Remenyi Orsolya

Disorder of the stomach and bowels is one of the most fruitful sources of the diseases of infancy. Only prevent their derangement, and, all things being equal, the infant will be healthy and flourish, and need not the aid of physic or physicians.

There are many causes which may give rise to these affections; many of them appertain to the mother’s system, some to that of the infant. All are capable, to a great extent, of being prevented or remedied. It is, therefore, most important that a mother should not be ignorant or misinformed upon this subject. It is the prevention of these affections, however, that will be principally dwelt upon here; for let the mother ever bear in mind, and act upon the principle, that the prevention of disease alone belongs to her; the cure to the physician. For the sake of clearness and reference, these disorders will be spoken of as they occur:

To the infant at the breast.
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The infant’s stomach and bowels may become deranged from the breast-milk becoming unwholesome. This may arise from the parent getting out of health, a circumstance which will be so manifest to herself, and to those more immediately interested in her welfare, that it is only necessary just to allude to it here. Suffice it to say, that there are many causes of a general kind to which it may owe its origin; but that the most frequent is undue lactation, and the effects both upon mother and child fully dwelt upon.

Anxiety of mind in the mother will cause her milk to be unhealthy in its character, and deficient in quantity, giving rise to flatulence, griping, and sometimes even convulsions in the infant. A fit of passion in the nurse will frequently be followed by a fit of bowel complain in the child. These causes of course are temporary, and when removed the milk becomes a healthy and sufficient for the child as before.

Sudden and great mental disturbance, however, will occasionally drive away the milk altogether, and in a few hours. A Mrs. S., aet. 29, a fine healthy woman, of a blonde complexion, was confined of a boy. She had a good time, and a plentiful supply of milk for the child, which she continued to suckle till the following January, a period of three months, when her milk suddenly disappeared. This circumstance puzzled the medical attendant, for he could not trace it to any physical ailment; but the milk never returned, and a wet-nurse became necessary. In the following spring the husband of this lady failed, an adversity which had been impending since the date when the breast-milk disappeared, upon which day the deranged state of the husband’s affairs was made known to the wife, a fact which at once explained the mysterious disappearance of the milk.

Unwholesome articles of diet will affect the mother’s milk, and derange the infant’s bowels. Once, I was called to see an infant at the breast with diarrhoea. The remedial measures had but little effect so long as the infant was allowed the breast-milk; but this being discontinued, and arrow-root made with water only allowed, the complaint was quickly put a stop to. Believing that the mother’s milk was impaired from some accidental cause which might now be passed, the infant was again allowed the breast. In less than four-and-twenty hours, however, the diarrhoea returned. The mother being a very healthy woman, it was suspected that some unwholesome article in her diet might be the cause. The regimen was accordingly carefully inquired into, when it appeared that porter from a neighbouring publican’s had been substituted for their own for some little time past. This proved to be bad, throwing down, when left to stand a few hours, a considerable sediment; it was discontinued; good sound ale taken instead; the infant again put to the breast, upon the milk of which it flourished, and never had another attack.

In the same way aperient medicine, taken by the mother, will act on the child’s bowels, through the effect which it produces upon her milk. This, however, is not the case with all kinds of purgative medicine, nor does the same purgative produce a like effect upon all children. It is well, therefore, for a parent to notice what aperient acts thus through her system upon that of her child, and what does not, and when an aperient becomes necessary for herself, unless she desire that the infant’s bowels be moved, to avoid the latter; if otherwise, she may take the former with good effect.

Again; the return of the monthly periods whilst the mother is a nurse always affects the properties of the milk, more or less, deranging the stomach and bowels of the infant. It will thus frequently happen, that a few days before the mother is going to be unwell, the infant will become fretful and uneasy; its stomach will throw up the milk, and its motions will be frequent, watery, and greenish. And then, when the period is fully over, the milk will cease to purge. It is principally in the early months, however, that the infant seems to be affected by this circumstance; for it will be generally found that although the milk is certainly impaired by it, being less abundant and nutritious, still, after the third or fourth month it ceases to affect the infant. Is then a mother, because her monthly periods return after her delivery, to give up nursing? Certainly not, unless the infant’s health is seriously affected by it; for she will generally find that, as the periods come round, by keeping the infant pretty much from the breast, during its continuance, and feeding him upon artificial food, she will prevent disorder of the child’s health, and be able in the intervals to nurse her infant with advantage. It must be added, however, that a wet- nurse is to be resorted to rather than any risk incurred of injuring the child’s health; and that, in every case, partial feeding will be necessary at a much earlier period than when a mother is not thus affected.

The milk may also be rendered less nutritive, and diminished in quantity, by the mother again becoming pregnant. In this case, however, the parent’s health will chiefly suffer, if she persevere in nursing; this, however, will again act prejudicially to the child. It will be wise, therefore, if pregnancy should occur, and the milk disagree with the infant, to resign the duties of a nurse, and to put the child upon a suitable artificial diet.

The infant that is constantly at the breast will always be suffering, more or less, from flatulence, griping, looseness of the bowels, and vomiting. This is caused by a sufficient interval not being allowed between the meals for digestion. The milk, therefore, passes on from the stomach into the bowels undigested, and the effects just alluded to follow. Time must not only be given for the proper digestion of the milk, but the stomach itself must be allowed a season of repose. This evil, then, must be avoided most carefully by the mother strictly adhering to those rules for nursing.

The bowels of the infant at the breast, as well as after it is weaned, are generally affected by teething. And it is fortunate that this is the case, for it prevents more serious affections. Indeed, the diarrhoea that occurs during dentition, except it be violent, must not be subdued; if, however, this is the case, attention must be paid to it. It will generally be found to be accompanied by a swollen gum; the freely lancing of which will sometimes alone put a stop to the looseness: further medical aid may, however, be necessary.

At the period of weaning.
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There is great susceptibility to derangements of the stomach and bowels of the child at the period when weaning ordinarily takes place, so that great care and judgment must be exercised in effecting this object. Usually, however, the bowels are deranged during this process from one of these causes; from weaning too early, from effecting it too suddenly and abruptly, or from over-feeding and the use of improper and unsuitable food. There is another cause which also may give rise to diarrhoea at this time, independently of weaning, viz. the irritation of difficult teething.

The substitution of artificial food for the breast-milk of the mother, at a period when the digestive organs of the infant are too delicate for this change, is a frequent source of the affections now under consideration.

The attempt to wean a delicate child, for instance, when only six months old, will inevitably be followed by disorder of the stomach and bowels. Unless, therefore, a mother is obliged to resort to this measure, from becoming pregnant, or any other unavoidable cause, if she consult the welfare of her child, she will not give up nursing at this early period.

Depriving the child at once of the breast, and substituting artificial food, however proper under due regulations such food may be, will invariably cause bowel complaints. Certain rules and regulations must be adopted to effect weaning safely, the details of which are given elsewhere.

If too large a quantity of food is given at each meal, or the meals are too frequently repeated, in both instances the stomach will become oppressed, wearied, and deranged; part of the food, perhaps, thrown up by vomiting, whilst the remainder, not having undergone the digestive process, will pass on into the bowels, irritate its delicate lining membrane, and produce flatulence, with griping, purging, and perhaps convulsions.

Then, again, improper and unsuitable food will be followed by precisely the same effects; and unless a judicious alteration be quickly made, remedies will not only have no influence over the disease, but the cause being continued, the disease will become most seriously aggravated.

It is, therefore, of the first importance to the well-doing of the child, that at this period, when the mother is about to substitute an artificial food for that of her own breast, she should first ascertain what kind of food suits the child best, and then the precise quantity which nature demands. Many cases might be cited, where children have never had a prescription written for them, simply because, these points having been attended to, their diet has been managed with judgment and care; whilst, on the other hand, others might be referred to, whose life has been hazarded, and all but lost, simply from injudicious dietetic management. Over-feeding, and improper articles of food, are more frequently productive, in their result, of anxious hours and distressing scenes to the parent, and of danger and loss of life to the child, than almost any other causes.

The irritation caused by difficult teething may give rise to diarrhoea at the period when the infant is weaned, independently of the weaning itself. Such disorder of the bowels, if it manifestly occur from this cause, is a favourable circumstance, and should not be interfered with, unless indeed the attack be severe and aggravated, when medical aid becomes necessary. Slight diarrhoea then, during weaning, when it is fairly traceable to the cutting of a tooth (the heated and inflamed state of the gum will at once point to this as the source of the derangement), is of no consequence, but it must not be mistaken for disorder arising from other causes. Lancing the gum will at once, then, remove the cause, and generally cure the bowel complaint.

Deficiency of milk may exist even at a very early period after delivery, and yet be removed. This, however, is not to be accomplished by the means too frequently resorted to; for it is the custom with many, two or three weeks after their confinement, if the supply of nourishment for the infant is scanty, to partake largely of malt liquor for its increase. Sooner or later this will be found injurious to the constitution of the mother: but how, then, is this deficiency to be obviated? Let the nurse keep but in good health, and this point gained, the milk, both as to quantity and quality, will be as ample, nutritious, and good, as can be produced by the individual.

I would recommend a plain, generous, and nutritious diet; not one description of food exclusively, but, as is natural, a wholesome, mixed, animal, and vegetable diet, with or without wine or malt liquor, according to former habit; and, occasionally, where malt liquor has never been previously taken, a pint of good sound ale may be taken daily with advantage, if it agree with the stomach. Regular exercise in the open air is of the greatest importance, as it has an extraordinary influence in promoting the secretion of healthy milk. Early after leaving the lying-in room, carriage exercise, where it can be obtained, is to be preferred, to be exchanged, in a week or so, for horse exercise, or the daily walk. The tepid, or cold salt-water shower bath, should be used every morning; but if it cannot be borne, sponging the body withsalt-water must be substituted.

By adopting with perseverance the foregoing plan, a breast of milk will be obtained as ample in quantity, and good in quality, as the constitution of the parent can produce, as the following case proves:

I attended a lady twenty-four years of age, a delicate, but healthy woman, in her first confinement. The labour was good. Every thing went on well for the first week, except that, although the breasts became enlarged, and promised a good supply of nourishment for the infant, at its close there was merely a little oozing from the nipple. During the next fortnight a slight, but very gradual increase in quantity took place, so that a dessert spoonful only was obtained about the middle of this period, and perhaps double this quantity at its expiration. In the mean time the child was necessarily fed upon an artificial diet, and as a consequence its bowels became deranged, and a severe diarrhoea followed.

For three or four days it was a question whether the little one would live, for so greatly had it been reduced by the looseness of the bowels that it had not strength to grasp the nipple of its nurse; the milk, therefore, was obliged to be drawn, and the child fed with it from a spoon. After the lapse of a few days, however, it could obtain the breast-milk for itself; and, to make short of the case, during the same month, the mother and child returned home, the former having a very fair proportion of healthy milk in her bosom, and the child perfectly recovered and evidently thriving fast upon it.

Where, however, there has been an early deficiency in the supply of nourishment, it will most frequently happen that, before the sixth or seventh month, the infant’s demands will be greater than the mother can meet. The deficiency must be made up by artificial food, which must be of a kind generally employed before the sixth month, and given through the bottle.

Exercise is essentially important to the health of the infant. Its first exercise, of course, will be in the nurse’s arms. After a month or two, when it begins to sleep less during the day, it will delight to roll and kick about on the sofa: it will thus use its limbs freely; and this, with carrying out into the open air, is all the exercise it requires at this period. By and by, however, the child will make its first attempts to walk. Now it is important that none of the many plans which have been devised to teach a child to walk, should be adopted the go-cart, leading-strings, etc.; their tendency is mischievous; and flatness of the chest, confined lungs, distorted spine, and deformed legs, are so many evils which often originate in such practices. This is explained by the fact of the bones in infancy being comparatively soft and pliable, and if prematurely subjected by these contrivances to carry the weight of the body, they yield just like an elastic stick bending under a weight, and as a natural consequence become curved and distorted.

It is highly necessary that the young and experienced mother should recollect this fact, for the early efforts of the little one to walk are naturally viewed by her with so much delight, that she will be apt to encourage and prolong its attempts, without any thought of the mischief which they may occasion; thus many a parent has had to mourn over the deformity which she has herself created.

It may be as well here to remark, that if such distortion is timely noticed, it is capable of correction, even after evident curvature has taken place. It is to be remedied by using those means that shall invigorate the frame, and promote the child’s general health (a daily plunge into the cold bath, or sponging with cold salt water, will be found signally efficacious), and by avoiding the original cause of the distortion never allowing the child to get upon his feet. The only way to accomplish the latter intention, is to put both the legs into a large stocking; this will effectually answer this purpose, while, at the same time, it does not prevent the free and full exercise of the muscles of the legs. After some months pursuing this plan, the limbs will be found no longer deformed, the bones to have acquired firmness and the muscles strength; and the child may be permitted to get upon his feet again without any hazard of perpetuating or renewing the evil.

The best mode of teaching a child to walk, is to let it teach itself, and this it will do readily enough. It will first crawl about: this exercises every muscle in the body, does not fatigue the child, throws no weight upon the bones, but imparts vigour and strength, and is thus highly useful. After a while, having the power, it will wish to do more: it will endeavour to lift itself upon its feet by the aid of a chair, and though it fail again and again in its attempts, it will still persevere until it accomplish it. By this it learns, first, to raise itself from the floor; and secondly, to stand, but not without keeping hold of the object on which it has seized. Next it will balance itself without holding, and will proudly and laughingly show that it can stand alone. Fearful, however, as yet of moving its limbs without support, it will seize a chair or anything else near it, when it will dare to advance as far as the limits of its support will permit. This little adventure will be repeated day after day with increased exultation; when, after numerous trials, he will feel confident of his power to balance himself, and he will run alone. Now time is required for this gradual self-teaching, during which the muscles and bones become strengthened; and when at last called upon to sustain the weight of the body, are fully capable of doing so.

Exercise during childhood.
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When the child has acquired sufficient strength to take active exercise, he can scarcely be too much in the open air; the more he is habituated to this, the more capable will he be of bearing the vicissitudes of the climate. Children, too, should always be allowed to amuse themselves at pleasure, for they will generally take that kind and degree of exercise which is best calculated to promote the growth and development of the body. In the unrestrained indulgence of their youthful sports, every muscle of the body comes in for its share of active exercise; and free growth, vigour, and health are the result.

If, however, a child is delicate and strumous, and too feeble to take sufficient exercise on foot, and to such a constitution the respiration of a pure air and exercise are indispensable for the improvement of health, and without them all other efforts will fail, riding on a donkey or pony forms the best substitute. This kind of exercise will always be found of infinite service to delicate children; it amuses the mind, and exercises the muscles of the whole body, and yet in so gentle a manner as to induce little fatigue.

The exercises of horseback, however, are most particularly useful where there is a tendency in the constitution to pulmonary consumption, either from hereditary or accidental causes. It is here beneficial, as well through its influence on the general health, as more directly on the lungs themselves. There can be no doubt that the lungs, like the muscles of the body, acquire power and health of function by exercise. Now during a ride this is obtained, and without much fatigue to the body. The free and equable expansion of the lungs by full inspiration, necessarily takes place; this maintains their healthy structure, by keeping all the air-passages open and pervious; it prevents congestion in the pulmonary circulation, and at the same time provides more completely for the necessary chemical action on the blood, by changing, at each act of respiration, a sufficient proportion of the whole air contained in the lungs, all objects of great importance, and all capable of being promoted, more or less, by the means in question.