The Mother's Manual of Children's Diseases

The once popular honey and borax is not the best application, and this for a reason which I will at once explain. The secretion of the mouth in infants is acid, disease increases this acidity; and it has been found that this acid state is not merely favourable to the increase of thrush, but also to the development between the specks of thrush of a sort of membrane formed by a peculiar microscopic growth, of whose existence, just as of that of the phylloxera which destroys the vine, or the muscardine which kills the silkworm, we were ignorant till brought to light by recent scientific research.

You will therefore at once see why saccharine substances, apt as they are to pass into a state of fermentation, are not suitable, and why it is better to employ a solution of—

Borax, twenty grains

Glycerine, one teaspoonful

Water, an ounce.

Now and then the use once or twice a day in addition of a very weak solution of caustic, as two grains of lunar caustic to an ounce of water, in bad cases is necessary; but of this it must be left to the doctor to decide.

Teething.—The transition is a very natural one by which we pass from the study of the dangers and difficulties which attend the feeding and rearing of young infants, to those which accompany teething.

The time of teething is looked forward to by most mothers with undisguised apprehension, nurses attribute to it the most varied forms of constitutional disturbance, and doctors constantly hold forth to anxious parents the expectation that their child will have better health when it has cut all its teeth. The time of teething, too, is in reality one of more than ordinary peril⁹, though why it should be so is not always rightly understood. It is a time of most active development, a time of transition from one mode of being to another, in respect of all those important functions by whose due performance the body is nourished and built up.

The error which has been committed with reference to this matter, consists not in overrating the hazard of the time, when changes so important are being accomplished, but in regarding only one of the manifestations—though that indeed is the most striking one of the many important ends which nature is then labouring to bring about. A child in perfect health usually cuts its teeth at a certain time and in a certain order, just as a girl at a certain age begins to show signs of approaching womanhood; and at length attains it with but slight inconvenience or discomfort. The two processes, however, have this in common, that during both, constitutional disturbance is more common, and serious diseases are more frequent than at other times, and the cause in both lies far deeper than the outward manifestation.

The great changes which nature is constantly bringing about around us and within us are the result of laws operating silently but unceasingly; and hence it is that in her works we see little of the failure which often disappoints human endeavours, or of the dangers which often attend on their accomplishment. Thus when her object is to render the child no longer dependent on the mother for its food, she begins to prepare for this long beforehand. The first indication of it is furnished by the greatly increased activity of the salivary glands, which during the first few months of existence have scarcely begun to perform their function, a fact which accounts for the tendency to dryness of the tongue of the young infant under the influence of very trivial ailments. About the fourth or fifth month, this condition undergoes a marked alteration; the mouth is now found continually full of saliva, and the child is constantly drivelling; but no other indication appears of the approach of the teeth to the surface, except that the ridge of the gums sometimes becomes broader than it was before. No further change may take place for many weeks; and it is generally near the end of the seventh month before the first teeth make their appearance. The middle cutting teeth of the lower jaw are in most instances the first to pierce the gum; next the middle cutting teeth of the upper jaw; then usually the side cutting teeth of the lower jaw, and lastly, the corresponding ones of the upper. This, however, is not quite invariable, for sometimes all the cutting teeth in one jaw precede in their appearance any of those in the other. The first four grinding teeth next succeed, and often without any very definite order as to whether those of the upper or of the lower jaw are first visible, though in the majority of instances the lower are the first to appear. The four eye teeth follow, and lastly, the remaining four grinding teeth, which complete the set of first, or as they are often called, milk teeth.

We must not, however, picture to ourselves this process as going on uninterruptedly until completed—a mistake into which parents often fall, whose anxiety respecting their children is excited by observing that after several teeth have appeared in rapid succession, the process appears to come to a standstill. Nature has so ordered it that teething which begins at the seventh or eighth month, shall not be completed until the twenty-fourth or thirtieth; and has doubtless done so in some measure with the view of diminishing the risk of constitutional disturbance that might be incurred if the evolution of the teeth went on without a pause. As a rule the two lower central incisors or cutting teeth make their appearance in the course of a week; six weeks or two months often intervene before the central upper incisors pierce the gum, but they are in general quickly followed by the lateral incisors. A pause of three or four months most frequently occurs before we see the first grinding teeth, another of equal length previous to the appearance of the eye teeth, and then another still longer before the last grinding teeth are cut.

Though a perfectly natural process, teething is almost always attended with some degree of suffering. This, however, is not always the case, for sometimes we discover that an infant has cut a tooth, who yet had shown no signs of discomfort, nor any indication that teething was commencing, with the exception of an increased flow of saliva. More frequently indeed, the mouth becomes hot, and the gums look tumid, tense, and shining, while the exact position of each tooth is marked, for some time before its appearance, by the prominence of the gum; or the eruption of the teeth is preceded by much redness, and great heat of the mouth with profuse flow of saliva, and even with little painful ulcers of the edge of the tongue, or of the inner surface of either lip. With either of these conditions the child is feverish, fretful, and cries from time to time with pain, while at the same time the bowels often are relaxed, or the child coughs and wheezes as if it had caught cold.

Symptoms such as these make up what nurses mean when they say that the child is suffering from its teeth, and this opinion is constantly followed by a request to the doctor to lance the baby's gums. Now this little operation when really called for often gives great relief, both to the local discomfort, and also to the general ailment from which the infant suffers, but it is often done when there is no occasion for it, and when consequently it causes needless pain, and does no good.

There are four different conditions in which it may be right to have the child's gums lanced:

First. When a tooth is very near the surface, and by cutting through the thin gum the child may be spared some needless suffering.

Second. When the gums are very red and hot and swollen; only in this case the gum is scratched or cut, to bleed it, not with the idea of letting out the imprisoned tooth.

Third. When the child has for some week or two been feverish and suffering; while, though the gum is tense and swollen, the tooth does not seem to advance.

Fourth. As an experiment, when during the progress of teething a child is suddenly seized with convulsions for which there is no obvious cause. The irritation of the teeth may have to do with their occurrence; and the chance of relieving it by so simple a means is not to be thrown away.

If the process of teething is going on quite naturally, no interference, medical or other, is either necessary or proper. The special liability of children to illness at this time must indeed be borne in mind, and care must be taken not to make any alteration in the infant's food while it is actually cutting its teeth, but rather to choose the opportunity of some one of those pauses to which reference has been made, as occurring between the dates of appearance of the successive teeth, for making any such change. If the child is feverish, a little soda or seltzer water sweetened and given after the effervescence has subsided will be taken eagerly, and avoid the risk of putting the child too often to the breast, or giving it food too frequently. It seeks the one or the other because it is thirsty, and craves for moisture to relieve its hot mouth; not because it is hungry and needs nourishment. If the child has been weaned, still greater care will be required, for it will often be found that it is no longer able to digest its ordinary food, which either is at once rejected by the stomach, or else passes through the intestines undigested. Very thin arrowroot made with water, with the addition of one third of milk, will suit in many cases, or equal parts of milk and water with isinglass, or equal parts of milk and the white decoction. The bowels of course must be kept open with very simple and mild aperients, but the bowels are in general more inclined to diarrhœa than to constipation, and the diarrhœa of teething children is often troublesome and requires good medical advice.

The ulcerated state of the mouth is usually connected with special disorder of the digestive organs, and that condition of acidity for which I have already recommended soda, magnesia, and similar remedies, while locally the mouth needs just that local care which is applicable in cases of thrush. Now and then, severe inflammation of the gums occurs, in which they become extremely swollen; and ulceration takes place of the gum just above where the tooth should come through, and even around some of those which have already appeared. These are cases in which lancing the gums would do nothing but mischief. They require the local care already insisted on, a mild plan of diet, and treatment to reduce any feverishness; and above all one medicine, the chlorate of potass, which in doses of four grains every four hours for a child a year old, is almost a specific.

Affections of the Skin.—There are a few affections of the skin to which children in early infancy are especially liable, concerning which a few words must be said.

The Latin word intertrigo is used for that chafing of the skin of the lower part of the body of an infant which is by no means unusual, and is often very distressing. It is almost invariably due to want of care. Either wetted napkins are dried, and put on again without previous rinsing in water, or they have been washed in water containing soda, and not passed through pure water afterwards, or attention is not paid to change the infant's napkin immediately that it requires; or a fresh napkin is put on without previous careful ablution of the child; or lastly it occurs almost unavoidably in cases of diarrhœa from the extension of irritation beginning at the edge of the bowel.

Care is usually all that is needed to remove, as it is to prevent this condition. The precautions which I have referred to with regard to cleanliness must be carefully observed, and moreover, each time even after passing water, the child should be carefully washed with thin gruel, or barley water, then dusted abundantly with starch powder, while the napkin must be thickly greased with zinc ointment. After the first six or seven months of life the napkin can be almost always dispensed with, if the child has been brought up in good habits, and in all cases of chafing, it is much the better way to put no napkin on the child when in bed, but to lay under it a folded towel, which can be removed, and a clean one substituted for it as soon as it becomes soiled.

There is a very obstinate form of chafing, with great redness of the skin, and disposition to crack about the edge of the bowel which depends on constitutional causes, and calls at once for the interference of the doctor.

Besides this purely local ailment, there is another skin affection which is seen over the body generally, and is known popularly by the name of red gum, or in Latin strophulus. I mention the Latin name because I have known persons sometimes, misled by the similarity of sound, fancy that it had some connection with scrofula. It is met with less commonly now than formerly, when people were accustomed to keep infants unduly wrapped up, and to be less careful than most are now-a-days about washing and bathing. It depends on over-irritation of the sweat glands of the delicate skin of the infant, the result of which shows itself in the eruption on the body and face of a number of small dry pimples sometimes surrounded by a little redness, itching considerably, and when their top has been rubbed off by scratching having a little speck of dried blood at their summit.

A rash like this, a sort of nettle rash, more blotchy and causing little lumps on the skin, which in a day or two come and go, sometimes appears in the intervals between the pimples, sometimes takes their place, and causes, as they do, much irritation. This nettle rash is usually dependent on some error of diet, on some acidity of the stomach, and, on their being corrected soon passes away, leaving the pimples as they were before, but sometimes being reproduced if the pimples cause excessive irritation of the tender skin.

The matter of chief importance for a mother to know, is that these rashes have no serious signification. Their treatment is very simple. It consists in dressing the child very lightly, in bathing it very frequently with tepid water, avoiding as far as may be the use of soap, and in sponging it often to relieve the irritation with some simple alkaline lotion; such for instance as one recommended by the late Dr. Tilbury Fox, and which is composed of twenty grains of carbonate of soda, two teaspoonfuls of glycerine, and six ounces of rose water. Of course if the stomach is out of order that must be attended to, but a little fluid magnesia, once or twice a day, is all that is usually needed in the way of medicine.

One other affection of the skin, very common, very distressing, very tedious, of which there are many varieties, generally known by the technical name of eczema, from a compound Greek word which signifies to flow, needs that I should say something about it. It is not limited in its occurrence to infancy, nor does it of necessity cease when childhood is over, but continues to recur even in grown persons, and shows itself still from time to time even in the aged.

For the most part, however, it makes its appearance between the fifth and twelfth month; sometimes seeming to be induced by the change of food when the child is weaned, and that even though the weaning may have been wisely managed; at other times showing itself when the irritation of teething begins, and in every instance being aggravated by the approach of each tooth to the surface, and abating in the intervals.

It does not occur in all children with equal frequency or severity, and though there is no doubt but that it is often hereditary, and this especially in families some members of which have suffered from gout, yet it is by no means unusual for two or three of the children of the same parents to be affected by it severely, while no trace of it appears in the others.

It shows itself in general first on the cheeks and sides of the face, where the skin becomes red and rough, and slightly puffy. On looking very closely—more closely indeed than most persons are wont to do—this appearance will be seen to be produced by innumerable small pimples, smaller than pins' heads, and which itch violently. Now and then, even in the course of a few hours, these pimples disappear, leaving the skin rough, and peeling off in branny scales, while the surface beneath is red and irritable, a condition which also in a few days may subside. This, however, is less frequent than the opposite course of the affection, in which a drop of fluid forms at the top of each tiny pimple, and escaping forms a yellowish, thin, transparent, watery, irritating discharge, which reddens still more the raw and weeping surface of the skin. The fluid when abundant dries at length into yellowish flakes or crusts, which sometimes assume a brownish colour if the surface is made to bleed by irritating or scratching. If the crusts are not removed, the fluid which still continues to be poured out beneath them soon changes into matter or pus as it is called, and this, shut up beneath the hard crust above, increases the irritation, and thickens the deposit. After a time the inflammation lessens of its own accord, the secretion diminishes, the crusts dry up, and at length fall off, leaving the skin red, slightly swollen, and its surface scaling off in flakes, which gradually cease to form, and the skin by degrees becomes quite sound again, and so remains, until perhaps the irritation caused by the approach of a new tooth to the surface, rekindles the old trouble, to go once again through the same stages as before.

It is on the cheeks, the sides of the face, and the top of the head that these changes may be best studied, but there are other situations in which the same kind of process often goes on. It may be seen in the creases of the neck, or the folds of the thigh in fat children, only as two surfaces of skin are there in contact the fluid never dries to a crust, but the skin, red and sore and swollen, pours out an abundant secretion which, just as when it occurs behind the ears, gives out a strong and offensive smell. It occurs, too, at the bends of the joints, as under the knee, and at the inside of the elbow joint, as well as on the front of the chest, the back, and sometimes even over the whole body, and especially at any part where the pressure of the dress irritates the skin. When thus general, it seldom fails to pass into a chronic state such as to call for constant, skilled medical treatment.

The attack often comes on with general feverishness, a hot skin, fretfulness, and restlessness, which subside when the skin begins to discharge, though the discomfort produced by the local irritation still continues. At other times, and this perhaps more often when the eruption first appears on the head, its onset is more gradual, and slight scurfiness and redness at the top of the head are first noticed, and then a little crust forms there which is firmly adherent, and is, therefore, often not entirely removed as it should be, and thus bit by bit the mischief extends until its cure becomes tedious and troublesome. When either from neglect, or from the ailment having set in acutely, the affection of the scalp is severe, the child's state is one of much suffering. The whole of the scalp becomes hot and swollen, and covered over a large surface by a thick dirty crust, through cracks in which a thick ill-smelling greenish-yellow matter exudes on pressure. At different points around, pimples form with mattery heads,—pustules they are called—while the glands on each side of the neck become swollen and tender. When thus severe on the head it will be found also not merely on the face, but also on the body, and the poor suffering child is not only a miserable object to look upon, but, worn by constant restlessness, it loses flesh, and seems almost as though it could not long survive. Happily, however, the condition scarcely ever terminates fatally, though feeble health and stunted growth are not seldom the results of the early suffering. But besides, severe eczema in infancy always returns again and again in childhood and in after-life, and there is also a distinct connection between liability to eczema and to asthma; and this not simply nor mainly that the disappearance of an attack of eczema may be succeeded by an attack of asthma, but that the child who in infancy has had severe general eczema is more prone than another to develop a disposition to asthma as he attains the age of five or six, and this even though he should not have had any return of the skin affection in a severe form.

It is evident then, that one cannot take too much pains to guard against the occurrence of eczema if possible, and at any rate to prevent its becoming severe. The disposition to it is often controlled by very simple precautions, such as bathing the face, the moment the skin shows any redness or roughness, with thin gruel or barley water, then powdering it with starch powder, and when the infant goes out, smearing the spot very lightly with benzoated zinc ointment, and making the child wear a veil. It will be observed that the exclusion of the air is in all these cases the object of the application far more than any specific virtue which it is supposed to possess, and many of the worst cases of eczema in grown persons are treated, in the great hospital for skin diseases in Paris, by an india-rubber mask, or by india-rubber covering of the affected part, and benefit thereby without any medicated application whatever. The thin layer of scurf which often forms on an infant's head should not be allowed to remain there, since its presence is a source of irritation. If it is very adherent, the surface may be well greased overnight with a little clarified lard which will soften it, so that it can be readily washed off with weak soap and water in the morning. If, however, the skin is very irritable soap must not be used, but the head must be washed with yelk of egg and warm water, and instead of a sponge, which would be too harsh, it is better to employ a very large camel's hair brush or a soft shaving brush, which is more handy, and the surface after careful drying may be lightly smeared with zinc ointment. All ointments used must be washed off most scrupulously every day, otherwise they become rancid, irritate, and make matters worse.

When eczema sets in acutely, with general feverish disturbance, cooling medicines are required, and the help of the doctor becomes necessary. These are the cases in which the eruption is not confined to the head or the face, but extends over the body generally. The child must be dressed as loosely as possible; and when in its cot, should lie there with no other covering than its little shirt; and nothing gives so much relief to the irritation as the abundant use of powder, either simple starch powder, or ten parts of starch powder to one of oxide of zinc, or carbonate of bismuth. All powders must be absolutely free from grit, or, in other words, quite impalpable; otherwise they irritate the surface. On the face and other parts where it can be employed, the puff may be used to apply the powder; but between the creases of the skin—which it is important to keep apart—fine linen, lint, or charpie must be employed, covered freely with powder, so as to prevent the surfaces from coming into contact. If the irritation is very distressing, a weak spirit lotion with a little carbolic acid may sometimes be sponged over the surface, and the powder renewed immediately; or other forms of soothing lotions may be used to abate the irritation.

When the scalp is affected in the acute form of eczema crusts form very quickly; or in other cases they collect because people fear to disturb them when they see the raw surface beneath. It is, however, a grievous mistake to allow them to collect; they are in themselves a source of irritation, and they entirely prevent any application reaching the skin beneath. They must always be removed, and never be allowed to form again. They can be removed either by the employment of a poultice, half of bread, half of linseed meal, or by the application over-night of a handkerchief soaked in sweet oil, and covered over with a piece of oiled silk, which softens the crusts effectually, and allows of their easy removal by abundant washing with weak soap and water.

The best applications afterwards vary so much that it is impossible to lay down any positive rule. Sometimes the Carron oil, as it is termed: a liniment compound of equal parts of linseed oil and lime-water—a popular and most useful application in burns—gives most ease to the irritated skin; sometimes the mere exclusion of the air by means of the india-rubber cap; sometimes the abundant use of powder. In every case, at least once in every twenty-four hours the whole surface must be washed quite clean with barley water or thin gruel; and when the discharge lessens or ceases, as it will do in the course of time, then, but not till then, various ointments may be of service.

When the chronic stage arrives, in which the skin becomes dry and scaly, then is the time for tonics, for iron, sometimes for cod-liver oil, and for arsenic; of which latter remedy, however, the results are uncertain; while in the acute stage, its influence is simply mischievous. Nothing is more difficult, nor calls for more skill, or larger medical experience, than the proper management of the various forms of chronic eczema.

The question is sometimes asked whether it is safe to cure, or, as people call it, to dry up these eruptions in teething children. There can be no doubt but that it is very desirable to prevent their occurrence as far as may be by the use of the precautionary measures which I have explained. But when they have existed for some time, either attended with profuse discharge, or causing great irritation by their extent, there is no doubt but that care must be exercised in attempts at their cure, that soothing measures such as I have advocated should be chiefly employed, and that the sudden drying up of the discharge by a too abundant use of dusting powders must be avoided. If, too, the diminution of the rash were followed by a worsening of the child's condition, by feverishness, by heaviness of the head, or any sign of disturbance of the brain, the attempt to cure the rash must at once be abandoned. At the same time I must add that such occurrences are very rare, and that for one case where I have had to regret my success in curing the rash, I have seen fifty in which I have been mortified by the failure of my endeavour.