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DECALOGUE
FOR THE
NURSERY
DONALDSON
A DECALOGUE FOR THE NURSERY
DONALDSON

LIBRARY OF
Dr. M. DESCHERE.
Ro.1371
ARTES
1837
SCIENTIA
VERITAS
LIBRARY
OF THE
UNIVERSITY OF MICHIGAN
JE PLURIBUS UNUM
வ
SQUAERIS PENINSULAM AMOENAMBAN
CIRCUMSPICES
D68
A
DECALOGUE FOR THE NURSERY
12) 436
BY
J. DONALDSON, M.D.
BOSTON
OTIS CLAPP & SON
1886
COPYRIGHT BY
S. J. DONALDSON, M.D.
1886
TROW'S
PRINTING AND BOOKBINDING COMPANY,
NEW YORK.
PREFACE.
A REVIEW of mortuary statistics reveals the
startling fact that nearly fifty per cent. of deaths
occur under the age of five years, about sixty
per cent. of these being infants under twelve
months. That this enormous blight of human-
ity is the legitimate outcome of ignorance or
carelessness concerning the fundamental laws
of life, and failure to conform to simple hygien-
ic measures, becomes a melancholy probability
in view of the significant fact that everywhere
the chief decimating factor of childhood is NU-
TRITIONAL DISORDERS.
How commonly physicians are made help-
less witnesses to the deplorable consequences
of inexcusable shortcomings on the part of
parents, who, so far as actual results extend,
are unwittingly party to infanticide! At such
iv
PREFACE.
times is keenly felt the want of some efficient
means whereby the parental mind might not
only be properly enlightened, but quickened to
a degree that would forefend the little ones
against similar evils in the future.
The best instruction is apt to prove futile
when advanced in the confusion of a sick-room,
or addressed to those perplexed with anxieties
or overwhelmed with grief; therefore, as just
remarked, the vital point is the early enlight-
enment which averts disaster. Moreover, it is
impracticable for the busy physician to be con-
tinually explaining orally the intricacies of in-
fant sanitation. Sooner or later the constant
reiteration which heedlessness and oft-recurring
events impose, must dishearten the most faith-
ful, and it is then he would gladly avail himself
of some material means to satisfactorily convey
the views he seeks to impart, and conserve to
him valuable time and energy.
It may be claimed that this requirement has
long since been met, and that there is, in fact,
already supplied to the public a surplus of do-
mestic books devoted to the clinical manage-
ment of children. Casually this point of ex-
PREFACE.
V
ception seems to be well taken, but a closer
inspection will show that the bulk of that
which has been written upon this topic has an
undesirable tendency; while containing much
valuable information, these publications are too
largely given to the discussion of diseases and
medication, to the neglect of those hygienic
measures which it is the special part of parents
to observe.
In the nursery nothing is more to be dread-
ed than the officiousness of someone possess-
ing a smattering of knowledge in the art of
prescribing medicines, with an ardent desire
to make practical application of his meagre
fund of information. Hence it often occurs
that the endeavors of physicians are not only
embarrassed, but it may be completely frus-
trated, by the pretentiousness of those given to
dabbling with drugs and the study of popular
domestic medical lore.
On every hand are met mothers possessing
a remarkable familiarity with the technicalities
of medicine, who are nevertheless wofully
ignorant of the primary laws of life. They
will discourse volubly on the character of the
vi
PREFACE.
pulse, the thermometric range of the bodily
temperature, of the medication they have
deemed especially suitable in certain disorders,
etc., and yet they are wholly unacquainted
with the principles of digestion and assimila-
tion, know little or nothing of the vascular
system, and from whence the body derives its
animal heat, nor have they ever thought to
look beyond the mere primary action to the
ultimate effects of drugs.
It
For a long time my mind has been pecu-
liarly alive to these and kindred evils, which en-
tail far more suffering upon the little ones than
the combined adverse elements in Nature.
is from this standpoint that the precepts em-
bodied in the following pages have been ad-
duced. I hold that the highest office in the de-
partment of domestic therapeutics consists not
in the knowledge of pathology, the action and
proper administering of drugs, or familiarity
with technical matters, but rather in the practice
of those fundamentals of correct living that shall
avert disease. Many of the precepts embodied
are so elementary in character, that only a per-
sonal observation of the disregard commonly
PREFACE.
vii
shown them, has emboldened me to direct atten-
tion to their importance. The beaten track of
popular beliefs and customs has been frequently
diverged from, but nothing has been offered
impulsively or upon mere speculation. Each
new measure resting upon a logical basis is sus-
tained by personal observation, and varied ex-
perience. Comparatively little space has been
given to the drug treatment of diseases for
reasons suggested. That which has been ad-
vanced under this head, has for its aim the elu-
cidation of a few valuable precepts regarding
the general action of medicine, with which every
adult should be acquainted; with a like practical
purpose, a few pages have been devoted to the
subject of diagnosing, for it is incumbent upon
all intelligent persons to learn the characteristic
symptoms of the various common ailments, that
valuable time may not be lost in securing proper
assistance.
In the matter of therapeutics, I have sought to
protect the nursery from drugging, as far as may
be. Were it possible I would make the precepts
of philosophical living so prominent and attrac-
tive, as to put completely out of sight compara-
viii
PREFACE.
tively worthless dosage. Since this is not at
present practicable, we will accord appropriate
attention to the right and wrong uses of a few
drugs, ever insisting, however, that in the most
perfect use of these the key to physical well-
being is not found, and to entertain such belief
is to foster delusion.
When physiological laws and nature's require-
ments are rightly comprehended the thought
of pill or potion, will not so fully preoccupy the
mind when contemplating physical ailments.
72 MADISON AVENUE, June 1, 1886.
CONTENTS.
CHAPTER I.
PART I.-WASHING AND CLOTHING OF INFANTS.
Relation between Skin and Mucous Membrane-Con-
struction of Integument-Number and Extent of
Sweat Glands-Nature and Amount of Excreta thrown
off by the Skin-Excessive Bathing Injurious-Warm
Bathing a cause of Catarrh-Temperature of Bath—
Bathing Appurtenances-Undue Friction of Skin-
Time of Bath.
PAGE
I-12
PART 2.-CLOTHING.
Essentials in the Raiment of Children-Protection of Ex-
tremities-Heavy Clothing or Bundling...
CHAPTER II.
BODILY POSTURE.
•
.13-15
Predilections of Children for certain Positions-Forcing
Infants to occupy Unnatural and Injurious Positions
X
CONTENTS.
PAGE
-Proper Bodily Posturing determined by Anatomi-
cal Principles--Reclining Position of Infants and the
Lower Animals-Faultiness of Dorsal Position-Neces-
sity for Frequent Shifting of the Body-Stagnation In-
duced by Inaction-Muscular Movement Indispensa-
ble to Complete Circulation of the Blood-Impurities
within the Tissues eliminated by Motion--Application
of these Principles to Diseased States-Massage.... 16-30
CHAPTER III.
INFANT DIET.
Digestive Apparatus, its Conformation and Extent-Ali-
mentary Glands, their Secretion, and Special Func-
tion of each Set-Significance of Drooling-Starch-
bearing Food, When and When not Admissible-Per-
nicious Habit of Overfeeding-Why Infants should
not be Fed during the Night-The Complaints due
to Gastric Irritation Mistaken for the Clamoring of
Hunger-The Nursing-bottle an Odious Device—Ap-
proved Form of Nursing-bottle-Teaching Infants to
Drink-Artificial or Alien Food-Cow's Milk, its
Constituents compared to those of Human Milk-
Modifications Necessary to be made in Cow's Milk-
Mother's Diet-Regulation of Diet and all Influences
affecting the Cow-Bone-forming Ingredients, Lack
of in Food, Regimen for, the Restoration of Misfort-
unes of Cow reflected upon Child-Condensed Milk
-Artificial Milk Food Preparations-Comparative
Table showing Relative Value of Breast, Cow's, and
CONTENTS.
xi
Attenuated Condensed Milk, and the Artificial Milk
Food-Cereals, Preparations of, Relative Merits, and
when Admissible...
PAGE
•
.31-79
CHAPTER IV.
DENTITION.
Time and Order of Appearance of Teeth-Remissions,
and Importance of Utilizing Periods of Rest-Diver-
gences from Usual Order-Intestinal Disturbance
during Dentition-Pernicious Management of Infan-
tile Diarrhoeas-"Soothing" Medicines-Laxatives
versus Astringents-Painful Gums and their Treat-
ment.
..80-96
CHAPTER V.
FRESH AIR.
Amount Exhausted in Normal Respiration Carbonic
Acid, its Relation to and Effect upon the Animal
Economy-Carbonic Acid, Amount Exhaled — The
Phenomena of Blood Oxygenation Circuit of the
Blood through the Body, Manner and Frequency of
Method of Ventilating Rooms Hot Stoves and
Burning Gas-jets.
..97-107
CHAPTER VI.
NURSERY APPURTENANCES.
Sunshine in the Nursery-Nursery Crib - Means of
Amusement Dangerous Playthings-Approved
xii
CONTENTS.
PAGE
Form of Toys Poisonous Pigments and Wall-
paper-Protection of Infants' Eyes from Injurious
Reflections-Safeguards against Accidents....... 108-117
CHAPTER VII.
EARLY INDICATIONS OF DISEASE.
Mother's Perception - Significance of Different Cries-
Colic Cry - Brain Cry-Cry peculiar to Chest Af-
fections - Various Movements and Gestures of In-
fants Indicative-Convulsions, Premonitions of—In-
dications of Pulmonary Affections; Premonitions of
Pneumonia, Pleurisy, Diphtheria, Croup-Differ-
entiation between False and True Types of Croup-
Early Indications of Tuberculosis....
.118-130
CHAPTER VIII.
THE RIGHT AND WRONG USAGE OF DRUGS.
Baleful Results of Drugging-Predilection of the Masses
for Dabbling with Medicines-Difficulties Besetting
the Construction of a Therapeutic Guide for the
Nursery Necessity of Studying Symptoms Intently
and the Proper Interpretation of Them
Acquire Reliable Knowledge of the
Drugs.
How we
Action of
·
.131-145
CONTENTS.
xiii
CHAPTER IX.
DOMESTIC TREATMENT OF DISEASE.
Importance of fixing Rigid Limitations to Domestic Ther-
apy-Croup: Spasmodic, Membranous; Manner of
giving Hot Baths in-Construction and Application of
Poultice Diphtheria: Nature, Diagnosis, and Treat-
ment: Old School Treatment of Diphtheria; Table
differentiating Croup from Diphtheria-Scarlet Fever;
Scarlatina-Measles; Early Exposure to Measles ad-
visable-Whooping-cough-Acute Affections of Res-
piratory Organs-Baleful Effects of Narcotics and
Quinia in Pneumonia -Mumps-Infantile Diarrhoea
-Danger of Checking Diarrhoea-Distinction made
between Dysentery and Diarrhoea-Fatal Tendency of
Dysentery-Prolapsus Ani-Habitual Constipation ;
Cathartics and use of Syringe Originating Factors in
- Incontinence of Urine-Spasmodic Convulsions—
Hip-joint Disease; Early Detection and Right Man-
agement of Utmost Importance: Danger of Trifling
with any form of Lameness in Childhood-Scald-
head, Tenia Capitis, Yellow Crust
PAGE
.146-227
CHAPTER X.
SELECTION, PREPARATION, AND USE OF REMEDIES.
Hints regarding Care and Handling of Medicines—List of
Remedies, Abbreviations, Attenuations, etc.—Size of
Dose--Action of Remedies in Health and Disease-
xiv
CONTENTS.
PAGE
The System rendered by Disease more Sensitive to
the Action of the Indicated Drug-List of Commended
Drugs, with their Characteristic Symptoms
.228-250
NURSERY SCRAP-BASKET.
·
Disinfectants and Disinfectant Solutions-House Sewer-
age - Rest as a Remedy-Barley-water-Gumarabic-
water Lime-water
Lime-water - Clinical Thermometer - Lac-
tometer, and Cream-gauge-Deceit in the Nursery
-Compulsory Kissing-Corporeal Punishment-The
Power of Example-Awakening of Intelligence—
Ghost Stories-Kindliness
...251-269
A DECALOGUE FOR THE NURSERY.
CHAPTER I.
WASHING AND CLOTHING OF INFANTS.
THROUGHOUT all time the attention accorded
physical cleanliness has been a fair criterion
of the ethics of individuals and communities,
and to the majority of cultivated minds, the
term cleanliness is synonymous with moral,
as well as physical excellence. Accordingly,
in the best homes of civilized countries, the
bath-tub is placed among the household gods.
Negligence in this particular is everywhere
repugnant, but nowhere more so than when
associated with childhood, its guilelessness
offering the strongest protest against the of
fence of bodily impurity. In view of this wide-
spread sentiment it is not strange that children
of parents in the higher classes are through
2
A DECALOGUE FOR THE NURSERY.
excess of this hygienic observance made to
suffer.
There are, doubtless, few mothers who would
not resent any suggestion that their knowledge
regarding the judicious application of this sim-
ple nursery rite was seriously at fault; and, in-
deed, positive indignation is usually aroused by
any professional encroachment upon that cere-
mony which is generally held to be the especial
prerogative of the mother. Notwithstanding
the apparent simplicity of this matter, observa-
tion has long since convinced me that where
every requisite is afforded, there will still be
found very objectionable practices connected
with infant bathing.
It must be conceded that, as individual tem-
perament and strength are by no means uni-
form, it is impossible to determine upon an
arbitrary course applicable to each and all.
The utmost, therefore, that we can hope to
accomplish, is an approximation to that which
common-sense and a correct appreciation of
physiological principles suggest.
Space will not admit of a detailed account of
the anatomical and histological peculiarities of
A DECALOGUE FOR THE NURSERY.
3
the skin, nor of the intimate functional relation-
ship it holds with the mucosa and the chief
organs of excretion, but it is necessary to our
present purpose to refer to a few of the essen-
tial features of this important topic.
Three layers compose the integument, every
part of which is pierced with a myriad of minute
excretory ducts ranging from four hundred to
three thousand to the square inch, which in
health are ceaselessly exuding from the body
moisture, known as sensible and insensible
perspiration, the chemical nature of which we
need not pause to discuss, but simply state that
a complete suppression of this noxious excre-
tion by sealing up the innumerable points of
egress, would speedily result in sickness and
death.
By the side of each one of these sweat-pores
is found a minute loop of sentient nerve-fila-
ment that turns back just beneath the epider-
mis or outer layer, which is squamous, con-
stantly ripening and scaling off, and at the same
time being replaced by the fresh scales contin-
ually forming beneath and crowding upward.
The office of this superficial layer is mani-
4
A DECALOGUE FOR THE NURSERY.
festly the protection of the sensitive subtissues,
as everyone who has suffered from its removal
by chafing or abrasion can testify. This denu-
dation exposes the extremities of the before-
mentioned nerve-filaments to external influ-
ences, and so exquisitely sensitive are they that
even atmospheric influences are painfully appre-
ciable; therefore we commonly allay the dis-
comfort by the application of an artificial cover-
ing until a new scarf-skin has had time to form.
There is another important feature of these
skin-ducts which we must refer to in this connec-
tion. Each one of these minute perforations is
supplied with a delicate constrictor, which in its
normal condition is capable of contracting the
tiny orifices, producing that roughened appear-
ance commonly called "goose flesh.” These
sphincters are presided over by the loops or ter-
minals of the cutaneous nerves just described.
We shall have occasion to return to this mat-
ter shortly.
Taken as a whole the integument constitutes
an extensive and highly important excretory
gland, and its function is so intimately asso-
ciated with the mucous tissues, (which, after all,
A DECALOGUE FOR THE NURSERY.
5
are but a continuation of the skin reflected
within the body) that every shade of condition
affecting the external, is reflected upon the in-
ner one. To obtain a more definite apprecia-
tion, it may be stated that an adult is supposed
to throw off by the surface, daily, eighteen
ounces of water, half an ounce of solid matter,
(oil, etc.), and about an once of carbonic acid
on an average. It is estimated that were all
the sweat-tubes of an adult uncoiled and laid
end to end they would reach a distance of from
eight to ten miles.
Having thus briefly alluded to these physio-
logical essentials, let us note their bearing upon
the question before us, although ready per-
ception has doubtless made the application.
Every experienced physician dealing with the
better classes can testify to the pernicious re-
sults of inordinate bathing, especially where
irritating ingredients (alkaline and alcoholic)
are employed, and where an undue amount of
friction is exerted. In this way myriads of
delicately organized beings destroy their men-
tal as well as physical happiness, rendering
themselves victims of neurasthenia, insomnia,
6
A DECALOGUE FOR THE NURSERY
hysteria, and other neurotic affections, the un-
happy condition being due to the fact that the
epidermis is kept prematurely removed, thereby
exciting and perpetuating hyperæsthesia of the
extensive surface covering the entire body.
Unfortunately this matter is quite generally
overlooked, consequently the injury may be in-
definitely prolonged even to the verge of in-
sanity.
A large percentage of bathers experience a
sensation of lassitude or devitalization following
the immersion of the entire body, which tran-
sient sensation of weariness is accounted for by
the fact that a part of the animal electricity
passes from the body to the water, and of
course when a body possessing but feeble
or sluggish reactionary powers is subjected
to frequent ablutions, the practice will simu-
late and may establish physical prostration.
Now it is readily seen that the philosophy of
this matter is of greater significance, when ap-
plied to children, in proportion to their more
delicate tissues, the greater sensibility of their
nervous organizations, and their lesser powers
of resistance. Let anyone compare the quiet
A DECALOGUE FOR THE NURSERY.
7
contentment and uninterrupted slumber of the
infant that is a comparative stranger to the
scrupulous enforcement of the bath, with the
peevishness, and the sleep broken by fitful
starts of the one who undergoes the observ-
ance in its most rigorous form. Of course
maternal pride will suggest to many minds a
different explanation, but careful observation
shows that (other things being equal) it mat-
ters little whether the child be the offspring of
the high or of the lowly, the effect taken in
the aggregate substantiates the postulate pre-
sented.
At this point attention is directed to another
exceedingly important matter also commonly
disregarded. All concede the greater agreea-
bility of the warm bath, but it is a pleasure
which cannot be indulged in with impunity,
since it so commonly incurs severe catarrhal
affections. Indeed there is no more fruitful
source of bronchitis and kindred disorders, than
warm bathing, with subsequent exposure to
draughts or cold. The warmth and moisture
combined relax the skin texture, and likewise
produce a semi-paralysis of the minute con-
8
A DECALOGUE FOR THE NURSERY.
strictors, consequently the surface continues to
be bathed in the sweat of enervation long after
the completion of the bath. This renders the
body peculiarly susceptible to a chill from even
the slightest exposure, and should this occur
the passive exudation is suddenly suppressed
and there ensues an opposite condition in
which repression or sealing-up of the skin ex-
cretories follows, causing a recession to the
mucosa and its consequent congestion, which is
manifested by sneezing, coughing, febrile symp-
toms, etc.
(C
Whenever we have to deal with children
unusually susceptible to taking cold, or habitu-
ally afflicted with infantile catarrh, termed the
snuffles," the matter of warm bathing should
at once suggest itself, for with hardly an ex-
ception the difficulty can be traced to this
source, and until this be rectified the best med-
ical means will prove unavailing.
Let us now proceed to consider some of the
more practical methods commendable in nur-
sery bathing. Our first instrument is a correct
thermometer, which is to the nursery what the
compass is to the ship at sea, and for its ab-
A DECALOGUE FOR THE NURSERY.
9
sence there is no excuse, as one can be obtained
at from fifteen to twenty-five cents, while its
actual value in regulating the hygienic matters
of a household cannot be computed. The
health of an infant is always in jeopardy when
its surroundings are not guarded by this faith-
ful monitor, for while the sensations of the few
may be approximately reliable, those of the
many are untrustworthy and subject to the
widest variance.
It is not exceptional upon entering a nursery
in the coldest winter weather to find child,
nurse, and mother living in an atmosphere ap-
proaching the nineties, which elevation was so
gradually and imperceptibly reached that noth-
ing but thermometric proof would be convinc-
ing. While preparing for the bath the room
should be a little warmer than usual, say sev-
enty degrees or even seventy-five degrees, as
cold atmosphere or draughts coming in contact
with the surface of the little one when emerg-
ing warm and dripping from the water, may in
a few moments work deadly mischief.
The bath-tub may be made of any material
and in any shape, providing its dimensions be
ΙΟ
A DECALOGUE FOR THE NURSERY.
suitable. If portable, it may for better conven-
ience be placed upon a stand or rack from two
to three feet in height. Soft wash-cloths should
be used instead of sponges, for even with scru-
pulous care the latter are liable to become
offensive, being the remnants of animals from
which the sarcous matter has been removed
by passing them through stages of rotting
before their final cleansing. For reasons pre-
viously stated, all unnecessary toilet articles
which tend to irritate the skin should be re-
jected. No soap but the oldest castile should
be used (no matter how highly other brands.
may be commended), and that but sparingly.
The thermometer should be placed in the
water, as the hand test is not to be trusted, and
here comes in the vexed question of "What
shall be the temperature?" One naturally
shrinks from destroying the mother's fondest
picture, that of her baby, to his great delecta-
tion, kicking and splashing in his little sea of
delight; but here the law of compensation must
be enforced, and if baby has had his frolic in a
bath with the temperature at ninety, he must
endure a brisk application of the cold" cloth
A DECALOGUE FOR THE NURSERY.
I I
dipped in water at a temperature of about sixty.
This will exert a tonic effect, re-establishing
the textural tone of the skin, and thus prevent
chill and consequent trouble, which would very
likely follow were the little one, removed
reeking with warm moisture, dried and dressed
without heed being paid to this precautionary
measure, which may be termed the hardening
process. I have no heart to advocate the cold
plunge or shower-bath for delicate infants,
sometimes insisted upon by vigorous, inflexible
mothers. It seems barbarous, and the shock
thus encountered unquestionably is not only a
temporary, but often an abiding injury to the
delicate organization. The pernicious effects
of the full bath are frequently manifested by
languor, livid lips, dull expression of counte-
nance, and petulance. In such cases rapid
sponge bathing is alone admissible, and for the
matter of that, this form is preferable for the
majority. Speaking from observation and in
the light of reason, the full warm bath should
be indulged in only occasionally, say once a
week, followed always by cold sponging. As a
rule the immersion should not exceed a hip-bath,
12
A DECALOGUE FOR THE NURSERY.
OGUE
extending the application to other portions of
the body with the wash-cloth, always finishing
by a rapid, cool application (if possible before
an open fire) and speedy drying. Let there
be no dallying over the process, for therein lies
the chief danger to the child; therefore it should
be completed briskly and cheerily to avoid. any
chill; and also to secure the benefits of a health-
ful after-glow. It is already understood that, in
drying, harsh friction is to be avoided; dry soft
towels are preferable, and they should previ-
ously have been thoroughly warmed by hang-
ing before the fire. Particular care should be
taken with the ears. Let no water enter the
auricular canal, and avoid all rough rubbing or
handling of these delicate organs, for while
meagrely endowed with sentient nerves, they
are peculiarly tender in their structure, and lia-
ble to take on obstinate, subacute inflammation.
Should the child evince a proneness to catarrh
of the nose, eyes, or ears, avoid wetting the
hair at every bath, and when through necessity
the scalp has to be washed, dry the hair thor-
oughly by friction instead of leaving it to dry
by evaporation. Finally, in conformity with
A DECALOGUE FOR THE NURSERY.
13
physiological principles, the bath should not
immediately follow a full meal.
CLOTHING.
ma-
A few words concerning the manner of cloth-
ing the baby follows naturally upon the forego-
ing. Since a small body loses its caloric more
rapidly than a larger one of the same
terial, it is imperative that the little ones be
suitably, and speedily protected from atmos-
pheric influences. It must be admitted that, in
the exceptional matter of dress, women are ever
incapable of drawing logical deductions, seldom
daring to adopt an independent course of action.
The endeavors of one opposing the caprices of
fashion are notoriously futile, rarely accomplish-
ing any sensible amendment. So, then, each
mother will dress her child in accordance with
the custom of the time, despite all appeals to
her better judgment.
As anything we might commend in the way
of infant wearing apparel would probably be
tabooed by fashionable mothers, we will bow
with what grace we may to the powers that be,
and offer only a few suggestions that can hardly
14
A DECALOGUE FOR THE NURSERY.
arouse opposition in any quarter. In the first
place reason would suggest tha. simplicity,
ready adjustment, and comfort are the essentials
in the raiment of children. The articles worn
should be as few in number as possible, and
soft and pliable as a kitten's fur. Nothing is
more incongruous, or can be more exasperating
to the little ones, and to all with whom they
come in contact, than harsh or stiffly starched
clothing. How often we see a child made per-
fectly wretched by a stifly starched cap-string
so adjusted that the natural movements of the
head are prevented. For the underwear of chil-
dren all-wool fabrics should be selected on ac-
count of their low conductile properties. Gar-
ments made of this material do not allow the
animal heat to escape readily and, likewise, to a
proportionate degree exclude untempered at-
mospheric influences. In cool weather it is of
paramount importance to the child's safety that
the extremities be well clad and kept warm;
this accomplished the trunk will seldom suffer.
It is not, however, the matter of protection
to which I desire to call attention, so much as
to the over-burdening with covering, from which
A DECALOGUE FOR THE NURSERY.
15
I am confident that infants suffer far more often
than from the opposite extreme. Mothers
should realize that the little one repeatedly
forced to swelter under too heavy clothing by
day or night, is constantly in danger of chill
from the slightest exposure, and the practice is
extremely enervating, being also the cause of
persistent catarrhal affections. Moreover, like
their elders, the little ones feel the approach of
summer, and are entitled to a similar timely
modification of clothing. A child whose cov-
ering is too heavy at night will, if possible, kick
it off, in this way exposing itself to a chill. All
this is so simple that it seems superfluous to
dwell upon it, but we are impelled by the re-
peated evidences encountered, showing abun-
dant reason for directing the attention of the
indifferent as well as the over-cautious mothers,
to the observance of these commonplace mat-
ters, which, after all, contribute directly to the
happiness of the household.
CHAPTER II.
BODILY POSTURE.
In studying the movements of young children
we cannot fail to observe that they possess un-
mistakable preferences for certain bodily atti-
tudes. When their wishes in this particular
are complied with, and their little bodies rightly
adjusted, contentment reigns, but should their
pantomimic appeals be disregarded or misun-
derstood, or their individual efforts restrained
and an undesired position thrust upon them, an
expression of proper resentment is not wanting.
This is a matter calling for intervention, since,
as a rule, there exists a direct contradiction be-
tween the conception of the adult as to what
constitutes the proper mode of reclining, and
baby's predilections. The nurse or mother
probably lies on her back, and sits in a half-
reclining position, but the little ones resent both
these attitudes, choosing to lie prone or semi-
prone, or if sitting, to be erect or slightly tilted
A DECALOGUE FOR The nursery.
17
forward; hence a contention is usually carried
on, until through superior strength, and dint of
persistence, infants are trained to conform their
ways to the controlling power.
Fortunate would it be for the children could
opinionated adults be led to intelligently study
these early natural expressions. The habit of
enforcing upon the young, by virtue of physical
superiority, our personal preconceptions of what
is a suitable position is too often a grievous in-
jury to them.
Let us turn to facts in nature for a settle-
ment of this question. If we compare the re-
clining position, voluntarily assumed by young
children, with that of the domestic animals, we
will find that in most respects they correspond.
If we search for an explanation of this, we will
find it plainly shown in the study of comparative
anatomy. In the first place, it should be under-
stood that there is a natural upper and lower
portion of every organ and gland within the
body, as unmistakably indicated as in the fruit
growing upon the tree. As the cranium mani-
festly indicates the crowning part of the erect
body, so does the relative position of the spinal
2
18
A DECALOGUE FOR THE NURSERY.
column, designate the superior portion of the
reclining body. The spinal cord (a prolonga-
tion of the brain), extends along the centre of the
backbone, sending forth many nerve-branches
to all parts. From the numerous processes of
the spinal column, the principal muscles of the
trunk diverge, while along its anterior surface
extend the great thoracic blood-vessels, in front
of which lie the heart, liver, spleen, kidneys,
viscera, etc., each and every one attached along
the mesian line of the dorsum in such a manner
that with the trunk prone, they are freely and
properly disposed as an apple hanging on its
stem. Examination of the surface of the body
shows the back rigid, abounding in bony prom-
inences, for the attachment of the many powerful
muscles, but we find here a very meagre supply
of fat. On the other hand, the anterior surface
is rounded, highly elastic, affording no attach-
ment to organs internally, while externally it is
spread with an abundant layer of fat which
forms an admirable cushion, and non-conductor
of dampness, and cold, upon which the body
may rest.
We now begin to perceive the physiological
A DECALOGUE FOR THE NURSERY.
19
principle that prompts children to lie prone,
and to rebel against supineness. In the first
position the organs and textures are suspended,
and disposed, in a manner favorable to the ful-
filment of their respective functions, while in
the other confusion prevails, the organs, falling
a dead weight upon their attachments, rest in-
verted upon blood-vessels, nerves, and other
textures that should be free from compression.
Hence, while lying upon the back normal secre-
tion is perverted, and free circulation of the
blood impeded.
We are so accustomed to seeing the quad-
rupeds reclining prone or semi-prone, that we
would regard with surprise and solicitude the
reverse posture, and yet reasoning from anal-
ogy, to lie upon the back, is scarcely more un-
natural in them, than in human beings, for com-
parative anatomy shows a striking similarity of
conformation, and distribution in corresponding
structures and blood-vessels in each.
muscle, artery, vein, and gland common to one
finds its analogue in the other.
Bone,
Intimately associated with this phenomenon
is another, of which the observer of child life
20
A DECALOGUE FOR THE NURSERY.
must take cognizance; that is, the inborn ne-
cessity for frequent shifting of position. After
remaining motionless for a time, the young
child makes known its strong desire to be
moved, and should the attendant comply, and
turn the little body to the other side, it is con-
tent and will probably resume its slumber.
The recognition of this physiological principle,
which makes motion an absolute necessity, no
doubt underlies the creation of the cradle and
similar oscillating contrivances.
This necessity for movement is common
throughout the animal kingdom. Everyone
knows that prolonged inactivity causes at first
a sensation of weariness that soon merges into
irksomeness, and finally positive distress, un-
less the position be changed. The rationale
of this lies in the law of hypostasis, for the
fluids within the body (as those without) grav-
itate and seek the lowest parts, and this sur-
plus of blood soon arouses sensations of dis-
comfort, that demand relief in change.
!
This gravitatory process, which constantly
pervades the entire body, may be readily demon-
strated by allowing the hand to hang motion
A DECALOGUE FOR THE NURSERY.
21
less below the heart's level, and watch the
increased distention of the surface veins, as
well as the deepened hue of the textures, while
the sensation is one of fulness and increasing
unpleasantness. Now elevate the hand, and
note how quickly the swelling of the veins dis-
appears, the tissues blanch, and a sense of
relief is experienced. The opinion generally
obtains, that the heart's action supplies all need
ful propulsion for complete circulation of the
blood, but this is far from correct. Indeed, at
first thought it appears that nature has made
very unequal provision for the vascular system,
for on one side we have the direct vis a tergo
afforded by the powerful cardiac muscle, while
on the other it seems that the current is not
only denied all impelling force, but to the diffi-
culties that beset the return of the blood to the
heart and lungs, are superadded the influences
of gravitation.
In order to properly acquaint ourselves with
the workings of the vascular system, let us for
convenience commence at any suitable point
and intercept by a free incision, a current of
blood on its way to the tissues. Immediately
22
A DECALOGUE FOR THE NURSERY.
upon the severing of the canal, a flow of bright
crimson fluid appears in jets, which may spurt
quite a distance, the interruptions being syn-
chronous with the heart-beats. Analyzing this
fluid we find it rich in oxygen and the product
of freshly assimilated food, chemically prepared
into material suitable for repairing, and up-
building, the tissues toward which it is being
transported. If we seize the end of the sev-
ered tube and pull a little we shall find it quite
elastic and tough, while a closer examination
shows its walls to be made up of several layers.
of muscular and fibrous tissue.
This, then, is what we find by severing an
artery. Suppose now we follow the course of
one of these active blood-carriers. Soon the
main channel diverges into two; farther on
these divisions subdivide, growing smaller, and
smaller, as the branches multiply, until the re-
mote destination is reached, when all are lost
in a meshwork of ultimate subdivisions called
capillaries. These are very delicate tubes, with
membranous walls of such fine texture as to
favor the passage of liquids through their own
substance, to the tissues lying in the inter-
A DECALOGUE FOR THE NURSERY.
23
spaces and surrounding these minute ramifica-
tions.
As the volume of blood pushes its way
through this broad area of tiny tubes, the fric-
tion being relatively greater, the movement is
proportionately slower, and the heart-throbs be-
coming less and less perceptible, are finally lost
in the capillaries. It is at this ultimate point
of division that the tissues receive their food-
supply, and give up the waste matter resulting
from their wear and tear.
Instead of being lost, like the terminal
branches of a tree, these little blood-vessels
anastomose, or continue on into a set of similar
delicate blood channels, which converge in
their course, growing larger and larger as their
branches conjoin. If now we sever one of
these blood-carriers corresponding in size to
the one previously divided on the active side,
we shall witness an entirely different result.
Instead of the bright and interrupted flow, we
shall have a sluggish, continuous stream of
dark or purplish red fluid, that reveals tissue
débris, and a myriad of broken-down, effete
cells. This is blood on its way back to the
24
A DECALOGUE FOR THE NURSERY.
great central organ of revitalization, the lungs.
The passivity of the flow makes it apparent
that there is no impelling force. If, however,
the muscles of the limbs through which the
severed vessel passes be exercised, that is, made
to relax and contract, the flow is greatly quick-
ened, and if the motions be vigorous the
stream increases in rapidity correspondingly.
We have now progressed another step in
the important lesson suggested by baby's in-
sistence to be moved, for we have learned that
while the function of the arteries is presided
over by the powerful cardiac muscle, which like
a force-pump impels the blood into the tis-
sues, all the muscles of the body, by their
movements, aid in the performance of the func-
tion of the veins, and thus force the column of
blood toward the heart; for we should explain
that the veins are supplied with valves, at-
tached along the inner wall like little pouches,
with their mouths looking heartward, conse-
quently the volume of venous blood can move
in only the one direction.
Not only does muscular activity quicken the
return of the venous blood, but it squeezes the
A DECALOGUE FOR THE NURSERY.
25
effete elements out of the tissues, forcing their
departure, and hastening them on their way to
final elimination. It is apparent that prolonged
quietude must result in the engorgement of
the capillaries, as the heart incessantly forces
the blood into the tissues, which become sur-
charged with blood and noxious matter, conse-
quently the nerves telegraph the necessities of
the situation, and the senses afford a temporary
relief by impelling the muscles to exert them-
selves. If the body is horizontal, the return of
the blood is not greatly impeded, and therefore
an occasional turning of the body is sufficient.
In the erect position, however, greater and
more continuous muscular activity is demanded,
hence a healthy baby kicks and wriggles inces-
santly, thus fulfilling Nature's laws. Under the
same principle, standing or sitting motionless
can (at any stage of life) be endured but for a
brief time. A little reflection in this connection
will lead us to perceive the Divine wisdom
which makes bodily activity incumbent upon
all animal life; compliance therewith securing
physical and mental well-being, while neglect
entails the opposite condition.
26
A DECALOGUE FOR THE NURSERY.
Much more might profitably be advanced by
showing that the neglect of exercise engenders
disease through the collection of noxious matter,
and on the other hand, that activity not only
averts this evil, but secures a nobler develop-
ment, made possible through a more perfect
assimilation.
We have, then, ample proof that the prefer-
ence for proneness, evinced by the young, is a
compliance with the natural laws or require-
ments of a healthy body, therefore the appeals
for frequent change of position are as purely
physiological as expressions of hunger.
Now it is highly important that we make
practical application of our knowledge concern-
ing these physiological influences, when deal-
ing with pathological conditions, for be it under-
stood that statical influences forever at work
within the body, are infinitely more potent for
good or ill, when associated with diseased tex-
tures. Everyone who has experienced the in-
crease of suffering caused by holding an aching
head below the heart's level, or who has allowed
a diseased foot or hand to hang, can appreciate,
in a measure, the importance of taking into ac-
A DECALOGUE FOR THE NURSERY.
27
count the influence of posture when dealing with
diseased textures.
With these thoughts fresh in our minds let
us contemplate a picture, unfortunately familiar
to everyone.
An infant afflicted with cerebral or spinal ir-
ritation, stretched upon its back, the sick head
rolling from side to side, which not uncommonly
hangs over the lap upon which the body rests.
The pinched, drawn features, open mouth,
partially exposed, upturned eyeballs, cold ex-
tremities, clinched thumb, etc., each and all in-
dicate congestion at the base of the brain. The
feet, legs, hands, and face are cold, but slip the
hand beneath the restless head, or along the
spine, and these parts will be found swelter-
ing in heat. In this position the little body
is retained, hour after hour-the hyperæmic
nerve-centres occupying the most dependent
position, suffer greater congestion through grav-
itatory influences, and the irritated textures of
the spine and base of brain, are afflicted still
more deeply by the pent-up bodily heat pro-
duced by the enforced position of supineness
upon a heated pillow, or across the warm lap.
28
A DECALOGUE for the NURSERY.
Moreover, as heretofore explained, in this po-
sition the visceral organs are inverted, and in-
stead of hanging free upon their attachments,
fall a dead weight upon sub-adjacent blood-ves-
sels, obstructing the circulation. It goes with-
out saying that all this evil would be alleviated
by simply turning the body prone, and as any
mother can testify, the little ones, if able, will
express in their own way, appreciation of the re-
lief thus afforded. Furthermore, in the normal
(prone) posture, the surface over the diseased
tissues is readily accessible, and the suffering
may be greatly assuaged, by bathing with tepid
water, and by gentle passes of the hand, so
that in a little while instead of tingling, swelter-
ing heat, coolness and comfort are secured; the
incessant moanings and oscillations of the head
cease, and the restless body is soothed into
slumber.
There is another thought must not be over-
looked in this connection. We have already
perceived that free circulation is indispensable
to elimination of noxious matter from the sys-
tem, as well as for the healthful assimilation of
nutriment ingested. When the volume and
A DECALOGUE FOR THE NURSERY.
29
quality of the blood have been deteriorated
through pathological influences, the life current
moves erratically; while it is accelerated in
some parts, in others it may be sluggish, this
condition being more especially marked in
tissues remote from the centre of circulation.
The evidences of deficient capillary activity
are always unmistakable; loss of animal heat,
lividness or pallor, clamminess of the skin, etc.,
being the most prominent. For the relief of
this condition I know of nothing more effective
than the application of the hands of a strong
healthy person. Grasp the little limbs, and
gently squeeze them, working from below up-
ward, for the twofold purpose of dislodging
effete cell products, and vitiated blood, and for
the restoration of animal heat.
This massage
should be exerted gently, yet methodically and
thoroughly, each time holding the feet and
hands until a glow and warmth supersedes the
damp and chill of stagnation. No artificial
heat-supplying apparatus will successfully sub-
stitute the manipulation of a healthy vigorous
hand, for in this manipulating process, there
is doubtless not only the benefit of textural
!
1
30
A DECALOgue for tHE NURSERY.
quickening, but a direct transmission of vital
fluid, or animal electricity. No more efficient
health-restoring process can be practised, than
the one just commended. When all else proves
unavailing, its faithful and intelligent applica-
tion will ofttimes restore the equilibrium of
unbalanced vital tissues, and re-establish the
feeble life that trembles on the verge of disso-
lution. So deep and far-reaching is the signifi-
cance of this question, that it is difficult to con-
fine our remarks to a space so restricted, since
there arise before us many allied conditions:
however, if the cardinal points are rightly com-
prehended, the reflective mind will hardly fail
to extend the matter to its greater applicability.
CHAPTER III.
INFANT DIET.
THE question of food selection and digestion
is of such prime importance in the management
of young children, that it is doubtful if any
other has received more attention at the hands
of physicians. It is a problem by no means
easy of solution, so complicated is it with
manifold contingencies similar in complexion,
but widely divergent in true significance.
Whenever the physical vigor of a child is
impaired from an apparent defect in the nu-
trient processes, the cause is almost invariably
attributed to the quality of the food partaken—
a very natural deduction, but one far from be-
ing uniformly correct; for closer inspection
will frequently discover the origin to be some
fault of the digestive apparatus, or of some
other constitutional defect, instead of faultiness
with the ingesta.
32
A DECALOGUE FOR THE Nursery.
This point is of the greatest importance, and
one to be borne earnestly in mind, since neg-
lect of it is liable to work irremediable mischief,
and cases primarily amenable to the applica-
tion of suitable measures, are merged into hope-
less conditions. We desire, therefore, to em-
phasize this feature at the outset, because of
the prevailing disposition to expend all thought
and effort upon the selection of food to the neg-
lect of other essentials more deeply affecting
the root of the matter.
To enable the reader to interpret from a
rational standpoint, the numerous phases pre-
sented, it is necessary to refer briefly to the
chief mechanical and chemical appliances, for
the fulfilment of the process of alimentation,
within the human economy, for it is impossible
to speak intelligently of infant dietetics without
a previous knowledge of the working of the in-
tricate machinery employed by nature in the
metamorphosis of food into pabulum fit for the
upbuilding of these delicately organized beings.
In the first place, let us consider the extent
and conformation of the digestive apparatus.
Beginning at the lips it extends throughout the
A DECALOgue for THE NURSery.
33
entire length of the alimentary canal, and if its
convolutions were unfolded, would equal six
times the length of the entire body. It is lined
with mucous membrane exceeding in extent that
of the skin covering the body. This membrane
is richly supplied with minute glands, both for
the absorption of pabulum when properly emul-
sified, and the throwing out of chemical juices
which attack, break down, and digest the food.
In the beginning, then, we point to the fact that
this extensive mucous tract abounding in com-
plex gland-structure, affords a most favorable
field for the origin and development of dis-
ease.
Various constrictions and expansions divide
the alimentary canal into several divisions or
cavities, each one of which performs a separate
office.
It is not desirable, in this essay, to attempt
a detailed enumeration of all the minutiae of this
intricate apparatus; therefore we will briefly
scan the principal features that are necessary
to a practical understanding of our subject.
We begin by noting the physiological pecu-
liarities of the mouth. The intestinal
organs of
3
34
A DECALOGUE FOR THE NURSERY.
an infant are as incomplete in their develop-
ment as the more visible textures, and like these
tangible structures, the hidden ones are con-
stantly undergoing changes, in their progres-
sion toward maturity.
There are numerous glands in the infant
body that remain latent; until the allotted pe-
riod of awakening; as for instance, the lach-
rymal glands may afford no tears until several
weeks have passed, and so with the eyes, which
may be bright and staring, yet the sense of
sight does not immediately appear. Were it
relevant to our subject, we could cite numerous
illustrations of this provident law (gradual de-
velopment) which continues throughout adoles-
cence. In the development of the mouth is
found a notable exemplification of this physi-
ological principle. During the earlier months
the mouth is a passive organ and has scarcely
more to do with digestion than the hand; is, in
fact, simply a means of conveyance. At the
end of the first three or four months, there ap-
pear unmistakable evidences of a change in the
secretions, and baby is said to drool, and we
shall now show that this phenomenon marks an
A DECALOGUE FOR THE NURSERY.
35
important epoch in the growth of the digestive
process. This increase in the saliva follows
the functional awakening of three pairs of
glands (parotid, sub-maxillary, and sub-lingual)
which hitherto have lain dormant, but now
pour forth a transparent viscid secretion, giv-
ing an alkaline reaction, and possessing the
power of converting starchy matter into glu-
cose, thereby reducing it to a state fit for as-
similation, for without being first changed into
glucose or sugar, starchy or farinaceous matter
cannot enter the system through the lacteal
absorbents, but must traverse the alimentary
canal, unchanged save by maceration and fer-
mentation, in which condition it would consti-
tute a pernicious element and give rise to
severe and painful intestinal irritation.
The fact that nature's food for infants con-
tains not a trace of starch, taken in connection
with the absence of the secretion necessary for
its assimilation, is, to those who reason, suf-
ficient evidence of its unsuitableness during
this early period. On the other hand, subse-
quent to the flow of saliva, an addition of
properly prepared starchy matter is often de-
36
A DECALOGUE FOR THE NURSERY.
manded for the better fulfilment of physical re-
quirements.
It is certain that about this time the bone-for-
mative process is greatly accelerated,-(made
evident in dentition,) and the flow of saliva
reveals nature's care for the wants of the sys-
tem, for thereby is made possible the addition
to the regimen, of ingredients rich in bone
food, in the form of cerealia, which, to meet the
wants of the system, must be prepared from
the whole grain, and not from the finer product
merely, which is deficient in phosphates.
Should it be deemed advisable at this time to
give broths, let them be made from bones and
joints, rather than from choice bits of muscle,
for the reason that bones and cartilage are
richer in phosphates.
We next consider the stomach and its func-
tion. The contour of the infant stomach dif-
fers from that of the same organ in the adult.
Owing to the greater relative size of the liver
in early life, the stomach is pushed consider-
ably beyond the mesian line, toward the left.
It rests obliquely, with the inlet at its cardiac
portion and the outlet at the right or hepatic
A DECALOGUE FOR THE NURSERY.
37
portion, and for this reason, a child will, after a
full meal, rest and digest its food better if
placed on its right side.
In early life the stomach is less pouched, and
more tubular in form than in the adult, which
conformation renders vomiting quite easy, be-
ing little more than simple regurgitation, a most
beneficent provision of nature, as it constitutes
a safeguard by which the little ones escape the
penalties of ill-regulated over-feeding. They
would indeed be in a pitiable plight if the su-
perfluous food crowded into the stomach could
not be thus easily ejected.
If the inner surface of the stomach be exam-
ined with a lens it will be found to exhibit a re-
markable cribriform appearance, the tiny crypts
being the orifices of glands which lie in great
numbers imbedded in the mucous wall, from
which oozes a thin acid fluid called gastric juice,
the acidity of which is due to the presence of free
hydrochloric acid. In addition to this, the gas-
tric juice contains a small proportion of an es-
sential ingredient called pepsin, which substance
plays in the digestion of milk, meat, and other
albuminous products a corresponding part to
38
A DECALOGUE FOR THE NURSERY.
that of ptyalin in the saliva, in the assimilation
of starchy matter.
So then the special function of the stomach
is determined by the properties of the juice it
secretes, which has the power of dissolving pro-
teids (albumen) and converting them into pep-
tone, a product that readily passes through
those membranes that separate the contents of
the intestine from the vital fluids. The action
of gastric juice may be demonstrated by placing
the white of an egg in a bladder, and suspending
it in water; we find in time that no interchange is
taking place between the contents of the bladder
and the surrounding liquid. Now place in the
bladder with the albumen, a proper quantity of
pure gastric juice, and immediately there is a
change, or a process termed osmosis is set up,
that is, the contents of the bladder pass through
the membrane, and mingle with the water.
Furthermore, after the white of eggs, or any
proteid, has been changed to peptone by the
action of gastric juice, coagulation is not effected
by heat.
The part performed by the stomach in assim-
ilation, is definitely limited to the digestion of
A DECALOGUE FOR THE NURSERY.
39
albuminous compounds, and does not include
fats or starch. On the other hand the digestion
of starch, which has been only partial in the
mouth, is, at once arrested in the stomach, and
not resumed until it escapes thence and mingles
with the alkaline secretion of the pancreas, a
gland we are about to consider.
We have now learned the following impor-
tant principles connected with the nutrition of
the body, viz.: Proteids, (casein, meat, white
of eggs, etc.) are fitted for absorption by the
action of the gastric juice, which is secreted
from earliest infancy. Amyloids (starch, dex-
trin, and farinacea) are acted upon only by the
saliva, which is not secreted until the child is
several months old.
It is well for humanity that digestion is not
restricted to the mouth and stomach. If starchy
food was slowly and thoroughly masticated,
and remained in the mouth a sufficient length
of time, it might enter the stomach in the form
of glucose ready for absorption, but food is sel
dom retained in the mouth long enough to per-
mit the organ to exert its digestive function to
its full capacity. This contingency has been
40
A DECALOGUE FOR THE NURSERY.
anticipated and provided for by nature, in a
large racemose gland, situated immediately
beneath the stomach, and which pours its se-
cretion into the intestinal canal, just below its
junction with this organ. This is the pancreas,
in the lower animals called the "sweetbread,
and so closely does its function resemble that
of the salivary glands, that it is sometimes des-
ignated "the salivary gland of the abdomen."
The pancreatic fluid, like the saliva, is alka-
line, and besides being greater in quantity, has
stronger digestive power; furthermore, its ac-
tion is not restricted to amyloids, but includes
proteids, so that fortunately it possesses the
double capacity of completing the work begun
by both salivary and gastric glands.
It has been suggested that the secretion of
the pancreas begins as early as that of the
stomach, which theory, if tenable, would justify
the use of starchy food from the beginning, but
recent physiological experiments have demon-
strated that the function of the pancreas is es-
tablished even a trifle later than that of the
glands of the mouth.
The researches of the physiologist Korowin,
A DECALOGUE FOR THE NURSERY.
4I
of Russia, has placed the question beyond
controversy.
At the same point where the intestinal wall
is pierced by the pancreatic duct, the bile-duct
enters. Without discussing the minute anat-
omy of the liver, we will state that it fulfils the
office of a vast percolator for the blood, and
that the peculiar extract thus supplied (the bile)
is used in the emulsifying of fat-globules, that
is, the breaking down and ultimate division of
fat-globules into particles sufficiently minute to
secure their transudation into the system. Bile
is also said to prevent fermentation, and to
maintain solvency of the fæces.
It is a
Having thus briefly surveyed the chief char-
acteristics of the infantile digestive apparatus,
let us now turn to the selection and best man-
ner of administering the food.
It is a foregone
conclusion that the best diet for an infant is
that which nature supplies from the human
breast, but numerous exigencies may occur to
render an artificial substitute the only alterna-
tive.
Before taking up the subject of artificial feed-
ing, we will give a passing thought to the
42
A DECALOGUE FOR THE NURSERY.
natural method, for it is by no means ex-
ceptional to find in the matter of nursing, the
most favorable conditions perverted through
pernicious customs. Unquestionably the young
child's greatest misfortune lies in the over-so-
licitude of the mother regarding bounty in
feeding. The thriving of her nursling is her
greatest delight; hence the short-sighted be-
lief that the amount of food ingested secures
corresponding corporal growth, underlies her
'assiduous endeavor to guard against even mo-
mentary hunger, and, to the infant's disaster, it
is crammed day and night. Should the over-
worked stomach show resentment, and plead for
a respite by ejecting an unwelcome amount, the
imprudent mother, instead of heeding nature's
protest, hastens to make good the loss by forc-
ing a fresh supply into the much-abused organ.
It is not surprising that these victims of misdi-
rected kindness, sooner or later, develop the
baleful consequences thereof-suffer the tort-
ures of dyspepsia, and intestinal affections, and
while surfeited with plenty, actually perish from
inanition.
The fact cannot be too strongly accentuated,
A DECALOGUE FOR THE NURSERY.
43
that the reward for the needless labor, and over-
watchfulness, with which parents so commonly
afflict themselves, quite often appears in the
form of puny irritable children whose sufferings
are perpetuated by the very means employed
for their alleviation. The injudicious ways of
parents are nowhere more clearly shown, than
in the hurtful habit of night-feeding. The
world is filled to-day with invalided peevish
children, and broken-down disheartened moth-
ers, made so by this mischief-working habit.
That this will be discredited and met with
manifold objections I am fully aware, but never-
theless it is no random statement, but a verita-
ble fact, supported by long and varied practi-
cal observation.
The digestive organs, in common with the
brain and other parts of the body, require pe-
riods of rest, and when this requirement is dis-
regarded, and incessant activity thrust upon
them, the penalty is sure and severe. The
plea always advanced in behalf of tender age
is puerile, as a moment's reflection will show.
The power of habit is proverbial, but nowhere
is it more strongly displayed than in matters
44
A DECALOGUE FOR THE NURSERY.
pertaining to the sleep of children. We rarely
find a child who has not some peculiar charm
by which sleep is wooed. It may be the cor-
ner of an old blanket, a dilapidated toy which
the little fingers grasp tightly, or, what is too
common, a repulsive rubber nipple between the
lips. Let the fondling be never so absurd, it
constitutes a magical bond which, if severed
banishes sleep, and for the time fills the young
heart with inconsolable grief. Of course the
lamentation associated with hunger is most
distressing for the mother to hear, but is in
reality of no more serious moment to the child
than the thwarting of any caprice, providing it is
only a matter of a few hours' abstinence. We
grant that the sense of hunger, intensified by
excitement and temper, is unquestionably a
genuine misery, but it is only temporary and
harmless, while the ultimate benefits secured
are incalculable. In truth infants are amenable
to influences applicable to persons of riper
years. The adult, accustomed to a midnight
lunch, will waken promptly at the usual hour
expectant, and when the sensations of hunger
which have aroused him are unappeased, they
A DECALOGUE FOR THE NURSERY.
45
are not easily endured. When, however, these
cravings are resolutely denied, their poignancy
gradually diminishes with each successive re-
currence, until they finally cease to return.
In like manner,-despite the whimsical no-
tions of opinionated nurses and over-anxious
mothers, the same principle applied to the very
earliest childhood, is absolutely safe, appropri-
ate and successful. It would be fortunate, in-
deed, for all interested, were women governed
less by their impulses and sympathy, and were
more willing to give heed to the precepts sus-
tained by logical deductions. The physician
may present his philosophy (the outgrowth of
years of study and observation) in the most
painstaking manner, and he will probably be
listened to complacently with silent though ill-
concealed dissent, or, what is more common,
his most cogent arguments will be promptly
set aside by the exultant citation of one or more
exceptional cases which to the frivolous disput-
ant seems enough to controvert all formulated
views. The fact that such and such a child,
by virtue of superior physical endowment, has
escaped the evils of mismanagement, does not
46
A DECALOGUE FOR THE NURSERY.
cancel the truth that similar ill-treatment has
blighted a legion of tender lives, and brought
misery to many more who barely struggled
through the needless suffering thrust upon
them. So then to the mother who flippantly
declares that she has always fed her child day
and night, untrammelled by any logical method,
and that without encountering evil consequen-
ces, we have only to say, "You have been ex-
ceptionally fortunate in escaping the retribution
suffered by the majority essaying a similar
course.
"
Notwithstanding popular customs and doc-
trines to the contrary, we reassert that the
young mother may with perfect safety inaugu-
rate her infant's life with total abstinence from
all food during the night, thus sparing herself
untold trouble and pain in the future, and se-
curing for her nursling the benefits which un-
broken slumber affords, and more than all,
comparative immunity from dyspepsia. Dur-
ing the day, let stated periods be established
and strictly adhered to, and it is well that the
intervals be reasonably long. An infant will
thrive as well or even better when fed every
A DECALOGUE FOR THE NURSERY.
47
three or four hours regularly, than if fed more
frequently.
Besides the benefit thereby conferred upon
the child, is the advantage such a system
secures the mother, according her liberty for
the performance of any other duties she may
have. Let the mother bear in mind, that the
noisy demonstrations of her baby are by no
means a sure indication that food is required,
for the little creature may manifest all the
symptoms of hunger, while suffering from gas-
tric irritation due to recent over-feeding. Like-
wise when the food is ejected, it is folly to im-
mediately set about making good its loss by
refeeding, since the stomach has made known
in the plainest way that the task imposed upon
it is for the time too heavy, and it seeks a
respite. Let this motto be engraved upon the
lintel of every nursery: "For each child that
famishes, a thousand suffer from repletion."
We return now to a consideration of the
welfare of those unfortunates who are denied
their natural rights, whose existence is only
made possible through some artificial substi-
tute.
48
A DECALOGUE FOR THE NURSERY.
Probably no other subject in the realm of
medicine deserves more earnest thought than
the one now before us, and one may justly add,
probably none other has been more shabbily
treated. This may seem a most unwarranta-
ble statement in the face of the vast array of
artificial foods and sucking-bottles, that glut
the market, but it is in these manifold devices
is found the strongest justification for the al-
leged assertion.
Granting the nursing-bottle to be the crea-
tion of a benevolent endeavor to approach as
near as possible to nature's methods, its aim
has wofully miscarried, for beyond contradic-
tion its use has entailed untold misery, and
strewn the earth with numberless little graves.
If every form of sucking-bottle could be for-
ever banished from among nursery appurte
nances, and cast into the depths of the sea, it
would confer the greatest possible boon upon
coming generations.
About ten years ago I called the attention of
the profession to the fact that the white rubber
material used for the nipples of the nursing-
bottle, contained carbonate of lead in sufficient
A DECALOGUE FOR THE NURSERY.
49
quantity to poison the system, and in some
instances to develop the familiar toxic symp-
toms. This wrong was easily disposed of by
the substitution of pure black rubber. At that
time I regarded the bottle as a necessary evil,
but the detection of one noxious element led
to the discovery of so many, that taken as a
whole it showed itself such an execrable nui-
sance that for years I have opposed its use un-
qualifiedly, and when the faithful co-operation
of mothers has been secured the results have
invariably proved highly satisfactory.
It is in the faulty manner of using that the
greatest danger is found, and so long as the
average nurse or mother holds her personal
comfort of paramount importance, just so long
will it be impossible to permit with safety the
use of the present style of nursing-bottle.
Probably everyone is familiar with the sight of
a child dozing in its carriage or crib, with the
nipple of its constant companion-the bottle-
between its lips, from which it sucks automat-
ically. Not infrequently the bottle is empty,
and then the child imbibes only vitiated air.
It is quite usual for those having the care
4
50
A DECALOGUE FOR THE NURSERY.
of bottle-fed babies, to stifle all frettings by
thrusting the vile nipple of the empty or par-
tially empty bottle, into the mouth of the help-
less unfortunate. Thus from the force of an
odious habit do nurslings become so strongly
wedded to this detestable device, that its con-
stant presence seems indispensable even to the
securing of sleep, while any attempt at removal
breaks the fitful slumber. Is it any wonder
that the effects of this practice are manifested
sooner or later in the waxy complexion, blood-
less ears and lips, heavy eyes, with blue mar-
gins, and fitful sleep, while the capricious ap-
petite, frequent ejections, and other intestinal
disturbances, combine to complete the doleful
picture of a "sucking-bottle dyspeptic."
I will not say that there are never extenu-
ating conditions which may render the use of
the nursing-bottle excusable, although I have
never met such except where a child already
strongly attached to its use is suffering from
some serious illness, in which dilemma we must
hedge with discretion until a more favorable time
for reform. I will also concede that with a
properly constructed bottle, and scrupulous care
A DECALOGUE FOR THE NURSERY.
51
exercised in the matter of cleanliness, its use
may be in a measure unobjectionable.
APPROVED FORM OF NURSING-BOTTLE.
The bottle should be constructed as follows:
Oval in form, with the base on one side; two
apertures, one for filling on the upper side, and
the other at the end for the attachment of the
nipple. No rubber should be in use except
the nipple, which is of pure desulphuretted rub
ber. The neck of the flask is so formed that
the nipple is easily adjusted and detached. In
the stopper, which closes the larger opening on
the side, let there be a small vent-hole for the
admission of air. A bottle thus constructed ne-
cessitates its being held in the hand of the nurse,
who is obliged to place her finger over the vent-
hole to regulate the admission of air and out-
flow of milk. As soon as the meal is finished,
the residue (if any) is thrown away, the nipple
and side stopper detached, everything rinsed
thoroughly in hot water, and placed in a dish
of cold water until next required. Unless every
above condition be faithfully complied with, we
should rigidly enforce the entire abandonment
52
A DECALOGUE FOR THE NURSERY.
of the bottle in every form, which is always the
wiser course.
TEACHING INFANTS TO DRINK.
Whenever an infant is to be nourished by
alien food, it should be taught at once to feed di-
rectly from a spoon or cup, and it is gratifying
to note with what readiness the little creature
will conform to this method, which is, in fact, as
readily established as the objectionable one of
bottle-feeding, and in the maintenance of health
its advantages are beyond comparison.
When the bottle is used a vigorous child will
almost inevitably continue feeding beyond act
ual requirement, providing the allowance is not
exhausted, and this habitual overloading of the
stomach sooner or later develops gastric affec-
tions. Moreover, the earlier symptoms of gas-
tro-intestinal irritation quite commonly simulate
hunger, consequently the mischief is aggravated
by a more frequent recourse to the bottle.
The facts are so obvious that an extended
explanation of the manner in which the custom
of feeding from a spoon or open cup averts the
evils engendered by bottle-feeding is unneces-
A DECALOGUE FOR THE NURsery.
53
sary. Those predisposed to question the fea-
sibility of this expedient will have their doubts
I am
speedily dispelled by a faithful trial.
aware that certain eminent authorities hold the
theory that the mechanical process of sucking
involves a physiological principle in the matter
of exciting a freer flow of saliva etc.; but while
the assumption seems plausible enough, a closer
examination reveals its weakness, for at the
time when the bottle seems most necessary the
salivary glands are inoperative; besides, natural
conditions show that the process of suction can
be as safely dispensed with in childhood as in
later life.
ARTIFICIAL FOOD.
We come now to the selection of food for
infants. The standard by which all artificial
products are gauged, is supplied by analysis of
breast milk. So simple is the combination of
the natural supply, that casually its imitation
seems to be within the easy reach of chemis-
try, consequently many have essayed to com-
pound an article the virtues of which should
vie with those of the natural food.
54
A DECALOGUE FOR THE NURSERY.
We need not undertake a review of the
many brands of infant food manufactured, for
such a task would hardly prove advantageous.
We are fully justified in setting aside the bulk
of colorable laudations with which these prepa-
rations are tricked out; for, notwithstanding the
fact that the ingredients employed tally closely
with those found in nature's supply, the re-
sults secured in their using are frequently
disappointing. It is certain that the most ac-
curate chemical experimentation can never pro-
duce an article more than approximately like,
for human skill has never grasped those subtle
properties which emanate only from the hidden
springs of life. It is only those deficient in
physiological knowledge, and who reason mere-
ly from the surface, who can honestly believe
they have successfully emulated nature's pre-
rogative. It is but right to admit that all cereal
foods are not to be discarded unqualifiedly, for
there arise conditions where the appropriate-
ness of some one of them will exceed that of
any other known food, as we shall have occa-
sion to explain more fully when dealing with
those conditions occurring later in childhood,
A DECALOGUE FOR THE NURSERY.
55
or about the period of dentition. In earlier
life, however, we will find it more prudent to
live closer to the heart of ever-provident nat-
ure, whose resources, if wisely apprehended,
are adequate to the supply of every ordinary
want. We may be sure that in the matter of
infant diet, as in every contingency of life, we
will find the best things lie close at hand, if we
will only perceive and contentedly appropriate
them. True, we may be called upon to make
slight modifications, but these are always sim-
ple when made in harmony with, and subser-
vient to, nature's requirements.
COW'S MILK.
Beyond question the most natural substitute
for human milk is that obtained from a healthy,
properly fed young cow. The ingredients con-
stituting cow's milk are so closely allied to
breast milk and so simple that any slight dis-
crepancy in excess, or deficiency in any of its
constituents which analysis discloses, can be
readily adjusted. To aid us in presenting this
subject more clearly, we will insert in tabulated
form the analyses of both human and cow's
56
A DECALogue foR THE NURSERY.
milk, so that the relative proportion of the
chief constituents common to each may be
seen at a glance, 1,000 being taken as the sum
total:
Water..
Milk sugar.
Casein..
Butter..
•
Lactate of soda..
Calcium phosphate
Sodium.
•
Potassium chloride...
Sodium chloride
Total....
Human milk.
900.00
56.00
I 1.00
Cow's milk.
875.00
44.00
48.00
33.00
•
32.00
00.10
00.00
00.30
00.25
00.25
00.00
00.175
00. 15
00.30
00.24
1000.125
1000.64
In the substitution of cow's for breast milk it
is necessary to add several modifying ingredi-
ents, and as every mother should act intelli-
gently in the matter, it is well to give a mo-
ment's attention to the study and balancing of
the above comparative analysis.
It will be
seen that water preponderates largely in both
fluids, that is, a thousand drops of human milk
contain nine hundred of water, while the same.
quantity of cow's milk contains only twenty-
five less; therefore to make the two equal in
water, only half a teaspoonful of this diluent
A DECALOGUE FOR THE NURSERY.
57
need be added to two ounces of cow's milk.
On looking down the columns, however, we
find a much greater discrepancy in two most
important ingredients, casein and butter.
These two elements represent the nutritive
property of the milk-the casein, or cheese-pro-
ducing element, being the part of the milk from
which curds are formed. Now it is apparent
that to make the average good between these
two ingredients, we must add a more liberal
supply of water, for should this matter be over-
looked and the cow's milk be given undiluted
to an infant, the casein precipitates and forms
into a tough curd, which greatly retards diges-
tion, is very likely to ferment and fill the diges-
tive tract with gas and an acrid acid, which
may cause severe suffering. Without entering
into definite computation, we will roughly esti-
mate that the addition of from one-fourth to
one-third the amount of water to the cow's
milk will secure a gravity approximately cor-
rect in the matter of casein and butter; but
further inspection shows that several other
ingredients (milk sugar, sodium chloride, cal-
cium phosphate, etc.) are by this dilution re-
58
A DECALOGUE FOR THE NURSERY.
duced considerably below the normal standard,
as shown in the opposite column, which must
be rectified.
It is so generally understood that casein and
butter represent the chief nutritive constitu-
ents, that one is apt to forget the fact that
there are other ingredients playing important
parts in securing all the requisites to normal
alimentation and the complete development of
all the tissues. We must bear in mind that in
a matter requiring such delicate adjustment, a
slight divergence will often work deeper injury
than we would at a glance suspect, especially
when the oft-repeated fault extends over a long
period.
Sugar performs an essential part in the trans-
formation of casein into peptones. It is an
efficient solvent, and aids in the formation of
lactic acid, thus accelerating the digestion of
casein. When milk is deficient in this ingredi-
ent, digestion is sluggish, and curds are apt to
form, the peristalsis of the intestine is lessened
and constipation favored. Furthermore, the
heat-producing power of sugar is next to that of
fat, and in its passage through the system it ulti-
A DECALOGUE FOR THE NURSERY.
59
mately serves the same purpose. By referring
to the above tables it will be seen that cow's
milk normally possesses a lesser proportion of
sugar, and by dilution this discrepancy is in-
creased, consequently we make good the de-
ficit by adding a proper amount of pure milk
sugar to the meal, graduating the quantity
as may be suggested by present indications.
Sometimes, when ordinary cane-sugar is used,
the buccal secretion becomes acrid, and gives
rise to sore mouth, which necessitates its dis-
continuance, in which case extract of malt may
be substituted for a time. When increased
laxness of the bowel is desired, use common
brown sugar, or ordinary molasses, instead of
the milk sugar.
We have next to give a moment's attention
to several inorganic constituents that appear in
both tables, viz.: salts of sodium, potassium,
calcium, etc., found, it is true, in minute quanti-
ties, but physiology teaches that the presence
of each, and everyone, is indispensable to the
proper nutrition of the animal economy, which
if deprived of anyone of them for a protract-
ed period, would inevitably suffer profoundly.
60
A DECALOGUE FOR THE NURSERY.
Although existing in such insignificant propor-
tions yet each salt fills an important and dis-
tinct office in the metamorphosis of food stuffs
into tissue material, and at the same time assists
in the elimination of effete matter from the sys-
tem. Chloride of sodium, or common table-salt
is found in every texture throughout the body,
and as it is also found in all the excreta it is
evident that this waste must be made good
through ingestion. Let us hastily trace the
action of this agent within the body. In the
first place, as soon as it enters the stomach it
undergoes a change, its decomposition giving
out hydrochloric acid (an essential in digestion),
and in addition to stimulating the gastric glands,
it attacks and dissolves the delicate albuminous.
wall that forms the milk globule, acts as a sol-
vent to all albuminous matter, and prevents the
formation of hard curds. It then passes on to
the liver, where, in the form of chloride of sodium,
it quickens the function of this great gland. In
short, salt acts everywhere in the system as an
efficient solvent, its presence holding in solution
those materials that are in a state of transition,
thereby facilitating their transudation, and se-
A DECALOGUE FOR THE NURSERY.
61
curing their diffusion throughout the body. A
marked deficiency of salt in the secretions, would
incur a blocking up of the tiny sluice-ways of
the system, the intestinal villi would become
choked so that the food pabulum could not pass
through the intestinal walls, the little streams
conveying the fresh material for building up
cell structures would run sluggishly, and the
delicate excretories become clogged with tissue
débris.
On the other hand, it must be understood that
the quantity, of salt introduced into the system
should be limited to actual requirements, for an
excess will induce an abnormal state by unduly
stimulating the excretories, and incur destruc-
tive melting down and premature casting out
of tissue matter; hence through an
through an excess
we may have exhaustive diarrhoeas, inordinate
voiding of the urine, inducing a condition of
marked general prostration. A pinch of salt
averaging in size from an apple-seed to twice
as much, added to each meal, is sufficient.
Glancing again at the analysis we perceive
that calcium phosphate (phosphate of lime) is
less in cow's milk than nature's requirement
62
A DECALOGUE FOR THE NURSERY.
for infant diet, and of course this deficiency
is increased in proportion to the amount of
diluent added. This is an exceedingly impor-
tant matter, as it seriously affects the well-being
of infants fed wholly upon cow's milk. Every-
one familiar with the rudiments of physiology
will remember that the phosphatic salts con-
tribute firmness, and strength, to the osseous
textures, and unless these be supplied to the
system in the proper manner, the bones degen-
erate and become soft, often to such a degree
as to allow the limbs to twist out of shape, pro-
ducing that distorted appearance peculiar to
rickets. Given a number of children reared on
cow's milk, and a corresponding number fed on
breast milk, it will be found that with the former
the appearance of the teeth is considerably de-
layed, a fact too significant to require comment.
Besides the delay in the appearance of the
teeth there are other characteristic indications
of a deficit in the bone-forming elements. The
child refuses to make timely efforts of locomo-
tion; the fontanelles, or open spaces in the skull,
are unnaturally slow in filling, and the flesh is
soft and unhealthy in complexion.
A DECALOGUE FOR THE NURSERY.
63
When, therefore, we have to deal with a child
who, without other evident reason pines, is
anæmic, and at the same time shows a back-
wardness or lack in the teeth, and bone struct-
ure, we must supply means, whereby an increase
of phosphates, will be secured to the system.
This can often be accomplished by simply
changing to another kind of food. The fact
that the child is at the breast is by no means a
guarantee that its food is normal, for, as already
intimated, a constitutional defect on the part of
mother or nurse, ofttimes lies at the root of
baby's calamity. The vocation of the mother
should always be taken into account, for if her
vital force be expended upon exhaustive brain
work, her milk will probably be lacking in the
phosphatic element. The same result will fol-
low a diet from which coarse food is excluded,
and which is composed largely of fruits and
amyloids (starch, sugar, etc.). Neither is the
physical appearance of a nurse a reliable indi-
cation that her breast secretion is correspond-
ingly rich or impoverished, for often the most
robust physiques yield depraved milk, and vice
versa. As the combined physical and mental
64
A DECALOGUE FOR THE NURSERY.
conditions must be taken into account, before
a safe conclusion obtains, it is always prudent
to refer the matter to a skilful physician.
It is quite possible for the mother to correct
this deficit by instituting the appropriate hy-
gienic measure, as, for instance, the eating of
soups made from bony meat, bread and gruels
made from the meal of entire cereals, clam-
broth, fish, etc., and diminishing the amount of
fruits and starchy food. Should these measures
be impracticable from inability on her part to
conform to the restricted regimen, and the em-
ployment of a healthy wet-nurse be impossible,
a change to cow's milk will be the only alterna-
tive and may prove efficacious. Should the con-
dition appear at a time when the child is already
living upon cow's milk, we must make suitable
investigations, or perhaps obtain milk from
some other source. Providing the milk agrees
in every other way, and the animal is appar-
ently in a healthy condition, the difficulty may
be overcome without change, simply by mess-
ing the cow once a day with bran, into which a
spoonful of ground bone is stirred. It is a fact
familiar to farmers that cows often evince a crav-
A DECALOGUE FOR THE NURSERY.
65
ing for bones, which found they will gnaw and
lick ravenously. Furthermore, if this craving is
not gratified, they develop an unhealthy condi-
tion, and if in this state they bear young, the
calves are puny and rickety. We should surely
from these facts be able to draw valuable de-
ductions. Of course this method of enriching
the milk is only feasible when all the conditions.
are under personal superintendence. In the
majority of cases, the only alternative will be
the administration in minute doses, of some one
of the well-known pharmaceutical preparations
of phosphates.
Before passing to our next consideration I
must insist upon a careful supervision of the
influences surrounding the cow.
It is gener-
ally understood that the mental as well as
physical condition of a mother, is reflected upon
the infant at her breast; but so remote seems
the field from the nursery, that it is seldom
taken into consideration, that a similar relation-
ship may exist between the young mammifer in
the nursery and its quadruped foster-mother.
It is a truth needing no argument with any
experienced nurse, that a child may be either
5
66
A DECALOGUE FOR THE NURSERY.
slowly, or suddenly, poisoned by milk from a
cow unhappily conditioned or imprudently fed.
A mess of cabbage leaves, green fruit, or other
like substance, may convey to the lacteal secre-
tion a virulent ferment, which will give rise tò
severe gastric irritation. Instances are not
rare in which the grief-poisoned milk of cows
recently bereft of their young, has caused
marked physical disturbances in children to
whom it has been fed.
In view of these possibilities it is incum-
bent upon parents to faithfully superintend the
surroundings of the quadrupeds supplying the
food for their children, since neglect of this may
be the cause of much suffering. Milk for the
nursery should never be obtained from dairies
where there is a suspicion of swill feeding, or
where the animals are subjected to undue hard-
ships, such as long drives which may overheat
the blood, or where they are penned up in
illy ventilated stables.
Finally, we have only to allude to the neces-
sity of guarding against the adulterated article
sold as cow's milk, and here the lactometer is
indispensable. If the specific gravity is below
A DECALOGUE FOR THE NURSERY.
67
1.026 it shows a free dilution; 1.032 is the
normal standard.
CONDENSED MILK.
If it be true that many American manu-
factories procure their material from swill-fed
cows, stabled most filthily, the foreign prod-
uct is far preferable, especially that which is
gathered from the rich pastures of Switzerland
and Bavaria, and where the manufacture is
under governmental supervision. When prop-
erly prepared, refined cane sugar only is added.*
The mixture is evaporated in vacuo, to req
uisite density, run into tin cans and hermeti-
cally sealed. The large amount of sugar (30 to
40 per cent. in the can) is the chief objection.
It is generally estimated that one pint of
condensed milk to twenty-five of boiling water
will give a material corresponding in its nutri-
tive properties to breast milk, and it is true that
the majority of young children seem to thrive
upon this preparation. Although plump to
* Some brands contain starch and flour, and when thus adul-
terated should be banished from the nursery. The genuine Swiss
brands (not Anglo-Swiss) are believed to be free from starch.
68
A DECALOGUE FOR THE NURSERY.
excess, still the flesh lacks firmness and looks
blanched. Analysis of a specimen of this attenu-
ated mixture reveals a notable deficiency in the
two principal ingredients (fat and casein), there-
fore if we would bring it up to normal standard
we should add from one to two teaspoonfuls of
fresh cream to every half-pint of the composi-
tion, which will make an excellent substitute
for the cow's milk when the child suffers from
the formation of curds, as there is no precipita-
tion of coagula from this condensed-milk pre-
paration. The following mixture will prove
highly satisfactory in the majority of instances.
To twenty teaspoonfuls of hot water add of
fresh cream and Swiss condensed milk, one
teaspoonful each; of lime-water, four teaspoon-
fuls; common salt, a tiny pinch. Mix by stir-
ring gently, and, when cool feed from the cup.
As the sugar used in the manufacture of con-
densed milk is from the cane or vegetable, it
may be unavailable for some cases, especially
where an intolerance of sweets exists as a
family idiosyncrasy. In other cases the pre-
ponderance of vegetable sugar induces intes-
tinal catarrhs, and in rare instances skin erup-
A DECALOGUE FOR THE Nursery.
69
tion. When from any of the usual opposing
conditions, singly or combined, the use of the
cow's and condensed milk preparations is inter-
dicted, we have still left another expedient of
preparing a food made from cream, sugar of
milk, and water, with a modicum of cow's milk.
With a very little care we are in this way
enabled to secure a preparation which quite
accurately tallies with breast milk. The ingre-
dients, with the relative proportions, are as
follows:
Fresh Cream..
Cow's Milk..
Lime-water
•
Warm Water.
in which is dissolved
•
2 tablespoonfuls.
·
. I tablespoonful.
2 tablespoonfuls.
66
•
•
3
Milk Sugar
I full teaspoonful.
Occupy about five minutes in the warming
(never boil), stirring gently meanwhile; add a
very small pinch of salt, and feed from a cup.
We are indebted for this excellent formula
to the little work of Dr. Arthur V. Meigs on
"Milk Analysis and Infant Feeding."
take the liberty of quoting the following.
We
70
A DECALOGUE FOR THE NURSERY.
"The easiest way to prepare and use the food
is as follows: There must be obtained from a
reliable druggist, packages of pure milk sugar,
containing seventeen and three-quarters (17)
drachms each. The contents of one package
is to be dissolved in a pint of water, and it is
best to have a bottle which will contain just
one pint, as then there is no need for further
measuring. The contents of one of the sugar
packages is put into the bottle, and when filled
with water the sugar soon dissolves, and it is
ready for use. The dry sugar keeps indefin-.
itely, but after it is once dissolved it sours if
kept more than a day or two in warm weather;
it is understood, therefore, that the sugar water
must be kept in a cool place, and if it should at
any time become sour, which is easily discov-
ered if it is smelled and tasted, it should be
thrown out, and after the bottle has been care-
fully washed with boiling water the contents
of a fresh package dissolved. A milkman must
be found who will serve good milk and cream
fresh every day. By good milk is meant ordin-
ary milk, such as is easily procured in most
cities, and not rich Jersey milk; and in the
A DECALOGUE FOR THE NURSERY.
71
same way the cream should be such as is or-
dinarily used in tea and coffee, and not the
very rich cream of fancy cattle. The reason
that ordinary milk and cream are recommended
is because they are within the reach of almost
every one, and not because they are any better
than the rich milk of high bred stock.
If Jer-
sey milk was to be used, it would be necessary
to analyze specimens, and then make the nec-
essary calculations as to how to dilute it to
obtain the desired relative proportions of the
proximate principles. When the child is to be
fed, the nurse should mix together two (2)
tablespoonfuls of cream,one (1) of milk, two (2)
of lime-water, and three (3) of the sugar water,
and then, as soon as the mixture has been
warmed, it may be poured into the bottle and
the food is ready for use. If the infant is
healthy this quantity will not satisfy it after
the first few weeks, and then double the quan-
tity must be prepared for each feeding. Twice
as many tablespoonfuls of each of the ingredi-
ents must be mixed together, making sixteen
tablespoonfuls (about half a pint) in all.
"This food is not given any stronger until the
72
A DECALOGUE FOR THE NURSERY.
child is eight or nine months old, at least; but
if the infant is a healthy one, it may take as
much of it as it wants, but always of the same
strength. A robust infant will often take three
pints, or even more, in the twenty-four hours."
From the same work is the subjoined table,
showing the relative proportions of the chief
ingredients of human and cow's milk; also of
the artificial food above described, and con-
densed milk diluted, one part to twenty-four of
water, which is the strength ordinarily em-
ployed. The instructive features of this ex-
hibit are, Ist, the close correspondence between
breast milk and the "artificial food."
2. The
excess of casein in cow's milk over human. 3.
The deficiency of fat, as well as casein, shown
in the condensed-milk dilution. These points
of variance separately and combined are highly
suggestive without further elaboration.
Human
milk.
Cow's
milk.
Artificial
food.
Condensed
milk, 1 to 24.
Water..
87.163
88.549
87.639
92.673
Fat..
4.283
3.310
4.765
1.095
Casein.
1.046
2.792
1.115
.868
Sugar..
7.407
4.898
6.264
5.206
Ash..
.IOI
.451
.217
.158
100.000
100.000
100.000
100.000
A DECALOGUE FOR THE NURSERY.
73
FARINACEOUS PREPARATIONS.
The list of artificial food compounds on the
market, is long and ever increasing, and as this
work cannot include an exhaustive treatise upon
this question, no attempt will be made to par-
ticularize. The majority of physicians, as well
as mothers, have usually some preferred arti-
cle which they unqualifiedly commend upon
every possible occasion. Reason suggests
that the favorite food should be the one that
openly avows its method of preparation, and
discloses a purpose to comply with the laws of
assimilation as revealed in physiology; but
these preparations must not be so elaborate as
to be beyond ordinary intelligence, and the in-
gredients should be simple and easy of mod-
ification, since there can be no sovereign prep-
aration which singly meets the wants of the
ever-varying conditions that present themselves
in the infant economy.
The requirements of nature are so simple,
when rightly understood, that ordinarily they
can be readily complied with. It is always pru-
dent to distrust every brand that displays an
74
A DECALOGUE FOR THE NURSERY.
elaborate formula, or boasts of proprietary mer-
its superior to all other allied products. No
food compound should receive a moment's con-
sideration that does not afford a plain official
statement of its ingredients, with their relative
proportions and method of preparation. When
this is supplied, and a comprehension of the
laws of nutrition obtains, it renders wordy at-
testations and worthless testimonials unneces-
sary.
It is impossible to reconcile the inconsisten-
cies encountered in the current literature de-
voted to rearing of infants, or in the practices of
many educated physicians. In the beginning
of this chapter we explained the danger of
feeding young children with farinaceous food,
and yet, in defiance of obvious laws, we find
many practitioners recommending for infant
diet such articles as "Gerber's Milk Food,
which is made of condensed milk and cooked
flour; or "Nestle's Milk Food," a similar
preparation produced by mixing together milk
condensed to a powder and the meal of entire
wheat kernels. Conceded that these as well
as kindred foods are excellent preparations
A DECALOGUE FOR THE NURSERY.
75
subsequent to salivation, but the recommenda-
tion of their earlier use is evidence of thought-
lessness or ignorance. Let every mother un-
derstand that, despite all statements to the
contrary, an infant will perish as inevitably
upon an exclusive diet of starch foods as if
kept on a regimen of saw-dust, no matter how
delicately or carefully they may be prepared.
True, there are many little ones with whose
food farinaceous ingredients are mixed, before
the period designated by nature, who endure
the transgression without serious consequences.
So also do the savages, who mix finely pow-
dered woods and barks with their honey be-
fore eating it; and these practices are on a
par so far as philosophy is concerned. The
fortunate cases in which the constitution seems
to ignore or triumph over the violation of all
physiological principles are of course in the
minority.
Before leaving this subject a word should be
said in reference to the relative properties of
the cereals commonly employed in the prepara-
tion of food for children. We cannot do better
than to borrow a few paragraphs from Dr.
76 A DECALOGUE FOR THE NURSERY.
Jacobi's excellent monograph, "Infant Diet."
On page 81 he says, speaking of cereals:
There are a few only of which I make any
use in the feeding of infants. To justify my
selection, I must, although I have carefully
avoided the quotation of figures and statistics,
beg your permission for the following, which
contain per mille the proportions of the con-
stituents in a number of articles:
Albuminous substances.-In wheat, 135; bar-
ley, 123; rye, 107; oat-meal, 90; Indian corn,
79; rice, 51.
Starch. In rice, 823; Indian corn, 637;
wheat, 569; rye, 555; oat-meal, 503; barley,
483.
Fat.-Indian corn, 48; oat-meal, 40; barley,
rye, wheat, rice, but little.
Salts (principally phosphates).-Barley, 27;
oat-meal, 26; wheat, 20; rye 15; Indian corn,
13; rice, 5.
From this small list you would exclude, for
their small percentage of salt, as regular ad-
ditions to infants' food, rice and Indian corn.
For their large percentage of albuminous sub-
stances you would select wheat, barley, rye, or
A DECALOGUE FOR THE NURSERY.
77
oat-meal; for their high percentage of salt, so
absolutely required in the healthy organization
of the blood and of the rest of the tissues,
barley, oat-meal, and wheat. Your list would
consist of these three then: barley, wheat, and
oat-meal, as possessing all the necessary ele-
ments of nutrition, while holding so much
amylum as to render it dangerous when in
good preparation. Among the three, barley
seems to be preferable for its nutritiousness
and digestibility. There is another advantage
it has over the other cereals mentioned, viz.,
that it bears the removal of a husk after grind-
ing better than any other. The large propor-
tion of the proteinous substances in wheat and
rye is deposited in the inner layer of the husk,
which is not generally used (Payen). Not so
in barley, where the protein is spread on a
larger portion of the grain. Thus the husk
may be removed, and the consistency made
fine, without diminishing to any considerable
extent the nutritive value of its constituents.
Barley and oat-meal are the two substances
I mostly employ; for their chemical constituents
are nearly alike, with the exception of a large
78 A DECALOGUE FOR THE NURSERY.
portion of fat in oat-meal which is not found in
barley. Barley-water or thinned and sweet-
ened oat-meal gruel may be given to the child
at the breast, as above described. The indi-
cations for the use of one or the other lie in the
condition of the infant. Where there is a de-
cided tendency to constipation I prefer oat-
meal; where there is no such tendency, or
perhaps even a tendency of the bowels to
be loose, I employ barley. The "prepared'
barley is a good preparation; but it is safer,
as no mistake or deception can take place, for
every mother to grind it in a common coffee-
grinder of her own. A teaspoonful of either is
boiled in from three to six ounces of water, with
some salt, for twelve or fifteen minutes, the de-
coction to be quite thin for very young infants,*
thicker for later months, and then strained
* From the wording of these sentences the reader would
naturally infer that Dr. Jacobi advocates feeding infants one or
two months old, with starchy preparations. As, however, in
other pages of "Infant Diet" the author has referred particu-
larly to the fact that there is a lack of saliva during the first
four months, we must conclude that the words "child at the
breast," and "
very young infants,” do not necessarily apply to
infants under four and a half months.
A DECALOGUE FOR The nurseRY.
79
through a linen cloth. Infants of four to six
months are to have equal parts of this decoc-
tion, which ought to be made fresh for every
meal; and boiled and skimmed cow's milk and
sugar are to be added. At an early age the
thin decoction, at a later the milk ought to
prevail in the mixture, which ought to be given
at a temperature of 80-90°, ought to be neutral-
ized, when acid, with a few grains of bicarbo-
nate or carbonate of potassa or soda, and un-
til infants are eight or ten months old thin
enough to be taken through a nursing-bottle.”
CHAPTER IV.
DENTITION.
THE belief generally obtains that the period
of dentition is one peculiarly inimical to child-
hood. During the last few years, in deference
to the plausible arguments of an eminent teacher
in this department, it is not unusual to hear
physicians taboo the "old-time notion that
dentition, a purely physiological process,
should give rise to such serious derangements
as are ordinarily attributed thereto.
"
It cer-
tainly stands to reason that nature should
kindly superintend a work so especially her own,
but the host of facts encountered by a physi-
cian forces the conclusion that teething is a
tedious and painful ordeal, ofttimes working
great mischief to the infant economy.
A theory that appears incontrovertible in
the lecture-room, or in print, will often be
proved wholly untenable by bedside experi-
A DECALOGUE FOR THE NURSERY.
81
ence. Supposing that scores of instances can
be brought forward where little ones blessed
with sound bodies and excellent care have
gotten their teeth as painlessly as the hair
upon their heads," this does not dispose of the
fact that, on the other hand, thousands writhe
and languish till their vital forces are well-nigh
exhausted because of the protracted irritation,
due unquestionably to the crowding of hidden
teeth against the unyielding, irritated gums.
Every gesture, act, facial expression, and la-
ment proclaim more forcibly than words that
the local disturbance is driving the little sufferer
to distraction; and, unless relief be secured in
the complete eruption of the offending teeth,
the irritation may, through the medium of the
sympathetics, extend to remote parts, and thus
profoundly affect the entire system even to the
endangering of life. The most specious scien-
tific argument would hardly convince the adult
world that the comparatively insignificant mat-
ter of cutting the wisdom teeth (likewise a
"purely physiological process") was unattended
by constitutional as well as local disturbance.
There are few physicians who cannot recount
6
82
A DECALOGUE FOR THE NURSERY.
instances in which a slight incision made in a
swollen, tense gum has afforded instantaneous
and marked relief, banishing as if by magic
severe nervous manifestations and other mor-
bid conditions. What stronger argument can
be offered to prove that the teething process is
one of misery than that which is plainly rec-
ognizable in the little ones suffering from it?
Previously contented and happy, they suddenly
develop unmistakable morbid symptoms. Slight
febrile reaction, exaltation of pulse, peevishness,
fitful sleep, starting at the slightest noise, ap-
pearance of fright upon awaking, dissatisfied
whimpering, sometimes twitching of the mus-
cles, disordered digestion, diarrhoea, and finally,
to locate the cause of the disturbance, the little
sufferers direct the hand to the head, or thrust
the fingers into the drooling mouth.
Generally, dentition involves a period of many
months, marked by seasons of remission, alter-
nating with exacerbations of suffering, these
intermissions corresponding to the successive
appearance of groups or pairs of teeth.
The following quotations are peculiarly ap-
propriate in this connection:
A DECALOGUE FOR THE NURSERY.
83
"The appearance of the twenty milk-teeth,
as those at the first dentition are termed, does
not take place in an uninterrupted sequence, but
in groups separated by intervals of weeks or
months. The following is the usual order of
cutting the several groups:
66
Group I. Between the fourth and seventh
months of life the two lower middle incisors ap-
pear almost simultaneously, whereupon a pause
of from three to nine weeks ensues.
<<
Group II. Between the eighth and tenth
months of life the four upper incisors appear,
following shortly upon each other, at first
the two central, then the two lateral. The
second pause amounts to from six to twelve
weeks.
Group III. Between the twelfth and fif-
teenth months of life six teeth appear at once,
the four first molars, and the two latter inci-
sors; generally the molars in the upper maxilla
first, next the lower incisors, and lastly the
molars of the lower jaw. A pause until the
eighteenth month ensues.
"Group IV. Between the eighteenth and
twenty-fourth months of life the canine teeth cut
84
A DECALOGUE FOR THE NURSERY.
through (the upper ones are called eye-teeth).
Again a pause until the thirtieth month.
((
Group V. Between the thirtieth and thir-
ty-sixth months the second four molars finally
make their appearance. This concludes the
first dentition" (Vogel).
Many divergences from these rules will be
met with, as children may be born with one or
more teeth already cut, or the teeth may appear
earlier than usual or out of the usual order. In
some families the upper incisors always appear
before the lower or one of the molars, or the
canine teeth precede the incisors; but these
irregularities are of no importance. Delayed
appearance of the teeth is, however, of greater
moment, for it generally indicates some fault in
nutrition, or a rickety habit of body" (Steiner).
Taking into account the wisdom teeth the
whole period of dental development covers
This time is divided
twenty years or more.
into periods, and then again into minor divis-
ions, all of which have accentuations more or
less pronounced.
A DECALOGUE FOR THE NURSERY.
85
REMISSIONS IN DENTITION.
Particular attention is directed to the im-
portance of profiting by this fortunate provision
of nature in according to children who are
teething periods of remission from suffering.
Were it not for these the little patients would
fare much worse. Mothers alive to the ne-
cessities of the situation will diligently employ
every hygienic measure during the interim, in
fortifying the system against the next attack,
thereby averting possible calamity. This sug-
gestion cannot be too strongly presented, for
mothers, as a rule, allow themselves to be de-
luded in this particular. It is enough that the
suffering is over for the time, the offending
tooth or teeth are through, and wholly unmind-
ful of the approaching exacerbation, the valu-
able time is squandered, until some day the
gravity of their shortcoming is realized in the
prostration of the little one, who is wholly un-
prepared.
We reiterate, let mothers note well the fact
that the first period of suffering which is suc-
cessfully passed is only one of a succession
86
A DECALOGUE FOR THE NURSERY.
which must be met, the endurance of which
depends largely upon the course that has been
pursued in fortifying the system against the
attacks.
That which is meant by wise improvement of
these remissions, is the employment of every
well-known means which favors a sound, well-
regulated state of the system. So manifold
are these hygienic essentials, and so obvious
withal, that they need not here be particu-
larized.
An important feature in dentition, made es-
pecially interesting from the neglect usually
attending it, must here be alluded to. After
the child has passed through the first period
of teething-extending it may be to the third
year there ensues a long time of quiet, and
the majority of parents believe that all possible
trouble arising from teething, is.passed. So
secure are they in this opinion that they are
wholly at a loss to account for the physical
disturbance that sometimes appears about the
fourth or fifth year. The child develops vague
nervous affections, becomes peevish, and lan-
guishes. Often a teasing cough accompanies,
A DECALOGUE FOR THE NURSERY.
87
which the old wives commonly call "stomach
cough" or "worm cough."
All these symp.
toms may prevail in varying degrees of se-
verity, and run their course, (albeit assailed
with various forms of treatment) without one
thought having been directed to the true nat-
ure of the disturbance. It is well, therefore,
whenever the health of a child four or five
years of age becomes unbalanced without ap-
parent cause, to examine the mouth, and in
all probability the four front molars will be
found pushing their way through the gums.
We will not undertake a detailed enumeration
of all the anomalies directly and indirectly as-
sociated with the evolution of the teeth, as this
would inevitably lead to confusion. We will
therefore briefly attempt a discussion of some
of the most notable associate disturbances.
INTESTINAL DISTURBANCES.
Dentition exerts an undeniable influence
over the intestinal economy, not unfrequently
being the direct cause of serious gastro-intes-
tinal disturbances. Indeed there are few chil-
dren who escape one or more attacks of gas-
88
A DECALOGUE FOR THE NURSERY.
tro-intestinal catarrh during dentition. These
attacks vary in severity from slight relaxation
to the fatal flux. So many children fall victims
to the severer type, that all diarrhoeas at this
period are regarded with solicitude, and parents
are apprehensive so long as the alvine excre-
tions are abnormally frequent. Accordingly, no
sooner does this condition present itself than a
routine of drugging is instituted, and it matters
little what constitutes the remedy, or its manner
of working, so long as it checks the diarrhoea
for the time.
If by any means humanity could be per-
suaded to accept Nature as the kind foster-
mother in all bodily ills, it would be most fort-
unate, and many physical manifestations that
are now considered mischievous, and treated as
such, would be turned to good account.
This oversight is nowhere more amply ex-
emplified, than in the management of infantile
diarrhoea. The current belief is, that if an in-
testinal catarrh be neglected, and allowed to
pursue its course unchecked, it will most likely
assume a more pernicious, and perhaps fatal,
form, hence the first idea is speedy suppression.
A DECALOGUE FOR THE NURSERY.
89
A little reflection will show the unsoundness
of such a policy. The diarrhoea does not con-
stitute the disease, per se any more than the
increased secretion from the nose constitutes
the irritation, and congestion, due to expos-
ure and consequent rhinitis. The increase in
number of the evacuations, and their altered
character, are due to congestion and irritation
somewhere in the system, which nature is
seeking to relieve by opening wider the sluice-
ways. It is perfectly plain, then, that the
diarrhoea is merely an effect, and may proper-
ly be regarded as a signal by which nature
indicates her manner of operating for the re-
lief of congestion, or the expulsion of morbid
matter, and suggests to those who would lend
a helping hand, what measures are most ap-
propriate.
In other words, if we would act wisely we
should study nature's ways attentively, as re-
vealed in the symptoms of physical expres-
sions characterizing the disorder, and having
noted these carefully, adopt a parallel remedial
course. We may be certain that the more
closely the modus operandi of our medicinal
90
A DECALOGUE FOR THE NURSERY.
agents, tallies with the symptoms characterizing
the morbid condition in toto, the greater will
be our success. As we shall have occasion to
deal with this matter more fully in its appro-
priate place, we will not here make further al-
lusion to the laws of drug selection, further
than to urge that the two following essentials
be firmly fixed in the mind:
First, study faithfully and follow Nature's
suggestions as presented in characteristic
symptoms of disease.
Second, bear in mind the fact that all drugs
exert upon the living animal economy a two-
fold action, called the primary and secondary,
which two effects are the opposite of each
other; the first being the active and transitory,
and the second the reactionary and lasting,
consequently the latter must be regarded as
the curative. This is an abiding principle,
and should be heeded whenever drugs are ad-
ministered with a view to a curative* result.
*Since the full sense in which the term curative result "
may not appear to the reader, we will add a word of explana-
tion to show that drugs are not always prescribed with a view
to their curative virtue, but often for the simple purpose of
A DECALOGUE FOR THE NURSERY.
91
Suppose a
Let us illustrate its application.
dose of castor-oil or other simple laxative be
given to a child afflicted with diarrhoea, the
effect will be, primarily, a slight increase of
the relaxation (nature being thus abetted), the
evacuations changing to a healthier complex-
ion, and this will be succeeded by symptoms
of decided improvement, or diminution in the
frequency of the dejections, which constitutes
the secondary stage. Suppose, on the other
hand, there be adopted the short-sighted policy
of administering a dose of paregoric, "compound
chalk mixture," or other astringent, what will
be the result? Probably the urgent symptoms
will be promptly allayed, the child may sleep,
and the alvine evacuations checked; but a little
palliation. As for instance, when opium is given in ordinary
doses to allay the pain of colic or of a broken bone, it is a pal-
liative. If on the other hand, it be administered in minute
doses to meet its indication in some form of apoplexy, or
habitual drowsiness, it is given solely as a curative. Drugs
are curatives only as they, through the virtue of their action,
eliminate disease. They may suppress, mask, temporarily
check, causing all these and many more results to ensue,
whereby they who see only the surface of things are deluded,
for it is found that when their primary force has been ex-
pended no curative result" has been effected.
92
A DECALOGUE FOR THE NURSERY.
later we find that this apparent improvement is
a delusion, and that the disease has only been
masked. While the drug is exerting its pri-
mary action, the symptoms are merely palliated,
the channels of egress for the noxious matter
sealed up; but the disease proper has been
steadily gathering force, and upon the super-
vening of the secondary action of the drug, the
disorder reappears, fortified by the evil evoked
through misguided medication.
""
""
SOOTHING MEDICINES IN INTESTINAL AFFEC-
TIONS.
A child suffering from gastro-intestinal irrita-
tion coincident with dentition, the leading symp-
toms being slight fever, restlessness, petulance,
capricious digestion, thirst, frequent alvine de-
jections accompanied with severe abdominal
pains, the whole combining to picture a familiar
condition demanding speedy alleviation. If the
ordinary routine of medication be employed,
the shortest cut is taken in the direction of im-
mediate relief from present suffering. In all
probability a dose of paregoric, combined with
some astringent, or a dose of "compound-chalk"
A DECALOGUE FOR THE NURSERY.
93
mixture, or some other favorite soothing prep-
aration is administered, which in a few minutes
exerts its charm, and to a superficial observer
all seems well. This is the primary effect, and
now note that which the secondary effect re-
veals. While the child is soothed, and to the
mother seems to be doing well, the skilled ob-
server will perceive a number of undesirable
and significant changes; the character of the
pulse will probably be sharper and more rapid;
the face may be cooler, but the base of the cra-
nium will be warmer, the lips pallid, and the
tongue dryer; while the half-closed eyelids, re-
vealing the upturned eyes, have a deepened
tint underneath. As a rule, the extremities
are cold and jerk frequently, or a single set of
muscles will give slight quivering spasms.
All
these symptoms belong to the narcotic, and
forebode evil.
Soon the child awakes disconsolate, obstinate
wakefulness succeeds the unnatural slumber,
and now all the symptoms, which for a time
have been held in abeyance by the mischief-
working potion, recur greatly intensified. We
have not only the orginal distemper to deal
94
A DECALOGUE FOR THE NURSERY.
with, but the after-effect of the palliative, which
is now on the side of the disease. This ag-
gravated condition too often leads to a repeti-
tion of the previous injudicious measures, which
strengthen the disease and render inevitable
the ultimate calamity, which might have been
averted by following the steps plainly indicated
by nature.
The opinion prevails with the intelligent
classes that the use of narcotics in the nursery
is no longer countenanced by the rank and file
of physicians. Unfortunately this belief would
be effectually dispelled by a glance through the
current medical literature of the day, or better
still, by scanning at random the prescriptions
compiled in any pharmacy.
TREATMENT OF PAINFUL GUMS.
When dentition is painful and the gum tense
and swollen, gentle rubbing with the ball of the
finger is grateful and soothing to the little one;
but the practice of first moistening the finger in
paregoric, laudanum, or other anodyne cannot
be too thoroughly condemned, for the narcotic
A DECALOGUE FOR THE Nursery.
95
thus introduced into the system is no less per-
nicious than if swallowed in the usual manner.
Finally, great relief may be afforded by slight
incisions made at the proper time, in such a
manner as to completely sever the tense bridle
of resistant tissue stretched over the prominent
yet hidden tooth. Few procedures are more
gratifying in their results than this simple one
when correctly performed. To be effectual it
is necessary that the condition be perfectly ripe,
and also that the incision be thorough, other-
wise the cicatrix resulting from a premature and
imperfectly made cut, will render the future
eruption of the tooth more tedious and pain-
ful.
When it is certain that the tooth has ap-
proached well toward the surface, let the nurse
hold the child's hands, and rest its head firmly
between the knees of the operator. Then
make a clean, free incision, down to and along
the crest of the tooth, and before liberating
the head rub apart the edges of the wound
with the finger, so as to push the severed gum
apart on either side of the tooth—a simple pre-
caution which should never be neglected, for so
96
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rapidly does a clean incision made in the gum
heal, that all signs of it may disappear in a few
hours. When the gum is markedly swollen it
is well to make two incisions crossing each
other in the form of a letter X. It is probable
that one or more delicate nerve-filaments which
have been rendered exquisitely sensitive and
inflamed through being drawn tensely over the
advancing tooth is severed, and the relief se-
cured instantly extends to remote nerve-cen-
tres.
CHAPTER V.
FRESH AIR.
NOTWITHSTANDING all that has been written
and is everywhere taught concerning the vital
importance of fresh air, few of those superin-
tending nursery affairs appreciate the full sig-
nificance of the matters. The ordinary mind is
more surely swayed if directed to the contem-
plation of that which can be seen and handled,
while the unseen and imponderable is naturally
disregarded.
Out of a thousand mothers, scrupulous in
the personal cleanliness of their children, it is
doubtful if there will be one among the num-
ber who intelligently realizes that fresh air is
the chief cleansing factor of the body, and that
without its purifying effect within, the blood so
speedily becomes loaded with effete product,
that death from poisoning is only a matter of a
few seconds.
Water that has been used, or that is visibly
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impure, is rejected as being unfit for further
use, because its filthiness is revealed by sight;
but air that has been used, and is loaded with
the poisonous exhalations of the system, is
often respired over and over again by those
fastidious in personal cleanliness. They make
no protest because nothing reveals to any phys-
ical sense the uncleanliness of the atmosphere
enveloping them; nevertheless, breathing air
defiled and exhausted by previous respiration is
infinitely more obnoxious and injurious than bath-
ing in water soiled by previous bodily contact.
The body has very properly been likened to
a furnace, the fuel of which is the food ingested;
the lungs, of course, constitute the draught or
bellows. If the air be freely supplied and of
good quality, the combustion is proportionately
complete, and it goes without saying, that the
opposite condition will incur corresponding de-
ficiency. If we advance another step we may
regard animal life as nothing more than a chem-
ical process, the principles of which are within
the range of comprehensible laws and analysis.
The combination of oxygen with carbon, (as,
for example, the burning of charcoal) generates
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99
carbonic acid, an imponderable, imperceptible,
tasteless gas, yet most deadly in its effects upon
animal life. Were a little charcoal ignited and
left to burn in a room from which all air is ex-
cluded, and at the end of an hour a dog be shut
in this room, we should witness the workings of
vitiated air. Immediately the animal evinces a
desire for a fresh atmosphere, which is speedily
followed by drowsiness, stupor, and death.
So, then, we may liken the living body to the
burning charcoal, for like the burning coal the
respiring body is constantly appropriating oxy-
gen and throwing off carbonic gas and other nox-
ious exhalations. To explain our meaning more
fully let us revert to certain elementary facts.
The atmosphere is composed chiefly of two
elements, oxygen and nitrogen, in the relative
proportion of twenty-one of the former to sev-
enty-nine of the latter, with a trace of carbonic
acid, of which a very slight increase over the
nominal proportion will seriously embarrass ani
mal life, as authorities on hygiene consider air
in which this impurity exceeds one part in every
four thousand by volume—that is, a room 20
feet square and 10 feet in height, containing
Jord
100
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more than one cubic foot of carbonic acid is
so vitiated as to be unfit for respiration.
Now let us note that an adult breathing at
the rate of seventeen times each minute, and
respiring twenty-five cubic inches of air at each
respiration, will transpire about three hundred
and sixty cubic feet of air in the twenty-four
hours. In passing through the lungs the air
loses about five per cent. of its volume of oxy-
gen, and gains from four to five per cent. car-
bonic acid. Hence it will be seen that an adult
in repose exhales about sixteen cubic feet of car-
bonic acid gas per diem, a sufficient amount to
vitiate 64,000 cubic feet of atmosphere, which
would fill a room 80 feet long, 40 feet wide, and
20 feet high.
To those who have hitherto given the mat-
ter no particular thought these deductions drawn
from mathematical calculations will be startling
and may appear incredible, especially when
there can be recounted so many instances of
long lives passed almost entirely in foul air,
which would seem to refute scientific assertions.
We must take into consideration, however, that
in a very brief time many cubic feet of air may
Maou
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ΙΟΙ
pass through crevices insignificant in size, and
fortunately none of us have our rooms hermeti-
cally tight, for, were this the case, instead of
the languid, pallid creatures who waken with a
sense of fatigue in their illy ventilated rooms,
we would find inanimate bodies self-slain by
their own poisonous exhalations.
In the construction of hospitals at the pres-
ent time, facilities for proper ventilation are the
first consideration, these arrangements being
made with a view to, and in conformity with, rec-
ognized philosophical principles, consequently
wards are so arranged that they can be flushed
with fresh air at the rate of 4,000 cubic feet per
hour for each adult patient. Enormous as the
quantity may at first appear, a little calculation
will demonstrate that these magnificent figures
do not exceed the demands of Nature.
Having given the approximal fundamental
estimate it will serve to carry the truth home
for each one to elaborate this matter with varied
computations. Of course a fuller allowance is
accorded the occupants of a hospital, as a rel-
atively greater amount of carbonic acid is pro-
duced by the quickened respiration of the sick,
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hence it is that 96,000 cubic feet are allotted
invalids instead of 72,000, the standard for
healthy adults at rest.
We need hardly state that exercise, which re-
sults in heightening the respiration, necessitates
a proportionate increase in the atmospheric
allowance allotted rooms in which physical
exercise is being prosecuted. Bodily exertion
causes deeper respiration, quickened circulation,
with a corresponding increase in the consump
tion of oxygen and elimination of carbonic acid
and tissue débris. Professor Huxley estimates
that an average-sized adult ordinarily consumes,
in twenty-four hours, 10,000 grains of oxygen,
and during the same time produces 12,000
grains of carbonic acid, equalling nine ounces
of pure carbon, constituting so much poison-
ous matter which has been purged from the
system by the process of respiration.
To explain still more forcibly the manner in
which fresh air is constantly importing oxygen
into the body for its renovation, returning sat-
urated with the noxious exhalations that have
been given in exchange, we will give in passing
a brief explanation of the phenomenon of blood
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103
aëration, which constitutes the grand function
of the lungs. We note that 6,000,000 is the
approximate number of air-cells contained in a
normal pair of lungs. Into this multitude of
little sacs the air rushes, and at the same
time the heart throws the venous blood into the
meshwork of pulmonary capillaries, which dis-
tribute the blood throughout the lungs, so that
only the delicate tissue membrane which forms
the wall of the air-cell intervenes between the
blood and the air, and it is through this filmy
septum that oxygen passes to the blood, and the
morbid effluvium is given off.
Immediately after the interchange the en-
riched blood enters the return pulmonary ves-
sels and hastens back to the heart, where it is
speeded on its way to the upbuilding of remote
tissues, where in turn it gives up its revivifying
elements, and again enters the venous system
laden with effete product, on its way once more
to the grand centre of purification, and thus
the ceaseless round goes on while life endures.
By carrying our computation a little farther
we can see how frequently the blood is sub-
jected to this cleansing process.
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It is estimated that the blood constitutes one-
thirteenth of the total weight of the body: for
instance, a body weighing one hundred and
thirty pounds, contains ten pounds of blood.
The heart beats at the rate of seventy to eighty
times in the minute, and at each stroke it throws
out from five to six ounces, so it will be seen
that more than twice the entire volume of blood
passes through the heart every minute, or, in
other words, all the blood of the body is sub-
ject to the process of oxygenation within the
lungs every thirty seconds.
Data could be multiplied showing the neces-
sity of supplying ourselves with an abundance
of fresh air, but surely enough has been offered
to make good our object, which is to prove the
importance of having children's rooms so ar-
ranged as to be at all times readily flushed with
air from outside.
Were more practical heed given to this mat-
ter there would be fewer pallid children who
waken in the morning petulant and unrefreshed,
remaining dull and listless, or fractiously rebel-
lious without apparent cause.
A word concerning the method of admitting
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105
fresh air into our apartments. The ill effects
of sitting in draughts are so well known that it
is hardly necessary to insist that they shall be
guarded against by so locating the aperture
for the admission of air that it will be out of
range of the occupants of the room.
When the matter of ventilation has been
overlooked in the architecture of an apartment,
lower the window to admit the air from above,
and the outer air being cooler, and therefore
heavier than the rarefied air within, gravitates
to the floor, and thus a constant change in the
atmosphere is effected. When the air enters
near the floor, with no means of escape above,
the ventilation is imperfect, for in such a room
the temperature near the floor, where the baby
is apt to be sitting, will be quite chilly, while
a few feet higher it may be uncomfortably
warm.
The situation of the child's crib should be
discreetly selected. It should not be directly
in front of a window, even though the width of
the room intervene, for a current of cool air
entering near the ceiling will project itself to
the wall opposite, and then be reflected down-
106
A DECALOGUE FOR THE NURSERY.
ward, so that any one sleeping there will be
virtually subjected to a draught.
Again, it is impossible to secure free circu-
lation of air in an alcove, and therefore these
recesses are utterly unsuited to the purpose for
which they were intended. Unfortunately if
such a nook be connected with the nursery or
bedroom, it is quite sure to be allotted to the
little one because "it looks so cosey."
It is wellnigh impossible to secure an intel-
ligent co-operation on the part of mothers, in
observing the requirements necessary to proper
ventilation. They are apt to confound temper-
ature with ventilation, that is, the coolness of
a room is regarded as equivalent to purity of
air, and vice versa, I know that physicians have
constantly to contend with this perverted idea,
and for this reason it is here explained that
the warmth or coldness of a room has nothing
to do with its atmospheric purity, for the air
that is odorless and unbearably cold may be
highly charged with noxious effluvium infinitely
more harmful than the warm, sweltering atmos-
phere reeking with offensive odors.
Finally, we must not neglect to take into ac-
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107
count the effect wrought by burning gas jets, or
heating apparatuses. The fact is not always
appreciated that a small gas flame consumes
more air than four or five men and gives off a
proportionate amount of the poisonous carbonic
gas. Of course it is easy to perceive that a
hot stove is, in proportion to its size and in-
tensity of heat, an active destroyer of air. We
have before us a most alluring topic for elab-
oration, but it is my purpose to present only
the salient points of this subject concisely and
plainly so that every reader may draw prac-
tical deductions since the propositions adduced
are sustained by simple arithmetical calcula-
tion.
No other question of such vital moment can
be thus absolutely determined by elementary
computation, when once in possession of nu-
merical as well as physiological facts, which es-
sentials have been pointed out in the preced-
ing paragraphs. A careful inspection of these
precepts can hardly fail to convince every in-
telligent mother that the health and happiness
of a household hangs extensively upon proper
ventilation.
CHAPTER VI.
NURSERY APPURTENANCES.
IN providing good things for the nursery we
must remember that sunlight stands first in the
advantages it confers. Strange to state, many
mothers pay little heed to this matter, while
others, and we may say the majority, treat the
sunlight as though it possessed some baleful
influence to be avoided, and so strive to shield
themselves and little ones from its rays, priding
themselves upon their dainty flesh-tints, a blame-
worthy condition rather than one meriting ad-
miration. The blanched, delicate-complexioned
child, denied the benefits of sunshine, and the
one saturated with its life-giving rays, bear the
same relation to each other as the blanched
friable sprout, growing in a darkened cellar,
and another of the same kind thriving under
the sun, tough, pliant, and strong,-able to with-
stand rough encounter, while the former readily
succumbs to the most trivial disturbance.
A DECALOGUE FOR THE NURSERY.
109
When we reflect upon the far-reaching influ-
ence emanating from this great central power,
it ceases to be a marvel that nations have wor-
shipped the sun as the supreme benefactor of
mankind. Search diligently on every hand and
we will find scarcely a blessing that directly or
indirectly is not wrought by the sun.
Not only
are our physical wants and conditions domi-
nated thereby, but our moral faculties also are
swayed by its subtle power. Study the dispo-
sitions of men who for a long period have been
deprived of sunlight, and note how they gravi-
tate to the spirit evinced by the lower animals
that prowl in darkness. Sunshine cheers and
ennobles, while its absence breeds moroseness,
cruelty, and baseness.
Again, sunlight is our most efficient disinfec-
tant, and as a destroyer of morbid germs it in-
finitely excels all artificial germicides.
Not only does it banish the floating microbes
that poison the surrounding air, but it pene-
trates and renovates the structure of the body.
The "
blue-glass-cure" craze that swept the
country not long since pointed a lesson which
should not readily be forgotten. Every sensi-
I 10
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ble person knows that the color of the glass had
nothing to do with the many cures wrought be-
yond intensifying the subjective elements of the
process.
Let mothers who would have their children
cheery and vigorous, sound in mind and body,
flood the home, especially the nursery, with sun-
shine.
NURSERY CRIB.
The position of the cot must be considered.
It should be placed in a quiet part of the room,
removed from the heating apparatus, and never
beneath a gas fixture, instances being on record
of children who were poisoned by inhaling car-
bonic oxide falling from fixtures suspended
above their cribs. In the arrangement of the
little bed let there be no canopy, or drapery in
any form, as it only obstructs atmospheric cir-
culation. It may seem superfluous to advise
the mothers of to-day to discard feathers for
the more sanative article, curled hair, for mat-
tress and pillows, nor would it seem necessary
to suggest covering the mattress with a rubber
sheet; but, strangely enough, we still find the
old germ-breeding feathers in use, and the mat-
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III
tress unprotected. A folded quilt or blanket
should always interpose between the child and
the rubber sheet.
While commending the stationary crib, and
believing that with a little turning from side to
side blood stasis may be prevented, still the old-
time custom of rocking the baby need not be so
unqualifiedly denounced. The modern swing-
ing substitute, suspended in an oscillating form
is a senseless device and affords no satisfaction
whatever to the child; but the little flaring box,
with its rigid foot-worn rocker has (besides the
tender home associations that cluster around it)
the merit of being philosophically constructed.
Young Homunculus awaking in one of these
old-time beds, and protesting against the dis-
comfort of blood stasis, derives immediate relief
from a few vigorous motions imparted to the
cradle, which jolts and rolls his little body, send-
ing the blood more briskly through the passive
tissues, and he falls asleep again.
The framework of the crib should be as light
and open as possible for the securing of per-
fect ventilation, and for safety a sufficiently
high side-railing should always surround it.
II2
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The old-fashioned close boxes demanded more
attention than was always accorded them, and
their contents were often found to be in a
most objectionable condition. For sanative
and other reasons, open wicker-work cannot be
excelled. When necessary for the economiz-
ing of room, the little bed can be in basket
form and easily suspended by four ropes from
the ceiling; they should be well separated above
to prevent swinging. If desired, it may be con-
veniently swung over the foot or at the side
of the mother's bed.
MEANS OF AMUSEMENT.
It seems hardly within the province of a
physician to call attention to the matter of play-
things for infants, but how often is he called
upon to deal with serious, and sometimes fatal,
accidents arising from lack of discrimination in
supplying the nursery with suitable articles of
amusement.
Scattered over the floor, in accessible draw-
ers, on the table or shelves, may be found but-
tons, hooks and eyes, small coin, marbles, hair-
pins, etc., in addition to the unsuitable play-
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113
things that often are either smeared with cheap
poisonous paints, or are so constructed that
through accident (like the breaking of a string
of beads) they may become a host of smaller
fragments. Every one who has studied the
habits of baby knows how eagerly everything
that the tiny hands can grasp is conveyed in-
discriminately to its general receptacle, the
mouth.
The importance of exercising vigilance in
these apparently trivial matters is seldom ap-
preciated, until some dire calamity befalls as the
penalty of carelessness. It is no more trouble
or expense to provide the nursery with safe
and instructive articles, than with those that
are dangerous and meaningless.
It would be difficult to mark the period
when an infant begins to appreciate the merits
of surrounding objects, but one thing is certain,
that adults blunder stupidly in dealing with the
impressionable, keenly alert, infantile mind.
We have no right to confuse and vex the little
brain by placing before it distorted caricatures
of objects at a time when the mind is struggling
out of the void toward a knowledge of things;
8
I 14
A DECALOGUE FOR THE NURSERY.
neither is it pardonable to perplex it with a
jargon of meaningless sounks, as though re-
ducing one's self to imbecility was necessary in
order to be acceptable to a child. As far as
possible and consistent, then, let the attentions
and gifts to the little ones be in keeping with
practical intelligence.
From the earliest days encourage a fondness
for the toys, by securing those of a substantial
nature, and at all times firmly discountenance
destructiveness, an indifference to which is fa-
vored by the possession of cheap and fragile
toys. The various rubber toys, such as man-
ikins of animals and persons, large gayly-
tinted balls, etc., are safe and afford great
pleasure. The colors must be properly ap-
plied and inoffensive. At a very early day
children will evince delight over harmony of
sounds, a fact which some toy-makers have
turned to good account, by supplying a chime
of bells properly attuned and of soft tone,
which are suspended on a string attached to
two upright standards of suitable height.
With a baton in the little hand this device is a
source of much pleasure. Not only should all
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115
cheaply painted toys, colored candy, and all
suspicious pigments, be excluded from the nur-
sery, but the coloring matter of the paper on
the walls should be subjected to analysis.
Within the last few years this sanative ques-
tion has revealed some startling facts. The
written reports of Professors Woods and Lyon
are especially instructive. Professor Wood has
recorded forty-two cases of severe illness
caused by wall-paper charged with arsenic.
In Professor Lyon's report are described four-
teen cases of sickness due to arsenical wall-
paper, all of which came under his personal
observation. Careful examination and experi-
ment proved that in each of these cases the
system was impregnated with the poison, which
had become loosened and floated in the at-
mosphere in which the victims lived.
In one
house the paper revealed eleven grains of ar-
senic per square yard. It is generally sup-
posed that the tint indicating the presence of
arsenic is green, but it is found that papers of
every hue may contain the poison, the highest-
priced as well as the cheapest. Many of a
greenish tint contained not a trace of arsenic.
116 A DECALOGUE FOR THE NURSERY.
White glazed and plated papers, designed for
the use of children in Kindergartens, yielded
from twenty to fifty-five grains per square
yard. The white paper generally used for
covering or lining small boxes was the most
heavily loaded of all, yielding forty-five grains
to the square foot, a quantity sufficient to kill
fifteen men. The lesson afforded by these strik-
ing facts shows to the head of every household
the plain duty of submitting the matter to a
skilled chemist, since the question is beyond
the ken of laymen.
The eyes of infants are far more susceptible.
to the injurious effects of light than are those of
older persons, consequently special care is de-
manded in this particular when arranging the
nursery. Besides selecting suitable tints for
wall decoration, see to it that the light be not
reflected into the nursery from some neighbor-
ing wall or object of dazzling whiteness, as it is
not unusual to find the sight of children seri-
ously impaired in this manner.
Perhaps the most satisfactory and untiring
means of happiness to the little ones is a bed
of clean white sand. It is easily arranged by
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117
constructing a bin or box of such dimensions as
can be afforded, in which the sand is deposited.
It is unnecessary to determine wherein lies the
charm of this for children, but certainly it is a
never-failing source of delight to them. Into it
they will carry their miniature animals, houses,
and fences, and hour after hour play contentedly.
SAFEGUARDS.
Do not procrastinate in supplying the nur-
sery with all necessary guards against possi-
ble accidents; see to it that every door or pas-
sage at the head of stairs has a lattice-work gate,
made self-closing by simply adjusting thereto a
rubber band. Likewise, let the stove or open
fire be enclosed by a suitable wire screen.
Should the windows be low, these too must re-
ceive proper attention. There should be no
water-closet, bath-room, or set-basin connected
with the nursery apartments. Finally, the point
urged is the timely execution of these measures,
for we can all recall instances where the sad
penalty of delay has been paid.
CHAPTER VII.
EARLY INDICATIONS OF DISEASE.
No eye studies more faithfully, or detects so
quickly, the shifting of the lights and shadows
in Baby's physical state as that of the devoted
mother. She may not always be correct in her
deductions, or comprehend the full significance
of the change, but, be it never so slight, she is
keenly alive to it. Compared with her delicate
conception, the physician's understanding, while
more methodical and definite, is ofttimes slug-
gish. The intimate relationship which a mother
holds renders it imperative that she should ac-
quaint herself with the varied physical expres-
sions constituting the language of disease, and
everyone can realize how peculiarly important
it is that she should be able to detect early, and
interpret wisely, these physical manifestations;
for she must be the mouth-piece of the little one,
"who has no language but a cry" by which to
convey its sensations. Then, again, a child
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I 19
when ill is subject to more sudden and frequent
changes of condition, developing perhaps nu-
merous phases in the interim of a doctor's visits;
and an intelligent report of these is invaluable
to the welfare of the case, for without such in-
formation the most skilful practitioner may find
himself in a perplexing position.
Were we to undertake an enumeration of all
the indications by which we are guided in the
treatment of children's diseases, the reader's
mind would soon be helplessly bewildered by
their great number. There are, however,
certain manifestations that may be designated
"key-note symptoms," that, whenever dis-
played, are always indicative of special morbid
conditions. As these characteristics are com-
paratively few, and more sharply outlined, an ac-
quaintance with them (which is quite possible)
cannot fail to be of great help to mothers in
the early detection and possible arrest of dis-
ease. To the experienced observer every in-
tonation of voice, every gesture or movement
of the body, manner of breathing, and cast of
countenance, are all significant.
120
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CRY OF INFANTS.
In the first place, the cry of an infant is full
of meaning. The lusty, vociferous cry of tem-
per is wholly different from the beseeching
moan of chronic suffering, or sharp, rending cry
of acute pain. A healthy child seldom wakens
with a sharp cry, and when this occurs we
should think of hip-joint disease, or cerebral
irritation. Whimpering and constant fretful-
ness are suggestive of intestinal affections.
the case of colic, however, the cry is usually a
full, loud one. The restricted, catching cries
associated with flushed face, hurried breathing,
jerky respiration, and high temperature indi-
cate pleuritic or pulmonary affections.
In
The brain-cry is peculiarly characteristic, and
once heard is never forgotten. It consists of a
single sudden, sharp, piercing shriek, which
penetrates to the very soul of the listener.
When this is heard there is not a doubt of the
existence of some serious cerebral disorder.
The difficulty may be located in one of the
ears, but oftener there is meningeal irritation.
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121
GESTURES AND MOVEMENTS.
A child's gestures are also highly signifi-
cant. Whenever a little one pats or strokes
its head, pulls at its hair, ears, or cap, cerebral
irritation may be apprehended ;
be apprehended; and should
there be added constant rolling from side to
side of the head, which is drawn back as
though boring into the pillow, the nature of
the case is still more evident.
With rarely an exception, healthy children
are perpetually in motion while awake; there-
fore, when a child remains motionless, evincing
fear of anything threatening to disturb the posi
tion, or jar the body, we should, in the absence
of fever, suspect some lesion along the spinal
column or hip-joint. If fever exist, it will prob-
ably be found that some one of the serous
membranes-the peritoneum, pleura, or the lin-
ing of the great joints—is inflamed.
Whenever a child cries out or shrinks from
a free movement of its legs, and it is found that
the motions of either leg are restricted, or it
looks blanched and slightly wasted when com-
pared with its fellow, no time should be lost in
122 A DECALOGUE FOR THE NURSERY.
ascertaining the cause, no matter how trivial
the disturbance may seem to be. See to it
that the examination be thorough, and made by
one competent to determine. The necessity
of this cannot be too strongly emphasized, for
on every hand we see victims of hip-joint dis-
ease whose life-enduring sufferings bear witness
to the culpable indifference of parents, or the
ignorance of medical men.
CONVULSIONS.
An ominous hush following tumultuous cries
of pain, together with slight muscular jerkings,
or sudden springs and starts, as if frightened;
facial twitchings, scintillating, rapidly rolling eye-
balls, demand prompt and energetic measures
for the prevention of a convulsion, which is un-
questionably imminent. To this end let the
body be speedily placed in a full, warm bath,
and, should there be a suspicion that the stom-
ach or intestinal canal contain irritating mat-
ter, give twenty drops of syrup of ipecac (a
vial of which should be kept constantly on
hand) every fifteen minutes until free emesis is
induced, and at the same time a movement of
A DECALOgue for tTHE NURSERY.
123
the bowels should be secured by an enema of
warm soap-suds. For further instruction see
page 203.
EARLY SIGNS OF PULMONARY AFFECTIONS.
Respiration affords us many valuable sug-
gestions; so instructive are the modulations in
breathing that, by this means alone, one is
often able to determine the condition of a pa-
tient. Especially does it constitute an indis-
pensable element in the diagnosis of disease in
childhood.
PNEUMONIA.
Supposing we have to treat a child whose
respiration is hurried, labored, and evidently
insufficient, short stuffy coughs of more or less
frequency are heard, and if the child be old
enough to expectorate (which they seldom do
under five years) the sputa show rust-colored
streaks.
With no further investigation we are war-
ranted in believing the case to be one of Pneu-
monia-which suspicion becomes a certainty if,
superadded to these indications, there is a deep
crimson spot on one or both cheeks. The nos-
124
A DECALOGUE FOR THE NURSERY.
trils dilate and fall with each respiratory effort;
the large blood-vessels extending on either
side of the neck mark the accelerated heart-
action with a bounding impulse, which imparts
a peculiar thrill to the touch. The thermom-
eter will probably declare an elevation of per-
haps six degrees. The diagnosis of such a case
is very simple, and the lesson aimed at is con-
cisely stated as follows: The quickened, panting,
painful breathing, accentuated with a peculiar
stuffy, restricted cough, are the initial symptoms
which sound the note of alarm to the mother.
As a rule, in pneumonia the onset is sudden,
without any previous warnings in the form of
coughs and colds, as many believe. The rigor
and chill which invariably usher in this affection
are seldom noted in young children.
PLEURISY.
Pleurisy, or inflammation of the serous sac
enclosing the lung, is occasionally met in child-
hood, and may be mistaken in its early stages
for pneumonia; and here also the character of
the respiration is our chief aid in differentiating.
It is quick, but not labored as in pneumonia ;
A DECALOGUE FOR THE NURSERY.
125
the air does not descend deep into the lungs,
for the pain excited will not permit the walls of
the thorax to expand; in fact every movement
of the body is restrained through dread of the
pain incurred. The cough is dry, short, and
spasmodic, evidently causing excruciating pain
-evinced by the peculiar catching, sharp cry it
forces-which the little one vainly endeavors to
suppress, lest it too intensify the pain which ac-
companies every free play of the lungs. In
pleurisy, as a rule, the fever does not reach so
high a grade as in pneumonia.
DIPHTHERIA.
If, at any time after a few hours of fretfulness,
the voice assumes a thick, muffled tone, and the
child lies with parted lips, breathing heavily, the
inspiration sounding thick and "mussy," while
the skin feels hot and dry, do not fail to open
wide the mouth, depress the tongue, and ex-
amine the throat carefully, for probably it will
be found swollen, injected, and bearing, on one
or both sides, one or more white or grayish
patches, thus completing the diagnosis of an
attack of diphtheria.
126
A DECALOGUE FOR THE NURSERY.
CROUP.
We need not linger to detail the peculiarities
of respiration when associated with the ordi-
nary physical derangements of less urgent nat-
ure; as, for instance, whooping-cough and ca-
tarrhal affections. These may find a passing
note in the chapter devoted to therapeutics.
Before closing this section, however, we must
refer to another anomaly of the respiratory or-
gans universally designated "Croup.
Croup." It is
currently believed that there are two distinct
types of croup—the "Spasmodic," or "False,
and the "Membranous," or "True," varieties.
The form which is most commonly met with
is the so-called "False Croup." The child
retires in its usual health, with perhaps symp-
toms of having taken cold. Suddenly, the still-
ness of the night is broken by a loud, hoarse
cough resembling the deep bark of a watch-dog.
The suddenness of the attack, the time, the un-
naturalness of the sounds emitted, and the ter-
rible suggestiveness of the cough as it echoes
dismally through the house, fill the mother's
heart with fearful forebodings. The little one
A DECALOGUE FOR THE NURSERY.
127
Al-
is found restless, slightly feverish, temperature
seldom above 102°, respiration more or less
wheezing and rough. The voice is changed,
being either gruff, with a metallic clang, or
pitched on a higher key, sounding as though
forced through a narrowed or contracted space.
In a little while the cough returns more furi-
ously and in paroxysms, and the little one
springs up, tosses its arms and head about,
while the face deepens in hue, and the pro-
truded eyes have a wild, anxious stare.
though the symptoms combined present a
frightful picture to those whose minds are
filled with the dread of that formidable disease,
"Membranous Croup," for the alleviation of
the parents' apprehension we are warranted in
stating that, ominous as the situation may be,
there is no cause for deep alarm; providing the
appropriate measures (which we shall describe
later) be properly and calmly employed, the
storm will be passed before morning.
The reader will now naturally look for a des-
criptive account to follow, of the more formid-
able companion affection, so graphically de-
picted in the text-books, and firmly believed in
128
A DECALOGUE FOR THE NURSERY.
by the masses," Membranous Croup; " but, as
in my sixteen years' practice I have never seen
the disease-nor have I found any intelligent
physician who has had any personal experience
with it-I venture to predict that it will not be
encountered save as a complication of diph-
theria.
The following Symptom Table will be all
that is necessary in this connection for differen-
tiating the conditions:
SYMPTOMS OF SPASMODIC OR
FALSE CRoup.
1. The premonitory symptoms
are insignificant and are those of
acute catarrh.
2. Its onset is sudden; appear-
ing unexpectedly in full force and
always in the night.
3. The cough is lusty, resonant,
and full, like the baying of a young
hound, and the voice is hoarse and
husky.
SYMPTOMS
CHARACTERIZING
""
THAT CONDITION DESIGNAT-
AS "MEMBRANOUS OR
"TRUE" CROUP.
ED
1. The premonitory symptoms
are severe chill, followed by fever.
The eyes are injected and look
heavy; the general appearance is
suggestive of heavy cold.
2. So far as local manifestations
extend they are not usually violent
at the onset, and may appear either
day or night.
3. The cough in the beginning
is but little, not noisy, but short,
dry, husky, and the voice is corre-
spondingly dry, stuffy and hoarse,
but instead of this hoarseness
being gruff and deep, it is apt to
to be cracked, or even piping.
A DECALOGUE FOR THE NURSERY.
I29
4. There is little fever, tempera-
ture seldom above 102°.
5. There is no physical prostra-
tion.
6. Child does not complain of
pain when swallowing.
7. The attack subsides to a de-
gree with the night, to return the
following one, unless successfully
treated.
8. The throat displays no
patches, but as a rule is injected,
and the color deepened.
9. The termination (which is
almost invariably favorable), is ac-
complished gradually. Decided
amelioration may
may be expected
after the second night. The
hoarse cough and catarrhal symp-
toms may linger for a week or ten
days.
10. All the symptoms point to a
congested irritable state of the
mucous membrane of the upper
portion of the windpipe and phar-
ynx.
4. There is intense fever from
the first, often ranging as high as
106°.
The surface is hot and dry,
the respiration hurried and con-
stricted, as if forced through a
constantly narrowing space.
5. Physical prostration is marked
from the beginning.
6. The child frequently com-
plains of pain in deglutition.
7. The attack is steadily pro-
gressive throughout, being unre-
lieved by any periods of decided
remission.
8. The throat reveals a white or
grayish exudation, which often
covers the back part of the throat
or pharynx, dips down and is lost
to view in the glottis.
9. The termination is death from
asphyxia, as respiration grows more
and more difficult, and occlusion
ultimately ends the struggle.
Io. It will be seen that all con-
stitutional indications closely re-
semble those of diphtheria.
9
130
A DECALOGUE FOR THE NURSERY.
EARLY INDICATIONS OF TUBERCULOSIS.
For the successful management of thoracic
disorders occurring in patients of a consumptive
tendency, the early recognition of the tubercu-
lar diathesis is of the highest importance. The
chief indications are: a too clear and brilliant
complexion, while the delicate skin is so trans-
parent that the superficial veins show quite
prominently; an over-bright eye, large pupil,
and long, fine lashes; soft, glossy, moist, hair;
precociousness; enlarged cervical glands;
heart's action easily increased; pulse habit-
ually too frequent; catarrhal condition, etc.
CHAPTER VIII.
THE RIGHT AND WRONG USAGE OF DRUGS.
A PHILOSOPHER once declared that, "through
the art of drugging more harm had been
wrought upon humanity than from pestilence
and sword combined." The truth of this enun-
ciation would seem assured to anyone conver-
sant with the history of medicine, for its annals
abound, to a degree exceeding the wildest fancy,
in doctrines illogical, practices cruel and vile, and
beliefs preposterous. Indeed, we have not to
revert to that which is written to establish this,
since practices which would not be tolerated
by the present generation were popular during
the earlier years of men still living, who at one
time upheld and practised salivation, blistering,
wet cupping, purging, vomiting, starvation by
denial of food, water, and air-which, less than
fifty years ago, combined to represent the spirit
of orthodox treatment of the sick. To-day it
is the boast of the profession that their methods
132 A DECALOGUE FOR THE NURSERY.
are diametrically opposed to severe measures.
So rapid and sweeping has been this reform
in therapeutics that it is imperfectly compre-
hended by the masses, who are so obdurate in
this particular, and so tenacious withal of old
time customs and beliefs, that from them the
conscientious practitioner who seeks only the
greatest good of his patients, is apt to incur
disfavor and loss of patronage for his zeal in
behalf of milder forms. We are constantly
made to feel that it is the influences impress-
ing the senses that sway the multitude, rather
than those appealing to the intellect.
The intestinal commotion and brisk purge
following the employment of some vaunted pill
or compound, conveys to ordinary minds infi-
nitely more meaning than does an hour's philoso-
phizing in favor of safer, more efficient, though
less obtrusive, measures.
With the majority the intrinsic virtue of a
drug is not measured by the ultimate effect, but
by the appreciable disturbance immediately se-
cured. After all, the difficulty with which phy-
sicians have to contend in this matter is the
legitimate fruit of their former erroneous teach-
ฟัน
A DECALOGUE FOR THE NURSERY. 133
ings, which time, and precept upon precept,
alone can overcome.
While indiscriminate dosing is everywhere
objectionable, it is especially so when imposed
upon little children. Few objects are more
pitiable than the offspring of those parents who
habitually resort to drugs upon the slightest
pretext, and who, moreover, evince an overween-
ing confidence in their personal ability to pre-
scribe them. It is no marvel that the victims
of such pernicious interference are soon in a
sorry plight, and unless resolute counter-influ-
ences be successfully interposed, the officious
parents unwittingly destroy the life they would
give their all to save.
Personal observation warrants me in saying
that there is not an active practitioner who can-
not point to many instances where health, happi-
ness, and life itself have been destroyed through
the folly of dabbling with medical preparations
warranted to be "safe and sure." Many be-
reaved mothers sit now in the shadow of irre-
mediable sorrow, the source of which is readily
found in the accumulation of empty bottles and
pill-boxes which lie around on every hand.
134
A DECALOGUE FOR THE NURSERY.
}
It is in vain that the most forcible reasons
are brought to bear upon the devotee of patent
medicines. We are constantly brought in con-
tact with mediocre intellects so completely in-
fatuated with the desire to dose themselves,
their children or friends with every loudly ad-
vertised nostrum, that, blind to the misery pro-
duced, deaf to the voice of warning, they per-
tinaciously continue in their homicidal policy,
secretly suspicious of and resenting every ad-
monition. These are the genii who preside over
the fortunes of the patent medicine dealers, and
we may add, too, that indirectly they sway the
fortunes of physicians, for their wretched meth-
ods pave the way to professional interference.
From the above remarks the reader must
not infer that the author unconditionally con-
demns domestic medication, for such a deduc-
tion would be to a degree incorrect. The
judicious employment of drugs by the laity
must obtain the approbation of all well-in-
formed persons, but they should ever be
looked upon as two-edged weapons, and as
such most dangerous in the hands of the un-
taught and venturesome.
A DECALOGUE FOR THE NURSERY. 135
In the administering of medicinal agents
we must not forget the important fact that a
drug that creates but trifling disturbance in a
healthy body, may profoundly affect the sys-
tem when made impressionable by disease, just
as the light of the sun, which is pleasant to the
normal eye, causes exquisite suffering to the
one diseased.
Then, again, through long and varied experi-
ence we are enabled to speak intelligently of
the action of certain tested remedies when ad-
ministered singly; but it is absolutely impos-
sible for human skill to forecast the action of
compounded drugs; hence every prescription
that combines several botanical ingredients is
concocted upon guessing merely, is wholly
wanting in science, and uncertain in its action.
In a previous chapter we remarked that all
drugs display in the system two distinct actions
when administered in toxic doses; these effects
being known as the primary and secondary—
the one being directly contrary to the other
in every detail. More definitely speaking, the
first effect upon the organization is its peculiar
medicinal action, which ceases when the drug
136
A DECALOGUE FOR THE NURSERY.
has expended its transitive force. Then en-
sues the retroactive effect, which is the abiding,
and therefore curative issue; consequently this
secondary result is the one to be borne in
mind when we attempt cures through the vir-
tue of medicinal agents.
I am conscious of the fault of repetition, and
plead in extenuation an earnest desire that my
readers may comprehend the vital significance
of the principle involved.
It is easily shown that every drug introduced
into the system in opposition to this principle
results disastrously, since by this blunder we
assuredly intensify the difficulties we seek to
overcome. Everyone having personal experi-
ence with the action of drugs can recognize the
soundness of this postulate. Its truth can be
shown by reverting to the familiar effects of
some drug that has been quite generally
tested, as, for instance, some one of the do-
mestic cathartics. In a short time after a full
dose is taken, the bowel acts freely, which
disturbance represents the primary effect;
then succeeds a period of more or less pro-
longed intestinal inertia (the secondary effect);
A DECALOGUE FOR THE NURSERY.
137
and when the bowel next performs its function
there is a degree of constipation greatly ex-
ceeding that which preceded the catharsis. If
in this condition another portion of the physic
be administered, of exactly the same quantity
as the first, the system responds less vigor-
ously to the primary action of the drug, but
the sequelæ show that the secondary action
continues in full force-which is proved by the
subsequent increased intestinal inertia. There
are multitudes of people to-day who are suffer-
ing from the lack of an earlier comprehension
of this law, for through its transgression con-
stipation of the most inveterate type is induced,
and that, too, where no predisposition existed.
This dual action is not peculiar to cathartics
or to any class of drugs, but is, without an ex-
ception, common to all. The stupor and tran-
quillity secured by the narcotic is followed by
wakefulness and irritability. The exhilaration
afforded by the stimulant is invariably suc-
ceeded by depression. The arterial sedatives
(digitalis, veratrum viride, etc.) for a time re-
strain inordinate cardiac action, but the turbulent
heart is only temporarily subdued, for soon the
138 A DECALOGUE FOR THE NURSERY.
primary action is spent, and then the secondary
joins forces with the pathological influences, the
reinforcement being readily measured by the
exaggeration of the heart's action, the pulse
counting twenty or even a greater number of
beats, every minute, in excess of the rate shown
before the medicine was administered.
So much remains to be said regarding the
necessity of an intelligent apprehension of the
elements of therapeutics before resorting to the
use of drugs in disease, that it is difficult to set
a limit to our remarks. However, the above
should suggest to mothers the real danger in-
volved in the prevailing habit of dosing, and,
moreover, the fact should be taken into ac
count that all proprietary drugs and nostrums
are prepared according to the precepts of old
school doctrine, which relies upon the self-de-
feating method of depending upon the primary
action of medicines for the cure.
There is yet another difficulty besetting the
task of drawing defining lines for domestic
therapeutics. The majority are accustomed to
think of the various well-known diseases as so
many entities distinguished by arbitrary charac-
A DECALOGUE FOR THE NURSERY.
139
teristics and limitations, and, accordingly, a
disease is currently supposed to run its course
and disappear under certain fixed conditions,
uniformly the same in a given number of cases.
Hence an individual whose knowledge is limi-
ted to the study of one typical case, fancies
that all others of this type present the same
peculiarities, allowance being made only for de-
grees of severity. Accordingly, to these minds
of narrow experience the treatment of disease
resolves itself into a very simple process, for
their stereotyped conception of a disease re-
quires a corresponding cut-and-dried form of
therapeutics-the measure employed in one
successful instance must, as a matter of course,
be applicable to all subsequent cases of like
nature.
When we study separately a series of cases
of any given type of disease, we will find that
no two are counterparts, so far as minor con-
ditions and symptoms are concerned, although
the characteristics that stamp the type of the
disorder tally. To illustrate, take typhoid fe-
ver, which most of us have had more or less
opportunity of studying. We have seen that
140
A DECALOgue for the nurseRY.
whenever a number of such cases coexist in a
community they differ markedly in physical
manifestations. One will be delirious, noisy,
and unmanageable, the next tranquil and
keenly cognizant of his condition; a third over-
come with sleep, and can be aroused only
with considerable difficulty; while a fourth is
tormented with insomnia, and although perfect-
ly lucid in mind suffers tortures from want of
sleep, which may not visit him for days or
even weeks. We might continue indefinitely
to portray the individual phases which this
one disease presents, and as other types are
in like manner prolific in diversified symptoms,
we cannot fail to appreciate the folly of adopt-
ing empirical methods in the treatment of any
general disease, or, in other words, of prescrib-
ing, on the authority of reputed success, one or
more drugs in the management of a given
number of cases of the same nature, but of
varied indications.
Few things in medicine are more objection-
able than empiricism, and yet he who loudly and
persistently boasts of the marvellous success
uniformly attending the administration of some
A DECALOGUE FOR THE NURSERY.
I4I
favorite remedy is, as a rule, favorably regarded
by the public.
There exists such a wide disparity between
the therapeutic views generally upheld, and
the opinions that experience and impartial in-
vestigation have constrained me to accept, that
I am often embarrassed when presenting views
so markedly radical. However, so far as space
will admit, logical reasons shall accompany each
method advocated, and while many precepts
may obviously run counter to orthodox tenets,
an unprofitable discussion of technical matters
will, as far as possible, be avoided.
My first and controlling desire is to force
home to the minds of mothers a full realization
of the dangers attending the practice of indis-
criminate dosing, even when the remedies are
of the system reputed harmless (Homœopathic).
It is fortunate for the little ones that the heal-
ing power of nature is often sufficient to over-
come both the disease and the effects of mis-
chievous therapy.
To escape confusion and obtain a clearer
conception of our argument, a recapitulation of
the precepts heretofore set forth is subjoined.
142
A DECALOGUE FOR the nursery.
First, disease renders the system more sus-
ceptible to the action of those drugs whose
effects run parallel to the morbid condition.
Second, every drug possesses a twofold
power of action, the primary and secondary,
the latter being the curative.
Third, every drug when administered alone
in quantitative doses to a healthy person mani-
fests its workings upon the organism through a
set of characteristic symptoms, but a combina-
tion of two or more drugs destroys all uniform-
ity of action.
Fourth, whereas the various physical dis-
orders are set apart and recognized by the aid
of characteristic elements, symptoms, and con-
ditions more or less common to the form of
disease, still the individual manifestations of
each case are so peculiarly dissimilar to those
exhibited by others of the same order that
there is no well-defined, constantly recurring
set of symptoms by which we may be guided
to the adoption of an arbitrary form of medica-
tion; consequently we must study each case
separately and determine our therapeutics by
the totality of indications revealed in each case.
A DECALOGUE FOR THE NURSERY.
143
Let us approach our subject from another
standpoint. If the second proposition concern-
ing the action of drugs be correct, it follows
that to remove a morbid condition of the sys-
tem we must find and carefully consider all
the symptoms which spring from the abnormal
state, and then select and administer a portion
of a drug which, if given freely in health, would
induce a corresponding set of symptoms, as, for
instance, a scarlet flush of the skin, sore throat,
red and congested fauces, headache, suffused
and injected eyes, flushed face, nausea, and
febrile condition combined, afford the picture of
a familiar disease, scarlatina. Now we turn to
our list of remedies and find that belladonna
when taken in a poisonous dose, induces nausea,
dryness, and soreness of throat when swallow-
ing, mucous membrane of mouth and fauces
is deep red and swollen, face flushed, eyes
suffused, congestive headache, quickened pulse,
scarlet blush on skin, etc. Accordingly we
select this drug because it affords a companion
symptom picture to that which portrays the
morbid state.
Paradoxical as this reasoning may appear, it
144 A DECALOGUE FOR THE NURSERY.
supplies the key to sound philosophy in medi-
cine.
We assume the positive ground, therefore,
that symptoms are to be regarded as the mode
of expression employed by nature to make
known her wants, or rather to indicate her
manner and the channels she has appointed for
the elimination of morbid matter from the
system; hence we will do wisely to heed these
suggestions and implicitly follow her lead, in-
stead of instituting artificial measures that
thwart her processes. It is argued by some
that for every abnormity which may befall the
human organism nature has provided the need-
ful medicinal aid, which it is our prerogative to
discover; a plausible hypothesis that time may
prove true through fuller investigation.
Reasoning from the above propositions it is
evident that a foreknowledge of the action of
drugs upon the healthy body is an indispen-
sable requisition to their skilful application in
disease. To this end much research, experi-
ence, and faithful labor have been devoted to
the proving or testing of drugs upon the
human body while in a normal state.
As a re-
A DECALOGUE FOR THE NURSERY.
145
sult, we have a complete symptom record of
almost every known medicinal agent, carefully
arranged and compiled for ready reference
when required for future contingencies. As
the list of remedies thus proven numbers be-
tween two and three hundred, it is evident that
the category of possible pathological require-
ments thereby met is correspondingly large.
ΙΟ
CHAPTER IX.
DOMESTIC TREATMENT OF DISEASE.
IN the preceding chapter were pointed out
some of the difficulties besetting the construc-
tion of a domestic guide for the application of
drugs in the cure of disease, in accordance with
philosophical principles as avowed in new-school
tenets.
There obtains quite currently a misappre-
hension of this matter, to the effect that the
methods and precepts of this system are not-
ably simple and of ready acquirement. A very
natural conclusion in view of the studied mis-
representations of the opposing faction, and
more especially the mass of cheap literature
created with a desire to benefit the public, but,
in fact, constituting a most wretched abortion
of a laudable purpose.
To any one who has thoughtfully read the
foregoing pages it must be apparent that prece-
dence has been accorded hygiene, as through-
A DECALOGUE FOR THE NURSERY.
147
out, I have sought to turn the reader's thoughts
from, rather than toward, the use of medicinal
agents, not from any lack of faith in the virtue
of drugs, but because of the great harm which
may attend their misuse.
While acknowledging that the experiences.
of every-day life demonstrate the desirability of
preparing an abridgment of medical treatment
in disease, in a simple form adapted to domestic
wants, I still insist that such license should be
hedged about by rigid limitations so pronounced
and arbitrary as to restrain the venturesome
from exceeding the bounds of safety. Such a
task is not easily accomplished, but the demand
is none the less urgent and must be met in a
manner calculated to do the greatest amount of
good.
The prime motive in supplying popular coun-
sel in therapeutics is more especially to benefit
that worthy class in the community who, through
adversity, are constrained to be self-reliant in
sickness as in other conditions; also for the
help of those mothers who are sometimes over-
taken by unlooked-for trouble of such a charac-
ter that the life of the child is in jeopardy at a
148
A DECALOGUE FOR The nurseRY.
time when professional services are not readily
available.
Let us now proceed to the treatment of some
of the troubles that may befall the nursery.
CROUP.
The appellation originated with the peasants
of Scotland, who are accustomed to give to all
obstructions of the windpipe the name of croup.
The term is really a misnomer, and unscientific,
but is retained from usage. The belief is every-
where current that there are two distinct forms
of the disease, and in a previous chapter are
embodied the essential differentiating symp-
toms that have been repeated for generations
whenever an attempt has been made to describe
"croup" in its two accepted types, “Membra-
nous" and "Spasmodic," or the "True" and
False" varieties. In the section referred to
I ventured to question the veritable existence
of a common disorder which, during many years
of active practice, I have failed to discover
I
save in the imaginations of the credulous.
am by no means alone in the belief that those
A DECALOGUE FOR THE Nursery.
149
cases in which membranous formations have
appeared, if correctly diagnosed would have
been relegated to diphtheritic conditions. It
is a fact that now and then diphtheria takes
on symptoms closely simulating those of ordi-
nary croup, and, moreover, those cases of diph-
theria in which the diphtheritic exudation in-
vades the larynx and glottis always manifest
croupous symptoms, and besides, they almost
invariably terminate fatally. The author can
recall several instances of this nature, in which
the diphtheritic exudate forming lower than
usual, excited symptoms that might easily have
led the novice to an erroneous diagnosis, but to
a skilful physician the character of the pulse,
high temperature, profound prostration, and
general complexion of the case, made misappre-
hension impossible. I believe that I am fully
justified in teaching parents to banish all fear
of the formation of a deadly membrane in croup.
The obvious partial obstruction of the respira-
tion is due to the following conditions: The
chink through which the air enters the wind-
pipe, known as the glottis, is relatively nar-
rower in early life than later; consequently,
150 A DECALOGUE FOR THE NURSERY.
when the membrane lining the sides of the
glottis becomes inflamed and swollen, to a
corresponding degree the aperture is nar-
rowed. Add to these conditions a highly ir-
ritable or spasmodic temperament, and we have
all the elements necessary for the explana-
tion of the symptoms attending the phenome-
non, croup.
Even slight inflammation produces a dry,
husky state of the glottis, and as the little one
lies sleeping, breathing heavily through its
open mouth, the glottis becomes dry and irri-
tated, which precipitates the sudden, spasmodic
cough, and as the vocal chords are dry and
thickened, and the aperture contracted, the
tone of the cough is dry and inflexible, resem-
bling the deep baying of a dog. When the
membrane is moistened, the paroxysm subsides,
only to return when again dry, or excited by
titillation or nervous excitement. Naturally
the spells grow more severe and frequent as
the local irritation increases, until the catarrhal
stage ensues, when the cough loses its dry
metallic ring, and assumes a moist or phlegmy
character. It is apparent, therefore, that the
A DECALOGUE FOR THE NURSERY.
151
affection, although ushered in with alarming
and very
ominous sounds, is in reality not so
formidable as associations have made it, and a
case must be very badly managed to terminate
fatally.
In the treatment two essentials must be
kept in view: First, the exciting cause is an
inflammatory or congested state of the mem-
brane about the larynx; and second, the ner-
vous temperament which is usually associated.
It is important, therefore, that those in attend-
ance betray no undue excitement, and that the
patient be kept as quiet as possible.
Send for a physician, if one be convenient,
and it will afford more satisfaction; but there is
no actual need provided the following direc-
tions be strictly carried out.
Prepare a full bath of warm water (tempera-
ture 95°) and have a pailful of hot water
standing at hand. Then deliberately undress
and quietly immerse the little one, so that
nothing but the head is free. Continue the
bath from ten to twenty minutes, gradually
adding hot water, until the temperature is 100°
or 104°. Of course the countenance and breath-
152 A DECALOGUE FOR THE NURSERY.
ing must be watched, for a hot bath will some-
times cause fainting.
Awaiting the conclusion of the bath, have
ready a large woollen blanket, and woollen
undershirt, both well warmed. Dry the little
body rapidly and apply two warm, ample, flax-
seed poultices (which have been prepared dur-
ing the bath) over the lungs, both in front
and on the back, taking especial care to ad-
just and properly secure them close up around
the neck and throat. Cover with cotton-wool,
or a few thicknesses of soft flannel, and secure
it well in position with a little jacket and roller,
adjusted in form of a figure-eight bandage
around the shoulders. All this should be per-
formed before a comfortable fire, rubbing
briskly meanwhile. Finally, roll the child up in
the blanket, leaving just enough uncovered to
permit free respiration, and put to bed in a
warm room, with the temperature from 70° to
75°. As the inhalation of cold dry air excites
the spasmodic state, if necessary, add to the
humidity of the atmosphere of the room by
plunging a heated brick in a pan of water.
Aconite is a sovereign remedy in this affection,
A DECALOGUE FOR THE NURSERY. 153
especially if there be febrile symptoms; hot
dry skin, quick pulse, etc.
A favorite remedy, and one that does good
service in urgent cases, is the syrup of ipecac;
so, if noisy breathing, and dry, hoarse cough-
ing persist, give from fifteen to thirty drops
every half-hour until relieved, or nausea is pro-
voked. As a rule, however, the warm bath, a
few doses of aconite and subsequent swaddling
in a large blanket, and, above all, the careful
application of poultices, will subdue the attack,
or so modify it as to banish all alarming symp-
toms.
pro-
As the effects of the poultice are an impor-
tant, if not the chief element in the curative
cess, and as comparatively few mothers are
expert in managing one, we will offer this in-
struction.
First, secure a material that will retain
warmth and moisture, forming a tenacious
plastic mass when wet. Ground flaxseed meal
meets these requirements admirably, and a
quantity should be kept constantly on hand,
on account of the unseasonableness of the hour
when it is usually needed.
154
A DECALOGUE FOR THE NURSERY.
Of this take a pint and stir in enough warm
water to saturate thoroughly, avoiding the mis-
take of too much wetting, for a poultice that
drips or runs is a disagreeable failure. Have
ready a strip of cloth of such dimensions that
when made into a sack it will cover the surface
for which the poultice is intended. Spread
evenly to the depth of about one-fourth of an
inch upon one-half the cloth, then bring the
other half over the face of the poultice, and sew
the edges together, so as to confine it in a
neatly closed sack. The poultice is then laid
warm upon the surface, and over it is spread
a compress of cotton wool, or several layers
of soft cloth (well warmed), in such a man-
ner as to cover considerably beyond on all
sides.
Unless a poultice can be properly prepared
and adjusted it should not be undertaken at all.
Its purpose is that of a warm moist pack, and
if not thoroughly protected from the atmos-
phere and held smoothly and evenly in posi-
tion, it becomes cold and clammy, displaced,
or rolled into an uncomfortable bunch, and so
turned into a positive evil.
A DECALOGUE FOR THE NURSERY.
155
This is a very important matter for mothers
to understand, and the above instructions can-
not be too minutely observed. No other one
measure in the therapeutics of children, has
afforded the writer such satisfactory results as
this simple one. In all forms of pulmonary
and intestinal affections it is invaluable, and in
those gastro-intestinal disorders so destructive
to life in the hot season, it is especially efficient.
The torturing thirst, heat and distention of
abdomen, are soothed, as if by magic, by en-
veloping this part of the body in an ample
poultice. These salutary workings can be
likened to the influence exerted upon a burn
or scald by similar soothing application to the
irritated surface which protects the terminal
nerve filaments from atmospheric or external
influences.
DIPHTHERIA.
The premonitory symptoms are, shivering,
aching in legs and back as if severely bruised,
and great lassitude. The child insists upon
lying down, is drowsy, and the face looks heavy
and congested. Following the chill, a severe
156 A DECALOGUE FOR THE NURSERY.
fever sets in, pulse rapid and bounding, tem-
perature high, ranging from 102° to 106°. The
child lies with mouth partly open, breathing
audibly, and voice thick. As a rule the pa-
tient does not complain of severe pain when
swallowing, and the more extensive the patches
upon the fauces, the less appears the pain.
The peculiar dirty grayish patches are seen
upon one or both sides of the throat soon after
the fever sets in. There is usually more or less
enlargement of the submaxillary glands on the
side affected, perceptible externally. As the
disease is unquestionably constitutional, and
not local, or, in other words, as we have to deal
with blood-poisoning attended with great pros
tration, our task is to neutralize or eliminate
the blood poison, and sustain the stricken vital
powers by the judicious use of supporting
measures. To this end let the patient be well
nourished with suitable food. Even in mild
cases the recumbent posture and perfect quietude
in bed is a wise precaution for the harboring of
the strength, which is of the utmost importance,
for it is often in the milder forms that cardiac
failure appears as a most dangerous sequel.
A DECALOGUE FOR THE NURSERY.
157
The chief danger with young children lies in
the fact that their delicate vital forces can-
not be fortified sufficiently to resist the sud-
den great prostration. Small indeed are the
chances of recovery if, superadded to the mor-
bid conditions which have already profoundly
depressed the system, the jeopardized life is
assailed (as is too often the case) with nox-
ious drugs, and harsh measures that effectu-
ally ruin the powers of assimilation, and be-
yond question contribute to the destruction of
life.
Does any reader doubt this assertion and
plead that such cruel malpractices belong to the
past, and cannot justly be attributed to the pres
ent period of advanced thought? My advice to
such an one is to glance through the published
doctrines of the orthodox school of medicine,
promulgated within the last two years. Turn
to pages 720 and 721 of the Philadelphia
Medical News, June 27, 1885, and there will
be found advocated for the treatment of diph-
theria, calomel in forty-eight-grain doses, and
one hundred grains during the twenty-four
hours.
158
A DECALOGUE for the nursery.
In "A System of Practice of Medicine by
American Authors," vol. i., p. 105, Dr. Jacobi
avows his custom of prescribing to infants half
a grain of corrosive mercury every day for
many days in succession. In passing, note that
corrosive mercury is one of our most deadly
poisons; gr., three times a day for an adult,
is regarded the full officinal dose, but here we
have gr. given to an infant, against gr.
8
allotted an adult.
16
3
16
On page 576 of the Medical Record, May
24, 1884, we are advised to divide eight to
twelve grains of calomel into thirty or forty
doses, of which one is to be taken every half-
hour, "which is apt to yield a constitutional
effect." We think quite likely.
Finally, read a very instructive article pub-
lished in the New York Medical Record,
December 5, 1885, written by one of the lead-
ing members of the New York Academy of
Medicine, and read before that body. In this
article the author condemns the use of mercuric
preparations and extols the liberal administra-
tion of the tincture of chloride of iron. The
author insists that "at least" one drachm (a
A DECALOGUE FOR THE NURSERY.
159
teaspoonful) of the tincture be given every
hour, and says: "We have given two drachms
every half-hour for forty-eight hours, or twelve
ounces in two days, to a boy eight years old."
Farther on, he states, "the employment of emet-
ics is imperative in young children who cannot
expectorate," and since young children never
do expectorate, the inference is obvious. Hav-
ing read the paper, turn to the records of the
reported discussion which followed the reading,
and note the prevailing sentiment of this assem-
bly of eminent practitioners. The printed min-
utes testify to that which would be seriously
doubted if repeated in these pages. I have
been careful to refer only to the doctrines of
widely known and acknowledged authorities.
Were it advisable, these data could be greatly
multiplied.
Those who are not practically familiar with
the exceedingly astringent, metallic, nauseous
taste of tincture of chloride of iron, can form
but slight idea of the suffering which the swal-
lowing of a teaspoonful of this acrid drug in-
flicts. Let it further be considered that the of-
ficinal adult dose is from four to twenty drops,
160
A DECALOGUE FOR the nursery.
and also that comparatively few patients are
able to persist in the taking, on account of the
intestinal and cerebral disturbances arising. In
view of these facts, consider a child already
prostrated by a terrible disease, forced to swal-
low, every brief half-hour, two teaspoonfuls, or
double the greatest quantity apportioned an
adult in twenty-four hours. Superadded to this
terrible ordeal, we have, recommended, "an
occasional emetic."
We are not surprised at the statement of the
advocates of such heroic measures, that "the
results are by no means encouraging."
From its earliest days the new school has
treated diphtheritic affections with the vari-
ous forms of the mercuric salts, but always in
attenuations, or greatly diluted doses, as, for
instance, seldom giving to an infant more than a
hundredth part of a grain of calomel. It is not
for me to say that the results secured led to
the adoption of mercurials by the opposing fac-
tion, but one thing is certain, that whereas they
have experimented with the same drugs, they
have pursued the opposite extreme as to the
size of doses, and with results proportionately
A DECALOGUE FOR THE NURSERY.
161
disastrous, as health-board statistics testify.
Who will deny that a child stricken with diph-
theria is not infinitely safer when implicitly en-
trusted to the healing power of nature than
to methods such as we have just contemplated?
If personal feeling were followed, the above ap-
parently severe criticism would not appear in
this connection, but there is infinitely more at
stake than individual interests, and a sense of
duty underlies the strictures.
The practice of swabbing the fauces with
various astringent applications all more or less.
irritating is to be discountenanced. It is a
fault that in past years I have tested extensively,
and I speak authoritatively from experience. If
the patient is old enough to gargle, let this be
done faithfully, using warm water made slightly
salt, and as frequently as the strength will war-
rant. The hot water constringes the dilated
capillaries, thus reducing the congestion, and
its cleansing effect softens the exudate and hast-
ens its detachment. Should the skin be dry
and hot, pulse rapid and quick with high tem-
perature, give aconite 5 drops 1st x in half a
tumbler of water; a teaspoonful every two
II
162
A DECALOGUE FOR THE NURSERY.
hours. If the skin be moist, yet hot, the
face having a congested appearance, and the
throat presenting a deep red hue, give bella-
donna.
In my own practice prot.-iod. of mercury
2d. x trit., has proved the remedy par excellence
in the treatment of this disease. It should be
given from the inception of the attack until the
patches begin to loosen. For an infant, give
every two hours a one-grain powder dry upon
the tongue, alternating it, one hour apart, with
any associated remedy that may be called for
by the symptoms. Bichromate of potash is also
frequently indicated. Either Merc. bin.-iod.,
merc. cyan., or phytolac-may be demanded.
Should there be soreness and considerable
swelling of the submaxillary tissues, persistent
fomentation with a large hot poultice will be
very grateful. A teaspoonful of red pepper
mixed with the flaxseed before wetting adds to
the virtue of the poultice; vinegar may be used
instead of water.
The use of ice either internally or externally
is a most culpable practice; applied externally it
depresses the forces of life, and when sucked it
A DECALOGUE FOR THE NURSERY.
163
ultimately parches the mouth and intensifies the
congestion about the fauces.
The sequela of diphtheria are, besides the
marked prostration, temporary paralysis of the
throat, and, in some instances, of the entire
body. At one time I had to deal with a case in
which this secondary or paralytic condition ap
parently involved every muscle of the body, even
the eyelids and tongue, and yet a perfect re-
covery was gained. This condition usually ap-
pears some days subsequent to the clearing up
of all local manifestations, and is as liable to at-
tack simple as severe cases. The one to which
reference has been made had not been confined
to the bed even a day, and had seemingly made
good recovery. When nearly a week had
elapsed, the sight, voice, and gait were suddenly
found to be defective. The loss of muscular
power gradually increased, until at the end of
four days the little one lay absolutely helpless,
without the power of speech, or even of mov-
ing the eyelids. Unless the heart becomes
seriously complicated, perfect recovery may
be safely predicted. Nux vomica and Phos.,
together with electricity, are the therapeutic
164 A DECALOGUE FOR THE NURSERY.
means most frequently employed. Massage
properly performed by a healthy nurse is un-
doubtedly the most effective curative meas-
ure.
As diphtheria is obviously an infectious dis-
ease, every means should be put into force to
prevent its spreading to other members of the
household. Direct inspiration of the patient's
breath should be guarded against. Parents
and nurse should understand that bodily fa-
tigue, or general exhaustion from overwork
or worry, renders the system of one exposed
especially susceptible to contamination. Of
course every means must be used to discover
and abolish all probable sources of the dis-
order-cesspools, defective drainage, decaying
vegetables in the cellar, etc. Finally, during
the sickness, rigidly enforce the rules for proper
disinfection, and upon the removal of the con-
valescent, have everything that has been in the
sick-room thoroughly disinfected. (See pp.
250-252 on this subject.);
A DECALOGUE FOR THE NURSERY.
165
TABULATED PRESENTATION OF THE DIFFERENTIATING SYMPTOMS
OF CROUP AND DIPHTHERIA.
CROUP.
DIPHTHERIA.
I. Begins with slight febrile I. Begins with chilliness, aching,
symptoms, resembling a catarrhal and deep bruised feeling in the
cold. Cheeks may be slightly legs and loins. Countenance pal-
flushed, eyes injected, and cough lid and dull. In a few hours high
dry, hoarse, brazen. Voice usu- fever, face flushed, pulse bound-
ally rough and deepened in low ing, quick. Desires to lie down.
tones, but piping and pinched No cough. Respiration only
when crying, or attempting loud | slightly accelerated, sounds heavy,
tones. No evidence of severe as if sleeping soundly with lips
constitutional disturbance. There apart.
Breath offensive. Voice
much thickened.
is no marked chill or pain, and
no great prostration. Respiration
wheezy, roughened and found to
be quite noisy when the ear is
placed against the chest.
2. An examination of the
throat reveals little that is abnor-
mal, the membrane is usually
more or less reddened, and to the
experienced eye is seen to be |
thickened. No difficulty in swal-
lowing, and breath not offensive.
No swelling externally.
2. Examination of throat re-
veals the characteristic patches,
more or less extensive, of a white
or grayish cast, located on one or
both sides of fauces.
There may
be more or less pain in swallow-
ing. As a rule, however, the diffi-
culty in this particular does not ap-
pear till after the removal of the
patches. Child constantly en-
deavoring to swallow, or what is
known as empty swallowing.
ternally there is swelling under the
angle of the jaw on one or both
sides.
Ex-
166
A DECALOGUE FOR THE NURSERY.
3. Pulse slightly accelerated in
the early stages, but may become
quite rapid from nervous excite-
ment consequent upon the diffi-
culty experienced in respiration.
Temperature seldom reaches 103°.
There are no signs of great gen-
eral depression, the physical
strength is not lessened, no in-
dications of severe constitutional
disturbance, and, in fact, the com-
bined symptoms testify that croup
is purely a local affection, and
when terminating unfavorably the
end is one of asphyxia, the pa-
tient usually succumbing to the
benumbing effects of carbonic acid
poison, which condition is due to
the restricted respiration conse-
quent upon the oedematous state
of the glottis, which may be the
sequel of severe inflammation
when badly managed.
3. Very high fever, often reach-
ing 105° or 106°. Pulse tumultuous
and very rapid in severe cases.
The whole appearance of patient
indicates the working of a virulent
poison within the system, which
attacks and undermines the vital
forces, threatening the extinction
of life through profound exhaust-
ion. When the exudation in-
vades the glottis or larynx, the
symptoms of impeded respira-
tion, or croupous manifestations,
are persistent, steadily increasing
with no well-defined spells of re-
mission and exacerbation as in
croup.
SCARLET FEVER.
Scarlet fever,"
scarlatina,"
"canker
rash," are different names of the same dis-
ease. It is true, some writers have attempted
to differentiate between scarlatina and scarlet
fever, and there are practitioners who hold
that there is a distinction as well as difference
A DECALOGUE FOR THE NURSERY.
167
between the two, but it is perfectly safe to as-
sert that the difference lies in the degree of se-
verity. Accordingly, it is less confusing, when
we wish to distinguish between the two ex-
tremes, to use the qualifications "simple" and
"malignant." That there exists no difference
in the nature of the two conditions, is evidenced
by the fact that a child coming in contact with
the lightest form, may develop the most malig-
nant and vice versa, which also proves that the
severity of the attack depends greatly upon the
nature of the soil, or constitution, into which the
seeds of infection have fallen. Furthermore,
half the members of a family may be stricken
with the disease while the remainder escape,
which likewise suggests the necessity of a
receptivity within the system. While this is
peculiarly a children's disease, young infants
seem especially exempt, since we rarely find a
child under three months attacked with it.
Like all exanthematous diseases, the primary
irritation or eruption occurs first upon the in-
ternal skin, which we call the mucous mem-
brane, and this fact explains to us why, among
the early symptoms of this type of disorder, is
168 A DECALOGUE FOR THE NURSERY.
nausea or vomiting. At this stage, if the roof
of the mouth, fauces, and buccal surfaces be in-
spected, there will be evidence of this primal
internal eruption in the injected and heightened
color of the mucosa. If the child be old enough,
it will complain first of chilliness, frontal head-
ache, thirst, and sore throat; and, upon in-
spection, there will sometimes be seen in the
throat little white patches, as of milk-flakes,
distributed upon the inflamed fauces. To the
shiverings and nausea succeed febrile symp-
toms; the eyes appear injected and glistening,
the face flushed, and the skin hot and dry,
while the little one is petulant, languid and
drowsy. The pulse runs from one hundred
and forty to as high as two hundred, according
to the severity, and the temperature is corre-
spondingly increased. The duration of this
stage is about two days, at which time the
characteristic blush appears upon the breast
and back, and next on the face, great joints and
limbs, successively, until the entire body is cov-
ered. The hue of this efflorescence varies
from a faint, or bright scarlet, to a deep pur-
ple, and the deepness of the blush usually
A DECALOGUE FOR THE NURSERY.
169
marks the severity of the disease; consequently,
if we find a purplish tint, we may know without
the aid of the thermometer that the fever is in-
tense, and we shall have to summon our best
skill to subdue the dangerous congestion. At
the height of the fever, in an ordinary or
medium attack, the surface presents a smooth
scarlet efflorescence.
The aspect of the tongue is also quite in-
dicative. In the early stage it is covered with
a thin white fur, but soon tiny red papillæ ap-
pear, making it look as though sprinkled with
red pepper; while the edges and tip (on ac-
count of the close resemblance) are designated
"strawberry tongue." The rash lasts about
four days on an average, and then disappears
gradually, in the same order in which it came.
This is known as the period of desquamation,
and the severity of the peeling is determined by
the intensity of the fever. On some parts of
the body (palms of hands and soles of feet)
the shed material peels off in large flakes,
while on others (back, abdomen, thighs, etc.)
it escapes in dust so fine as to float in the air
of the room, to settle upon remote objects—
170 A DECALOGUE FOR THE NURSERY.
clothing, open trunks, etc.; and in this
and in this way
germs of the disease may be transported to
any distance, and it may be at any remote fut-
ure period.
Scarlet fever is unquestionably the most for-
midable disease of childhood, for not only are
its ravages marked by a large percentage of
deaths, but it is estimated that nearly fifty per
cent. of those surviving are left the victims of
some serious disablement, more or less abiding,
and frequently loathsome as well as incurable.
The most common of these after-conditions are
affections of the ears and kidneys, and to treat
of either one of these thoroughly would in-
volve us in too lengthy a discussion. These
cases should be confided to a skilled physician,
and with this suggestion we must leave them,
after a passing comment upon the nephritic
complication,-Post-Scarlatinal Dropsy. The
evidences that the kidneys are affected are
suppression of urine, puffiness of the face, es-
pecially beneath the eyes in the morning, and
swelling of the feet in the evening. For the
relief of this condition: even, warm protection
of the body, bland food, plenty of distilled
A DECALOGUE FOR THE NURSERY.
171
water, or that which the author prefers, Poland
spring water, and for a medication arsenicum
alb. 4th x. dil., a drop every two hours.
Against the deplorable practice of syringing
diseased ears, so widely commended, I cannot
refrain from entering a protest. Myriads of
little unfortunates have been rendered hope-
lessly incurable by this destructive practice.
In cleansing the auricular canal of the offensive
discharge, with the utmost gentleness wipe
and dry with a very small soft mop, made of
prepared cotton twisted around the point of a
wooden toothpick, in such a manner that the
cotton extends considerably beyond the end of
the stick. After drying anoint with an ointment
composed of vaseline one ounce, pulverized
borax ten grains. Do this so deftly as never
to excite the slightest pain, and not oftener
than once a day.
MANAGEMENT OF SCARLET FEVER.
Place the patient in a well-ventilated, cool
room, the temperature of which keep as near
sixty as possible. Give light, plain food—bread
172
A DECALOGUE FOR THE NURSERY.
and butter, gruel, milk, etc. Do not be per-
suaded into torturing the patient and derang-
ing the digestion by drenching the stomach
with forcing drinks. Keep the patient com-
fortable and quiet, and wait patiently until the
end of forty-eight hours, when the rash will be
found "on time." On no consideration physic,
or administer laxatives. Let the patient drink
freely of water, a little at a time, but avoid iced
water, or the sucking of ice, as either one of
these will increase the nausea, add to the thirst,
and increase the parched state of the mouth and
throat. Hot or warm water will always allay
thirst much more effectually than cold drinks.
If there be high fever and restlessness, sponge
the soles of the feet, the hands, and spine with
quite warm water. The sovereign remedy is
Belladonna. It is my custom to give bella-
donna 3d x one drop every hour for six hours,
and then omit six hours. During the interim
give aconite same potency, providing the skin
is dry and hot, and there is considerable fever.
If, however, the attack be light, be content
with watching the symptoms, and giving an
occasional dose of belladonna. Above all, re-
A DECALOGUE FOR THE NURSERY.
173
frain from overdosing, and to this end bear
in mind that mischievous interference is the
most fruitful source of unfavorable termina-
tions.
To prevent the spread of the disease, if
pos-
sible let one attendant be allotted the sole care
of the invalid who is quarantined, and all visit-
ing prohibited. The nurse should wear a large
cotton wrapper, which is removed upon leaving
the room.
For after-disinfection of room and
clothes see p. 250.
MEASLES.
This disease is currently regarded as belong-
ing to childhood, but, unlike scarlet fever, is not
restricted to children, as any of us can recall
instances of its occurrence in adults, even those
in advanced life. Moreover, it is worthy of,
note that the severity of the attack seems to be
in direct ratio to the age of the patient. The
disorder is highly infectious and epidemic. It
is far more readily and widely propagated than
scarlet fever, and few children will escape if
directly exposed—that is, if they breathe an at-
174 A DECALOGUE FOR THE NURSERY.
mosphere contaminated with the exhalations of
an existing case. Symptoms: The early symp-
toms of the disease are those of influenza or
acute catarrh. Hoarse, harsh cough; sneez-
ing; eyes red, watery, and eyelids look swollen;
more or less fever, and gastric disturbance.
This condition lasts, with slightly increasing
tendency, for three or four days, when the
eruption makes its appearance on the skin.
Previous to appearing externally the eruption
has run its course upon the mucosa, as an early
inspection of mouth will show. (Hence cough,
nausea, and catarrhal manifestations.) The
rash appears externally, first on the face, which
looks swollen, next upon the body, and finally
upon the legs. If examined closely, the erup-
tion is first in the form of half-moon spots which
run together and form blotches slightly raised
above the healthy surface. Its color varies
from the tint of a ripe raspberry (the favorable
sign) to a dark purple (which is unfavorable).
About three days are required to fully complete
its coming out, and after remaining three or
four days, fades gradually, the fever declining
at the same time. The attack has usually
A DECALOGUE FOR THE NURSERY.
175
reached its climax on the fifth day. In an or
dinary case the thermometer registers 103°,
and, as it varies either way, the case is mild or
severe. The only disease with which measles
is apt to be confounded is scarlet fever. The
following differentiating indications will clear
up all doubt in diagnosis.
SCARLET FEVER.
MEASLES.
1. Appears fourteen days after
1. Requires only five to seven
days' incubation, that is from date | exposure.
of exposure.
2. Eruption appears the second
day after the onset of the attack.
3. No inordinate coughing or
sneezing.
4. Rash fine and smooth, begin-
ning on the chest, and resembling
a boiled lobster in color.
2. Eruption appears fourth day
after attack.
3. Severe catarrhal symptoms,
hoarse coughing, sneezing, coryza.
4. Rash appears first on face
close to hair; is slightly raised,
and looks blotched.
The unfavorable consequences of measles
are affections of the air-passages or bowels,
especially when the patient is predisposed to
tubercular disease. The eyes and ears like-
wise are the seat of subsequent irritation in
delicate, strumous constitutions.
176
A DECALOGUE FOR THE NURSERY.
TREATMENT.
Keep the patient in a moderately warm (70°),
well-ventilated room. Never administer laxa-
tives. Pulsatilla is universally considered the
prime remedy.
Phosphorus is preferable if the cough be dry
and hollow, and the patient thin and predis-
posed to stoop. Should the appearance of the
eruption be long delayed, with evidence of con-
siderable congestion, give a warm bath, after
which keep well wrapped in a large blanket.
Since the severity of the disease unquestion-
ably increases with age, and as few escape an
attack sooner or later in life, it is wise to pre-
cipitate it as early as possible. With infants
it is scarcely worse than indisposition from a
severe cold. For some weeks subsequent to
recovery the convalescent must be protected
from exposure to chills.
WHOOPING-COUGH (PERTUSSIS).
This is a very troublesome, though rarely fa-
tal, disease. It evinces a special predilection for
children under three years of age, and unfort-
A DECALOGUE FOR THE NURSERY. 177
unately, the younger the child the more severe
is apt to be the attack; it behooves parents,
therefore, to guard against, or postpone the
disease until the third year, if possible. There
are no well-defined limits of duration; it may
last from two weeks to six months. Although
ranked as a child's disease, it may develop in
the parents, or even grandparents, of the chil-
dren affected.
The first symptoms are those of ordinary
catarrh, with spells of coughing and an occa-
sional sneeze. This first stage may last a
week or ten days, during which time the nat-
ure of the disturbance is in doubt; at the end
of this time, however, the "fits" of coughing
recur at shorter intervals and increase in se-
verity until, ere long, a distinct " whoop" ter-
minates an unusually
an unusually severe paroxysm of
coughing, and all doubt is banished. Between
these paroxysms the little one seems bright
and happy, but soon learns to dread a recur-
rence, and struggles to suppress it; but when
the disease is in full force is powerless to do
so the diaphragmatic impulses succeed each
other so rapidly, allowing no opportunity to
12
178 A DECALOGUE FOR THE NURSERY.
breathe. The face becomes congested, the
eyes run over, and when all air seems utterly
spent the lungs are refilled with a prolonged
crowing inspiration, to be once more driven
out through a succession of rapid diaphrag-
matic impulses till the child seems on the verge
of strangulation when suddenly a gush of
phlegm and ingesta is ejected, and the little
sufferer, very much fatigued and frightened, has
one spell less to endure. If at any time during
the height of the disease the ear be laid to the
little chest, a combination of peculiar respira-
tory sounds will be heard. The treatment con-
sists in giving the indicated remedy, protection
from fresh attacks of cold, living in the out-
door air when pleasant, together with care that
the child is held properly (partially prone) dur-
ing the paroxysm.
PNEUMONIA, OR INFLAMMATION OF THE LUNGS.
On page 123 will be found a description of
the prominent physical symptoms attending the
early stage of this affection, which is every-
where, and with good reason, regarded as a
most formidable one. The appalling ravages
A DECALOGUE FOR THE NURSERY.
179
of this disease unquestionably are largely due
to the wretched methods employed in the treat-
This is a graceless statement, and deep
solicitude for the welfare of the suffering, could
alone move me to make it.
ment.
The barbarous methods of salivation, bleed-
ing, and starving, have been superseded by
others hardly less objectionable so far as results
extend. The cruel blistering is still practised
by many, but although this is a harsh and pain-
ful procedure, it does not interfere with, or un-
dermine the vital forces. The most reprehen-
sible feature of the modern orthodox treatment
in pneumonia is the free use of quinia and
opiates, quinia to crush the fever, opium to
allay the pain. No more deadly drug combina-
tion for the treatment of pneumonia could be
devised. While this medication secures the
lowering of animal heat, and freedom from
pain, it at the same time interferes with or
blocks the excretory processes, and checks
the functions of all the secretions save that of
the skin, consequently nature is handicapped.
The patient lies comparatively free from pain,
with cough checked and temperature lowered;
180
A DECALOGUE FOR THE NURSERY.
but all this time the deadly work is going on
within, the fatal deposit is extending and les-
sening the area of free lung texture, and the re-
sult is that soon the portion of the lungs left
uninvaded is too limited to perform the duty
which devolves upon the normal lungs, so one
more death is added to swell the percentage.
It becomes us to look at the matter logically.
Pain is not our worst foe; on the contrary, it is
a beneficent monitor in many ways. Remove
it, and we are lulled into a dangerous sense of
security. Likewise cough is nature's way of
freeing the lungs of superfluous secretion.
is an easy matter to suppress a cough by the
use of an opiate, but is always dangerous and
delusive. Moreover, an exalted temperature
and accelerated pulse, up to a certain limit, have
their serviceable significations, telling of nec-
essary achievements in the life-saving process.
Infinitely more commendable is the expectant
method, where inactive we stand aside and
reverentially study the workings of nature, than
to work deadly havoc by ill-chosen, perverted
measures. It may seem to savor of boastful-
ness, but such is not intended when I state that
It
A DECALOGUe for the nURSERY. 181
during the last fifteen years of active practice
I have had to record but one death from pneu-
monia, and that the case of an habitual drunk-
ard. While I have no account of the number
of cases treated, it is probable that I have had
my relative proportion-at one time seventeen
cases, all in the active stage. In extenuation
of this personal allusion I will state that it is
introduced as a commendation of the very sim-
ple course that has served me so well. I have
never given, in a case of pneumonia, a single
dose of quinia, morphine, cathartic, or alco-
holic stimulant, nor applied a blister. The
medicinal remedies chiefly relied upon are Aco-
nite and Lobelia, with the accessories Bryonia,
Phosphorus, and Belladonna.
As soon as the symptoms have declared the
invasion of the disease, soak the lower limbs
for ten or fifteen minutes in water as hot as
can be borne, during which time prepare a gen-
erous poultice. This apply and keep warm,
covering both back and front of the thorax.
Of course put the patient to bed and keep him
quiet. Mix five drops of tincture of lobelia in
twenty-five teaspoonfuls of pure cold water in
182
A DECALOGUE FOR the nursery.
Ad-
one tumbler, and two drops of tincture of aco-
nite in another, with like amount of water.
minister alternately a teaspoonful every hour.
(We are treating in fancy a child of ordinary
conditions, say one year old.) Pursue this
treatment until the acute stage has softened,
i.e., until the intense fever abates, and the
symptoms of severe acute pain subside, which
will require ordinarily about twenty-four hours.
Should the cough now be dry, the nostrils play
with each respiration, a round crimson spot ap-
pear on one or both cheeks, give a few doses
of phosphorus. Mix five drops of the 3d x.
in half a tumbler of water, and give a teaspoon-
ful every hour for six hours, at the end of which
time discontinue the phosphorus and resume
the lobelia, with or without the aconite, as the
fever may indicate. If there be present catch-
ing or stitching pains, suggestive of pleuritic
complications, bryonia of the same strength as
the aconite mixture has the precedence until
the sharp pain be subdued. Violent headache,
with unmistakable evidences of a congested
condition, calls for belladonna.
In favorable cases, after the first three or four
A DECALOGUE FOR THE NURSERY.
183
days the inflammatory condition subsides, and
the period of resolution or absorption of the
lymph deposit sets in. Very commonly the
patient lies quite comfortable, with only slight
discomfort felt in the affected side (for, as a rule,
only one side is invaded, a most fortunate pro-
vision of nature), and an occasional short cough
and fever are noted, the fever exacerbating
every afternoon and evening, abating after
midnight, until by morning little is manifest.
Thus for perhaps a week matters progress,
when suddenly an intense fever prevails for a
few hours, which as suddenly disappears, and
with it the dulness which has marked the dis-
eased or infiltrated portion of the lung. How-
ever this sudden absorption of the exudate (the
product of the early inflammation) is not the
usual way in which the hepatization is cleared
up, for in the majority of cases it is a matter of
gradual restoration, and little by little the area
of dulness over the lung grows smaller till the
normal resonance and respiratory murmur per-
vade the entire organ. The disease usually re-
quires from its invasion till the regaining of full
use of lung two weeks. In severe cases, espe-
184 A DECALOGUE FOR THE NURSERY.
cially if the reactionary powers be feeble, a much
longer time may be needed. Let the diet be
plain and nutritious, and bear in mind that the
amount of food must be greatly decreased dur-
ing the active or acute stage of the fever, since
a full diet will relatively increase its intensity.
PLEURISY OR PLEURITIS, PERITONITIS, MENIN-
GITIS, SYNOVITIS.
All cavities within the body not communi-
cating with the surface are lined with a deli-
cate, smooth membrane (serous), which is also
reflected or continued over and enveloping
the contents of each cavity. Although the
membrane possesses the same characteristics
throughout, it goes by different names in dif-
ferent locations. Where it lines the cavity of
the joints it is termed the " synovial mem-
brane; " the abdominal cavity, "peritoneum ;
the chest, "pleura; " the skull and spinal canal,
"meninges." In health it is remarkably smooth
and devoid of sensation, and with every move-
ment of the body, or shifting of the organs it
enwraps, the duplications glide to and fro
against each other painlessly. When, however,
A DECALOGUE FOR THE NURSERY. 185
inflammation invades, the glistening, smooth
membrane becomes congested, thickened and
rough, and so exquisitely sensitive that every-
thing which causes the duplications to rub each
other excites excruciating pain, which is al-
ways recognized by its sharp, catching, stab-
bing character. The inflamed condition is des-
ignated "synovitis," "peritonitis," "pleuritis,"
etc. As this membrane rarely suffers from dis-
ease in early life, we will only state that the sov-
ereign remedy for the relief of its inflammation
in any locality is bryonia, with the accessory
remedy, aconite, when it is demanded. The
patient should be kept quiet and warm in bed,
and the cutaneous function promoted.
MUMPS (PAROTIDES).
This is an inflammatory affection of the large
salivary gland, situated at the hinging of the
jaw; hence the pain and restriction attending
its movement during the disease. The gland
swells more or less, sometimes attaining an
enormous size, the centre of the enlargement
being located directly in front of the lobe of the
ear. Both sides are rarely attacked simulta-
186
A DECALOGUE FOR THE NURSERY.
once.
neously, but the disease usually invades one
side, and in a few days the other. It is in-
fectious, and rarely attacks a person more than
The early symptoms are malaise, ten-
derness, or sore, constricted feeling at the
maxillary joint, aggravated by motion, and es-
pecially increased by anything which excites
the function of the sick gland; as, for instance,
acids or sweets. This pain is somewhat in-
tense. There is always slight fever attending
the first few days.
The treatment is simple and chiefly hygienic.
Keep the patient quiet within doors, for the pur-
pose of preventing exposure to damp or cold,
for therein lies the only danger, such mishap
often causing metastasis of the inflammation to
the mammæ in girls, and to the testicles in
boys. At one time the writer had to deal with
a case of metastasis to the brain, provoked by
lying upon the ground. The patient remained
violently delirious for over a week.
The remedies suggested are Merc. sol., for the
relief of highly inflamed enlarged glands, Aconite
for fever, Belladonna for metastasis to brain,
Pulsatilla for metastasis to testicles or mammæ.
A DECALOGUE FOR THE NURSERY.
187
Should
Boys should be kept quiet indoors.
the inflammation be severe, and the swelling
tense and painful, use topical fomentations
during the height of the disease.
INFANTILE DIARRHEA.
In the management of all functional diseases
within the body, it behooves us to search first
for the cause, for a functional disorder is not the
effect, that is, the disease per se, but the result
or expression of the morbific element. There is
everywhere apparent the short-sighted disposi-
tion to regard diarrhoea as an independent dis-
ease, even as diphtheria or measles are looked
upon. The laity cannot be sharply criticized in
this matter, when we consider how commonly
physicians lapse into the same error. Whole
books have been written upon this subject with-
out containing a single philosophical deduction
which would lead the reader to occupy a com-
mon-sense standpoint in the treatment of this
simple functional disturbance, which nine times
in ten can be traced to some palpable indiscre-
tion. What can be more absurd than the com-
pilation of a multitude of symptoms dealing
188 A DECALOGUE FOR THE NURSERY.
with the variety of stools, their various tints,
consistency, times of day, odor, accompanying
sensations; and so on, ringing the changes
upon the endless combinations into which the
symptoms may be arranged, and thus piling
chapter upon chapter, without once directing the
attention to a rational solution of the matter?
We know full well that the diarrhoeas of chil-
dren afford an infinite variety of phases; that
they may be associated with febrile symptoms,
and also be devoid of fever; inflammatory and
non-inflammatory; profuse and scanty; pain-
less and painful; simple and dysenteric or chol-
eraic. All conditions must of course be taken
into account fully and intelligently, but our first
duty is to go to the fountain-head, and seek the
transgression of which the existing condition
is the penalty. When this is done we will find
the violation of dietary laws will in one case
give rise to one form, and in another an entirely
different form of intestinal disturbance, and it
follows that the mere regulation of alimentation
will succeed in correcting numerous forms of
diarrhoea without the intervention of carefully
selected medicines. I am anxious to drive this
A DECALOGUE for the NURSERY.
189
truth home to the minds of mothers, and, if pos-
sible, dislodge the blind policy (so commonly
followed) of beginning at the wrong end of the
matter. The followers of one school are ever
hunting up some "indicated" remedy, and those
of the other plying some "diarrhoea mixture"
or "cordial," while none of them stop to reflect
in what way they may dispense with remedies
entirely through seeking out and correcting the
underlying trouble. It would be much easier
and far more popular to pursue the beaten
track, and compile a chapter of symptoms for
the adherents of one school, or to set forth
formulæ of "cordials " or specifics for the other.
This would spare the reader intellectual effort,
always a politic consideration on the part of
the writer, but it would not secure the best
good of the little ones.
To come, then, directly to the root of the
matter, I shall insist upon the attainment of the
first requisite,—an intelligent comprehension of
the process of assimilation. This is the central
pivot of our subject, upon which all minor con-
siderations revolve. Then instead of investing
the symptoms with undue importance and con-
190
A DECALOgue for THE NURSERY.
stituting them the disease, view them simply as
the expressions of nature in her efforts to main-
tain a healthful equilibrium.
The first step in the direction of our duty is
the regulation of the diet, in conformity with
physiological laws, and the second is to as-
sist nature in correcting the mischief which our
carelessness has wrought, providing we are
sure that the indications have been interpreted
aright. Let us suppose that the diet has con-
tained starch before saliva has appeared; then
it is probable that nature is laboring to purge
this irritant out of the body. Or, supposing
that the delicate stomach has been overworked,
and undigested curds have been forced along
unprepared into the bowel, where they act as
offending or foreign matter, or it may be that,
through suppression of the skin function, the
mucosa lining the intestinal canal have become
congested, and the surcharged vessels and
glands seek relief through this form of deple-
tion; these and many other exciting causes
may result in an increased action of functional
derangement of the intestine. Now what is the
sensible course for us to take? Shall we give
A DECALOGUE FOR The nurseRY.
191
a dose of "chalk mixture," or some other con-
stringing "cordial" or "diarrhoea compound?"
By so doing we can surely check the flux, but
would it be wise to lock up within the irritated
canal that which nature has declared obnoxious
and is seeking to expel? Does it not rather
appeal to our common sense to select some drug
that would imitate nature as near as possible
(if given in health), and administer of it a small
dose—not so large as to outstrip nature, but
barely sufficient to join in sympathy and aid her
methods? Whether we approve or no, the fact
remains, that a small dose of a laxative, given
for the relief of an intestinal catarrh resembling
that condition which would follow the adminis-
tering of large doses of the drug, will most
speedily and effectually cure the morbid condi-
tion. I do not hold that to treat diarrhoeas
successfully it is absolutely necessary to be
hair-splitting in exactness in the selection of a
laxative that would produce a state precisely
the counterpart of that presented for treatment,
for I know that considerable latitude is admis-
sible, as, for example, a few small, successive
doses of castor-oil will succeed in curing the
192 A DECALOGUE FOR THE NURSERY.
majority of diarrhoeas though differing widely
in complexion; all I claim is that the closer the
drug-selection is made the smaller is the dose
required, and the speedier will be the cure.
These remarks are calculated to be broadly
suggestive, for it would be utterly impossible
to take up separately all the phases that may
attend intestinal catarrh. I have sought only
to present the central thought, for when the
cardinal principle of a subject is grasped, the
accessories are readily evolved.
In another section will be found an allusion
to the value of poultices for the alleviation of
internal inflammation, and it will not be amiss.
to repeat here, that a properly applied poultice
is an indispensable adjuvant in the treatment
of acute diarrhoeas attended with thirst, hot
skin, abdominal tenderness, tympanites, etc. It
should be ample in size and thoroughly secured,
otherwise it fails in its object, and is only a
source of annoyance.
DYSENTERY OR DYSENTERIC DIARRHEA.
This is an extremely painful and fatal dis-
ease with young children. It is apt to prevail
A DECALOGUE FOR THE NURSERY.
193
during the autumn months, or at the time
when the days and early part of the nights
are warm, but toward morning the tempera-
ture drops to the neighborhood of freezing.
Through carelessness, the little one, who has
been uncomfortably warm the first few hours
of the night, has been allowed to kick himself
naked, is subjected to a severe chill while
sound asleep; the cutaneous exhalations are
effectually suppressed and driven inward.
This is followed by violent internal congestion,
manifested in the form of dysentery.
A distinction must be made between this
affection and simple diarrhoea, for quite com-
monly a mother will state that her baby is sick
with dysentery when, were she properly in-
formed, she would have designated it simply
as diarrhoea.
The seat of this acute affection is obviously
in the large bowel or rectum, but there is
always associated considerable constitutional
disturbance, intense fever, insatiable thirst,
nausea, great irritability, etc. The first few
evacuations are usually copious, resembling
profuse diarrhoea, but these are soon followed
13
194
A DECALOGUE FOR THE NURSERY.
by smaller dejections, more urgent, and pre-
saged by more or less pain. The symptoms
speedily increase in severity, soon very little
fecal matter is voided, and this is mixed with
slime or mucus. At this stage the little one
evinces great reluctance to quit its chair and
persists in making expulsive efforts. In a few
hours this straining becomes involuntary, and
the child is utterly powerless in the paroxysms
of tenesmus, at which time the breath is held,
the face will become livid and terrible to look
upon, and at each effort as the little one strains
and presses downward, the greatly congested
bowel is forced out of the body. At this stage
scarcely anything passes except a little gush
of horribly offensive watery, slimy, matter,
which is immediately succeeded by the tenes-
mus which forces out a small quantity of slime
and blood, which would seem to be wrung out
of the inflamed intestinal wall. When this con-
dition is reached recovery is well-nigh hopeless.
To cope successfully with this terrible disease
requires that it should be brought under con-
trol before it has thus seized upon and mas-
tered the vital forces. It is usually through
A DECALOGUE FOR Tthe nurseRY.
195
mismanagement that dysentery succeeds in
gaining this ascendency. In the majority of
fatal terminations the administration of opium
in some one of its preparations has been the
chief prejudicial element. The present con-
templates with commiseration the practices of
the past generation, who bled their emaciated
consumptives in all good faith. So may we
safely predict that the time is near when the
present use of opiates in the treatment of in-
testinal flux will be equally deplored.
In the management of this terrible disease,
our first endeavor should be the full restora-
tion of the cutaneous function, and for this noth-
ing surpasses the hot bath, and small doses of
aconite. At the same time, unload the bowel
by giving from twenty to thirty drops of pure
castor oil, abetting its action by the administra-
tion of a warm enema of starch. It is likewise
of vital importance to engage the active co-op-
eration of the renal function, and to this end
there is no more efficacious adjunct than gum-
arabic water, which allays the inordinate thirst,
checks intestinal peristalsis, and promotes the
secretion of urine. Mix a teaspoonful in a
196 A DECALOGUE FOR THE NURSERY.
half-tumbler of warm water, and give a tea-
spoonful of this mixture every hour, or even
oftener if the thirst be great. It should always
be warm when nausea is present, as cold liquids
and especially the sucking of ice will aggravate
the gastric disturbance and intensify the thirst.
In an attack of dysentery the extremities are
invariably cold and livid, and especial atten-
tion must secure their warmth.
Merc. cor. is invaluable in the cure of dys-
enteric conditions. Hot starch injections are
highly commended, but they require to be
used gently and with proper discretion. The
diet should be scalded fresh milk, to which is
added one-fourth the quantity of lime water,
as the formation of curds must be prevented.
During the season favorable to the develop-
ment of this disease, the mother should be vigi-
lant in guarding the young sleeper from expos-
ure and chills.
PROLAPSUS ANI,
or falling of the lower bowel, is an abnor-
mity characterized by a protrusion of the gut
through the anal orifice, and is brought about
A DECALOGUE FOR THE NURSERY.
197
by severe constipation and consequent habitual
straining at stool. It is usually associated with
a lax-fibred or delicate patient. The treatment
consists in the removal of the cause (habitual
constipation) and preventing the child from sit-
ting unnecessarily long on the chair. After a
movement of the bowels, the protruding por-
tion should be bathed carefully with quite warm
water, using a soft sponge with great gentle-
ness, and, just before pushing the bowel back,
dip the sponge in cold water, and so give a
constringing final dash. This treatment is all
that is necessary, provided it is faithfully carried
out.
UMBILICAL HERNIA.
Umbilical hernia is a very common affection
of young children, and consists in the imperfect
closure of the umbilical or navel ring, which al-
lows the intestines or bit of the omentum to
protrude through. The abnormity is readily
cured by obtaining a piece of sheet lead, or an
ivory button about the size and shape of a silver
dollar, which make slightly convex, and with a
neatly fitting band fasten over the tumor. This
should be worn three or four months.
198
A DECALOGUE FOR THE NURSERY.
HABITUAL CONSTIPATION.
Obstinate torpidity of the bowel is not in-
frequently a very troublesome condition with
young children.
children. In the majority of cases it is
the penalty exacted by nature for trespassing
upon her domain with physic. In the old ré-
gime, the belief was rife with all the monthly
nurses, that a dose of castor oil was indispen-
sable to the proper inauguration of life; conse-
quently, without any other reason, a child scarce
a day old must be physicked. One dose
paved the way for the next. The custom was
condoned by the physicians, and it is not
strange that mothers followed in these same
steps, partly from seeming necessity and partly
from popular custom and belief. Not one child
in a hundred would require "opening" medi-
cine were laxatives rejected from the beginning.
It may be true that children inherit the ten-
dency, but I question it. Granted that one or
both parents may have been life-long sufferers
from this trouble, but all the proof they can ad-
duce is that from birth, perhaps, they too had
been the victims of physic, which makes it all
A DECALOGUE FOR THE NURSERY.
199
the more reasonable to believe that the habit,
not the disease, has been transmitted. See to
it that no opening" medicines be adminis-
tered to the little ones. Depend upon it that
here is found the originating as well as perpet-
uating cause of all the trouble. Supposing the
little one is constipated, it does not justify turn-
ing into the delicate alimentary canal, a vile
drug which acts by virtue of its irritating prop-
erties and arousing nature's forces for its speedy
expulsion. For a cathartic to accomplish its
end it must needs first create a disturbance,
or irritate the intestinal textures, and in pro-
portion to this disturbance will be the intes-
tinal commotion for its ejectment. A glimmer
of this truth has touched the minds of many
mothers, and the enema has been substituted, a
most pernicious makeshift, through which the
worst forms of constipation are established.
It is not unusual to have to deal with pale,
nervous, unhealthy-complexioned women and
children, who have not had a movement of the
bowel for years without first having resorted
to the use of the syringe.
The condition following upon the action of
200
A DECALOGUE FOR THE NURSERY.
either a cathartic or an enema is that of consti-
pation, and the longer either one is used the
more inveterate becomes the consequent tor-
por. After the syringe has been resorted to
persistently for a time, the muciparous glands,
whose function is the secretion of the intestinal
juice which lubricates the lower bowel, becomes
inert, and in time, through inaction, atrophied,
rendering the rectum absolutely passive. The
question may be asked if I would prohibt un-
qualifiedly the use of both syringe and cathartic.
Most certainly I would so far as treatment for
the cure of constipation is concerned, since by
resorting to either we add to the difficulty
opposing us. On the other hand I recognize
fully the legitimate use of means for clearing
the alimentary canal of offending matter, which
at the time threatens the safety of the per-
son, as has been repeatedly explained in these
pages. The other field in which their employ-
ment is commendable, is in the management of
diarrhoeas. The treatment of constipation re-
solves itself into the following suggestions:
First, the regulation of diet. Should the child
be an infant in arms, mix with its milk a little
A DECALOGUE FOR THE NURSERY.
201
molasses or flaxseed tea; shampoo the abdo-
men, and, provided the child be not already
the victim of indiscreet dosing, the bowels will
respond. If the child has attained the age
when gruels are admissible, a few daily allow-
ances of rye meal gruel, thoroughly boiled and
strained, will usually be effective.
The judicious use of plain molasses, flaxseed
tea, or what is better, a teaspoonful of the
whole seed swallowed with milk, if the patient
is old enough.
An especially faithful, punctual observance
of the effort at an established hour, whether
there be felt the promptings of nature or not.
The remedies most often available are Nux
vom., Bryonia, Phos., Sulph. See "Indica-
tions."
INCONTINENCE OF URINE.
Wetting the bed at night is a very common
and vexatious habit in childhood, for which
time and patience are the best remedies.
Harsh punishment, so often resorted to in
the lower classes, is unpardonable, unless the
child be wittingly and persistently dirty. As
a rule however, the little fellows are greatly
202
A DECALOGUE FOR THE NURSERY.
chagrined, and if old enough will relate how
in a dream they exerted themselves to the ut-
most to leave the bed, and believed they had
succeeded. I have never yet found a child,
old enough to talk, who was not eager to
adopt any regimen (within reason) whereby he
might escape the humiliating weakness. The
mother should always explain the matter to
him, and secure his hearty co-operation.
The
most successful treatment is abstinence from
liquids and liquid food as entirely as possible
through the after part of the day. All that is
needful for health should be taken during the
first two-thirds of the day, but for the remain-
ing third let the diet be dry bread and butter.
It is surprising that the body will so readily ac-
commodate itself to every habit, and here as in
other matters the desire soon vanishes with the
persistent refusal. The habit of waking at some
stated hour for the relief of nature should if
possible be established. Every morning and
evening bathe the back, loins, and groin, with
a sponge dipped in cold water, this measure
followed by brisk drying and shampooing.
Concerning internal medication I know of noth-
A DECALOGUE FOR THE NURSERY.
203
ing reliable. Bell., Canth., Equisetum are gen-
erally recommended.
SPASMODIC CONVULSIONS.
Let us next suppose a case of suffering from
general hyperæsthesia induced by severe and
protracted teething. The usual gastro-intesti-
nal disturbances prevail, and the little one is
worn and excitable. After a severe fit of cry-
ing, or perhaps while falling asleep or during
sleep, there appears an unusual slight twitch-
ing of the muscles of one or both arms, or
of the face; or after remaining motionless a
while, he will spring, as if frightened at an un-
expected noise. The eyes are staring, with now
and then a rapid quiver. The limbs are found
to be slightly rigid, the thumbs usually flexed
into the palms of the hands and clasped tightly
with the fingers. Extremities often cold and
livid, and the head hot. The respiration is
sighing, as though the chest felt oppressed.
All these symptoms are intensely significant.
It is an agonizing sight to a mother, that of her
baby writhing in convulsions, and at the time it
seems almost mockery to counsel calmness and
204
A DECALOGUE FOR THE NURSERY.
deliberation, but there is great necessity of act-
ing quickly and collectedly when the earliest in-
dications of a spasm have been detected, since
by the opportune employment of correct meas-
ures the evil will be overcome, and a panic
averted.
To restore the equilibrium of the circulation
is the first desideratum, and this is accom-
plished most speedily and effectually by placing
the child immediately in a hot bath of say 100°
to 104°. If a tub is not available, place the
child's legs in a bucket of warm water and hold
hot cloths about the hands and arms or hold
them in a pan of warm water. In the mean
time search for inflamed or tensely swollen
gums, and when found do not hesitate a mo-
ment in liberating the imprisoned teeth by
making a free incision with the point of any
sharp cutting instrument. Again and again I
have banished instantaneously threatened at-
tacks of convulsions by this simple procedure.
Do not fail to devote proper attention to the
condition of the intestinal tract, for in all prob
ability the climax in the nervous erethism was
brought about by some indiscretion of diet, and
A DECALOGUE FOR THE NURSERY. 205
one or two teaspoonfuls of syrup of ipecac, to
induce vomiting, will often bring to light irri-
tants in the form, perhaps, of firm, tough curds,
or, more likely, a fermenting mass due to cul-
pable feeding with crumbed crackers, biscuit,
cake, or other objectionable matter. If the
child has been constipated, a teaspoonful of
castor oil and an enema of warm water will
complete the clearing out of the intestinal tract.
After the bath, rub the hands and feet briskly
and put the little patient in a warm bed in a
quiet, darkened room, and prevent lying on the
back. Seldom is other medication needed; but
as the mother values her child's life she must
protect it from the pernicious drug opium in all
its forms. Nux vomica 3d x., a few doses, will
be of benefit.
HIP-JOINT DISEASE.
As deeply as possible I wish to impress par-
ents with the fact that although the treatment
of hip-joint disease does not come within the
province of domestic therapeutics, neverthe-
less its course and termination depend chiefly
upon the attention accorded the initial stage,
206 A DECALOGUE FOR THE NURSERY.
which too seldom comes under the eye of the
physician. The same history, with but slight
variations, is repeated over and again, by the
great number of unfortunates whose life-long
sufferings must pay the penalty of early mis-
management or neglect. The premonitory pe-
riods of distress have been counted " grow-
ing pains," or more often looked upon as at-
tacks of rheumatism which rest and indifferent
medical treatment have allayed from time to
time, until finally an exacerbation unusually
severe has unmasked the terrible disease, which
too often has ere this taken on textural change,
more or less enduring. It is often the case
that the early misfortunes are still further in-
tensified by incompetent professional treatment.
Ultimately the case is sent to an expert, but not
until it has passed into the category of incura-
bles. Nothwithstanding the warning which
these unfortunate cases everywhere afford,
blind unconsciousness of impending danger is
as commonly seen to-day as fifty years ago.
It is never safe to disregard the slightest lame-
ness, or painful locomotion in children, where
the cause is in doubt: neither is it always, pru
A DECALOGUE FOR THE NURSERY.
207
dent to entrust the case to the sole care of the
general practitioner, who often fails to recog-
nize the special and frequently obscure indica-
tions of hip-joint disease. In a previous section
(p. 121) some of the early indications have been
alluded to, but they are of such vital moment
that we can well afford to review them: A dis-
position to trip often; in ascending stairs the
diseased leg follows, in descending precedes.
There is usually an inability to place the foot
of the affected leg upon the opposite knee when
sitting. The pain is commonly referred to the
knee cap, instead of hip. About this time, if
the circumference of the legs be compared, the
affected one will be found the smaller, and its
flesh tint will usually suffer by comparison.
course it must be understood that we limit our
present remarks to the earliest indications only.
The more striking and familiar symptoms com-
monly associated with the disease belong to
the later stages, and are here irrelevant. The
duty of parents in the direction of treatment is
plainly indicated in the text.
Of
208
A DECALOGUE FOR THE NURSERY.
ECZEMA-CAPITIS-MILK-CRUST-SCALD-HEAD,
ETC.
The subject of skin diseases is one so exten-
sive and peculiarly complicated, that we shall
make no attempt at its discussion; therefore our
remarks in this direction will be restricted to
the following observations upon an anomaly
quite commonly existing in childhood as a
complication of dentition. It is commonly
known as "scald-head" "yellow crust" "milk
crust" and "tenia capitis." Generally, it be-
gins as a small pimple or abrasion on the face,
scalp, or around the ears, and is quite insignifi-
cant in appearance during this early stage,
but the itching is considerable from the first,
and the child naturally scratches, thus spread-
ing the irritation rapidly, not only through con-
tinuity, but seemingly by inoculation in fresh
spots. Before long the separate patches ap-
proach and run together until a large scab,
which may involve the scalp, or the entire
head is formed. At first the abrasion or pim-
ple presents the appearance of an inflamed,
moist, broken spot on the skin, but in a short
A DECALOGUE FOR Tthe nursery.
209
time the limpid, sticky exudation dries into the
form of a yellow crust; hence the name. In
severe cases this crust is so extensive and thick
that it covers the scalp like a cap. The scab
lies loosely upon the surface for the reason
that interposed is the moist secretion, which is
constantly exuding, and collecting as fresh re-
lays of crust. Although this is an affection
generally of the head and face, it often invades
the hands and flexures of the joints. Very often
the disease proves quite obdurate, resisting for
many months the ordinary methods of treat-
ment. It is only natural that parents should
look upon the unsightly affection with disgust
as well as intense solicitude, and that their ab-
sorbing thought should be the banishment of
the offensive eruption, and it is not always pos-
sible to dissuade them from making applications
of harmful medicaments for the sole purpose of
drying up that which is unquestionably one of
nature's means for the venting of morbid matter
from the system. It is particularly suggestive to
note that the general health of a child afflicted
with an extensive cutaneous eruption is, as a
rule, exceptionally good. If, however, this be
14
210
FOR THE NURSERY.
A DECALOGUE LOGUE
suppressed suddenly, internal affections gener-
ally appear, showing that there has been a
metastasis of the noxious exhalations from the
surface inward. The morbific element may
now invade the mucous membrane of the intes-
tine, or lungs, the peritoneum or pleura, or the
cerebro-spinal investments may be complicated,
and in some rare instances synovial complica-
tions mark the new site of the disorder. It is
unnecessary to explain that so far as the well-
being of the child is concerned, it is infinite-
ly preferable that the irritation remain where
nature has placed it. I am perfectly aware
that some physicians will take exception to this
doctrine, and there was a time when I enter-
tained different views, but a number of in-
stances in which the reproduction of the per-
cussed eruption alone saved the jeopardized
lives, has caused me to look beyond the mere
surface of the matter.
Management of Eczema-Capitis.-It is at
once the greatest comfort and misery of the
little ones to scratch, or, if restrained in this,
to rub against every available object. Upon
the little hands, mittens should be securely
A DECALOGUE FOR THE Nursery.
211
fastened, and a cool cap should protect the
scalp. I am opposed to the oiled-silk and rub-
ber caps almost universally commended. They
tend to shut in the exhalations, keep the sur-
face sweltering in its own effluvia, and, as far
as observation teaches me, these non-porous
articles do not contribute to the welfare or
healing of the parts affected. Cleanliness is of
the utmost importance, and yet it must be ac-
complished judiciously. Too frequent ablu-
tions add to the irritation, and the use of com-
mon soap is always injurious. The surface
should not be washed oftener than once in
twelve hours, and I am favorably disposed
toward once in twenty-four hours. The water
should be as hot as is bearable, and should
contain half a drachm of boric acid to a pint.
When soap is used, it should be only the
oldest Castile. The drying must be thorough
yet gentle, and performed with soft pieces of
old linen, which, after each using, should be
soaked and washed in a solution formed of
one part of corrosive mercury to five thousand
of water. After the skin is thoroughly dry,
apply an ointment composed of vaseline one
212
A DECALOGUE FOR The nurseRY.
ounce, citrine ointment twenty grains, lac sul-
phur one drachm, tar ten drops. Let this oint-
ment be applied sparingly and evenly, rubbing
in with the ball of the finger.
I have never known this treatment to fail of
accomplishing everything desired in the way
of a safe cure. The remedies recommended
for internal medication are sepia 6*, sulphur,
arsenic 4*, psorinum 6*.
I must confess I have never witnessed any
good result from internal remedies unassociated
with appropriate external measures.
ACCIDENTS.
Who does not know that when children reach
a certain age they develop into inquisitive ma-
rauders, and, despite the most vigilant surveil
lance, crawl or toddle into their own calamity,
not infrequently pulling down upon themselves
scalding fluids, or through a misstep or too near
approach to fire, are seriously injured. Many
of the mishaps of childhood are the fruit of cul-
pable negligence of parents or nurses; still
there is a host of ways never suspected by
the elders, but which the young investigator
A DECALOGUE FOR THE NURSERY.
213
surely discovers, whereby he is made the vic-
tim of a
SCALD OR BURN,
which is sometimes slight, but too often severe,
and always painful, requiring prompt and ap-
propriate treatment, for it is necessary that im-
mediate relief be obtained to secure a favorable
course and termination. Nothing is simpler
than the right way of treating these accidents,
and yet few things are so bunglingly or im-
perfectly managed. In the first place, never
pull or forcibly remove the garment from a
scalded or burned surface, for in this way the
skin, which is the best protection, is usually torn
off a grave mishap. With a knife, scissors,
or any suitable means, rip open, boots, stockings
or clothing, and thus avoid lacerating the tissue.
As soon as the nature of the accident is ascer
tained, take a quantity of white flour and stir in
it sweet oil or vaseline or, if neither of these be
at hand, use water temporarily until a paste is
formed of such consistency as will spread evenly
and readily, and with this, plaster the injured
surface freely to the depth of a fourth of an inch
at least, the object being absolute exclusion of
Uor M
214
A DECALOGUE FOR THE NURSERY.
air. If the tissue be so deeply destroyed that
the cicatricial contraction consequent upon deep
burns be feared, the following application should
be used: Obtain a quantity of "blue-clay,"
dry, pulverize, and sift it. Add enough vas-
eline or flax-seed oil to form a smooth paste.
Keep the wound smothered in this until com-
pletely healed, removing each day all that may
be polluted by the discharge.
At the time of dressing, spray with a warm
solution of bichloride of mercury,-four grains
to each quart. Personal experience with this
earthy preparation leads me to believe that the
distortions and unsightly scars incident to se-
vere burns may, through its employment, be
wholly prevented.
The compound more extensively used than
any other, known as "caron oil," is made by
mixing lime-water and olive-oil in such propor-
tion as to form a creamy-looking emulsion.
This is a more elegant form of dressing, but as
it imperfectly excludes the atmosphere, it is not
so effectual as the measures just described.
A DECALOGUE FOR THE NURSERY. 215
FOREIGN BODY IN THROAT.
If there is a stray needle, pin, hook, or button
lying loose upon the carpet, Baby's eye is the
first to spy it, and it is quickly transferred to
the little mouth. Notwithstanding the most
rigid vigilance, the little one is heard at some
unexpected moment to utter a choking, gagging
sound, and a glance discovers protruded eyes,
livid countenance, and difficulty or perhaps ces-
sation, of breathing. The ignorant nurse or
mother, panic-stricken, catches up the stran-
gling child and roughly shakes it, with the
senseless command, "spit it up," a feat the
little fellow is most eager to accomplish if he
only could.
Others, still more foolhardy, rashly thrust the
forefinger into the throat to feel for the foreign
substance, which procedure is all very well,
providing it be a sizeable article too large to
enter the glottis, but the most gentle skill is
necessary when there is a possibility of pushing
a smooth hard body into the breathing aperture.
Then, again, nine times in ten, a stupid person
will hold the child on its back while it is strug-
216 A DECALOgue for tHE NURSERY.
gling with the foreign body in the throat. The
first practical thing to do is to seize the body
round the loins, let the head be suspended, face
downward, deliver two or three smart slaps
between the shoulders, and then feel very deli-
cately with the finger around the fauces, the
head still suspended. Tweezers or forceps
should never be employed blindly by a novice.
If the foreign body can be plainly seen, and the
forceps, guided by sight, can seize it, of course
it may be done, but it should be remembered
that there have been instances where the epi-
glottis has been laid hold of by the forceps
and severely mutilated.
If the obstruction be a needle, pin, or fish-
bone, the forceps will probably be the only re-
source, and if it is known that the obstruction
be any one of these, the habit of swallowing a
bolus of bread only adds to the difficulty. A
surgeon should be summoned with all despatch
in such cases, always sending a written message,
unless the messenger be competent to explain
that which is required, otherwise the surgeon
may appear on the scene helpless through being
unequipped for the emergency.
A DECALOGUE FOR THE NURSERY.
217
COLIC.
If there be a common heritage of children it
is colic. Few children escape this troublesome
complaint, and many are hardly free from it
during the early months. By colic we mean a
griping or twisting pain in the intestine, of an
intermittent, non-inflammatory character.
The following are its characteristics as dis-
tinguished from other affections:
The attack is usually sudden, the cry lusty
and violent: the head is thrown about, the
face is usually pallid, and sometimes bathed in
perspiration, the knees drawn up, and the feet
and hands cold. The abdomen will be found
more or less distended with gas, which fact we
prove by tapping lightly over the surface, the
sound produced being resonant or drum-like.
At this point of investigation we distinguish
the case from peritonitis, or an inflammatory
condition. If inflammation be present, mod-
erate pressure will cause the child to shrink,
cry loudly, and evince other signs of pain; but
in simple colic steady moderate pressure is
grateful, and for this reason, the child prefers
218 A DECALOGUE FOR THE NURSERY.
to lie on its belly resting upon some firm ob-
ject. The suffering is manifestly due to an
over-distended state of the intestine with gas,
which condition puts the textures and nerve-
filaments on the stretch, the spasms of pain
being induced by the contracting of the muscu-
lar coats of the intestine, in its efforts to dis-
lodge the flatus. Many mothers are curious
to know how so much gas can accumulate in
the intestinal tract despite their care in pre-
venting the child from sucking from an empty
bottle. Flatus is the product of fermentation
consequent upon the presence of undigested
food.
That many babies are born “ colicky," as
nurses declare, is doubtless true to a degree,
but the majority of cases are amenable to
proper hygienic measures, since they are un-
questionably the result of improper diet.
The trouble may arise from overfeeding, a
very fruitful source; the cry or fretting due to
indigestion being looked upon as evidence of
hunger the bottle is plied when it should be
withheld, and thus through ignorance the diffi-
culty is perpetuated and intensified, the child
A DECALOGUE FOR THE NURSERY.
219
growing constantly worse and "wasting away"
while being surfeited with food.
The popular notion that colic is generally
limited to the first four months of child life is
quite significant, and its origin is apparent to
those who have read in a previous chapter the
facts relating to the development of the diges-
tive apparatus. In the section devoted to the
feeding of children, it is shown that farinaceous
or starchy food ingested previous to the flow-
ing of the saliva, will pass through the ali-
mentary canal undigested; therefore pounded
crackers, bread-crumbs, farina or starch of any
kind fed to a child under four months of age
will ferment, and so give rise to colic from the
acrid product and gas developed. A large pro-
portion of children suffering from colic are hand-
fed, and as starch-yielding materials very fre-
quently form a part of their diet, perhaps from
the earliest days, we can readily understand
why at this age they are victims of colic, and
why at the age of four or five months it is alle-
viated.
The treatment of colic evidently consists
principally in obeying the laws of assimilation
220
A DECALOGUE FOR THE NURSERY.
as set forth in the chapter just referred to.
Shampooing the abdomen thoroughly with the
hand to dislodge the confined gas is an excel-
lent practice. The little one should not be
held supinely but prone: laid over the shoul-
ders or across the knees of the nurse. Warm
applications, or better still, warmth over the
entire body, allays the spasm.
In a severe attack the milk of assafetida in
twenty-drop doses, or Nux. vom. 2* dilution
in one-drop doses every hour, will often as-
suage the suffering.
It is in the management of colic that the
various products of that most baleful of all
drugs, opium, are most commonly resorted
to. So much has been said regarding this
matter, that I hesitate to supplement the argu-
ment of others who have reasoned most elo-
quently, and that to all appearance without
avail. The methods of introducing the drug
are so numerous, its workings so insidious and
alluring, that so long as pain is so much more
impressive than words, the most urgent appeal
will be futile.
To attempt to convince an illogical mother
A DECALOGUE FOR THE NURSERY.
221
or nurse that she is rendering the future more
painful and wretched for the child whom she
plies with "soothing syrups " is useless. She
cannot comprehend that any remedy, no matter
by what name it is called, that stupefies the
senses by narcotizing the brain, is hardly less
detrimental than the blow on the head that
causes temporary insensibility. The gullibility
of the public is a boon to the manufacturer of
patent medicine, who permits neither truth or
conscience to interfere with his trade. Despite
all attestations to the contrary, opium or some
of its products constitute the quieting proper-
ties of ninety-nine in a hundred proprietary com-
pounds that have for their object the alleviation
of pain, sleeplessness, cough, or irritation of
any sort.
We have yet to find one of these
noted nostrums that has not yielded opium in
some form when subjected to chemical analysis,
and that, too, when the preparation is sworn to
be "free from narcotics of every description."
If parents persist in the use of quieting
drugs let them deal with officinal preparations,
which have a uniform strength and standard
dose; they should remember, however, that a
222
A DECALOGUE FOR THE nursery.
penalty is attached to all ill-gotten comfort.
Narcotics invariably destroy the digestive
powers, and suspend the workings of the excre-
tories in this way the system is impoverished,
and charged with effete matter. Moreover,
the secondary effect is wakefulness, despon-
dency, and irritability. Finally, its habitual
use gradually but surely entails an anæmic and
neuralgic state of the system.
OPIUM AND SERVANTS.
It is incumbent upon those mothers who
relegate their nursery affairs to hirelings to
recognize the existence of a growing evil by
no means rare among nurses in large cities.
While many of these are foster-mothers in the
full sense of the term to the little ones, there
are others who are unscrupulous and utterly
untrustworthy,―mere time-servers, who, to se-
cure their selfish ends and comfort, do not
hesitate to trifle with the lives intrusted to
their care.
I do not refer to their stolen visits
to unhealthy abodes to spend an hour with a
boon companion, nor to the chastisements the
little ones have to endure, while too helpless
A DECALOGUE FOR THE NURSERY.
223
to voice a complaint, with other underhanded
customs often practised, but to the still more
pernicious habit of administering "sleeping po-
tions." There is no difficulty in obtaining any
one of the various "soothing" nostrums ex-
posed on the shelves of every pharmacy, but
these being comparatively impotent and in the
end more expensive, the stronger preparations
of opium are sought by the more practised.
The confessions of those who have been de-
tected go to show that many of these women
are never without a vial of laudanum, which
they have become adepts in the using. The
majority when apprehended volubly defend
their course, and it is only just to say, that in
some instances which have come under the
writer's notice, the culpable parties were in a
great measure unaware of the nature or enor-
mity of their crime.
The practice, however, is invariably so zeal-
ously guarded that detection is almost impossi-
ble without the utmost vigilance.
To aid in this matter I will here give some
of the physical characteristics produced by an
opiate in a child.
224
A DECALOGUE FOR THE NURSERY.
Spells of untimely drowsiness, which is not
natural sleepiness. A normally sleepy child is
usually fractious, but drowsiness from narcotism
is seldom petulant.
The eyes are dull, the pupils contracted, the
eyelids droop, and there are usually dark lines
underneath.
Often the tip of the nose and forehead are
unnaturally cold, and a peculiar pallor comes
over the face.
Without evident cause the child ceases to
thrive, grows puny, soft, and blanched. As a
rule the bowels are constipated, but in time
obstinate diarrhoea supervenes.
Whenever the above symptoms exist, and
especially if the nurse be in the habit of locking
herself in alone with her charge on the appear-
ance of fretfulness, let the mother not hesitate
to become the spy.
ALCOHOL IN THERAPEUTICS.
The custom of dosing young children with
alcoholic liquors is a matter for most serious
protest. It is amazing that in this day of ad-
vanced thought in medicine, so many physi-
A DECALOGUE FOR THE NURSERY. 225
cians can be found to commend a practice so
manifestly vicious in all its bearings, and so
absolutely devoid of temporary or permanent
benefit.
In the light of philosphy, experience, and
ordinary common-sense, there cannot be dis-
covered a single justifiable reason for dosing
infants with any form of alcohol. The evil is
upheld by the untenable caprice of certain
members of the profession, and the misconcep-
tion of the public concerning the effect of al-
cohol upon the system. Its appreciable or
early workings are greatly overestimated and
misapprehended. Instead of invigorating or
fortifying the system permanently, the effect
may properly be likened to that of the lash
which goads on the physical powers to greater
tension or effort, but the stimulus is soon ex-
hausted, and yields to the secondary effect,
when the organization oscillates to the other
extreme, and instead of the exaltation there.
appears a greater degree of depression. Of
course it is argued that so-called "tonic "
potions shun the extremes,-that the end,
sought and obtained is that of gentle stimu-
15
226 A DECALOGUE FOR THE NURSERY.
lation of the functions. This is the plausible
argument usually employed, but it is sustained
by nothing in chemistry, pathology, or obser-
vation.
For many years I have given assiduous at-
tention to this matter, and the information
gleaned from all available sources constrains
me to oppose the use of alcohol in the thera-
peutics of children in every form and quantity.
Not only have I failed to recognize any "tonic"
effects wrought by this agent, but I have yet
to find an instance in which it acted successfully
in bridging over the chasm of threatened dis-
solution. On the other hand, there is proof
positive to convince every impartial observer
that the use of whiskey, gin, brandy, or any
of the kindred agents, even in very moderate
quantities, will to a certain extent pervert the
secretions, unhinge the nervous system, and
irritate the mucosa. There can be no censure
too severe for the foolhardiness which com-
mends any one of the alcoholic agents as a
remedy in disease complicated with inflamma-
tion of the intestinal tracts or in cerebral irrita-
tion. An attempt to quench flames with a dash
A DECALOGUE FOR THE NURSERY. 227
of alcohol would display a corresponding de-
gree of intelligence.
Finally, alcoholic stupes when applied to a
broad surface like the abdomen may produce
through imbibition all the effect induced by
swallowing the liquor. It is not uncommon to
find young children in profound stupor from an
oversight in this direction.
CHAPTER X.
SELECTION, PREPARATION AND USE OF DRUG
REMEDIES.
7
For the preceding chapter we claim nothing
more than a running survey of the salient feat-
ures of those common ailments that most fre-
quently engage the mother's attention. We
have more than once confessed our inability to
cope with infantile theraputics in a comprehen-
sive manner in a work of this nature, and we
have heretofore, as now, entreated parents to
study the superior worth of common-sense
hygiene and to eschew the habit of relying
upon drugs. So profoundly intricate are the
laws, and so ever varying the conditions of
therapeutics, that of necessity the matter must
remain hidden to all who have not long toiled
for the knowledge which cannot easily be ex-
emplified, neither transmitted nor received
through the medium of words.
We allude now to therapeutics as a science
A DECALOGUE FOR THE NURSERY.
229
in the true significance of the word, but there
are fortuitous conditions in which the timely use
of drugs according to the grand law which dom-
inates their action, may prove as efficient when
supplied by the tyro as by the more learned.
It cannot be inferred by those who have read
the foregoing chapters that I approve of taking
risks in sickness, a custom far too prevalent
among the laity. Upon every possible occa-
sion I have insisted that whenever disease as-
serts itself sufficiently to demand medicinal aid,
the administration of the remedies should be
under the direct supervision of a skilled physi-
cian. Nothing is more objectionable than the
dabbler in drugs, who squanders valuable time
when danger is imminent, and who likewise
meddles with every trifling malaise that ap-
pears, that would be dispelled by a good night's
rest and sleep.
There are, however, extenuating circun.
stances. A physician is not always accessible
when sickness assails, or the methods of the
available medical counsel may possibly be to
the mother more to be dreaded than the dis-
ease. There are a number of reasons that not
230 A DECALOGUE FOR THE NURSERY.
only justify a supplementary chapter of this kind
but render it essential to the completion of
our task, but it is earnestly entreated that its
purport be rightly apprehended and its limi-
tations respected. The following suggestions
concerning the selecting and administering of
drugs are offered for careful consideration.
In the first place we reiterate that therapy
is the handmaid of Nature, and dosing merely
one of the numerous accessories in the treat-
ment of bodily ills. We are emphatic upon
this point for the reason that everywhere there
is shown a disposition to become so absorbed
in the expectation of that which the drug is to
accomplish, that the more essential aids found
in hygiene are forgotten.
In the next place, we must ever guard against
the mistake of looking upon disease as an entity
or substance that somehow has crept into the
system, and like an evil interloper works havoc
in the citadel of life. This too material concep-
tion draws out a correspondingly vigorous, op-
position with substantial measures.
Rather let us interpret disease as a subtle
influence that has caused functional derange
A DECALOGUE FOR THE NURSERY.
231
ment of one or more organs of the body, and
the symptoms attending the unbalanced state
are manifestations of nature's struggles for the
restoration of a healthy equilibrium. When
brought to witness the strife between nature
and disease the question at issue is, shall we
rashly rush in and by violently-opposing meas-
ures usurp nature and set up a drug domina-
tion, or shall we not rather observe Nature's
methods and unite with these in overcoming
the inimical elements. The answer is so self-
evident as to render the question absurd, were
it not that every-day experiences show a ruling
disposition on the part of those employing
orthodox therapia to impose measures which
arbitrarily reverse the original condition, wholly
ignoring the fact that this enforced subversion
includes the overthrow of Nature's restorative
processes. Furthermore, if a remedy be admin-
istered which has a verified analogous effect to
the workings of nature in disease, it invariably
seeks out and quietly joins forces with her at
the point affected, with precision and harmony
of action, while, on the other hand, the drug
that forces an opposite state expends its energy
232 A DECALOGUE FOR THE NURSERY.
upon the whole system with indefiniteness and
general confusion.
There is another misleading notion popular:
with the masses, that the virtue of a drug is in
some degree commensurate with the impression
it is capable of making upon the senses. The
smell, taste, color, and internal commotion ex-
cited are each significant, whereas the drug
that cannot in any way be measured by the
senses, and the workings of which are imper-
ceptible save in the benefits accruing, is too
often regarded with indifference. It would be
well for such minds to reflect that nature's most
wonderful works are achieved unperceptibly,
while the rarest phenomena are unassociated
with agitating or obtrusive elements.
The drop of acid acting upon bits of metal,
speeding in silence the message to the other
side of the ocean, is more wonderful than the
roar of machinery. It has been estimated that
scarcely a grain of metal is changed in evolving
the force that is felt through three thousand
miles of cable.
To discuss the vexed question of the limita-
tion of the curative power of drugs, is not my
A DECALOGUE FOR the nurseRY. 233
intention in this place. Two points only we
keep prominently in view and follow. First,
since drugs given in material doses work a
baleful effect upon the system, we will admin-
ister no more than is absolutely requisite to
accomplish the object desired. Second, the
physical receptivity to analogous drug effects is
wonderfully heightened through disease: as, for
instance, a child in health may probably swal-
low one-twentieth of a grain of strychnia with-
out exciting muscular twitchings; if however,
the child be subject to chorea, or involuntary
spasmodic affections of the muscles, a dose one-
tenth or perhaps one-twentieth as large will
cause an alarming exacerbation of the morbid
muscular excitement. A person suffering from
nausea will be made to retch violently by swal-
lowing a few drops of syrup of ipecac, whereas
were the stomach in its normal condition, a tea-
spoonful would hardly accomplish as much.
This principle must be borne in mind when
applying a remedy to a disease between which
there exists a similitude, for owing to the al-
tered sensibility of the organ to the stimulus of
the drug, the dose should be quite small if we
234 A DECALOGUE FOR THE NURSERY.
would avoid producing a serious aggravation.
For instance, if in scarlet fever belladonna be ad-
ministered in doses sufficient to induce its toxic
effect (several drops of the tincture), the result
will probably be disastrous because of the ex-
cessive force superadded to the already over-
strained vital powers. It is over this cardinal
principle that the majority of those imbued
with old-school sentiments essaying to pre-
scribe medicines according to the law of simi-
lars stumble, and instead of discovering that
the fault rests with the illogical methods of the
prescriber, the system is forever condemned.
Did space permit data could easily be ad-
duced to prove that extremely minute doses of
medicinal agents assuredly do affect the vital
forces within the healthy human body. For
example, the eruption and characteristic effects
of cow-pox have been produced by vaccine
lymph so diluted that one drop of the inocu-
lant contained only a one hundred-millionth part
of a drop of pure lymph. A trillionth part of
a drop of septicæmic blood injected into the
veins of a rabbit has caused blood-poisoning
and death. The one hundred-thousandth part
A DECALOGUE FOR THE NURSERY.
235
of a grain of atropine placed in the eye will
cause the pupil to dilate. Exceptional illustra-
tions might be cited more wonderful still, but
we have not time to dwell upon them.
We have now come to the consideration of
the following list of remedies with their charac-
teristics. To remove all chance of perplexity,
we repeat, that whenever there is found a close
resemblance or parallelism between a set of
symptoms revealed in the patient and the group
of characteristics pertaining to any one of the
following drugs, it is chosen as the appropriate
remedy. It is to be regretted that there exist
no abiding, uniform conditions from which can
be deduced rules whereby the size of doses can
be arbitrarily fixed. This is a
This is a question so broad
and varied in its applicability that only an edu-
cated intelligence and timely discrimination can
determine that which will meet the exigencies
of each case.
Therefore, while to every remedy
is affixed the numerals designating the attenu-
ation customarily employed in my own practice,
I do not design that the indicated limits shall
be accepted as absolute. The nature and ur-
gency of the case, and effect desired, can alone
236 A DECALOGUE FOR THE NURSERY.
indicate the frequency of the dose. Approxi-
mately speaking, it is seldom necessary to repeat
oftener than once an hour in acute, and twice a
day in chronic cases. Should a decided and un-
mistakable aggravation of the symptoms be pro-
duced, discontinue the remedy for at least a day,
and if necessary to resume give in greatly di-
luted form. When remedies are kept on hand
they should be protected from the light, as the
virtue of many drugs is destroyed by the chemi-
cal action of sunlight. There should always be
kept in reserve an ounce of syrup of ipecac, and
a half-pound of pulverized flaxseed, which should
be renewed at least once in three months. This
precaution costs but little and may save many
an unpleasant midnight trip to the druggist.
The mother who neglects to keep all medi-
cines secure from the reach of the little inves-
tigator is assuredly not a safe person to dis-
pense them. A pliable, well-padded leather
case, is preferable to the ordinary wooden
boxes supplied by the trade. The vials should
be extra stout, and need not contain more than
three drachms. A large number of remedies
are superfluous and confusing. A thorough un-
Ą DECALOGUE FOR THE nursery.
237
derstanding of a few of the most common reme-
dies is far better than an incomplete knowledge
of a greater number. Subjoined is a list of
such medicines as will best serve the household
needs. Opposite the name of each remedy is
placed its abbreviation, and then the numerals
indicating the attenuation commended for nur-
sery use.
Ten times the quantity appropriate
for a child is required for an adult.
Since the subject of attenuation is apt to be
confusing, a word of explanation on this point
will not be amiss. Formerly the centesimal
scale, i.e., dilution at the ratio of one hundred,
was in vogue, and is still, unless specific instruc-
tions accompany an order for medicines. At
the present time it is customary, because prefer-
able, to deal with medicines prepared according
to the decimal scale, i.e., with each successive
dilution or attenuation the relative proportion
of the drug to the diluent contained is reduced
tenfold, or is ten times weaker than the preced-
ing attenuation. In other words the first deci-
mal indicated thus, 1*, contains one part of the
drug to ten parts of the mixture, the 2*, one
part in a hundred of the mixture, and so on;
238
A DECALOGUE for the nursery.
each successive preparation is increased in
bulk ten-fold by the addition of sugar of milk,
or alcohol. For instance, the third decimal
trituration, written 3* trit. of arsenic, represents
one grain of arsenic thoroughly triturated
with 999 grains of milk sugar; so that one
grain from a vial filled with the 3 trit. grs.
will contain only one thousandth of a grain of
the drug. The fifth decimal, 5*, would con-
tain only the one ten-thousandth part of a
grain, the 6 one millionth, and so on. This
is no place to enter into the question of high
or low attenuations or dilutions. Personally,
I prefer the lower or stronger attenuations,
and seldom prescribe less than the 4-usually
the second, and third preparations. For good
reasons I have discarded the use of pills or
globules. It is always best to prepare tinct-
ures with alcohol, and the dry drugs in pow-
der, from using sugar of milk with thorough
trituration. A grain of the powder mixture
and a drop of the liquid are equivalent. The
remedies indicated in the list, having "trit." af-
fixed, should come in powder; those bearing no
mark are understood to be prepared in liquid.
A DECALOGUE FOR THE NURSERY.
239
As a rule, one drop, or one grain, of each
remedy here commended is taken as a dose.
For convenience, we usually mix the number of
allotted doses in the same number of teaspoon-
fuls of pure water, which saves the trouble of
preparing from the vial each time of administer-
ing, Furthermore, since it is understood that
we have in mind a child about a year old, judg-
ment will prompt us when to give only part of
a drop to the very young or feeble, or, on the
other hand, when to increase if the child be two
or three years of age.
We advise those who lack dexterity in drop-
ping liquid from a vial, to secure a piece of
solid glass rod, one-fourth of an inch in diam-
eter and three inches long; heat this over the
flame of a spirit-lamp, at a point three-fourths
of an inch from the end, and when malleable,
bend to a right angle. Whenever you wish to
drop from a vial, slip the longer part of the rod
into it, and the liquid will drop from the free
pendent end very neatly. The dropper should
be cleansed thoroughly after each using. The
ordinary pipette is unfit when delicate medi-
cines are dealt with.
240
A DECALOGUE FOR THE NURSERY.
Medicines should never be put in vials that
have been previously used, and old corks satu-
rated with drugs should always be destroyed.
Name of Remedies.
Aconite Napellus...
Abbreviation.
Attenuation.
Acon.
2 X
Antimonium Tartaricum.
Ant. Tart.
2 X
Apis Mellifica..
Apis.
4 x trit.
. Ars.
Arsenicum Album
Belladonna
•
Bryonia Album
Cantharis Vesicatoria...
Cina Anthelmintica.
Graphites.....
Ignatia Amara..
Ipecacuanha.
•
Bell.
Bry.
Canth.
Cin.
.Graph.
•
•
Ign.
Kali Bichromicum
Mercurius Protoiodide.
Mercurius Corrosivus.
Mercurius Solubilis..
Tr. Nucis Vomicæ.
Opium
•
Phosphorus.
Podophyllum.
Pulsatilla Nigricans..
Rhus Toxicodendron.
Rheum (Rhubarb)
Silicea
•
.Ipec.
.Kali Bichrom.
Merc. Prot.
.. Merc. Cor.
Merc. Sol.
.Nux Vom.
3 x trit.
3 x
2 x
3 x
Tincture
6 x trit.
2 X
2 X
2 x trit.
2 x trit.
3 x
3 x trit.
2 x
3 x
Opi.
.Phos.
3 x
Podoph.
2 X
Puls.
2 X
.Rhus.
3 x
·
•
. Rheum.
I X trit.
. Sil.
6 x trit.
Spong.
3 x
.Sulph.
2 x trit.
.Verat. Alb.
3 x
Spongia Marina Tosta.
Sulphur....
Veratrum Album.
•
The above remedies are intended for inter-
nal administration. Beside these the following
A DECALOGUE FOR THE NURSERY.
241
tinctures should be kept in four-ounce bottles
for external use:
Arnica, for bruises.
Calendula, for cuts, etc.
Cantharis, for burns, erysipelas, etc.
These are usually diluted with water in the
proportion of a teaspoonful of the tincture to a
gill of water, and used as a wash. Tincture of
Camphor is also a valuable remedy, and often
proves most efficient in cutting short a "cold
in the head" by simply smelling the fumes.
It must, however, be kept remote from all other
remedies.
ACONITE, 2x DIL.
Fifteen drops in gill of water; one teaspoon-
ful every hour until desired effect.
Pulse quick and bounding, skin dry and hot;
desire to be uncovered. Turns pale and giddy
when suddenly rising from reclining position.
Lips, mouth, and throat dry and parched; res-
piration rapid; short breathing with croupy
cough; starts at slightest noise; great restless-
ness and symptoms of fear; excitement and
fright without cause.
16
242
A DECALOGUE for the nuRSERY.
ANTIMONY TART. (TARTAR EMETIC), 2* DIL.
TRIT.
Ten drops in gill of water; one teaspoonful
every four hours.
Cough with rattling of loose mucus in throat
and lungs; coughing until vomiting; inability
to raise the loose mucus in air-tubes; face
pale; forehead cold and clammy; great loss of
strength.
ARSENICUM ALBUM (ARSENIC), 3* TRIT.
Four grains in gill of water; teaspoonful
three times a day.
Marked and rapid prostration of strength;
extreme thirst; cold water soon ejected; rest-
lessness; burning pains; short stuffy cough as if
dust in throat; dread of lying on the back for
fear of suffocation; all excretions are acrid and
corrode the parts. Diarrhoea (chronic), cadav-
erous smells, similar to decaying meat.
All symptoms worse after midnight and re-
mit every other day; violent burning in stomach,
with vomiting and great thirst. Pale face, with
puffiness under eyes; habitually cold extremi-
A DECALOGUE FOR THE NURSERY.
243
ties. Arsenic is a sovereign remedy in post-
scarlatinal dropsy, and often excels preparations
of iron in the treatment of thin, bloodless-look-
ing children, especially if there be suggestions
of dry, scaly skin affections.
BELLADONNA, 3* DIL.
Fifteen drops in gill of water; one teaspoon-
ful every four hours.
The picture is one of congestion. Violent
throbbing arteries; deep red flushed face; in-
jected eyes; loquacious delirium; sees frightful
visions; strikes and tries to bite; feels chilly
on uncovering; pains come and go suddenly;
shining redness of skin; mucous membrane of
throat and mouth deep red; distressing dry
cough excited by creeping sensation in throat
and chest; pressive throbbing headache, as if
head would burst; rolling of head; boring the
head into the pillow.
BRYONIA ALBA, 2* DIL.
Ten drops in gill of water; one teaspoonful
every two hours. Sharp stitching pains when
244 A DECALOGUE FOR THE NURSERY.
moving; cannot take deep breath on account
of catching pain.
(Pleurisy, Pneumonia, and Rheumatism.)
Patient desires to keep perfectly quiet, as mo-
tion excites the tearing, stitching pain; painful
stiffness in neck which extends between the
shoulders; breathing quick, anxious, difficult;
cough causes to cry out with sharp pain.
CINA TINCTURE.
Give child from two to six drops, night and
morning, for several days.
Crossness; irritability; cries out during
sleep; prominent round abdomen; spells of
griping pain in abdomen; canine hunger alter-
nating with loathing of food; hacking, gagging
cough; urine turns milky after standing.
GRAPHITES, 6× TRIT.
Eruptions from which oozes a thick, sticky se-
cretion of the consistency of honey; skin un-
healthy-looking, inclined to crack and ulcerate;
every injury suppurates and throws out the
characteristic viscid fluid; constipation; stools
dry, hard, and knotty; abdomen bloated and
A DECALOGUE FOR THE NURSERY. 245
hard; much croaking. Eczema capitis with
the peculiar excretion. Humid eruption around
ears. Especially indicated in young girls of
too much unhealthy adipose matter.
IPECACUANHA, 2*.
Drop doses. Nausea with all ailments;
pinching, griping pain about umbilicus; suffo-
cating cough as if lungs full of phlegm, which
rattles loosely; face pale, with blue margins
under eyes and around mouth; diarrhoea in
children; stools fermented and bright green.
KALI BICHROMICUM, 2* TRIT.
Ten grains in gill of water; one teaspoonful
every two hours.
Diphtheritic affections. White patches on
tonsils; bladder-like appearance of uvula; all
secretions from mucous membranes stringy and
tough.
MERCURIUS SOLUBILIS, 3* TRIT.
Grain on tongue, dry, every four hours.
Glands swollen and tender; profuse night-
sweats; salivation with bad breath; ulcerated,
246 A DECALOGUE FOR THE Nursery.
swollen gums; sore throat with much secretion
of mucus; takes cold easily; all symptoms
worse at night; syphilitic taint.
MERCURIUS PROTOIODIDE, 2* TRIT.
Grain doses every four hours, dry, on tongue.
This is a sovereign remedy in ordinary ton-
sillitis, which attacks scrofulous subjects with
every cold; glands of throat swollen; voice
thick; breathing noisy; mouth open; frequent
empty swallowing; sensation of lump in throat;
aching soreness of bones of nose and face.
MERCURIUS CORROSIVUS SUBLIMATUS, 3* DIL.
Five grains in gill of water; one teaspoonful
every four hours.
This is our sheet-anchor in dysentery. Face
pale, haggard, looks swollen and distorted;
gums puffy and tender; sensation in mouth as
if scalded; painful burning in mouth, with un-
quenchable thirst; stomach distended and sore;
burning, gnawing, darting pains, with vomiting
of stringy substance which is green or brown;
abdomen bloated and tender to the touch;
stools yellow-green, followed by slime, often
A DECALOGUE FOR THE NURSERY.
247
streaked with blood; evacuations accompanied
with burning, cutting, colicky pain, with intol-
erable tenesmus, or involuntary straining, with
blood; extremities cold and look purple; some-
times cramps in calves of legs.
NUX VOMICA, 2x DIL.
Dose, one to three drops.
Dark complexioned, with irritable, spiteful
disposition. Constipated habit; indigestion ;
pain in stomach as of a stone; sick headache
in the morning from indiscretions in diet, rich
food, coffee, wine, etc.
Drop doses.
OPIUM, 3× Dil.
Stupid indifference; lies with eyes half closed
and turned upward; face dark red, or pallid;
cold, clammy forehead; breathing very light;
imperceptible when dozing; stertorous and
blowing when sleeping on back.
PHOSPHORUS, 3*.
Tuberculous affections. Want of vital
strength and reaction. Pneumonia and other
248 A DECALOGUE FOR The nursery.
pulmonary affections. Cough dry and hoarse,
with pain under breast-bone; hectic fever, with
night-sweats; red spot on one or both cheeks;
habitual constipation; stools adherent, stringy,
and voided with great difficulty, as if the bowel
were passive.
Individual characteristics-tall, lean, round-
shouldered.
Drop doses.
PULSATILLA, 2*.
Mild, yielding disposition; tearful; cries ea-
sily without sufficient cause; fair, sandy com-
plexion; pains wandering; shift rapidly from
one point to another; stomach disorders and
diarrhoea from cakes or rich food, particularly
from fat pork and pastry containing lard.
SULPHUR, 2* TRIT.
Cold extremities, with burning palms and
soles; child dreads to be washed; unhealthy
skin; slight injuries suppurate; herpes; child
scratches when undressing and becoming warm
in bed; prolapsus of the rectum; strongly in-
dicated in early morning diarrhoea. An excel-
A DECALOGUE FOR THE NURSERY.
249
lent remedy in convalescence when recovery is
slow.
Finally, in the treatment of infant diarrhoea
there are four favorite remedies that deserve
special mention, and in my own experience I
have usually found some one of them satis-
factory. In simple, recent diarrhoea, where
there are febrile symptoms, restlessness, fre-
quent stools yellow, frothy and papacent, noth-
ing is better than castor-oil, given in doses of
from ten to twenty drops, once a day or every
other day.
In painless diarrhoea, where the stools are
profuse, watery, and with meal-like sediment,
the evacuations preceded by gurgling in the
bowels, then pouring forth in large quantity as
if to drain the patient, podophyllum in minute
doses is indicated. If, however, the stools are
black, tar-like, and very fetid, leptandrin one-
hundredth of a grain, or 2* trit. thoroughly
triturated in sugar, given twice daily, will have
a happy effect.
When the diarrhoea has assumed a chronic
form, and there are no febrile complications,
small doses of rhubarb will prove very effect-
250
A DECALOGUE FOR THE NURSERY.
ual. To an infant, give one-fourth of a grain
of the root, suitably prepared, three times a day
for two days, and then omit a day or two, when
it may be resumed until the desired effect is
produced.
THE NURSERY SCRAP-BASKET.
Disinfectants.-Among the laity there is a
widespread ignorance as to what constitutes
veritable disinfection. Although from earliest
times its importance has been recognized, still
in this matter the public has advanced but lit-
tle beyond the ideas of three thousand years
ago, and it is full time that a more definite
knowledge be obtained concerning the practi-
cal application of agents to prevent the spread
of infectious or contagious diseases. For some
unaccountable reason physicians have been
remiss in their duty regarding this particular;
otherwise we would hardly find the majority of
mothers of to-day relying upon the virtue of
cloths saturated in solution of carbolic acid,
chloride of lime, camphor, etc., hung up in the
rooms for the purpose of destroying or render-
ing inert poisonous germs that may be floating
through the atmosphere of the sick-room.
252
A DECALOGUE FOR THE NURSERY.
To disinfect a room-that is, to charge the
atmosphere to such a degree with vaporizable
or volatile disinfectants as to destroy the disease
spores, the air must be so saturated with the
chemical agent as to be unlivable; for ex-
periments demonstrate that the vital princi-
ple (so to speak) of the micro-organisms is
more difficult to destroy than that of nobler
organisms, or, in other words, the vapors of
carbolic acid, chloride of lime, or kindred
agents, might be made so strong as to poison
the human inmates of an apartment, and
yet the disease germs disseminated around
the same apartment remain viable so far
as their specific blood-poisoning power is con-
cerned.
To insure disinfection of the air and appur-
tenances of a room with a diffusable disinfect-
ant, it must be vacated, all means of ventilation
closed, and then disinfectant fumes generated
so as to charge the room with them to a high
degree. This is best accomplished by burning
brimstone. After a room has been occupied
with a case of scarlet fever, typhoid fever,
diphtheria, etc., shut all the windows and crev-
A DECALOGUE FOR THE NURSERY.
253
ices, place in each corner a tin dish containing
two or three ounces of sulphur, ignite, and
close the door. After a few hours ventilate
the room thoroughly.
Disinfectant solutions, to be efficient, must be
brought in direct contact with the poisonous
germs. Spittoons, slop-jars, etc., must not only
be washed with the solution, but a quantity
should stand in every vessel receiving the
excreta. In this way the microbes are de
stroyed in their nest before they have become
diffused through the air. The best disinfect-
ing fluid known to science is a solution of cor-
rosive sublimate. As this salt is a deadly poison
it must be handled carefully. Make a solution
as follows: In a gallon of water dissolve one
ounce of corrosive sublimate (bichloride mer-
cury) and half an ounce of permanganate potas-
sium. This germicide is superior to all others,
is cheap, and emits no unpleasant odor.
After a siege with a contagious disorder, do
not burn the soiled clothing that has been about
the patient, but soak for four hours in a bichlo-
ride of mercury solution, made of one part of the
salt to five thousand of water; then rinse and
254
A DECALOGUE FOR THE NURSERY.
boil them. The above measures can be exe-
cuted at very little expense, and with much less
annoyance than the ordinary ineffectual habit
of polluting the air with disagreeable odors.
HOUSE SEWERAGE.
We can make only a passing allusion to
house sewerage. Whenever possible, set ba-
sins should be abolished from the nursery, every
one of which is a death-trap, being an inlet for
poisonous effluvia thereby conveyed from the
foul cesspool reeking with the noxious germs of
numberless contagious and infectious diseases.
It may be argued that "sanitary plumbing
provides for the exclusion of foul gases, but
those who have investigated the subject know
that this is but imperfectly accomplished; and
indeed, it is well nigh impossible while the pres-
ent style of architecture prevails. Every well-
appointed house should have a semi-detached
extension whereby each floor could be supplied
with a bath-room and closet. Escape-pipes
should enter the chimney flue (the one in con-
stant use should be selected), or into a large
ventilating flue reaching high above the roof.
A DECALOGUE FOR THE NURSERY.
255
If, from inevitable circumstances, the presence
of a set basin must be endured in a nursery or
sleeping room, wash out the pipe with at least
a pint of disinfecting fluid every evening, and
should the faintest odor of sewerage be detected,
cork tightly the overflow holes and keep stand-
ing in the basin a pint of the solution. Unless
there be a leak in the pipe, by this precaution
all disease spores will be destroyed, and, it may
be, a dangerous or fatal illness escaped.
Finally, artificial disinfectants should never
usurp the place of sunlight and fresh air, for
after all is done, nature has given us in these
two factors, our most efficient safeguards. Add
to these cleanliness, and the actual need for
disinfectants will be reduced to a minimum.
REST AS A REMEDY.
Whenever a child is nauseated, and purges,
know that irritation exists somewhere along
the intestinal tract, or the digestive organs are
overworked, and rest is imperatively demand-
ed; consequently, for a few hours abstain from
all food, even though the little one rebel, and
for a day or two reduce the usual amount. Sub-
256
A DECALOGUE FOR THE NURSERY.
ject the disordered apparatus to rest, just as
you would enforce disuse for the benefit of an
inflamed eye.
Should the child cry and show
symptoms of thirst, do not give cold water, as
this will surely aggravate the nausea; give,
rather, warm barley water, or, should the bowels
be quite loose, gum-arabic water instead.
BARLEY WATER.
Grind coarsely a heaping teaspoonful of
choice barley grains. Boil in a gill of water;
strain; add a pinch of salt and a tablespoonful
of fresh milk.
GUM-ARABIC WATER.
Must be made fresh daily, as it spoils very
quickly in warm weather. Dissolve a drachm
of the clear lumps (the pulverized is often adul-
terated) in a gill of water. Mix from one to
four teaspoonfuls in the milk at each meal, or
add an equal part of water when given as
drink. One drachm of the gum should be
sufficient for the day, unless the diarrhoea is
excessive, in which case the amount may be
A DECALOGUE FOR THE NURSERY.
257
increased. The effect of gum-acacia is to stay
the action of the intestine, and at the same time
increase the secretion of the kidneys.
Mother's milk is normally alkaline, while
cow's milk is often slightly acid; therefore,
during the summer weather it is well to dip a
strip of blue litmus paper in the alien food, and
if it turns red the fluid is acid. To remedy this,
add a few teaspoonfuls of lime-water, when it
will be found that the strip remains blue, and
the bit previously reddened will regain its for-
mer blue tint if reimmersed.
LIME-WATER.
To a quart of clean filtered water, add a
piece of unslacked lime the size of a hen's egg,
and then let it stand over night, when it is ready
for use.
Do not shake the bottle, but turn the
clear fluid off as needed. When the sediment
is approached, refill the bottle and use as before.
No special care is necessary in preparing, as
water will only take up a constant relative pro-
portion of lime; therefore the water decanted
from a bottle half full of lime-deposit will be no
stronger than from one containing a teaspoon-
17
258
A DECALOGUE FOR THE NURSERY.
ful. Continue to add water and use without
adding fresh lime until the deposit is pretty
well exhausted.
A greenish tinge of the diarrhoeic discharges.
indicates acidity of the intestinal juices (the
normal state is slightly alkaline), hence a little
lime-water, and such regulation of the ingesta
as will check fermentation, will generally cor-
rect this condition.
CLINICAL THERMOMETER.
Every mother should possess one of these
health-monitors and be conversant with its use.
The sense of touch is far from being reliable in
determining the presence or intensity of fever.
Occasionally (rarely, of course), the surface
may be found quite cool, and still a dangerous
fever be present. The normal temperature
of the body is a trifle over 98°; abnormal
oscillations are limited to 7° or 8°. When
a temperature of over 100° is registered by the
thermometer, we may be sure there is an ab-
normal state of the system.
of the body rarely exceeds
The temperature
106°, even in the
most intense febrile condition. Bodily tem-
A DECALOGUE FOR THE Nursery.
259
perature remains unaffected by that of the im-
mediate atmosphere. While ascertaining the
temperature of an infant, a good place for the
clinical thermometer is between the thighs or,
better still, in the anus. In about five minutes
the mercury has acquired the same heat as that
of the body. Always obtain a self-registering
instrument, and from a thoroughly reliable
dealer. When cleansing, avoid dipping it in
warm water. It is economical to have a neatly
cushioned case for its protection, otherwise a
fall or jar will break an instrument ordinarily
costing from three to five dollars.
Nothing quiets the restlessness of fever,
quenches tormenting thirst, and lowers the
temperature of the body more speedily and
gratefully than frequent sponging of the dry,
heated surface (especially the back) with tepid
water. Never use it cold, as, secondarily, it
adds to the heat of the skin.
A wet compress laid along the stomach and
bowels allays thirst more effectually than
drinking, when intestinal inflammation exists.
260
A DECALOGUE FOR THE NURSERY.
LACTOMETER AND CREAM-GAUGE.
These are valuable instruments and will pro-
tect the little ones from the impositions of dis-
honest milk-dealers. They are inexpensive,
their use easily comprehended, and are almost
as indispensable as the thermometer that regu-
lates the heat of the nursery.
DECEIT IN THE NURSERY.
To betray the confidence of a child is always
contemptible but never more so than when ex-
ercised by a parent. Whenever I see a little
one distrusting all that is done and said, refus-
ing to be reconciled by a mother's assurances,
I am quite sure that in the past that child has
been treacherously dealt with. What is more
detestable than a mother or a nurse protesting
that a nauseous medicine is "
so nice," and pre-
tending to taste it with great relish, till through
coaxing, hiring, and threats, the dose is swal-
lowed and the child has additional cause to
question the honesty of its elders? Depend
upon it the mother who practises deceit toward
her child will have cause for bitter repentance.
A DECALOGUE FOR THE NURSERY. 261
I often stand amazed at the manifest lack
of moral tone and even-handed justice on the
part of mothers who will severely reprimand
every semblance of falsehood in children, and
yet will themselves not hesitate to practise a
score of untruths to gain some trivial end.
Once deliberately deceive a child and it will
never fully believe in you again. Who has
ever known a child forget a promise made to it,
and yet how frequently are promises made that
are never kept.
Children have remarkably retentive memo-
ries, and are keen-sighted and accurate ob-
servers just and correct in their deductions.
Therefore if parents expect their offspring to
live uprightly, with a loyal respect for truth in
its broadest sense, they must be prepared to
lead the way, not by precept and argument
only (for hypocrisy ever stands naked and
despised before the guileless perception of
childhood), but by being in all things just and
true.
COMPULSORY KISSING.
Every mother knows that, very early, babies
manifest decided likes and dislikes in the matter
262
A DECALOGUE FOR THE NURSERY.
of acquaintances, quite as pronounced as those
of older people. Fair play suggests that these
prejudices should certainly be respected, and
defended if need be; but exactly the opposite
is the case. Regardless of baby's frowns and
other expressions of aversion, he must submit
to be kissed and petted by every female friend
of the mother's. It is high time that popular
sentiment came to the rescue of the little ones,
for it is an unpardonable offence that their
delicate feelings should be overridden by a vul-
gar custom.
Incredible as it may seem to the
fond mother, kissing and fondling the "baby"
is not regarded as an inestimable boon by the
majority, loud as their protestations of delight
may be. Not only is this custom an imposi-
tion upon the helpless members of society, but
it is to a degree positively dangerous. For a
fuller explanation of the meaning of this asser-
tion let mothers consult the medical adviser.
CORPORAL PUNISHMENT.
It must be a cold and cruel heart that can
watch unmoved the whirl of emotions, shame,
anger, outraged pride, and keen resentment,
A DECALOGUE FOR THE NURSERY.
263
all mingled with grief, which fill the soul of the
little body smarting under corporal punish-
ment. Some of us recall with vividness occa-
sions of castigation endured fifty or seventy
Sore indeed must be the wounds
years ago.
in the young heart the scars of which are not
obliterated by the wear and tear of a lifetime.
Little do parents whose hearts have been heavy
with the vexing cares of a work-a-day life, reck
of the estrangement wrought, or thoughts of
revenge awakened by a whipping inflicted upon
a child. I once heard a young man confess with
grief that fifteen years of his young life had been
embittered by impatient longing for the time to
come when he could revenge upon a father a
severe box upon the ear. Of course, when the
time came, the thoughts of revenge were merged
into grief for the wealth of happiness and filial
love which had been blighted forever by an
apparently trivial affair. Nothing is more fatal
to mutual love, trust, and interest between par-
ents and children than corporal punishment.
Castigations and harsh reprimands invariably
lower a child's self-respect and debase the
moral tone. Moreover, a child who has reason
264
A DECALOGUE FOR THE NURSERY.
to believe himself unjustly treated is sure to
indulge in feelings of resentment rather than
repentance.
The knowledge that a child obeys through
fear instead of love will bring anguish to the
heart of any true or worthy parent. And yet
how often do we hear parents who yearn for
the love and best good of their children couple
their injunctions with a threat. "If you do not
mind what I say I shall whip you," is the vulgar
threat of multitudes of mothers, and wherever
heard, bespeaks narrow mindedness and ill-
breeding, and, furthermore, is suggestive of un-
told trials and strife. It is infinitely better to
draw upon a child's reason than fear, as an in-
centive to do or forbear. It is a wonderfully
short-sighted doctrine, no matter where applied,
that a wrong done can be cancelled by physical
pain inflicted.
It is an imperative duty to teach children
that every wrong-doing has its legitimate pen-
alty affixed, which must be paid sooner or later.
This lesson in moral training can be very early
impressed. If the mischievous hands upset the
work-basket, or scatter the contents of drawers,
A DECALOGUE FOR THE NURSERY. 265
instead of slaps and petulant reproaches, insist
upon a replacement of every disturbed article ;
and so on from this simple illustration of atone-
ment to others infinitely more complex, but
always keeping the grip of honor, or sense of
right upon the tender conscience.
It is always very gratifying to watch with
what earnestness the brave little hearts respond
to demands thus wisely made upon them.
There are a thousand resources at the command
of the wise, discreet mother who can illustrate
her precepts by well-chosen spirited stories, but
most of all by her own keenly noted, noble de-
meanor.
THE POWER OF EXAMPLE.
We are often amused while observing the re-
production of a father's peculiar movements or
mannerisms in his little son, in whose eyes
there is nothing so perfect as the personal
qualifications of his beloved parent.
In childhood we are not much more than im-
itators. The little girl personates her elder
companions, especially her mother. Let the
mother be never so gracious and kindly when
266
A DECALOGUE FOR THE NURSERY.
in the presence of strangers or friends, we sus-
pect her to be an ill-tempered body, given to
slapping and scolding if her little daughter be
loud, harsh-spoken, ready to scold and slap her
little playmates.
THE AWAKENING OF INTELLIGENCE.
What appeals more strongly to the sympa-
thies than the wistful, questioning look in a
baby's wide-open eyes. Many shades of ex-
pression come and go, but that of thoughtful
inquiry remains always. How unmindful seems
the adult-world to the fact that through these
round windows an intensely active, hard-work-
ing brain gazes, and in its eagerness to acquire
and comprehend, it pulls the curtains as far*
apart as possible. Stop a moment and reflect
seriously upon the vast amount of work this in-
fant brain has compassed during the brief pe-
riod of say one year. The first three months
of life we must not count, for during this period
the little body simply exists-breathes, eats,
and sleeps. It is hardly earlier than the fourth
month that the soul awakens, and the spirit of
intelligence begins to perceive and reason con-
A DECALOGUE FOR THE NURSERY.
267
cerning its surroundings. At first the outlines
must be very indistinctly seen through the
shimmering mists that are lifting. And now
consider what is accomplished within the next
few months: the names, uses, and nature of
countless objects; the formulation of ideas, and
the ability to associate sounds. Not only un-
aided, but in spite of many hindrances in the
form of idiotic grimaces and senseless sounds,
with which adults have intensified the mental
confusion, the little creature has achieved more
in one year, than older brains ordinarily accom-
plish in double that time.
It is no wonder, then, that infantile disorders.
are prone to take on neurotic or cerebral com-
plications. We have here broached a subject
of vital importance to parents. Instead of stim-
ulating the over-active brains of children, they
should relieve the mental tension by diverting
the vital energies into the channels for physical
development. It is infinitely better for a child
to tumble and frolic with a good-natured dog,
than to be always dressed ready to be carried
into the parlor for the benefit of visitors, who
will annoy and weary it with meaningless jargon.
268
A DECALOGUE FOR THE NURSERY.
GHOST STORIES.
It is sinful to inflict upon the highly imagina-
tive, impressionable minds of delicate, nervous
children stories of ghosts and frightful creat-
ures. This is a matter every mother should
attend to in the premises, whenever engaging
the services of a nurse, especially if she be
of the Teutonic race. In several instances I
have seen deplorable consequences follow this
wicked practice. The nervous system of one
little girl was dangerously affected, and for
months she suffered from nervous prostration,
being in constant trepidation lest a
"great
monster who lived on naughty children"
should come and steal her away while she
slept. All this anguish (which was really piti-
ful and persistent) was due to the wretched
devices of a German girl, who resorted to this
means of exacting obedience.
There is nothing the young mind more de-
lights in than to give the imagination full
wing into the realm of romance. 'Tis then the
fertile imaginations are teeming with creations,
which are easily conjured up before the mental
A DECALOGUE FOR THE NURSERY.
269
vision. This propensity, so dominant in child-
hood can be employed to great advantage in
coloring the impressionable brain with beauti-
ful pictures, the tints of which will bide through
life, to reappear in the dreams of second youth.
A wise mother will people the hours of dark-
ness with guardian spirits and lovely visions,
and will anticipate matters as far as possible, by
guarding against the approach of evil-working
influences. The mischief which would give to
the youthful fancies a morbid coloring being per-
petrated in this particular is by no means trifling,
if we may judge from that which always has been.
By a little judicious inquiry I have found that the
majority of adults possess vivid recollections of
the positive sufferings they were made to endure
through the relation of uncanny stories in the
nursery. Not a few confess that years and
reason have not succeeded in undoing the
injury which a single recital has wrought.
KINDLINESS.
What a common and deplorable sight is that
of a mother or nurse teaching a child, who has
met with an accident, to beat the innocent
270 A DECALOGUE FOR THE NURSERY.
cause of the mishap, at the same time berating
the object assailed, with various abusive epi-
thets;-as, for instance, a chair, stick, table,
or stove is "nasty," "wicked," naughty,"
mean," etc.
Anyone who encourages an angry child to
wreak vengeance upon some object of his
wrath, is planting in the young soul the deadly
seed of ungovernable passion, and malicious
revenge, which may develop to fill the future
with untold mortification, suffering, and perhaps
crime.
No true mother willingly darkens the soul
of her offspring, nevertheless a vicious thought
or rancorous emotion stamps its baleful impres-
sion upon the disposition, it may be for all time.
Fortunate is that child who is early taught that
pain, sorrow, and misfortune mark the trans-
gression of some beneficent law, made for our
own and the world's best good; and thrice for-
tunate the mother into whose life has come
the ennobling and softening influences-the
reflection of an earnest endeavor to make clear
to the wakening life the good and beautiful in
everything.
INDEX.
Accidents
Air-cells, number in lungs..
Alcohol in therapeutics..
Alimentary canal..
Amyloids .
•
•
Amusement, means of.
Analysis of cow's and woman's milk.
Anus, falling of......
Appearance of tongue in scarlet fever
Artificial food, selection of ...
Artificial milk-food formula.
Atmosphere, composition of.
Attenuation of medicines..
Awakening of intelligence....
• •
•
•
PAGE
212
103
225
33
39
I 12
56
196
167
53
69
99
237
265
BACK, ill effects from lying on.
Barley......
26
77
Barley-water.
Bathing, excessive..
255
5
Bath-tub.....
Bells, string of....
9
114
Bile, function of.
4I
272
INDEX.
Blood, aeration of ……...
Blood, rapidity of circulation..
Bottle, nursing...
Bowel, protrusion of
·
•
Brain-cry...
CANE sugar, cause of skin eruption.
Canker rash.....
Capillaries.
Carbonic-acid gas
·
Carbon, amount exhaled during the day
Catarrh, due to warm bathing
Cathartics, ill effects of..
Cleanliness .
Chloride sodium (table-salt)
Clothing...
Crib, situation of.
Croup
•
•
Croup, treatment of....
•
Cry of infants, significance of.
Cold sponge
Colic....
Condensed milk..
Condensed milk, dilution of..
Constipation, chronic...
Convulsions, premonitions of
Convulsions....
Corporeal punishment.
Cot, construction of..
·
Cow's diet...
Cough, whooping...
• •
Cow's milk..
Cow's craving for bones.
•
•
•
PAGE
103
104
48
196
120
68
166
22
99
100
8
199
I
60
13
105
..126, 148
151
120
I I
217
67
.67-68
198
122
203
261
IIO
176
64
55
64
INDEX.
273
Cutting of gums.
Cutting of teeth, order of
DECEIT in nursery.
Decimal scale.
Dentition....
Dentition, remissions in.
•
•
PAGE
95
83
259
Diarrhoea, sudden suppression of.
Diarrhoea not a disease.
Diarrhœa, infantile
•
Differentiation between "false" and true" croup.
Diet, infant.....
Digestive apparatus....
Diphtheria.
Diphtheria, premonitions of..
Diphtheria and croup.
Disinfectants.....
Disinfectant solution..
•
•
Disinfection after diphtheria.
Disinfection of a room....
Domestic treatment of disease.
Doors, safeguards for...
Dorsal position harmful.
Dose, size of.....
Dosing, indiscriminate.
Drooling, beginning of..
Dropping medicines.
Drugs, action of……….
•
•
Drugs, right and wrong uses of..
Duality of action of drugs.
Dysentery
EARLY indications of disease..
Ears, care of, in bath .
237
80
85
88
88
187
31
128
32
•
155
125
165
250
252
164
251
146
117
19
232
•
133
34
•
239
90
•
131
•
135
192
118
12
+
274
INDEX.
PAGE
171
Ears, care of, when diseased..
Eczema capitis
Epidermis
Example, power of...
Exercise, effects of, upon respiration..
Exhalations of skin.
Extremities, care of.
Eyes, care of.
•
•
208
3
•
264
102
•
บา
5
14
116
FARINACEOUS food preparations
Feeding at night
•
Flaxseed in constipation
Fresh air...
Frequency of dose
Food, selection of ..
Foreign substances in throat...
Four favorite remedies for diarrhoea.
GASTRIC juice.
Gerber's milk food..
•
Gestures and movements.
Ghost stories
•
Goose-flesh, nature of...
Gum-arabic water.
Gums, incision of.
Gums, painful..
HABITUAL Constipation
•
•
73
43
201
97
235
31
•
215
•
249
38
74
121
267
4
255
95
94
198
12
Hair, wetting of, causes catarrh.
Hip-joint disease..
Hip-joint disease, early symptoms of
Hospitals, ventilation of....
205
122
ΙΟΙ
INDEX.
275
PAGE
Hot bath in convulsions
House sewerage.
•
ICE, in diphtheria....
Ice, sucking, in dysentery.
Ice, in scarlet fever
Inactivity, harmful.
•
Incontinence of urine.
Infant diet
Infantile diarrhoea
Infinitesimal doses...
·
204
253
162
196
•
172
20
Intestinal disturbances during dentition
JACOBI on cereals
•
201
31
187
233
85
Juice, gastric
"KEYNOTE" symptoms
Kidneys, affections of, in scarlet fever..
Kindliness.....
Kissing, compulsory.
•
75
38
119
170
268
260
•
259
198
LACTOMETER and cream-gauge.
Laxatives and constipation...
Lime-water
•
List of remedies.
Lobelia in pneumonia
Lungs, inflammation of
·
MASSAGE, benefits of...
Measles
•
Measles and scarlet fever
Membranous croup.
•
256
240
181
178
29
173
175
126, 148
Meningitis
Metastasis
Morphine in pneumonia.
•
•
184
186
•
179
276
INDEX.
Mother's diet..
Mother's perception
Movement of body..
Mumps....
NARCOTICS in nursery.
Nestle's milk food...
Night-feeding
Nursery crib.
•
Nursery appurtenances
• •
•
Nursing-bottle, best form
OATMEAL
•
•
Opening medicines, harmful results of.
Opiates in colic..
Opium and servants.
•
Overfeeding.
•
PAGE
64
•
•
118
20
•
185
94
74
•
43
I 10
•
•
108
51
77
198
220
222
42, 47
PAINTED toys.
Pancreas
•
Pancreatic fluid...
Paralysis following diphtheria.
Parotides..
Peritonitis
•
Phosphate, lime..
Pleurisy ..
Pleurisy, symptoms of
Pneumonia.
Pneumonia, early signs of...
Post-scarlatinal dropsy.
Posture, bodily....
Posture and disease..
Poultice, construction of
• •
115
40
40
162
•
•
185
•
184
62
•
184
•
124
178
·
123
170
16
26
153
Poultices for the relief of intestinal irritation..
•
192
INDEX.
277
Prolapsus ani ……….
Proteids....
Pulmonary affections, early signs of.
QUINIA and morphia in pneumonia
REMEDIES, dual effects of.
Repetition of dose...
Respiration...
Rest as a remedy.
SAFEGUARDS
Salivary glands...
Sand-bed in nursery.
Scald-head…….
Scalds and burns
Scarf-skin..
Scarlatina.
• •
Scarlet fever.
•
Selection and preparation of drugs
Sequelae of diphtheria..
Servants and opium..
Size of dose..
Skin, anatomy of.
Soothing medicines..
Spasmodic croup.
Spasms...
• •
Sponge, objection to.
·
•
Sponging-surface in fevers
Stagnation, cause of....
Stomach and its functions.
•
Stomach, shape of, in infancy.
Sucking-bottle
Sugar an aid to digestion.
•
•
•
PAGE
196
39
•
•
123
179
•
135
235
100
254
117
35
116
208
213
4
166
166
228
162
222
•
232
2
92
126, 148
. 203
IO
258
20
37
37
48
58
278
INDEX.
161
3
Sunlight in nursery.
Swabbing of the throat.
Sweat-pores...
Sweat-tubes, extent of..
Swinging cots ...
Symptoms of opium
Synovitis.
•
PAGE
108
Syringe, mischievous results from use of..
TABLE, comparative analysis..
Table comparing different milks
•
Teaching infants to drink.
•
Teething, signs of..
Temperature of bath.
Temperature and purity of air confounded.
Thermometer in bath.
Thermometer, clinical.
Toilet articles..
·
Tongue, appearance of, in scarlet fever.
Toys, proper selection of... . . .
Tuberculosis, early indications of
UMBILICAL hernia...
Underwear...
Urine, incontinence of....
VASCULAR system.
Ventilation of rooms
WALL-PAPER
Warm bathing
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Warm bathing and catarrh.
Wetting of bed..
Whooping-cough.
Windows, protection of
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•
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5
III
224
184
200
56
72
52
82
9
106
9
257
ΙΟ
167
114
129
196
14
201
21
105
•
115
7
8
201
176
117

UNIVERSITY OF MICHIGAN
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