 section 100 of the book of household management this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Sarah Jennings the book of household management by Isabella Beaton the rearing and management of children and diseases of infancy and childhood chapter 42 part 2 the infant we have already described the phenomenon produced on the newborn child by the contact of air which after a succession of muscular twitching becomes endowed with voice and heralds its event by a loud but brief succession of cries but though this is the general rule it sometimes happens from causes it is unnecessary here to explain that the infant does not cry or give utterance to any audible sounds or if it does they are so faint as scarcely to be distinguished as human accents plainly indicating that life as yet to the new visitor is neither a boon nor a blessing the infant being in fact in a state of suspended or imperfect vitality a state of quasi-existence closely approximating the condition of a stillbirth as soon as this state of things is discovered the child should be turned on its right side and the whole length of the spine from the head downwards rubbed with all the fingers of the right hand sharply and quickly without intermission till the quick action has not only evoked heat but electricity in the part until the loud and sharp cries of the child have thoroughly expanded the lungs and satisfactorily established its life the operation will seldom require above a minute to effect and less frequently demands a repetition if there is brandy at hand the fingers before rubbing may be dipped into that or any other spirit there is another condition of what we may call mute births where the child only makes short ineffectual gasps and those at intervals of a minute or two apart when the lips eyelids and fingers become of a deep purple or slate color sometimes half the body remaining white while the other half which was at first Swarthi deepens to a livid hue this condition of the infant is owing to the valve between the two sides of the heart remaining open and allowing the unvitalized Venus blood to enter the arteries and get into the circulation the object in this case as in the previous one is to dilate the lungs as quickly as possible so that by the sudden effect of a vigorous inspiration the valve may be firmly closed and the impure blood losing this means of egress may be sent directly to the lungs the same treatment is therefore necessary as in the previous case with the addition if the friction along the spine has failed of a warm bath at a temperature of about 80 degrees in which the child is to be plunged up to the neck first cleansing the mouth and nostrils of the mucus that might interfere with the free passage of air well in the bath the friction along the spine is to be continued and if the lungs still remain unexpended while one person retains the child in an inclined position in the water another should insert the pipe of a small pair of bellows into one nostril and while the mouth is closed and the other nostril compressed on the pipe with the hand of the assistant the lungs are to be slowly inflated by steady puffs of air from the bellows the hand being removed from the mouth and nose after each inflation and placed on the pit of the stomach and by a steady pressure expelling it out again through by the mouth this process is to be continued steadily inflating and expelling the air from the lungs till with a sort of tremulous leap nature takes up the process and the infant begins to gasp and finally to cry at first low and faint but with every gulp of air increasing in length and strength of volume when it is to be removed from the water and instantly wrapped all but the face and mouth in a flannel sometimes however all these means will fail and affecting an utterance from the child which will lie with livid lips and a flaccid body every few minutes opening its mouth with a short gasping pant and then subsiding into a state of pulseless inaction lingering probably some hours till this basmotic panting's grow further apart it ceases to exist the time that this state of negative vitality will linger in the frame of an infant is remarkable and even when all the previous operations though long continued have proved ineffectual the child will often rally from the simplest of means the application of dry heat when removed from the bath place three or four hot bricks or tiles on the hearth and lay the child loosely folded in a flannel on its back along them taking care that there's but one fold of flannel between the spine and the heated bricks or tiles when neither of these articles can be procured place a few clear pieces of red cinder in a warming pan and extend the child in the same manner along the closed lid as the heat gradually diffuses itself over the spinal marrow the child that was dying or seemingly dead will frequently give a sudden and energetic cry succeed in another minute by a long and vigorous peel making up in volume and force for the previous delay and instantly confirming its existence by every effort in its nature with these two exceptions restored by the means we have pointed out to the functions of life we will proceed to the consideration of the child healthily born here the first thing that meets us on the threshold of inquiry and what is often between mother and nurse not only a vexed question but one of vexatious import is the crying of the child the mother in her natural anxiety maintaining that her infant must be ill to cause it to cry so much or so often and the nurse insisting that all children cry and that nothing is the matter with it and that crying does good and is indeed in a special benefit to infancy the anxious and unfamiliar mother though not convinced by these abstract sayings of the truth or wisdom of the explanation takes both for granted and giving the nurse credit for more knowledge and experience on this head than she can have contentedly resigns herself to the inflection as a thing necessary to be endured for the good of the baby but thinking it at the same time an extraordinary instance of the imperfectibility of nature as regards the human infant for her mind wanders to what she has observed in her childhood with puppies and kittens who except when rudely torn from their nurse seldom give utterance to any complaining we undoubtedly believe that crying to a certain extent is not only conducive to health but positively necessary to the full development and physical economy of the infant's being but though holding this opinion we are far from believing that a child does not very often cry from pain thirst want to food and attention to its personal comfort but there is as much difference in the tone and expression of a child's cry as in the notes of an adult's voice and the mother's ear will not be long in discriminating between the sharp peevish wine of irritation and fever and the louder intermitting cry that characterizes the want of sleep and warmth all these shades of expression in the child's inarticulate voice every nurse should understand and every mother will soon teach herself to interpret them with an accuracy equal to language there is no part of a woman's duty to her child at a young mother should so soon make it her business to study as the voice of her infant and the language conveyed in its cry the study is neither hard nor difficult a close attention to its tone and the expression of the baby's features are the two most important points demanding attention the key to both the mother will find in her own heart and the knowledge of her success and the comfort and smile of her infant we have two reasons both strong ones for urging on mothers the imperative necessity of early making themselves acquainted with the nature and wants of their child the first that when left to the entire responsibility of the baby after the departure of the nurse she may be able to undertake her new duties with more confidence than if left to her own resources and mother's instinct without a clue to guide her through the mysteries of those calls that vibrate through every nerve of her nature and secondly that she may be able to guard her child from the nefarious practices of unprincipled nurses who while calming the mother's mind with false statements as to the character of the baby's cries rather than lose their rest or devote that time which would remove the cause of the suffering administer behind the curtains those deadly narcotics which while stupefying nature into sleep ensure for herself a night of many unbroken hours such nurses as have not the hardy hood to dose their infant charges are often full of other schemes to still that constant and reproachful cry the most frequent means employed for this purpose is giving it something to suck something easily hid from the mother or when that is impossible under the plea of keeping it warm the nurse covers it in her lap with a shawl and under this blind surreptitiously inserts a finger between the parched lips which possibly moan for drink and under this inhuman cheat and delusion the infant is pacified till nature bulked of its desires drops into a troubled sleep these are two of our reasons for impressing upon mothers the early the immediate necessity of putting themselves sympathetically in communication with their child by at once learning its hidden language as a delightful task we must strenuously warrant all mothers on no account to allow the nurse to sleep with the baby never herself to lay down with it by her side for a night's rest never to let it sleep in the parent's bed and on no account to keep it longer than absolutely necessary confined in on atmosphere loaded with the breath of many adults the amount of oxygen required by an infant is so large and the quantity consumed by midlife and age and the proportion of carbonic acid thrown off from both so considerable that an infant breathing the same air cannot possibly carry on its healthy existence while deriving its vitality from so corrupted a medium this objection always in force is still more objectionable at night time when doors and windows are closed and amounts to a condition of poison when placed between two adults in sleep and shut in by bed curtains and when in addition to the impurities expired from the lungs we remember in cohescence and sleep how large a portion of mephitic gas is given off from the skin mothers in the fullness of their affection believe there is no harbor sleeping or awake where their infants can be so secure from all possible or probable danger as in their own arms yet we should astound our readers if we told them the statistical number of infants who in despite of their motherly solicitude and love are annually killed unwittingly by such parents themselves and this from the persistency in the practice we are so strenuously condemning the mother frequently on a waking discovers the baby's face closely impacted between her bosom and her arm and its body rigid and lifeless or else so enveloped in the head blanket and super incumbent bread clothes as to render breathing a matter of physical impossibility in such cases the jury in general returns a verdict of accidentally overlaid but one of careless suffocation would be more in accordance with truth and justice the only possible excuse that can be urged either by nurse or mother for this culpable practice is the plea of imparting warmth to the infant but this can always be affected by an extra blanket in the child's crib or if the weather is particularly cold by a bottle of hot water enveloped in flannel and placed at the child's feet while all the objections already urged as derivable from animal heat imparted by actual contact are entirely obviated there is another evil attending the sleeping together of the mother and infant which as far as regards the latter we consider quite as formidable though not so immediate as the others and is always followed by more or less of mischief to the mother the evil we now allude to is that most injurious practice of letting the child suck after the mother has fallen asleep a custom that naturally results from the former and which as we have already said is injurious to both mother and child it is injurious to the child by allowing it without control to imbibe to distension a fluid sluggishly secreted and deficient in those vital principles which the want of mental energy and of the sympathetic appeals of the child on the mother so powerfully produced on the secreted nutriment while the mother wakes in a state of clammy exhaustion with giddiness, dimness of sight, nausea, loss of appetite and a dull aching pain through the back and between the shoulders in fact she wakes languid and unrefreshed from her sleep with febrile symptoms and hectic flushes caused by her baby vampire who while dragging from her her health and strength has excited in itself a set of symptoms directly opposite but fraught with the same injurious consequences functional derangement the milk as nature has placed in the bosom of the mother the natural food of her offspring it must be self-evident to every reflecting woman that it becomes her duty to study as far as lies in her power to keep that reservoir of nourishment in as pure and invigorating a condition as possible for she must remember that the quantity is no proof of the quality of this element the mother well suckling as a general rule should avoid all sudden tary occupations take regular exercise keep her mind as lively and pleasingly occupied as possible especially by music and singing her diet should be light and nutritious with the proper sufficiency of animal food and of that kind which yields the largest amount of nourishment and unless the digestion is naturally strong vegetables and fruit should form a very small proportion of the general dietary and such preparations as broths groules arrowroot etc still less tapioca or ground rice pudding made with several eggs may be taken freely but all slops and thin potations such as that delusion called chicken broth should be avoided as yielding a very small amount of nutriment and a large proportion of flatulence all purely stimulants should be avoided as much as possible especially spirits unless taken for some special object and that medicinally but as part of the dietary they should be carefully shunned lactation is always an exhausting process and as the child increases in size and strength the drain upon the mother becomes great and depressing then something more even than an abundant diet is required to keep the mind and body up to a standard sufficiently healthy to admit of a constant and nutritious secretion being performed without detriment to the physical integrity of the mother or injury to the child who imbibes it and as stimulants are inadmissible if not positively injurious the substitute required is to be found in malt liquor to the lady accustomed to her madera and sherry this may appear a very vulgar quotation for a delicate young mother to take instead of the more subtle and condensed elegance of wine but as we are writing from experience and with the avowed object of imparting useful facts and beneficial remedies to our readers we allow no social distinctions to interfere with our legitimate object we have already said that the suckling mother should avoid stimulants especially spiritus ones and though something of this sort is absolutely necessary to support her strength during the exhausting process it should be rather of a tonic than of a stimulating character and as all wines contain a large percentage of brandy they are on that account less beneficial than the pure juice of the fermented grape might be but there is another consideration to be taken into account on this subject the mother has not only to think of herself but also of her infant now wines especially port wine very often indeed most frequently affect the baby's bowels and what might have been grateful to the mother becomes thus a source of pain and irritation to the child afterwards sherry is less open to this objection than other wines yet still it very frequently does influence the second participator or the child whose mother has taken it the nine or 12 months a woman usually suckles must be to some extent to most mothers a period of privation and penance and unless she is deaf to the cries of her baby and insensible to its kicks and plunges and will not see in such muscular evidences the griping pains that rack her child she will avoid every article that can remotely affect the little being who draws its sustenance from her she will see that the babe is acutely affected by all that in any way influences her and willingly curtail her own enjoyments rather than see her infant rendered feverish irritable and uncomfortable as the best tonic then and the most efficacious indirect stimulant than a mother can take at such times there is no quotation equal to porter and stout or what is better still an equal part of porter and stout ale except for a few constitutions is too subtle and too sweet generally causing acidity or heartburn and stout alone is too potent to admit of a full draft from its proneness to affect the head and quantity as well as moderate strength is required to make the draft effectual the equal mixture therefore of stout and porter yields all the properties desired or desirable as a medicinal agent for this purpose independently of its invigorating influence on the constitution porter exerts a marked and specific effect on the secretion of milk more powerful and exciting and abundant supply of that fluid than any other article within the range of the physician's art and in cases of deficient quantity is the most certain speedy and the healthiest means that can be employed to ensure a quick and abundant flow in cases where malt liquor produces flotulency a few grains of the carbonate of soda may advantageously be added to each glass immediately before drinking which will have the effect of neutralizing any acidity that may be in the porter at the time and will also prevent its after disagreement with the stomach the quantity to be taken must depend upon the natural strength of the mother the age and demand made by the infant on the parent and other causes but the amount should vary from one to two pints a day never taking less than half a pint at a time which should be repeated three or four times a day we have said that this period of suckling is a season of penance to the mother but this is not invariably the case and as so much must depend upon the natural strength the stomach and its power of assimilating all kinds of food into healthy kyle it is impossible to define exceptions where a woman feels she can eat any kind of food without inconvenience or detriment she should live during her suckling as she did before but as a general rule we are bound to advise all mothers to abstain from such articles as pickles fruits cucumbers and all acid and slowly digestible foods unless they wish for restless nights and crying infants as regards exercise and amusement we would certainly neither prohibit a mother's dancing going to a theater nor even from attending an assembly the first however is the best indoor recreation she can take and a young mother will do well to often amuse herself in the nursery with this most excellent means of healthful circulation the only precaution necessary is to avoid letting the child suck the milk that has lain long in the breast or is heated by excessive action every mother who can should be provided with a breast pump or glass tube to draw off the superabundance that has been accumulating in her absence from the child or the first gush excited by undue exertion the subsequent supply of milk will be secreted under the invigorating influence of a previous healthy stimulus as the first milk that is secreted contains a large amount of the saline elements and is thin and in nutritious it is most admirably adapted for the purpose nature designed it to fulfill that of an apparent but which unfortunately is seldom permitted in our artificial mode of living to perform so opposed are we to the objectionable plan of physically newborn children that unless for positive illness we would much rather advise that medicine should be administered through the mother for the first eight or ten weeks of its existence this practice which few mothers will object to is easily affected by the parent when such a course is necessary for the child taking either a dose of castor oil half an ounce of tasteless salts the phosphate of soda one or two teaspoonfuls of magnesium a dose of lennative electuary manna or any mild and simple apparent which almost before it can have taken effect on herself will exhibit its action on her child one of the most common errors that mothers fall into while suckling their children is that of fancying they are always hungry and constantly overfeeding them and with this the great mistake of applying the child to the breast on every occasion of its crying without investigating the cause of its complaint and under the belief that it wants food putting the nipple into its crying mouth until the infant turns in revulsion in petulance from what it should accept with eagerness and joy at such times a few teaspoonfuls of water slightly chilled will often instantly pacify a crying and restless child who has turned in loathing from the offered breast or after imbibing a few drops and finding it not what nature craved throws back its head and disgust and cries more petulantly than before in such a case as this the young mother grieved at her baby's rejection of the tempting present and distressed at its cries and in terror of some injury over and over ransacks its clothes believing some insecure pin can alone be the cause of such sharp complaining an accident that from her own care and dressing however is seldom or ever the case these abrupt cries of the child if they do not proceed from thirst which a little water will relieve not unfrequently occur from some unequal pressure a fold or twist in the roller or some constriction round the tender body if this is suspected the mother must not be content with merely slackening the strings the child should be undressed and the creases and folds of the hot skin especially those about the thighs and groins examined to see that no powder has caked and becoming hard irritated the parts the violet powder should be dusted freely overall to cool the skin and everything put on fresh and smooth if such precautions have not afforded relief and in addition to the crying the child plunges or draws up its legs the mother may be assured some cause of irritation exists in the stomach or bowels either acidity in the latter or distention from overfeeding in the former but from whichever cause the child should be opened before the fire and a heated napkin applied all over the abdomen the infant being occasionally elevated to a sitting position and well gently jolted on the knee the back should be lightly padded with the hand should the mother have any reason to apprehend that the cause of inconvenience proceeds from the bladder a not-unfrequent source of pain the napkin is to be dipped in hot water squeezed out and immediately applied over the part and repeated every eight or ten minutes for several times in succession either till the natural relief is afforded or a cessation of pain allows for its discontinuance the pain that young infants often suffer and the crying that results from it is as we have already said frequently caused by the mother inconsiderately overfeeding her child and is produced by the pain of distention and the mechanical pressure of a larger quantity of fluid in the stomach than the gastric juice can convert into cheese and digest some children are stronger in the enduring power of the stomach than others and get rid of the excess by vomiting concluding every process of suckling by an emission of milk and curd such children are called by nurses thriving children and generally they are so simply because their digestion is good and they have the power of expelling with impunity that super abundance of element which in others is a source of distention flatulence and pain the length of time an infant should be suckled must depend much on the health and strength of the child and the health of the mother and the quantity and quality of her milk though when all circumstances are favorable it should never be less than nine nor exceed fifteen months but perhaps the true time will be found in the medium between both but of this we may be sure that nature never ordained a child to live on suction after having endowed it with teeth to bite and to grind and nothing is more out of place and unseemly than to hear a child with a set of 20 teeth ask for the breast the practice of protracted wet nursing is hurtful to the mother by keeping up an uncalled for and after the proper time an unhealthy drain on her system while the child either drives no benefit from what it no longer requires or it produces a positive injury on its constitution after the period when nature has ordained the child shall live by other means the secretion of milk becomes thin and deteriorated showing in the flabby flesh and puny features of the child both its loss of nutritious properties and the want of more stimulating element though we have said that 12 months is about the medium time a baby should be suckled we by no means wish to imply that a child should be fed exclusively on milk for its first year quite the reverse the infant can hardly be too soon made independent of the mother thus should illness assail her her milk fail or any domestic cause abruptly cut off the natural supply the child having been annealed to an artificial diet its life might be safely carried on without seeking for a wet nurse and without the slightest danger to its system the advantage to the mother of early accustoming the child to artificial food is as considerable to herself as beneficial to her infant the demand on her physical strength in the first instance will be less severe and exhausting the child will sleep longer on a less rapidly digestible element and yield to both more quiet nights and the mother will be more at liberty to go out for business or pleasure another means of sustenance being at hand till her return besides these advantages by a judicious blending of the two systems of feeding the infant will acquire greater constitutional strength so that if attacked by sickness or disease it will have a much greater chance of resisting its virulence than if dependent alone on the mother whose milk affected by fatigue and the natural anxiety of the parent for her offspring is at such a time neither good in its properties nor likely to be beneficial to the patient all that we have further to say on suckling is an advice to mothers that if they wish to keep a sound and unchapped nipple and possibly avoid what is called a broken breast never to put it up with a wet nipple but always to have a soft handkerchief and readiness and the moment that delicate part is drawn from the child's mouth to dry it carefully of the milk and saliva that moisten it and further to make a practice of suckling from each breast alternately dress and dressing washing etc as respects the dress and dressing of a newborn infant or of a child in arms during any stage of its nursing there are few women who will require us to give them guidance or direction for their instruction and though a few hints on the subject may not be out of place here yet most women intuitively take to a baby and with a small amount of experience are able to perform all the little offices necessary to its comfort and cleanliness with ease and completeness we shall therefore on this delicate subject hold our peace and only from afar hint at what we would leaving our suggestions to be approved or rejected according as they chime with the judgment and apprehension of our motherly readers in these days of intelligence there are few ladies who have not in all probability seen the manner in which the indian squaw the aborigines of Polynesia and even the lap and Eskimo strapped down their baby on a board and by means of a loop suspended to the bow of a tree hang it up to the rafters of the hut or on travel dangling on their backs outside the domestic implements which as the slave of her master man the wronged but uncomplaining woman carries in order that her lord may march in unhampered freedom cruel and confining as this system of backboard dressing may seem to our modern notions of freedom and exercise it is positively less irksome less confining and infinitely less prejudicial to health than the mummying of children by our grandmothers a hundred i fifty years ago for what with chins days back stays body stays forehead cloths rollers bandages etc an infant had as many girths and strings to keep head limbs and body in one exact position as a ship has halyards much of this indeed we may say all has been abolished but still the child is far from being dressed loosely enough and we shall never be satisfied till the abominable use of the pin is avoided in total in an infant's dressing and a texture made for all the undergarments of a child of a cool and elastic material the manner in which an infant is encircled in a bandage called the roller as if it had fractured ribs compressing those organs that living on suction must be for the health of the child to a certain degree distended to obtain sufficient element from the fluid imbibed is perfectly preposterous our humanity as well as our duty calls upon us at once to abrogate and discounted by every means in our power instead of the process of washing and dressing being made as with the adults a refreshment and comfort it is by the dawdling manner in which it is performed the multiplicity of things used and the perpetual change of position of the infant to adjust its complicated clothing rendered an operation of positive irritation and annoyance we therefore and treat all mothers to regard this subject in its true light and to study to the utmost simplicity and dress and dispatch in the process children do not so much cry from the washing as from the irritation caused by the frequent change of position in which they are placed the number of times they are turned on their face on their back and on their side by the manipulations demanded by the multiplicity of articles to be fitted tacked and carefully adjusted on their bodies what mother ever found her girl of six or seven stand quiet while she was curling her hair how many times nightly has she not to reprove her for not standing still during the process it is the same with the unconscious infant who cannot bear to be moved about and who has no sooner grown reconciled to one position than it is forced reluctantly into another it is true in one instance the child has intelligence to guide it and in the other not but the modatory nerves in both instances resent coercion and a child cannot be too little handled on this account alone and for the moment setting health and comfort out of the question we beg mothers to simplify their baby's dress as much as possible and not only to put on as little as is absolutely necessary but to make that as simple in its contrivance and adjustment as it will admit of to avoid belly bands rollers girths and everything that can impede or confine the natural expansion of the digestive organs on the due performance of whose function the child lives thrives and develops its physical being end of section 100 section 101 of the book of household management this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Sarah Dennings the book of household management by Isabella Beaton the rearing and management of children and diseases of infancy and childhood chapter 42 part 3 rearing by hand articles necessary and how to use them preparation of foods baths advantages of rearing by hand as we do not for a moment wish to be thought an advocate for an artificial in preference to the natural course of rearing children we beg our readers to understand us perfectly on this head all we desire to prove is the fact that a child can be brought up as well on a spoon dietary as the best example to be found of those reared on the breast having more strength indeed from the more nutritious food on which it lives it will be thus less liable to infectious diseases and more capable of resisting the virulence of any danger that may attack it and without in any way depreciating the nutriment of its natural food we wish to impress on the mother's mind there are many cases of infantine debility which might eventuate in rickets curvature of the spine or mesenteric disease where the addition to or total substitution of an artificial and more stimulating element would not only give tone and strength to the constitution but at the same time render the employment of mechanical means totally unnecessary and finally though we would never where the mother had the strength to suckle her child supersede the breast we would insist on making it a rule to accustom the child as early as possible to the use of an artificial diet not only that it may acquire more vigor to help it over the ills of childhood but that in the absence of the mother it might not miss the maternal sustenance and also for the parent's sake that should the milk from any cause become vitiated or suddenly cease the child can be made over to the bottle in the spoon without the slightest apprehension of hurtful consequences to those persons unacquainted with the system or who may have been erroneously informed on the matter the rearing of a child by hand may seem surrounded by innumerable difficulties and a large amount of personal trouble and anxiety to the nurse or mother who undertakes the duty this however is a fallacy in every respect except as regards the fact of preparing the food but even this amount of extra work by adopting the course we shall lay down may be reduced to a very small sum of inconvenience and as respects anxiety the only thing calling for care is the display of judgment in the preparation of the food the articles required for the purpose of feeding an infant are a night lamp with its pan and lid to keep the food warm a nursing bottle with a prepared teat and a small papp saucepan for use by day of the lamp we need hardly speak most mothers being acquainted with its operation but to those to whom it is unknown we may observe that the flame from the floating rush light heats the water in the reservoir above in which the covered pan that contains the food floats keeping it at such a heat that when thinned by milk it will be of a temperature suitable for immediate use though many kinds of nursing bottles have been lately invented and some mounted with india rubber nipples the common glass bottle with the calf's teat is equal in cleanliness and utility to any besides the nipple put into the child's mouth is so white and natural in appearance that no child taken from the breast will refuse it the black artificial ones of kuchuk or gutta percha are unnatural the prepared teats can be obtained at any chemists and as they are kept in spirits they will require a little soaking in warm water and gentle washing before being tied securely by means of fine twine around the neck of the bottle just sufficient being left projecting for the child to grasp freely in its lips for if left the full length or over long it will be drawn too far into the mouth and possibly make the infant heave when once properly adjusted the nipple need never be removed till replaced by a new one which will hardly be necessary oftener than once a fortnight though with care one will last for several weeks the nursing bottle should be thoroughly washed and cleaned every day and always rinsed out before and after using it the warm water being squeezed through the nipple to wash out any particles of food that might lodge in the aperture and become sour the teat can always be kept white and soft by turning the end of the bottle when not in use into a narrow jug containing water taking care to dry it first and then to warm it by drawing the food through before putting it into the child's mouth food and its preparation the articles generally employed as food for infants consist of arrow root bread flour baked flour prepared grotes farinaceous food biscuit powder biscuits tops and bottoms and semolina or mana croup as it is otherwise called which like tapioca is the prepared pith of certain vegetable substances of this list the least efficacious though perhaps the most believed in is arrow root which only is a mere agent for change and then only for a very short time should ever be employed as a means of diet to infancy or childhood it is a thin flatulent and in nutritious food and incapable of supporting infantine life with energy bread though the universal regime with the laboring poor where the infant's stomach and digestive powers are a reflex in miniature of the fathers should never be given to an infant under three months and even then however finely beaten up and smoothly made is a very questionable diet flour when well boiled though infinitely better than arrow root is still only a kind of fermentative paste that counteracts its own good by after acidity and flatulence baked flour when cooked into a pale brown mass and finely powdered makes a far superior food to the others and may be considered as a very useful diet especially for a change prepared grotes may be classed with arrow root and raw flour as being in nutritious the articles that now follow in our list are all good and such as we could with conscience and safety trust you for the health and development of any child whatever we may observe in this place that an occasional change in the character of the food is highly desirable both as regards the health and benefit of the child and though the interruption should only last for a day the change will be advantageous the packets sold as farinaceous food are unquestionably the best element that can be given from the first to a baby and may be continued with the exception of an occasional change without alteration of the material till the child is able to take its regular meals of animal and vegetable food some infants are so constituted as to require a frequent and total change in their system of living seeming to thrive for a certain time on any food given to them but if persevered in too long declining in bulk and appearance as rapidly as they had previously progressed in such cases the food should be immediately changed and when that which appeared to agree best with the child is resumed it should be altered in its quality and perhaps in its consistency for the farinaceous food there are directions with each packet containing instructions for the making but whatever the food employed is enough should be made at once to last the day and night at first about a pint basin full but as the child advances a court will hardly be too much in all cases let the food boil a sufficient time constantly stirring and taking every precaution that it does not get burnt in which case it is on no account to be used the food should always be made with water the whole sweetened at once and of such a consistency that when poured out and it has had time to cool it will cut with the firmness of a pudding or custard one or two spoonfuls are to be put into the papp saucepan and stood on the hob till the heat has softened it when enough milk is to be added and carefully mixed with the food till the whole has the consistency of ordinary cream it is then to be poured into the nursing bottle and the food having been drawn through to warm the nipple it is to be placed in the child's mouth for the first month or more half a bottle full will be quite enough to give the infinite one time but as the child grows it will be necessary not only to increase the quantity given at each time but also gradually to make its food more consistent and after the third month to add an egg to every pint basin of food made at night the mother puts the food into the covered pan of her lamp instead of the saucepan that is enough for one supply and having lighted the rush she will find on the waking of her child the food sufficiently hot to bear the cooling addition of the milk but whether night or day the same food should never be heated twice and what the child leaves should be thrown away the biscuit powder is used in the same manner as the perinaceous food and both prepared much after the fashion of making starch but when tops and bottoms or the whole biscuit are employed they require soaking in cold water for some time previous to boiling the biscuit or biscuits are then to be slowly boiled in as much water as will when thoroughly soft allow if they're being beaten by a three pronged fork into a fine smooth and even pulp and which when poured into a basin and become cold will cut out like a custard if two large biscuits have been so treated and the child is six or seven months old beat up two eggs sufficient sugar to properly sweeten it and about a pint of skim milk pour this on the beaten biscuit in the saucepan stirring constantly boil for about five minutes pour into a basin and use when cold in the same manner as the other this makes an admirable food at once nutritious and strengthening when tops and bottoms or rusks are used the quantity of the egg may be reduced or altogether omitted semolina or mana croup being in little hard grains like a fine millet seed must be boiled for some time and the milk sugar and egg added to it on the fire and boiled for a few minutes longer and when cold used as the other preparations many persons entertain a belief that cow's milk is hurtful to infants and consequently refrain from giving it but this is a very great mistake for both sugar and milk should form a large portion of every meal an infant takes teething and convulsions fits etc the consequence of dentition and how to be treated the number and order of the teeth and the manner in which they are cut first and second set about three months after birth the infant's troubles may be said to begin teeth commence forming in the gums causing pain and irritation in the mouth and which but for the saliva it causes to flow so abundantly would be attended with very serious consequences at the same time the mother frequently relaxes in the punctuality of viregimen imposed on her and taking some unusual or different food excites diarrhea or irritation in her child's stomach which not unfrequently results in a rash on the skin or slight febrile symptoms which if not subdued in their outset super induce some more serious form of infantine disease but as a general rule the teeth are the primary cause of much of the child's sufferings in consequence of the state of nervous and functional irritation into which the system is thrown by their formation and progress out of the jaw and through the gums we propose beginning this branch of our subject with that most fertile source of an infant's suffering teething that this subject may be better understood by the nurse and mother and the reason of the constitutional disturbance that to a greater or lesser degree is experienced by all infants may be made intelligible to those who have the care of children we shall commence by giving a brief account of the formation of the teeth the age at which they appear in the mouth and the order in which they pierce the gums the organs of mastication in the adult consist of 32 distinct teeth 16 in either jaw being in fact a double set the teeth are divided into four incisors two canine four first and second grinders and six molars but in childhood the complementary first set consists of only 20 and these only make their appearance as the development of the frame indicates the requirement of a different kind of food for the support of the system at birth some of the first cut teeth are found in the cavities of the jaw in a very small and rudimentary form but this is by no means universal about the third month the jaws which are hollow and divided into separate cells begin to expand making room for the slowly developing teeth which arranged for beauty and economy of space lengthwise gradually turn their tops upwards piercing the gum by their edges which being sharp assistant cutting a passage through the soft parts there is no particular period at which children cut their teeth some being remarkably early and others equally late the earliest age that we have ourselves ever known as a reliable fact with six weeks such peculiarities are generally hereditary and as in this case common to a whole family the two extremes are probably represented by six and sixteen months pain and driveling are the usual but by no means the general indications of teething about the sixth month the gums become tense and swollen presenting a red shiny appearance while the salivary glands pour out an unusual quantity of saliva after a time a white line or round spot is observed on the top of one part of the gums and the sharp edge of the tooth may be felt beneath if the finger is gently pressed on the part through these white spots the teeth burst their way in the following order two incisors in the lower jaw are first cut though in general some weeks elapsed between the appearance of the first and the advent of the second the next teeth cut are the four incisors of the upper jaw the next in order are the remaining two incisors of the bottom one on each side then two top and two bottom on each side but not joining the incisors and lastly about the 18th or 20th month the four eye teeth filling up the space left between the side teeth and the incisors thus completing the infant set of 16 sometimes at the same period but more frequently some months later four more double teeth slowly make their appearance one on each side of each jaw completing the entire series of the child's first set of 20 teeth it is asserted that a child while cutting its teeth should either dribble excessively vomit after every meal or be greatly relaxed though one or the other or all of these at once may attend a case of teething it by no means follows that any one of them should accompany this process of nature though there can be no doubt that where the pain consequent on the unyielding state of the gums and the firmness of the skin that covers the tooth is severe a copious discharge of saliva acts beneficially in saving the head and also in guarding the child from those dangerous attacks of fits to which many children in their teething are liable the symptoms that generally indicate the cutting of teeth in addition to the inflamed and swollen state of the gums an increased flow of saliva are the restless and peevish state of the child the hands being thrust into the mouth and the evident pleasure imparted by rubbing the finger or nail gently along the gum the lips are often excoriated and the functions of the stomach or bowels are out of order in severe cases occurring in unhealthy or scrophilis children there are from the first considerable fever disturbed sleep fretfulness diarrhea rolling of the eyes convulsive startings laborious breathing coma or unnatural sleep ending unless the head is quickly relieved in death the treatment in all cases of painful teething is remarkably simple and consists in keeping the body cool by mild apparent medicines allaying the irritation in the gums by friction with a rough ivory ring or a stale crust of bread and when the head lungs or any organ is overloaded or unduly excited to use the hot bath and by throwing the body into a perspiration equalize the circulation and relieve the system from the danger of a fatal termination besides these there is another means but that must be employed by a medical man namely scarifying the gums an operation always safe and which when judiciously performed and at a critical opportunity will often snatch the child from the grasp of death there are few subjects on which mothers have formed such strong and mistaken opinions as on that of lancing in infant's gums some rather seeing their child go into fits and by the unrelieved irritation endangering inflammation of the brain water on the head rickets and other lingering affections that permits surgeon to afford instant relief by cutting through the hard skin which like a bladder over the stopper of a bottle effectually confines the tooth to the socket and prevents it piercing the soft spongy substance of the gum this prejudice is a great error as we shall presently show for so far from hurting the child there is nothing that will so soon convert an infant's tears into smiles as scarifying the gums in painful teething that is if effectually done and the skin of the tooth be divided though teething is a natural function and to an infant in perfect health should be unproductive of pain yet in general it is not only a fertile cause of suffering but often a source of alarm and danger the former from irritation in the stomach and bowels deranging the whole economy of the system and the latter from coma and fits that may excite alarm in severe cases and the danger that eventuates in some instances from organic disease of the head or spinal marrow we shall say nothing in this place of rickets or water on the head which are frequent results of dental irritation but proceed to finish our remarks on the treatment of teething though strongly advocating the lancing of the gums in teething and when there are any severe head symptoms yet it should never be needlessly done or before being satisfied that the tooth is fully formed and is out of the socket and under the gum when assured on these points the gum should be cut lengthwise and from the top of the gum downwards to the tooth in a horizontal direction thus and for about half an inch in length the operation is then to be repeated in a transverse direction cutting across the gum in the center of the first incision and forming across thus the object of this double incision is to ensure a retraction of the cut parts and leave an open way for the tooth to start from an advantage not to be obtained when only one incision is made for unless the tooth immediately follows the lancing the opening reunites and the operation has to be repeated that this operation is very little or not at all painful is evidenced by the suddenness with which the infant falls asleep after the lancing and awakes an apparently perfect health though immediately before the use of the gum lancet the child may have been shrieking or in convulsions convulsions or infantine fits from their birth till after teething infants are more or less subject or liable to sudden fits which often without any assignable cause will attack the child in a moment and well in the mother's arms which according to their frequency and the age and strength of the infant are either slight or dangerous whatever may have been the remote cause the immediate one is some irritation of the nervous system causing convulsions or an effusion to the head inducing coma in the first instance the infant cries out with a quick short scream rolls up its eyes arches its body backwards its arms become bent and fixed and the fingers parted the lips and eyelids assume a dusky leaden color while the face remains pale and the eyes open glassy or staring this condition may or may not be attended with muscular twitching of the mouth and convulsive plunges of the arms the fit generally lasts from one to three minutes when the child recovers with a sigh and the relaxation of the body in the other case the infant is attacked at once with total insensibility and relaxation of the limbs coldness of the body and suppressed breathing the eyes when open being dilated and presenting a dim glistening appearance the infant appearing for the moment to be dead treatment the first step in either case is to immerse the child in a hot bath up to the chin or if sufficient hot water cannot be procured to cover the body make a hip bath of what can be obtained and while the left hand supports the child in a sitting or recumbent position with the right scoop up the water and run it over the chest of the patient when sufficient water can be obtained the spine should be briskly rubbed well in the bath when this cannot be done lay the child on the knees and with the fingers dipped in brandy rub the whole length of the spine vigorously for two or three minutes and when restored to consciousness give occasionally a teaspoon full of weak brandy and water or wine and water an hour after the bath it may be necessary to give an apparent powder possibly also to repeat the dose for once or twice every three hours in which case the following prescription is to be employed take of powdered scaminy six grains gray powder six grains antimonial powder four grains lump sugar 20 grains mix thoroughly and divide into three powders which are to be taken as advised for an infant one year old for younger or weekly infants divide into four powders and give as the other for thirst and febrile symptoms give drinks of barley water or cold water and every three hours put 10 to 15 drops of spirits of sweet nighter in a dessert spoonful of either beverage thrush and its treatment this is a disease to which infants are peculiarly subject and in whom alone it may be said to be a disease for when thrush shows itself in adult or advanced life it is not as a disease proper but only as a symptom or accessory of some other element generally of a chronic character and should no more be classed as a separate affection than the patiki eye or dark colored spots that appear in malignant measles may be considered a distinct affection thrush is a disease of the follicles of the mucous membrane of the alimentary canal whereby there are formed small vesicles or bladders filled with a thick mucous secretion which bursting discharge their contents and form minute ulcers in the center of each vessel to make this formal but unavoidable description intelligible we must beg the reader's patients while we briefly explain terms that may appear too many so unmeaning and make the pathology of thrush fully familiar the whole digestive canal of which the stomach and bowels are only apart is covered from the lips eyes and ears downward with a thin hairy tissue like the skin that lines the inside of an egg called the mucous membrane this membrane is dotted all over in a state of health by imperceptible points called follicles through which the saliva or mucous secreted by the membrane is poured out these follicles or little glands then becoming enlarged and filled with a congealed fluid constitute thrush in its first stage and when the child's lips and mouth appear a mass of small pearls then as these break and discharge the second stage or that of ulceration sets in symptoms thrush is generally preceded by considerable irritation by the child crying and fretting showing more than ordinary redness of the lips and nostrils hot feted breath with relaxed bowels and dark ficulent evacuations the water is scanty and high-colored whilst considerable difficulty in swallowing and much thirst are the other symptoms which a careful observation of the little patient makes manifest the situation and character of thrush show at once that the cause is some irritation of the mucous membrane and can proceed only from the nature and quality of the food before weaning this must be looked for in the mother and the condition of the milk after that time in the crude and indigestible nature of the food given in either case this exciting cause of the disease must be at once stopped when it proceeds from the mother it is always best to begin by fizzling the infant through the parent that is to say let the parent first take the medicine which will sufficiently affect the child through the milk this plan has the double object of benefiting the patient and at the same time correcting the state of the mother and improving the condition of her milk in the other case when the child is being fed by hand then proceed by totally altering the style of element given and substituting farinaceous food custards blanche and ground rice puddings as an apparent medicine for the mother the best thing she can take is a dessert spoonful of carbonate of magnesium once or twice a day in a cup of cold water and every second day for two or three times an apparent pill as the thrush extends all over the mouth throat stomach and bowels the irritation to the child from such an extent of disease to surface is proportionately great and before attempting to act on such a tender surface by opening medicine the better plan is to soothe by an emollient mixture and for that purpose let the following be prepared take a castor oil two drams sugar one dram muesliage or powdered gum arabic half a dram triturate till the oil is incorporated then add slowly mint water one ounce and a half laudanum 10 drops half a teaspoon full three times a day to an infant from one to two years old a teaspoon full from two to three years old and a dessert spoonful at any age over that time after two days use of the mixture one of the following powders should be given twice a day accompanied with one dose daily of the mixture gray powder 20 grains powdered rhubarb 15 grains scamini 10 grains mix divide into 12 powders for one year eight powders from one to two and six powders from two to six years old after that age double the strength by giving the quantity of two powders at once it is sometimes customary to apply borax and honey to the mouth for thrush but it is always better to treat the disease constitutionally rather than locally the first steps therefore to be adopted are to remove or correct the exciting cause the mother's milk or food i lay irritation by a warm bath and the castor oil mixture followed by and conjoined with the powders to those however who wish to try the honey process the best preparation to use is the following rub down one ounce of honey with two drams of tincture of myrrh and apply it to the lips and mouth every four to six hours it is a popular belief and one most devoutly cherished by many nurses and elderly persons that everybody must at some time of their life between birth and death have an attack of thrush and if not in infancy or prime of life it will surely attack them on their death bed in a form more malignant that if the patient had been affected with the malady earlier the black thrush with which they are then reported to be affected being in all probability the patiki eye or purple spots that characterize the worst form and often the last stage of typhoid fever in general very little medicine is needed in this disease of the thrush an alternative powder or a little magnesium given once or twice being all with the warm bath that in the great majority of cases is needed to restore the mucus membrane to health as the rush is caused by an excess of heat or overaction in the lining membrane of the stomach and bowels whatever will counteract this state by throwing the heat on the surface must materially benefit if not cure the disease and that means every mother has at hand in the form of a warm bath after the application of this a little magnesium to correct the acidity existing along the surface of the mucus membrane is often all that is needed to throw the system into such a state as will affect its own cure this favorable state is indicated by an excessive flow of saliva or what is called dribbling and by a considerable amount of relaxation of the bowels a condition that must not be mistaken for diarrhea and checked as if it is ease but rather for the day or two it continues encouraged as a critical evacuant should there be much stability in the condolescence half a teaspoon full of steed wine given twice a day in a little barley water will be found sufficient for all the purposes of a tonic this with the precaution of changing the child's food or when it lives on the mother of correcting the quality of the milk by changing her own diet and by means of an antacid or a period improving the state of the secretion such as all the treatment that this disease in general requires end of section 101 section 102 of the book of household management this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Sarah Jennings the book of household management by Isabella Beaton the rearing and management of children and diseases of infancy and childhood chapter 42 part 4 the class of diseases we are now approaching are the most important both in their pathological features and in their consequences on the constitution of any group or individual disease that assails the human body and though more frequently attacking the undeveloped frame of childhood are yet by no means confined to that period these are called eruptive fevers and embraced chickenpox, cowpox, smallpox, scarlet fever, measles, millery fever, and erosipilis or St. Anthony's fire. The general character of all these is that they are contagious and as the general rule attack a person only once in his lifetime that their chain of diseased actions always begins with fever and that after an interval of from one to four days the fever is followed by an eruption of the skin chickenpox or glasspox and cowpox or vaccination chickenpox or glasspox may in strict propriety be classed as a mild variety of smallpox presenting all the mitigated symptoms of that formidable disease among many physicians it is indeed classed as smallpox and not a separate disease but as this is not the place to discuss such questions and as we profess to give only facts the result of our own practical experience we shall treat this affection of glasspox or chickenpox as we ourselves have found it as a distinct and separate disease chickenpox is marked by all the febrile symptoms presented by smallpox with this difference that in the case of chickenpox each symptom is particularly slight the heat of body is much less acute and the principal symptoms are difficulty of breathing headache coated tongue and nausea which sometimes amounts to vomiting after a term of general irritability heat and restlessness about the fourth day or between the third and fourth an eruption makes its appearance over the face neck and body in its first two stages closely resembling smallpox with this a special difference that whereas the pustules in smallpox have flat and depressed centers an infallible characteristic of smallpox the pustules in chickenpox remain globular while the fluid in them changes from a transparent white to a straw colored liquid which begins to exude and disappear about the eighth or ninth day and in mild cases by the 12th disquamates or peels off entirely there can be no doubt that chickenpox like smallpox is contagious and under certain states of the atmosphere becomes endemic parents should therefore avoid exposing young children to the danger of infection by taking them where it is known to exist as chickenpox in weekly constitutions or in very young children may super induce smallpox the one disease either running concurrently with the other or discovering itself as the other declines this of course is a condition that renders the case very hazardous as the child has to struggle against two diseases at once or before it has recruited strength from the attack of the first treatment in all ordinary cases of chickenpox and it is very seldom it assumes any complexity the whole treatment resolves itself into the use of the warm bath and a course of gentle appearance the bath should be used when the oppression of the lungs renders the breathing difficult or the heat and dryness of the skin with the undeveloped rash beneath the surface shows the necessity for its use as the pustules in chickenpox very rarely run to the state of separation as in the other disease there is no fear of pitting or disfigurement except in very severe forms which however happens so seldom as not to marrant apprehension when the eruption subsides however the face may be washed with elderflower water and the routine followed which is prescribed in the convalescent state of smallpox cowpox properly speaking is an artificial disease established in a healthy body as a prophylactic or preventative agent against the more serious attack of smallpox and is merely that chain of slight febrile symptoms and local irritation consequent on the specific action of the lymph of the vaccination in its action on the circulating system of the body this is not the place to speak of the benefits conferred on mankind by the discovery of vaccination not only as the preserver of the human features from a most loathsome disfigurement but as a sanitary agent in the prolongation of life fortunately the state has now made it imperative on all parents to have their children vaccinated before or by the end of the 12th week thus doing away as far as possible with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive for though vaccination has been proved not to be always an infallible guard against smallpox the attack is always much lighter should it occur and is seldom if indeed ever fatal after the precaution of vaccination the best time to vaccinate a child is after the 6th and before the 12th week if it is in perfect health but still earlier if smallpox is prevalent and any danger exists of the infant taking the disease it is customary and always advisable to give the child a mild apparent powder one or two days before inserting the lymph in the arm and should measles scarlet fever or any other disease arise during the progress of the pustule the child when recovered should be revaccinated and the lymph taken from its arm on no account used for vaccinating purposes the disease of cowpox generally takes 20 days to complete its course in other words the maturity and declension of the pustule takes that time to fulfill its several changes the mode of vaccination is either to insert the matter or lymph taken from a healthy child under the cuticle in several places on both arms or which is still better to make three slight scratches or abrasions with a lancet on one arm and work into the irritated parts the lymph allowing the arm to dry thoroughly before putting down the infant's sleeve by this means absorption is insured and the unnecessary pain of several pustules on both arms avoided no apparent change is observable by the eye for several days indeed not until the fourth in many cases is there any evidence of a vesicle about the fifth day however a pink areola or circle is observed round one or all of the places surrounding a small pearly vesicle or bladder this goes on deepening in hue till the seventh or eighth day when the vesicle is about an inch in diameter with a depressed center on the ninth the edges are elevated and the surrounding part hard and inflamed the disease is now at its height and the pustules should be opened if not for the purpose of vaccinating other children to allow the escape of the lymph and subdue the inflammatory action after the 12th day the center is covered by a brown scab and the color of the swelling becomes darker gradually declining in hardness and color till the 20th when the scab falls off leaving a small pit or cicatrix to mark the seat of the disease and for life prove a certificate of successful vaccination in some children the inflammation and swelling of the arm is excessive and extremely painful and the fever about the ninth or tenth day very high the pustule therefore at that time should sometimes be opened the arm fomented every two hours with a warm bread poultice and an apparent powder given to the infant measles and scarlet fever with the treatment of both measles this much dreaded disease which forms the next subject in our series of infantine diseases and which entails more evils on the health of childhood than any other description of physical suffering to which that age of life is subject may be considered more an affection of the venous circulation attending to general and local congestion attended with a diseased condition of the blood then either as a fever or an inflammation and though generally classed before or after scarlet fever is in its pathology and treatment irrespective of its after consequences as distinct and opposite as one disease can well be from another as we have already observed measles are always characterized by the running at the nose and eyes and great oppression of breathing so in the mode of treatment two objects are to be held especially in view first to unload the congested state of the lungs the cause of the oppressed breathing and secondly to act vigorously both during the disease and afterwards on the bowels at the same time it cannot be too strongly borne in mind that though the patient in measles should on no account be kept unduly hot more care than in most infantine complaints should be taken to guard the body from cold or any abrupt changes of temperature with these special observations we shall proceed to give a description of the disease as recognized by its usual symptoms which commence with the cold chills and flushes lassitude heaviness pain in the head and drowsiness cough hoarseness and extreme difficulty of breathing frequent sneezing deduction or running at the eyes and nose nausea sometimes vomiting thirst a furred tongue the pulse throughout is quick and sometimes full and soft at others hard and small with other indications of an inflammatory nature on the third day small red points make their appearance first on the face and neck gradually extending over the upper and lower part of the body on the fifth day the vivid red of the eruption changes into a brownish hue and in two or three days more the rash entirely disappears leaving a loose powdery desquamation on the skin which rubs off like dandruff at this stage of the disease a diarrhea frequently comes on which being what is called critical should never be checked unless seriously severe measles sometimes assumes a typhoid or malignant character in which form the symptoms are all greatly exaggerated and the case from the first becomes both doubtful and dangerous in this condition the eruption comes out sooner and only in patches and often after showing for a few hours suddenly recedes presenting instead of the usual florid red a dark purple or blackish hue a dark brown fur forms on the gums and mouth the breathing becomes laborious delirium supervenes and if unrelieved is followed by coma a fetid diarrhea takes place and the patient sinks under the congestive state of the lungs and the oppressed functions of the brain the unfavorable symptoms in measles are a high degree of fever the excessive heat and dryness of the skin hurried and short breathing and a particularly hard pulse the sequels or after consequences of measles are croup bronchitis mesenteric disease abscesses behind the ear ophthalmia and glandular swellings in other parts of the body treatment in the first place the patient should be kept in a cool room the temperature of which must be regulated to suit the child's feeling of comfort and the diet adapted to the strictest principles of abstinence when the inflammatory symptoms are severe bleeding in some form is often necessary though when adopted it must be in the first stage of the disease and if the lungs are the apprehended seat of the inflammation two or more leeches according to the age and strength of the patient must be applied to the upper part of the chest followed by a small blister or the blister may be substituted for the leeches the attendant bearing in mind that the benefit affected by the blister can always be considerably augmented by plunging the feet into very hot water about a couple of hours after applying the blister and kept in the water for about two minutes and let it further be remembered that this immersion of the feet in hot water may be adopted at any time or any stage of the disease and that whenever the head or lungs are oppressed relief will always accrue from its sudden and brief employment when the symptoms commence with much shivering and the skin early assumes a hot dry character the appearance of the rash will be facilitated and all the other symptoms rendered milder if the patient is put into a warm bath and kept in the water for about three minutes or where that is not convenient the following process which will answer quite as well can be substituted stand the child naked in a tub and having first prepared several jugs of sufficiently warm water empty them in quick succession over the patient's shoulders and body immediately wrap in a hot blanket and put the child to bed till it rouses from the sleep that always follows the effusion or bath this agent by lowering the temperature of the skin and opening the pores producing a natural perspiration and unloading the congested state of the lungs in most cases does away entirely with the necessity both for leeches and a blister whether any of these external means have been employed or not the first internal remedies should commence with a series of apparent powders and a saline mixture as prescribed in the following formularies at the same time as a beverage to quench the thirst let a quantity of barley water be made slightly assiduated by the juice of an orange and partially sweetened by some sugar candy and of which when properly made and cold let the patient drink as often as thirst or the dryness of the mouth renders necessary apparent powders take of scamini and jalap each 24 grains gray powder and powdered antimony each 18 grains mix and divide into 12 powders if for a child between two and four years of age into eight powders if for a child between four and eight years of age and into six powders for between eight and 12 years one powder to be given in a little jelly or sugar and water every three or four hours according to the severity of the symptoms saline mixture take of mint water six ounces powdered nighter 20 grains antimonial wine three drams spirits of nighter two drams syrup of saffron two drams mix to children under three years give a teaspoonful every two hours from that age to six a dessert spoonful at the same times and a tablespoon full every three or four hours to children between six and 12 the object of these apparent powders is to keep up a steady but gentle action on the bowels but whenever it seems necessary to administer a stronger dose and effect a brisk action on the digestive organs of course particularly imperative towards the close of the disease two of these powders given at once according to the age will be found to produce that effect that is two of the 12 for a child under four years and two of the eight and two of the six according to the age of the patient when the difficulty of breathing becomes oppressive as it generally does towards night a hot bran poultice laid on the chest will be found always highly beneficial the diet throughout must be light and consist of perinaceous foods such as rice and sago puddings beef tea and toast and not till convalescence sets in should hard or animal food be given when measles assume the malignant form the advice just given must be broken through food of a nutritious and stimulating character should be at once substituted and administered in conjunction with wine and even spirits and the disease regarded and treated as a case of typhus but as this form of measles is not frequent and if occurring hardly likely to be treated without assistance it was unnecessary to enter on the minutiae of its practice here what we have prescribed in almost all cases will be found sufficient to meet every emergency without resorting to a multiplicity of agents the great point to remember in measles is not to give up the treatment with the apparent subsidence of the disease as the after consequences of measles are too often more serious and to be more dreaded than the measles themselves to guard against this danger and thoroughly purify the system after the subsidence of all the symptoms of the disease a corrective course of medicine and a regimen of exercise should be adopted for some weeks after the cure of the disease to effect this an active apparent powder should be given every three or four days with a daily dose of the subjoined tonic mixture with as much exercise by walking running after a hoop or other bodily exertion as the strength of the child in the state of the atmosphere will admit the patient being wherever possible removed to a pure air as soon as convalescence warrants the change tonic mixture take of infusion of rose leaves six ounces quinine eight grains diluted sulfuric acid 15 drops mix dose from half a teaspoon full up to a dessert spoonful once a day according to the age of the patient scarletina or scarlet fever though professional accuracy has divided this disease into several forms we shall keep to the one disease most generally met with the common or simple scarlet fever which in all cases is characterized by an excessive heat on the skin sore throat and a peculiar speckled appearance of the tongue symptoms cold chills shivering nausea thirst hot skin quick pulse with difficulty of swallowing the tongue is coated presenting through its fur innumerable specs the elevated papillae of the tongue which gives it the speckled character that if not the invariable sign of scarlet fever is only met with in cases closely analogous to that disease between the second and third day but most frequently on the third a bright red efflorescence breaks out in patches on the face neck and back from which it extends over the trunk and extremities always showing thicker and deeper in color wherever there is any pressure such as the elbows back and hips when the eruption is well out the skin presents the appearance of a boiled lobster shell at first the skin is smooth but as the disease advances perceptible roughness is apparent from the elevation of the rash or more properly the pores of the skin on the fifth and sixth days the eruption begins to decline and by the eighth has generally entirely disappeared during the whole of this period there is more or less constants or throat the treatment of scarlet fever is in general very simple where the heat is great and the eruption comes out with difficulty or recedes as soon as it appears the body should be sponged with cold vinegar and water or tepid water as in measles poured over the chest and body the patient being as in that disease wrapped in a blanket and put to bed and the same powders and mixture ordered in measles administered with the addition of a constant hot bran poultice around the throat which should be continued from the first symptom till a day or two after the declension of the rash the same low diet and cooling drink with the same general instructions are to be obeyed in this as in the former disease when the fever runs high in the first stage and there is much nausea before employing the effusions of water give the patient an emetic of equal parts ipikakwana and antimonial wine in doses of from a teaspoon full to a tablespoon full according to age by these means nine out of every ten cases of scarletina may be safely and expeditiously cured especially if the temperature of the patient's room is kept at an even standard of about 60 degrees whooping cough, croup and diarrhea with their mode of treatment whooping cough this is a purely spasmodic disease and is only infectious through the faculty of imitation a habit that all children are remarkably apt to fall into and even where adults have contracted whooping cough it has been from the same cause and is as readily accounted for on the principle of imitation as that the gaping of one person will excite or predispose a whole party to follow the same spasmodic example if anyone associates for a few days with a person who stammer's badly he will find when released from his company that the sequence of his articulation and the fluency of his speech are for a time gone and it will be a matter of constant vigilance and some difficulty to overcome the evil of so short an association the manner in which a number of schoolgirls will one after another fall into a fit on beholding one of their number attacked with epilepsy must be familiar to many these several facts lead us to a duster notion of how to treat this spasmodic disease every effort should therefore be directed mentally and physically to break the chain of nervous action on which the continuance of the cough depends symptoms whooping cough comes on with a slight oppression of breathing thirst quick pulse hoarseness and a hard dry cough this state may exist without any change from one to two or three weeks before the peculiar feature of the disease the whoop sets in as the characteristics of this cough are known to all it is unnecessary to enter here physiologically on the subject we shall therefore merely remark that the frequent vomiting and bleeding at the mouth or nose are favorable signs and proceed to the treatment which should consist in keeping up a state of nausea and vomiting for this purpose give the child doses of ipikakwana and antimonial wines in equal parts and quantities varying from half to one and a half teaspoonful once a day or when the expectation is hard and difficult of expulsion giving the following cough mixture every four hours take of syrup of squills half ounce antimonial wine one ounce laudanum 15 drops syrup of tulu two drams water one and a half ounce mix the dose is from half a spoonful to a dessert spoonful when the cough is urgent the warm bath is to be used and either one or two leeches applied over the breastbone or else a small blister laid on the lower part of the throat such as the medical treatment of whooping cough but there is a moral regimen based on the nature of the disease which should never be omitted and on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping so the like means should be adopted with the whooping cough patient and in the first stage before the whooping has been added the parent should endeavor to break the paroxysm of the cough by abruptly attracting the patient's attention and thus if possible preventing the cough from reaching that height when the engulf of air gives a whoop or crow that marks the disease but when once that symptom has set in it becomes still more necessary to endeavor by even measures of intimidation to break this masmodic chain of the cough exercise in the open air when dry is also requisite and change of scene and air in all cases is of absolute necessity and may be adopted at any stage of the disease croop this is by far the most formidable and fatal of all the diseases to which infancy and childhood are liable and is purely an inflammatory affection attacking that portion of the mucous membrane lining the windpipe and bronchial tubes and from the effect of which a false or loose membrane is formed along the windpipe resembling an appearance the finger of a glove suspended in the passage and consequently terminating the life of the patient by suffocation for as the lower end grows together and becomes closed no air can enter the lungs and the child dies choked all dull, fat and heavy children are peculiarly predisposed to this disease and those with short necks and who make a wheezing noise in their natural breathing croop is always sudden in its attack and rapid in its career usually proving fatal within three days most frequently commences in the night and generally attacking children between the ages of three and ten years mothers should therefore be on their guard who have children predisposed to this disease and immediately resort to the means hereafter advised symptoms, languor and restlessness hoarseness wheezing and short dry cough with occasional rattling in the throat during sleep the child often plucking at its throat with its fingers difficulty of breathing which quickly becomes hard and labored causing great anxiety of the countenance and the veins of the neck to swell and become knotted the voice and speaking acquires a sharp crowing or croopy sound while the inspirations have a harsh metallic intonation after a few hours a quantity of thick ropey mucus is thrown out hanging about the mouth and causing suffocating fits of coughing to expel treatment place the child immediately in a hot bath up to the throat and on removal from the water given a medic of the antimonial or ipikakwana wine and when the vomiting has subsided lay a long blister down the front of the throat and administer one of the following powders every 20 minutes to a child from three to six years of age take of chamomile 12 grains tartaromatic two grains lump sugar 30 grains mix accurately and divide into 12 powders for a child from six to 12 years divide into six powders and give one every half hour should the symptoms remain unabated after a few hours apply one or two leeches to the throat and put mustard poultices to the foot and thighs retaining them about eight minutes and in extreme cases a mustard poultice to the spine between the shoulders and at the same time rub mercurial ointment into the armpits and the angles of the jaw such as a vigorous and reliable system of treatment in severe cases of croup but in the milder and more general form the following abridgment will in all probability be all that will be required first the hot bath second the emetic third a mustard plaster round the throat for five minutes fourth the powders fifth another emetic in six hours if needed and the powders continued without a termition while the urgency of the symptoms continue when relief has been obtained these are to be discontinued and a dose of senate given to act on the bowels diarrhea the diarrhea with which children are so frequently affected especially in infancy should demand the nurse's immediate attention and when the secretion from its clay color indicates an absence of bile a powder composed of three grains of gray powder and one grain of rhubarb should be given twice with an interval of four hours between each dose to a child from one to two years and a day or two afterwards an apparent powder containing the same ingredients and quantities with the addition of two or three grains of scammany for the relaxation consequent on an overloaded stomach or acidity in the bowels a little magnesium dissolved in milk should be employed two or three times a day when much griping and pain attend the diarrhea half a teaspoon full of dolby's carminative the best of all patent medicines should be given either with or without a small quantity of castor oil to carry off the exciting cause for any form of diarrhea that by excessive action demands a speedy correction the most efficacious remedy that can be employed in all ages in condition of childhood is the tincture of kino of which from 10 to 30 drops mixed with a little sugar and water in a spoon are to be given every two or three hours till the undue action has been checked often the change of diet to rice milk eggs or the substitution of animal for vegetable food or vice versa will correct an unpleasant and almost chronic state of diarrhea a very excellent carminative powder for flatulent infants may be kept in the house and employed with advantage whenever the child is in pain or griped by dropping five grains of oil of anise seed and two of peppermint on half an ounce of lump sugar and rubbing it in a mortar with a dram of magnesium into a fine powder a small quantity of this may be given in a little water at any time and always with benefit end of section 102