The Mother's Manual of Children's Diseases

by Charles West

Children, like grown persons suffering from indigestion, often continue, as I have already said, to keep up their flesh much better than could be expected, and in many cases grow up to be strong and healthy. Still the condition is one that not merely entails much suffering on the infant, but by its continuance seriously impairs the health, and tends to develop the seeds of any constitutional predisposition to consumptive disease.

In these cases there are many respects in which the mother can most efficiently second the doctor. All causes unfavourable to health must be examined into, and as far as possible removed. It must be seen that the nursery is well ventilated, and that its temperature is not too high; while it will often be found that no remedy is half so efficacious as change of air. Next, it must not be forgotten that the regurgitation of the food is due in great measure to the weakness and consequent irritability of the stomach, and care must therefore be taken not to overload it. If these two points are attended to, benefit may then be looked for from the employment of tonics, and as the general health improves the constipated condition of the bowels, so usual in these cases, will by degrees disappear; while if aperients are needed those simple remedies only should be employed of which I spoke in the first part of this book, and the use of mercurials is not to be resorted to without distinct medical order.

The above mode of treatment is appropriate to cases of what may be termed the indigestion of debility, but a different plan must be adopted in those instances in which it depends on some other cause. The rule, indeed, which limits the quantity of food to be given at one time is no less applicable here, for the rejection of some of the milk may be the result of nothing more than of an effort which nature makes to reduce the work that the stomach has to do within the powers of that organ. But when, notwithstanding that due attention is paid to this important point, uneasiness is always produced by taking food, and is not relieved till after the lapse of some twenty minutes, when vomiting takes place, or when the infant suffers much from flatulence and from frequent acid or nauseous eructations, it is clear that the symptoms are due to something more than the mere feebleness of the system.

It is not, however, the mere fact that the child vomits its food, or of the milk so vomited being rejected in a coagulated state, which proves that the stomach is disordered, but it is the fact of firmly coagulated milk being rejected with much pain, and after the lapse of a considerable interval from the time of its being taken, which warrants this conclusion. The coagulation of the curd is the first change which the milk of any animal undergoes when introduced into the stomach. The coagulum of human milk is soft and flocculent, and not so thoroughly separated from the other elements of the fluid, as the firm hard coagulum or curd of cow's milk becomes from the whey in which it floats. In a state of health the abundantly secreted gastric juice speedily redissolves the chief part of the curd in the stomach, while when it has passed into the intestine the alkaline bile which there becomes mixed with it, completes its solution, and converts the whole into a fluid which closely resembles one of the chief elements of the blood, is consequently very easily taken up by the minute vessels whose office it is to do so, and thus supplies with nourishment the whole body.

Milk tends, however, to undergo changes spontaneously, which produce its coagulation, and the occurrence of these changes is greatly favoured by a moderately high temperature, such as that which exists in the stomach. But the alterations of the fluid that accompany this spontaneous coagulation are very different from those which are brought about by the vital processes of digestion. An acid becomes formed within it, and the acid thus produced has none of the solvent power of gastric juice, but by its presence impedes rather than favours digestion. Every nurse is aware that a very slight acidity of the milk will suffice to give an infant vomiting, stomach ache, and diarrhœa, and the result must be much the same whether fermentation had begun in the milk before it was swallowed, or whether it commences afterwards, in consequence of the disordered condition of the stomach, and the absence of a healthy secretion of gastric juice.

The nature of the food is the first point that requires attention in the management of these cases of infantile dyspepsia. If the child had been fed on cow's milk the symptoms may be due to the gastric juice not having been able to dissolve the curd, which you will remember is much firmer than that of human milk as well as twice as abundant. In this case the substitution of asses' milk, the employing whey either entirely or in part instead of milk, and the adding white of egg in order to present the elements of the curd in a more easily digestible form, may all be tried with advantage. Sometimes children refuse whey; and then a mixture of cream and veal broth, more or less diluted either with water or with the white decoction, may be given instead. The addition of soda, potash, chalk or lime water to milk before it is given is also of service, since it not only prevents the occurrence of fermentation, but also renders the curd of cow's milk more easily soluble.

The indiscriminate and over-free employment of these alkalies, however, as nursery remedies is by all means to be avoided, for the symptoms of indigestion for which a grown person if suffering would seek the advice of a skilful doctor require his help no less when the patient is a child. When acids will be of service in promoting the secretion of the gastric juice, when pepsine will be likely to be of use, when stimulants such as a little brandy, when aromatics to get rid of flatulence, opiates to relieve pain or check diarrhœa, or when an occasional mercurial, or some other remedy may be of use by stimulating the liver to increased action, are questions which I would not advise any mother to try to answer for herself. Much care and pains and knowledge and experience are often required by the doctor to enable him to answer them correctly.

I must not leave the consideration of the ailments of the digestive organs in early infancy without some notice of that affection of the mouth popularly known as thrush to which an exaggerated importance was once attached as the supposed cause of those symptoms of disordered health, of which it is in reality only the accompaniment. Still it is a sign of such grave disorder that it needs a careful study.

Thrush.—If you examine the mouth of a young infant, in whom the attempt at hand-feeding is not turning out well, you will often observe its lining to be beset with numerous small white spots, that look like little bits of curd lying upon its surface, but which on a more attentive examination are found to be so firmly adherent to it as not to be removed without some difficulty, when they leave the surface beneath it a deep red colour, and now and then bleeding slightly. These specks appear upon the inner surface of the lips, especially near the angles of the mouth, on the inside of the cheeks, and upon the tongue, where they are more numerous at the tip and edges than towards the centre. They are likewise seen upon the gums, though less frequently and in smaller numbers. When they first appear they are usually of a circular form, scarcely larger than a small pin's head; but after having existed for a day or two, some of the spots become three or four times as large, while at the same time they in general lose something of their circular form. By degrees the small white crusts fall off of their own accord, leaving the surface where they were seated redder than before; a colour which gradually subsides, as with the infant's improved health the mouth returns to its natural condition. If the improvement is tardy the white specks may be reproduced and again detached several times before the mouth resumes its healthy aspect. In the worst cases the specks coalesce, and coat the mouth as though lined with a membrane which is usually of a yellowish-white tint instead of having the dead white colour of the separate spots. Even here, however, though the surface is very red, it scarcely bleeds if the deposit is removed from it gently and with care.

The popular notion that when the deposit of thrush appears not only in the mouth, but also at the edge of the bowel, it has passed through the child is altogether erroneous. The lining membrane of the bowel indeed is red, inflamed, and presents those conditions to which I have already referred when speaking of the atrophy of hand-fed children, but the actual deposit of thrush can take place only where there exists an appropriate structure for its formation, and that is to be found, not in the bowels, but only at the inlets and outlets of the digestive canal. The actual deposit at the outlet of the bowel is indeed exceptional, though the edges are often red and sore from the irritation produced by the acrid motions, and this irritation sometimes extends to the skin over the lower part of the baby's person, which becomes rough, and covered with a blush of redness.