a case which he saw, where "forty drops of Dolly's carminative destroyed an infant." Dr. Merriman gives the following in a note in Underwood, "On the Diseases of Children:"—
[FN#21] Two or three fatal cases, and upon which coroners' inquests were held, have occurred within the last two years.
"A woman, living near Fitzroy Square, thinking her child not quite well, gave it a dose of Godfrey's cordial, which she purchased at a chemist's in the neighbourhood. In a very short time after taking it the child fell into convulsions, and soon died. In less than a month the child of another woman in the same house was found to be ill with disordered bowels. The first woman, not at all suspecting that the Godfrey's cordial had produced the convulsions in her infant, persuaded her friend to give the same medicine to her child. A dose from the same bottle was given, and this child was likewise attacked almost immediately with convulsions, and also died."
Convulsions and epilepsy, without such fatal results as the foregoing, are not uncommon as the effect of a single dose of an opiate given unadvisedly; and by their continued and habitual use (and the form of syrup of poppies is but too often administered by an indiscreet and lazy nurse, unknown by the parent), a low, irritative, febrile state is produced, gradually followed by loss of flesh, the countenance becoming pallid, sallow, and sunken, the eyes red and swollen, and the expression stupid and heavy, and the powers of the constitution at last becoming completely undermined. Such an object is to be seen daily among the poorer classes,—the miniature of a sickly aged person: death soon follows here.
Sect. IV.—LEECHING.
Difficulty sometimes arises in putting a stop to the bleeding from leech-bites; a matter of considerable importance in the case of a delicate infant. The following measures may be resorted to for this purpose:—
1. Expose the surface of the part to the external air, so that a coagulum of blood may form at the orifice: this simple mode will frequently arrest it.
2. If this fail, make compression upon the part: this is one of the most effectual means of restraining haemorrhage. It is to be effected by taking a piece of lint folded three or four thicknesses, and the size of the finger-nail, to be steadily pressed upon the open orifice with the point of the finger until the blood has ceased to flow. The pledget of lint, however, must not be removed for some hours afterwards, or the bleeding will break out afresh.
3. If the compression fails in stopping the bleeding, or from the situation of the leech-bites it cannot be adopted, because there is no firm point of resistance upon which to make pressure, the part may be dusted with starch or gum arabic powder, or, if this is of no avail, the wound may be touched with lunar caustic.
If none of these measures are successful, the assistance of the medical attendant must be obtained; and if firm pressure be made upon the part, no serious loss of blood can ensue before his arrival.
Leeches should never be resorted to by a parent for any of the diseases of infancy, without medical direction.
Sect. V.—BLISTERS AND POULTICES.
A blister should never be applied for any infantile disease, except when ordered by a medical man, as its injudicious use might greatly aggravate the complaint.
There are also one or two precautions in reference to the mode of the application of a blister, which it is always right for a parent to attend to. From the great irritability of the skin, it should never be allowed to remain on longer than from two to four hours. At the expiration of this time, the surface will usually become red and inflamed; and, if the blister is removed, and the part dressed with fresh spermaceti ointment spread on lint, or with a soft bread and water poultice, a full blister will soon be raised: the little patient is thus saved much suffering, and a very troublesome sore prevented. A piece of tissue or silver paper, interposed between the blister and the skin, will answer the same purpose; the blister will act well, and the evils before alluded to will be prevented.
After a blister has been two or three hours applied, its edge should be carefully raised, to ascertain the effect produced; and if the surface be much inflamed, more particularly if little points of vesication (watery bladders) are present, it should be removed, and the above directions attended to.
Mustard poultices are invaluable in some of the diseases of infancy and childhood, and therefore frequently ordered.
A mustard poultice is made by mixing two thirds of mustard flour and one third of wheaten flour with warm water or vinegar, in sufficient quantity to render the powder of the consistence of paste. It is then spread on linen from the size of a half-crown to that of the palm of the hand, according to the effect intended, and placed on the skin. How long it is to be kept on will depend upon the individual sensibility of the skin of the child; but, in general, from fifteen to twenty minutes will be found amply sufficient. The application, however, must at all times be carefully watched; for if it remain on too long, ulceration, and death of the part, might ensue; therefore, directly the skin is found tolerably red, the poultice should be removed. After its removal, the part may be exposed, or, if very painful, smeared over with fresh cream or common cerate.
A bread and water poultice, although one of the commonest applications in use, is rarely well made or properly applied. It thus becomes injurious rather than useful; adding to the inflammation or irritation of the part, instead of soothing and allaying it. Nothing, however, is more simple than the mode of its preparation.
Cut slices of stale bread of sufficient quantity, scald out a bason, put the bread into it, pour upon it boiling water, cover it over, and let it stand for ten minutes; next strain the water oft, gently squeeze the saturated bread in a thin cloth, so that the poultice shall not be too moist, and then spread it upon a cloth so that it shall be in thickness half an inch, and of a size large enough to cover the whole of the inflamed part, and a little more. Apply it just warm enough to be borne, and cover it well with oiled silk. A poultice thus made, will act as a local tepid bath to the inflamed part; and the oiled silk preventing evaporation, it will be found, when taken off, as moist as the first moment that it was put on.
Sect. VI.—BATHS.
Baths are much resorted to during infancy and childhood, both in health and in disease. In the former state, they constitute an important measure of hygeiene (this has been briefly alluded to under the section "Bathing"), and in the latter, a valuable remedial agent. Their indiscriminate use, however, might be followed by serious consequences; it is therefore important to point out a few rules for their judicious employment.