The Mother's Manual of Children's Diseases

It is difficult to assign any sufficient reason for this conduct. Mere indolence seems sometimes to be the chief reason for it, oftener vanity; the sense of importance in finding everything in the household arranged with exclusive reference to itself appears to be the motive for it; and this may sometimes be observed to be very powerful even at an exceedingly early age. In many instances a morbid craving for sympathy is mingled with the love of importance, and both these sentiments are not infrequently exaggerated by the conduct of a foolishly fond mother. Real illness, however, in almost all these cases exists at the commencement, though the child persists in complaining of its old symptoms long after their cause has disappeared.

The great difficulty which the doctor meets with in the management of these cases arises from the incredulity with which his opinion is received. Candour is looked upon as so eminently characteristic of childhood, that deceit seems impossible; the case is thought by the parents to be an obscure one which the doctor does not understand; and therefore it is said, he, with want of straightforwardness and of kindness, throws doubts on the existence of disease, and on the truthfulness of a most loving, most suffering child. The vagaries of a hysterical girl, the fits, the palsy, the half-unconsciousness have all been assumed within my own observation by children from ten to fifteen years old, and I have more than once had to give place to the ignorant and impudent pretender who traded successfully on the feelings of the parents. Sometimes, one knows not why, except that the child has got tired of the part he was playing, the symptoms that had caused so much anxiety suddenly disappear, but even then the habit of mind left behind is anything but healthy. Indeed in all cases of this kind it is much less the state of the body than that of the mind which excites my apprehension. The constant watching its own sensations, the habit of constantly gratifying every wayward wish and temper under the plea of illness, and the constant indulgence which it too often meets with in this from the over-kindness of its parents, exert a most injurious influence on its character, and it grows up a juvenile hypochondriac.

A doctor is very unlikely to throw doubt recklessly on the reality of a child's illness. His hesitation should certainly not be attributed to unworthy motives; the parents should co-operate with him heartily in any course of observation which he desires to follow, and if necessary another medical man of experience should be associated with the first, and allowed to visit the child two or three times. One does not associate the idea of moral delinquency with hysteria; the child who shams belongs to the same class with the hysterical patient. It is only the strangeness of the occurrence in the eyes of non-medical people, that makes them fancy it something worse.

If now the suspicion is justified that the child is either greatly exaggerating or altogether feigning illness, it does not by any means always follow that he should at once be charged with it, since it is often of much importance that his self-respect should not be destroyed. It must be remembered that there is in all these cases a measure of real ailment underlying all the half-unconscious exaggeration, and that if spoiling and over-indulgence do much to foster it, sternness and punishment interfere with recovery. To turn the thoughts away from self, to occupy the mind with new scenes, new amusements, new pursuits, to call forth by degrees self-control, and to let the child perceive rather by your manner than by what is actually said that the parents have not been duped by all his past vagaries; such are the simple means by which the little one will be brought round again to health of mind and health of body. Unhappily, in the minds of too many people the idea of the doctor is associated with the administration of drugs and with nothing else; the treatment of disease is of much wider scope; and many of our best remedies are those which do not admit of being weighed or measured, and whose names are not inscribed on the drawers or bottles in Apothecaries' Hall.

Another phase of mental disorder in childhood sometimes presents itself as the result of overtasking the intellectual powers. This over-work too is by no means due in all cases to the parents' unwisely urging the child forward, but it is often quite voluntary on his part. The precaution too of limiting the hours of work is often inadequate from the want of some provision for turning the thoughts and energies during play hours into some perfectly different channel.

In many of these cases Nature happily takes matters into her own management. For a year or two, or more, the mind has grown apparently at the expense of the body; the parents take a fearful joy in their darling's acquirements; and if it should live, think they, of what remarkable talents will it not be the possessor! By degrees, the extreme quickness of intellect becomes less remarkable; but the body begins to increase in robustness; and a year will sometimes suffice to transmute the little fairy, so quick, so clever, but so fragile, into a very commonplace, merry, rosy, romping child. I may add that it is well to bear in mind the converse of this; to remember that body and mind rarely grow in equal proportion at one time; that the incorrigible little dunce, though not likely to prove a genius as he grows older, will yet very probably be found at twelve or fourteen to know as much as his playmates. A dull mind, and a sickly or ill-developed frame may make us anxious: but if the physical development is good, the mind will not be likely to remain long below the average standard.

But sometimes, the over-tasked mind leads to mischief which Nature cannot rectify; an attack of water on the brain destroys the child, or if not it sinks under almost any accidental disease. In other instances neither of these results takes place, but the whole nervous system seems profoundly shaken, and the moral character of the child seriously, and even permanently injured. I remember a quick and clever little girl aged five and a half years who was urged on by her governess to work which she delighted in, till at length the signs of over-taxed brain showed themselves in frequent extreme irritability, and occasional attacks of causeless fury amounting almost to madness. It was fully a year during which almost all mental work was suspended, while the child was sent to have complete change under most judicious management in the country, before her mind quite recovered its balance and she became able to resume her studies in a very moderate degree.

Cases such as this are instances of the slightest degree of a condition which if not remedied may pass into confirmed insanity. I believe the gradations to be almost imperceptible by which the one state passes into the other; and I have known instances in which the ungovernable temper and occasional fury of the child have passed in youth into abiding insanity which rendered the patient the inmate, and I fear the permanent inmate, of a lunatic asylum.

In whatever circumstances insanity comes on in childhood, and it does sometimes, though very seldom, come on independently of any obvious exciting cause, it always assumes the character of what has been termed moral insanity, or of that condition in which the moral system rather than the mental power is chiefly disordered.

Idiocy is unquestionably of much more frequent occurrence in childhood, than any of those forms of mental or moral disorder of which I have been speaking hitherto. The term idiocy, however, is a very wide one, including conditions differing remarkably from each other both in kind and degree, while not seldom it is misapplied to cases in which there is mere backwardness of intellectual power.

Backward Children.—Enfants arriérés—as the French call them—constitute a class by no means seldom met with. They generally attain their bodily development slowly, and the development of their mind is equally tardy. They cut their teeth late, walk late, talk late, are slow in learning to wash and dress themselves, are generally dull in their perceptions, and do not lay aside the habits of infancy till far advanced in childhood. When the time comes for positive instruction, their slowness almost wears out everyone's patience; and among the poor indeed the attempt at teaching such children is at length given up in despair, and growing up in absolute ignorance, it is no wonder that they should be regarded as idiots. Still, dull as such children are, there is between them and the idiot an essential difference. The backward child, unlike the idiot, does not remain stationary; his development goes on, but more slowly than that of other children, he is behind them in the whole course of their progress, and his delay increasing every day, places at length an enormous distance between him and them—a distance which in fact becomes insurmountable.

In some of its minor degrees even, this backwardness not infrequently excites the solicitude of parents. It is sometimes observed in children who had been ill-nourished in infancy or who had been weakened by some serious or protracted illness, even though unattended by any special affection of the brain; but it is also met with independent of any special cause. The distinction, however, between such a case and one of idiocy is this, that though at four years old the child may not seem to be intellectually superior to most children at two, yet in manners, habits, and intelligence it does agree with what might be expected from the child at two; less bright perhaps, less joyous, but still presenting nothing which if it were but younger would awaken apprehension.

It is well in all cases of unusual backwardness to ascertain the condition of the sense of hearing, and of the power of speech, for I have known the existence of deafness long overlooked, and the child's dulness and inability to speak referred to intellectual deficiency; and have also observed mere difficulty of articulation, dependent partly on malformation of the mouth, lead to a similar misapprehension. In both instances I have seen this inability to keep up ready intercourse with other children cast a shadow over the mind, and the little ones in consequence be dull, suspicious, unchild-like. I have already referred to a similar result as sometimes following serious illnesses. The child will for months cease to walk, or forget to talk, if these had been but comparatively recent acquirements; or will continue dull and unequal to any mental effort for weeks or months together, and then the mind will begin to develop itself once more, though slowly, possibly so slowly as never altogether to make up for lost ground.

Idiocy.—In idiocy, however, there is much more than the mere arrest of the intellect at any period. The idiot of eight years old does not correspond in his mental development to the child at six, or four, or two; his mind is not only dwarfed but deformed; while feebleness of will is often as remarkable as mere deficiency of power of apprehension. Even in earliest infancy there is usually a something in the child idiotic from birth which marks him as different from babies of his own age. He is unable to support his head, which rolls about from side to side, almost without an effort on his part to prevent it. Next it is perceived that the child, though he can see, does not notice; that his eye does not meet his mother's with the fond look of recognition, accompanied with the dimpling smile, with which the infant, even of three months old, greets his mother. Then it is found to have no notion of grasping anything, though that is usually almost the first accomplishment of babyhood; if tossed in its nurse's arms there seems to be no spring in its limbs; and though a strange vacant smile sometimes passes over its face, yet the merry ringing laugh of infancy or joyous chuckle of irrepressible glee is not heard. As time passes on, the child shows no pleasure at being put down 'to feel its feet,' as nurses term it; if laid on the floor it probably cries, but does not attempt to turn round, nor try to crawl about as other babies do. It does not learn to stand or walk till late, and then stands awkwardly, walks with difficulty, crossing its legs immediately on assuming the erect posture, an infirmity which it often takes years to overcome. Just, too, as the idiot is slow to notice, slow in learning to grasp anything, or to stand or walk, so he is late in learning to talk, he often acquires but few words, for his ideas are few. He learns even these few with difficulty, and employs the same to express many different things; he generally articulates them indistinctly, often indeed so imperfectly as to be almost unintelligible.

In other instances the evidences of idiocy are not present at birth, or at any rate are not then noticed, but succeed to some attack of convulsions or to some illness attended with serious affection of the brain. Sometimes too there is no point in the child's history which can be laid hold on as marking the commencement of the weakening of his intellect, but as the body grows the mind remains stationary, or its powers retrocede, until by degrees the painful conviction that the child has become idiotic forces itself upon the unwilling parents. Here we have sometimes the sad spectacle of the body perfectly developed, hale and strong, but the mind obscured; the child in constant unrest, perpetually chattering, laughing without cause, destroying its clothes, or the furniture of its room, for no purpose; or sitting silent, with a weird smile upon its face, looking at its spread-out fingers, or stroking a piece of cloth for a quarter of an hour together as though the sensation yielded it a kind of pleasure. It would be almost endless to describe the various degrees of mental weakness; from the slight silliness down to the condition in which the child is, and remains all life long, below the level of the brute.

Parents as a rule are anxious to persuade themselves, and to persuade the doctor that their idiot child was once as bright and intelligent as others; and that the mind was darkened by some grave illness. We have, however, the highest authority, that of Dr. Down, for saying that as a rule which has but few exceptions idiocy from birth is more amenable to training than that which comes on afterwards, that in fact it is more hopeful to have to do with an ill-developed than with a damaged brain.

The one great question which still remains is what can the parents do for best and wisest whom the affliction has befallen of having an idiot child.

First. To moderate their expectations as to the results of any, even the best devised and most successful treatment. The child who has been born of weak intellect, or who has become so as the result of illness, will always remain at a lower level than others, and this, even though some one faculty, as the musical faculty, or the power of calculation, should be above the average.

Secondly. From the child's earliest infancy to occupy themselves in perfecting as far as possible the physical powers and aptitudes, and the habits of cleanliness and order. Development of mind waits on development of body: to stand, to sit, to walk, to grasp an object put into the hand, are essential to bringing the idiot child into relation with the world around it; are its elementary education, to be given patiently, cheerfully, lovingly, even for years together. To attend to its natural wants, and by fixed routine to accustom it at stated hours to empty its bowels and its bladder is a lesson hard to teach; and not less difficult is it to make the child learn to masticate its food, to drink without slobbering, and then to use the spoon and fork, and to feed itself; and afterwards to dress itself, to wash itself, to tie its shoestrings; for idiots almost without exception are awkward as well as lazy.

The common class of nurses, even the very kindest, find it so much easier to feed the child, to wash it, and to dress it, than to teach it to do any of these things for itself, that it too often grows up, till too old to remain in the nursery, without having made the slightest advance above the condition of completest babyhood. It is absolutely essential either that the mother should devote herself solely to the care and teaching of the idiot, or that she should engage a nurse who will have no other duty. Such a person must be above the average in education and intelligence, and of course will command more than the ordinary wages. The mother, too, must resign herself to the little one's affection being transferred in a great degree from herself to the person who has constant charge of it—a hard trial this, but one to which, for her child's good, she must bring herself to submit.

Thirdly. So soon as the child has been taught at home to exercise these lower powers, and the question of what is termed its education arises, it is a matter of absolute necessity that he be sent to an institution specially set apart for the feeble-minded. It is absolutely impossible with the most devoted love and the most lavish expenditure of money, to do at home what can be, and is constantly, accomplished even in a pauper idiot asylum. The imitative faculty, which is usually very strongly marked in the idiot, furnishes one great means of his improvement; while besides there are many of the moral powers which cannot be brought out except in the society of other children of his own age and not differing too widely from him in mental power.

I have warned, and I repeat the warning, against exaggerated expectations as to the results of even the wisest treatment. To teach cleanliness, order, and neatness; to impart knowledge enough to enable the idiot to take care of himself; to develop his affections; to enable him to read and write; to practise some easy handicraft; to partake of some simple pleasures, and so at length to return to the shelter of his own home, and to be there, not an object to be hidden away, too painful to look upon, but an object rather of special tenderness, repaying with his guileless love the sad self-sacrifice of his parents for many a year; these are endeavours almost sure of accomplishment in a well-conducted institution, sure never to be realised in a home.

I have often sent afflicted parents, who shrank from parting with their children, to one institution near London; and I doubt not there are others in England, where pains, and care, and skill, and untiring love awake the slumbering intellect, arouse the dormant affections, and work miracles of healing on these helpless little ones.

1

This is the proportion stated in Quain's Dictionary of Medicine, to which the writer, Dr. Theodore Williams, adds that of 1,000 cases in the upper classes 12 per cent. showed direct hereditary predisposition, and 48 per cent. family predisposition.

2

Many useful suggestions will be found in Mrs. Gladstone's little tract, Healthy Nurseries and Bedrooms, published as one of the Health Exhibition Handbooks.

3

The actual numbers are 2,628 and 7,646. See Generalbericht ueber das Medizinal-und Sanitätswesen der Stadt Berlin im Jahre 1881. 8vo. Berlin 1883, p. 19.

4

The thermometer used for this purpose, called a clinical thermometer, may be bought for about twelve shillings, of any chemist or instrument-maker, and its mode of employment can be learned in five minutes. No mother should be without it.

5

I add in this note a few simple directions for making poultices, though, as I have stated in my preface, it is no part of my purpose to enter into all the details, important though they are, of a sick nurse's duties.

For a linseed meal poultice, see that the water is boiling, not merely hot; warm the basin, put the water in first; sprinkle the meal on it, stirring the whole time, till it becomes of the uniform consistency of porridge, then spread it about half an inch thick over the linen, or whatever it is spread on, and turn up the edges for an inch all round to prevent the poultice crumbling and soiling the night-dress; and then having smeared the surface with a little oil, test its warmth by applying it to your cheek before putting it on the patient. A broad bandage of some sort or a soft towel must then be put round the body to keep the poultice in its place, and secured with safety pins.

Pure mustard poultices are never used in children, on account of the pain they occasion, and the too great irritation which they would cause of the delicate skin of children. A mixture of one part of mustard to two of linseed meal is, however, often of much use in the chest affections of children.

Bread poultices are less generally useful than those of linseed meal. They do not retain the heat nearly so well as those of linseed meal, and are chiefly used in cuts, wounds, or small abscesses; and also because they are so easily made. A slice of stale bread without the crust is put on a plate, boiling water is poured over it, and drained off; it is then placed on a piece of muslin, pressed between two plates to squeeze out the remaining water, and its surface is greased before it is applied with a little oil or lard. I would refer for details about how to make poultices, and for many other things well worth the knowing, to Miss Wood's Handbook of Nursing, London, 12mo, 1883.

6

I am not ignorant of the doubts which have been raised with reference to the special influence of mercurial remedies on the liver, but prefer in a book written for non-medical readers to leave the popular opinion unquestioned.

7

These plasters for ruptured navel in sets of a dozen are to be had of Ewen, 106 Jermyn Street, St. James's, London, and I dare say at many other places besides.

8

The directions given by the distinguished chemist, Dr. Frankland, to whom I am indebted for the suggestion, are as follows: 'One-third of a pint of new milk is allowed to stand until the cream has settled; the latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk vessel placed in warm water.' (I may add that the artificial rennet sold by most chemists may be substituted for the other.) 'In about five minutes the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling to prevent its becoming sour. A further quantity of curd separates, and must be removed by straining through calico. In one quarter of a pint of this hot whey is to be dissolved three-eighths of an ounce of milk sugar, and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. This will constitute the food for an infant of from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quantity required for twenty-four hours. It is absolutely necessary that a fresh quantity should be prepared every twelve hours; and it is scarcely necessary to add that the strictest cleanliness in all the vessels used is indispensable.'

9

In our tables of mortality we find teething registered as having occasioned the death of nearly 5 (4.8) per cent. of all children who died in London under one year old; and of 7.3 per cent. of those who died between the age of twelve months and three years.

10

The exact numbers as given at p. xiv of the forty-fifth Report of the Registrar-General for all England in 1881 are to 1,000 living under one year 58 deaths; from one to five 6.1; from five to ten 3.3.

11

Reports of the Registrar-General, as quoted at p. 30 of my Lectures on Diseases of Children. The actual numbers are 9,350 under five years old, out of a total of 16,258.

12

Figures deduced from the 44th Report of the Registrar-General.

13

Before I called attention to this form of headache in the last edition of my lectures, it had already been noticed without my knowledge, by a friend of mine, Dr. Blache, of Paris, in a very valuable essay on the headaches which occur during the period of growth.