The Maternal Management Of Children, In Health And Disease Part 7

During teething there is generally much torpor of the bowels; here, then, castor oil is a very appropriate and useful artificial means of increasing the frequency of the alvine discharges.

Then, again, no purgative can be so much relied on for overcoming habitual costiveness as castor oil; it may for this purpose be given daily for some weeks, gradually reducing the dose until only a few drops be taken; after which the bowels generally continue to act without further artificial a.s.sistance. Even its occasional administration leaves the bowels in a relaxed state; a great advantage over other purgatives, which generally cause, after their action is pa.s.sed off, a confined state.

The proper dose will depend upon the age, and the known effect of aperient medicine upon the childsome requiring more, others less:

Under one year, one small tea-spoonful.

Under three years, two ditto.

Under six years, three ditto.

Under ten years and upwards, a table spoonful. The quant.i.ty being more or less according to the facility with which the bowels are purged.

It may be given in various ways; poured upon a little mint water, or blended with a little moist sugar;--or, if the stomach is unusually delicate, the oil may be made into an emulsion with some aromatic water, by the intervention of the yolk of an egg and a little syrup of roses or sugar combined with it. The following proportions make an elegant and not at all a disagreeable mixture, of which a desert- spoonful (or more, according to the age,) may be repeated every hour until it operate:

Castor oil, six drachms; The yolk of an egg; Mix well together, and add Dill water, two ounces, Syrup of roses, two drachms.

MANNA.

This also may be given with impunity to the youngest infant; it is sweet to the taste, and mild in its operation. It should be exhibited in doses of one to two drachms in a little warm milk; or if it cause flatulence in this form, in some aromatic water, a desert spoonful of carraway-seed or dill water. For children above two years, it must always be given with some other aperient: thus, it may be combined with castor oil by the medium of mucilage or the yolk of an egg; in fact, it might be subst.i.tuted for the syrup of roses in the previous prescription for castor oil.

MAGNESIA AND RHUBARB.

Magnesia, besides being a laxative, allays irritability of the stomach; it is consequently useful during dent.i.tion, at which period there is both much irritability and a prevailing acescency of the stomach. The dose is from five grains to ten for an infant, increasing the quant.i.ty to fifteen grains or twenty to children of nine or ten years of age. When taken alone the best vehicle is hot milk, which greatly quickens its aperient operation. And whenever the bowels are distended with wind, the pure magnesia is preferable to the carbonate.

It is well to mention here, that when the infant throws up the nurse's milk it is generally curdled; a fact which leads the inexperienced mother to infer that the child is suffering from acidity; and to counteract the supposed evil magnesia is given again and again. This is a useless and pernicious practice, for curdling or coagulation of the milk always takes place in the stomach, and is produced by the gastric juice, and is so far from being a morbid process, that milk cannot be properly digested without it.

Rhubarb, it should always be recollected, has an astringent as well as purgative property, according to the extent of the dose in which it is administered; the former of which never opposes or interferes with the energy of the latter, since it only takes effect when the substance is administered in small doses, or, if given in larger ones, not until it has ceased to operate as a cathartic. This latter circ.u.mstance renders it particularly eligible in cases of diarrhoea, as it evacuates the offending matter before it operates as an astringent upon the bowels.

As a purgative it operates mildly, and may be given to the youngest infant; if from two to twelve months old, from three to six grains; for children above that age, the dose may range from ten grains to twenty.

Its operation, however, is much quickened by the addition of magnesia; both of which are more effective when thus united than when given separately. The following form, in a costive and flatulent state of the bowels, will be found useful[FN#19]; a tea-spoonful or more may be given every three or four hours until the desired effect is obtained:--

Powdered rhubarb, half a drachm;

Magnesia, two scruples;

Compound spirits of ammonia, twenty drops;

Dill water, two ounces;

Simple syrup, two drachms.

[FN#19] This may be made up and kept in the nursery for a long time without spoiling.

Rhubarb, mixed with flour and warm water, may be made into a poultice, and applied to the abdomen of a child that obstinately refuses to swallow medicine, and it will be found to produce the same effect as if the medicine had been taken into the stomach; it will purge briskly.

THE LAVEMENT.

This is an excellent nursery remedy when the bowels are obstinately costive. It may then be employed as a subst.i.tute for medicine, a protracted and frequent use of which (even of the mildest aperients) is apt to injure the digestive functions, and to give rise to some degree of intestinal irritation. Lavements, however, like aperient medicine, must not be resorted to for a long time together; for whilst the latter irritate, the former most certainly tend, after a long continued use, to debilitate the bowels, and thus render them less than ever disposed to act for themselves. They are an excellent occasional remedy.

The simplest form of an aperient enema, is warm water; but barley- water, or thin gruel, or even milk and water, are to be preferred at all times, as they are of a more bland and less irritating nature. If it be desirable to increase the strength of the injection, castor oil may be added. The proportions of fluid which are necessary for the different stages of life, under ordinary circ.u.mstances, maybe stated as follows:--An infant at its birth requires about one fluid ounce; a child between the age of one and five years, from three to four fluid ounces; and a youth of ten or fifteen, from six to eight fluid ounces.

The mode of administering an injection to an infant deserves particular attention, as injury might be caused by its being performed in a careless or unskilful manner. A gum elastic pipe should be always used instead of the hard ivory tube. Having smeared this over with lard, and placed the infant on its left side, with its knees bent up in the lap of the nurse, it is to be pa.s.sed a couple of inches into the bowel, in a direction not parallel to the axis of the body, but rather inclined to the left. The latter circ.u.mstance should never be neglected, for if not attended to, there will be difficulty in administering the injection. The fluid must then be propelled very gradually, or it will be instantly rejected; on the whole being thrown up (the pipe carefully and slowly withdrawn), the child must be kept quietly reposing on its nurse's lap, and in the same posture for some little time.

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 s.p.a.ce 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.