The Mother's Manual of Children's Diseases

by Charles West

To a very great extent, a mixture of vanity and of a morbid craving for sympathy lie at the root of many of those perversions of character which excite a parent's anxiety. One of these consists in an over-scrupulousness with reference to the right or wrong of actions in themselves quite indifferent; in doubts as to whether the morning or evening prayer has been properly said, whether something was or was not absolutely true, whether this or that peccadillo was a grievous offence against God, and so on; and all these little cases of conscience are brought by the child several times a day to his mother or to his nurse for solution. If listened to readily the child's truthfulness becomes inevitably destroyed, and he grows up with a morbid frame of mind, which after-life will aggravate almost infinitely.

One knows indeed the history of child saints; but it must be remembered that one great characteristic of pre-eminent sanctity at all ages of life is reticence, while these little people are perpetually seeking to interest others in themselves, their doubts, and feelings. If wisely dealt with, not by direct ridicule, but by a wholesome neglect of the child's revelations, treating them as of no special interest or importance, and discouraging that minute introspection which, of doubtful good at any age, is absolutely destructive of the simplicity of childhood, this unnatural condition will soon pass away. It will help this object very much, if the child is sent on a visit to judicious friends, and change of scene, of pursuits, of playmates, and amusements will be of all the more service since these morbid states of mind seldom come on in children whose bodily health is robust.

Another mode in which the same perverted feelings display themselves is in the disposition occasionally noticed to exaggerate some real ailment, or to complain of some ailment which is altogether imaginary. So far is this from being rare that my experience coincides entirely with that of the French physician M. Roger, who has had larger opportunities than anyone else in France for observing the diseases of children, and who says, 'It must be borne in mind that simulated ailments are much more common in the children's hospital than in a hospital for adults.'

It is difficult to assign any sufficient reason for this conduct. Mere indolence seems sometimes to be the chief reason for it, oftener vanity; the sense of importance in finding everything in the household arranged with exclusive reference to itself appears to be the motive for it; and this may sometimes be observed to be very powerful even at an exceedingly early age. In many instances a morbid craving for sympathy is mingled with the love of importance, and both these sentiments are not infrequently exaggerated by the conduct of a foolishly fond mother. Real illness, however, in almost all these cases exists at the commencement, though the child persists in complaining of its old symptoms long after their cause has disappeared.

The great difficulty which the doctor meets with in the management of these cases arises from the incredulity with which his opinion is received. Candour is looked upon as so eminently characteristic of childhood, that deceit seems impossible; the case is thought by the parents to be an obscure one which the doctor does not understand; and therefore it is said, he, with want of straightforwardness and of kindness, throws doubts on the existence of disease, and on the truthfulness of a most loving, most suffering child. The vagaries of a hysterical girl, the fits, the palsy, the half-unconsciousness have all been assumed within my own observation by children from ten to fifteen years old, and I have more than once had to give place to the ignorant and impudent pretender who traded successfully on the feelings of the parents. Sometimes, one knows not why, except that the child has got tired of the part he was playing, the symptoms that had caused so much anxiety suddenly disappear, but even then the habit of mind left behind is anything but healthy. Indeed in all cases of this kind it is much less the state of the body than that of the mind which excites my apprehension. The constant watching its own sensations, the habit of constantly gratifying every wayward wish and temper under the plea of illness, and the constant indulgence which it too often meets with in this from the over-kindness of its parents, exert a most injurious influence on its character, and it grows up a juvenile hypochondriac.

A doctor is very unlikely to throw doubt recklessly on the reality of a child's illness. His hesitation should certainly not be attributed to unworthy motives; the parents should co-operate with him heartily in any course of observation which he desires to follow, and if necessary another medical man of experience should be associated with the first, and allowed to visit the child two or three times. One does not associate the idea of moral delinquency with hysteria; the child who shams belongs to the same class with the hysterical patient. It is only the strangeness of the occurrence in the eyes of non-medical people, that makes them fancy it something worse.

If now the suspicion is justified that the child is either greatly exaggerating or altogether feigning illness, it does not by any means always follow that he should at once be charged with it, since it is often of much importance that his self-respect should not be destroyed. It must be remembered that there is in all these cases a measure of real ailment underlying all the half-unconscious exaggeration, and that if spoiling and over-indulgence do much to foster it, sternness and punishment interfere with recovery. To turn the thoughts away from self, to occupy the mind with new scenes, new amusements, new pursuits, to call forth by degrees self-control, and to let the child perceive rather by your manner than by what is actually said that the parents have not been duped by all his past vagaries; such are the simple means by which the little one will be brought round again to health of mind and health of body. Unhappily, in the minds of too many people the idea of the doctor is associated with the administration of drugs and with nothing else; the treatment of disease is of much wider scope; and many of our best remedies are those which do not admit of being weighed or measured, and whose names are not inscribed on the drawers or bottles in Apothecaries' Hall.

Another phase of mental disorder in childhood sometimes presents itself as the result of overtasking the intellectual powers. This over-work too is by no means due in all cases to the parents' unwisely urging the child forward, but it is often quite voluntary on his part. The precaution too of limiting the hours of work is often inadequate from the want of some provision for turning the thoughts and energies during play hours into some perfectly different channel.

In many of these cases Nature happily takes matters into her own management. For a year or two, or more, the mind has grown apparently at the expense of the body; the parents take a fearful joy in their darling's acquirements; and if it should live, think they, of what remarkable talents will it not be the possessor! By degrees, the extreme quickness of intellect becomes less remarkable; but the body begins to increase in robustness; and a year will sometimes suffice to transmute the little fairy, so quick, so clever, but so fragile, into a very commonplace, merry, rosy, romping child. I may add that it is well to bear in mind the converse of this; to remember that body and mind rarely grow in equal proportion at one time; that the incorrigible little dunce, though not likely to prove a genius as he grows older, will yet very probably be found at twelve or fourteen to know as much as his playmates. A dull mind, and a sickly or ill-developed frame may make us anxious: but if the physical development is good, the mind will not be likely to remain long below the average standard.

But sometimes, the over-tasked mind leads to mischief which Nature cannot rectify; an attack of water on the brain destroys the child, or if not it sinks under almost any accidental disease. In other instances neither of these results takes place, but the whole nervous system seems profoundly shaken, and the moral character of the child seriously, and even permanently injured. I remember a quick and clever little girl aged five and a half years who was urged on by her governess to work which she delighted in, till at length the signs of over-taxed brain showed themselves in frequent extreme irritability, and occasional attacks of causeless fury amounting almost to madness. It was fully a year during which almost all mental work was suspended, while the child was sent to have complete change under most judicious management in the country, before her mind quite recovered its balance and she became able to resume her studies in a very moderate degree.