Читать книгу The Physical Training of Children - Pye Henry Chavasse - Страница 12
DENTITION.
Оглавление58. At what time does dentition commence?
The period at which it commences is uncertain. It may, as a rule, be said that a babe begins to cut his teeth at seven months old. Some have cut teeth at three months; indeed, there are instances on record of infants having been born with teeth. King Richard the Third is said to have been an example. Shakspeare notices it thus:
“York.—Marry, they say my uncle grew so fast
That he could gnaw a crust at two hours old;
’Twas full two years ere I could get a tooth.
Grandam, this would have been a biting jest.”
Act 2, sc, 5.
When a babe is born with teeth they generally drop out. On the other hand, teething in some children does not commence until they are a year and a half or two years old, and, in rare cases, not until they are three years old. There are cases recorded of adults who have never cut any teeth. An instance of the kind came under my own observation.
Dentition has been known to occur in old age. A case is recorded by M. Carre, in the Gazette Medicale de Paris (Sept. 15, 1860), of an old lady, aged eighty-five, who cut several teeth after attaining that age!
59. What is the number of the FIRST set of teeth, and in what order do they generally appear?
The first or temporary set consists of twenty. The first set of teeth are usually cut in pairs. “I may say that nearly invariably the order is—1st, the lower front incisors [cutting-teeth], then the upper front, then the upper two lateral incisors, and that not uncommonly a double tooth is cut before the two lower laterals; but at all events the lower laterals come 7th and 8th, and not 5th and 6th, as nearly all books on the subject testify.” [Sir Charles Locock, in a Letter to the Author.] Then the first grinders in the lower jaw, afterward the first upper grinders, then the lower corner pointed or canine teeth, after which the upper corner or eye-teeth, then the second grinders in the lower jaw, and lastly, the second grinders of the upper jaw. They do not, of course, always appear in this rotation. Nothing is more uncertain than the order of teething. A child seldom cuts his second grinders until after he is two years old. He is usually, from the time they first appear, two years in cutting his first set of teeth. As a rule, therefore, a child of two years old has sixteen, and one of two years and a half old, twenty teeth.
60. If an infant be either feverish or irritable, or otherwise poorly, and if the gums be hot, swollen, and tender, are you an advocate for their being lanced?
Certainly; by doing so he will, in the generality of instances, be almost instantly relieved.
61. But it has been stated that lancing the gums hardens them?
This is a mistake—it has a contrary effect. It is a well-known fact that a part which has been divided gives way much more readily than one which has not been cut. Again, the tooth is bound down by a tight membrane, which, if not released by lancing, frequently brings on convulsions. If the symptoms be urgent, it may be necessary from time to time to repeat the lancing.
It would, of course, be the height of folly to lance the gums unless they be hot and swollen, and unless the tooth or the teeth be near at hand. It is not to be considered a panacea for every baby’s ill, although, in those cases where the lancing of the gums is indicated, the beneficial effect is sometimes almost magical.
62. How ought the lancing of a child’s gums to be performed?
The proper person, of course, to lance his gums is a medical man. But, if perchance you should be miles away and be out of the reach of one, it would be well for you to know how the operation ought to be performed. Well, then, let him lie on the nurse’s lap upon his back, and let the nurse take hold of his hands, in order that he may not interfere with the operation.
Then, if it be the upper gum that requires lancing, you ought to go to the head of the child, looking over, as it were, and into his mouth, and should steady the gum with the index finger of your left hand; then you should take hold of the gum-lancet with your right hand—holding it as if it were a table-knife at dinner—and cut firmly along the inflamed and swollen gum and down to the tooth, until the edge of the gum-lancet grates on the tooth. Each incision ought to extend along the ridge of the gum to about the extent of each expected tooth.
If it be the lower gum that requires lancing, you must go to the side of the child, and should steady the outside of the jaw with the fingers of the left hand, and the gum with the left thumb, and then you should perform the operation as before directed.
Although the lancing of the gums, to make it intelligible to a non-professional person, requires a long description, it is, in point of fact, a simple affair, is soon performed, and gives but little pain.
63. If teething cause convulsions, what ought to be done?
The first thing to be done (after sending for a medical man) is to freely dash cold water upon the face, and to sponge the head with cold water, and as soon as warm water can be procured, to put him into a warm bath of 98 degrees Fahrenheit. For the precautions to be used in putting a child into a warm bath, see the answer to question on “Warm baths.”
No family where there are young children, should be without Fahrenheit’s thermometer. If a thermometer be not at hand, you must plunge your own elbow into the water: a comfortable heat for your elbow will be the proper heat for the infant. He must remain in the bath for a quarter of an hour, or until the fit be at an end. The body must, after coming out of the bath, be wiped with warm and dry and coarse towels; he ought then to be placed in a warm blanket. The gums must be lanced, and cold water should be applied to the head. An enema, composed of table salt, of olive oil, and warm oatmeal gruel—in the proportion of one tablespoonful of salt, of one of oil, and a teacupful of gruel—ought then to be administered, and should, until the bowels have been well opened, be repeated every quarter of an hour; as soon as he comes to himself a dose of aperient medicine ought to be given.
64. A nurse is in the habit of giving a child who is teething either coral or ivory to bite—do you approve of the plan?
I think it a bad practice to give him any hard, unyielding substance, as it tends to harden the gums, and by so doing causes the teeth to come through with greater difficulty. I have found softer substances, such as either a piece of wax-taper, or an india-rubber ring, or a piece of the best bridle-leather, or a crust of bread, of great service. If a piece of crust be given as a gum-stick, he must, while biting it, be well watched, or by accident he might loosen a large piece of it, which might choke him. The pressure of any of these excites a more rapid absorption of the gum, and thus causes the tooth to come through more easily and quickly.
65. Have you any objection to my baby, when he is cutting his teeth, sucking his thumb?
Certainly not; the thumb is the best gum-stick in the world—it is convenient, it is handy (in every sense of the word), it is of the right size, and of the proper consistence—neither too hard nor too soft; there is no danger, as of some artificial gum-sticks, of its being swallowed, and thus of its choking the child. The sucking of the thumb causes the salivary glands to pour out their contents, and thus not only to moisten the dry mouth, but assists the digestion; the pressure of the thumb eases, while the teeth are “breeding,” the pain and irritation of the gums, and helps, when the teeth are sufficiently advanced, to bring them through the gums. Sucking of the thumb will often make a cross infant contented and happy, and will frequently induce a restless babe to fall into a sweet refreshing sleep. Truly may the thumb be called a baby’s comfort. By all means, then, let your child suck his thumb whenever he likes, and as long as he chooses to do so.
There is a charming, bewitching little picture of a babe sucking his thumb in Kingsley’s Water Babies, which I cordially commend to your favorable notice and study.
66. But if an infant be allowed to suck his thumb, will it not be likely to become a habit, and stick to him for years—until, indeed, he become a big boy?
After he has cut the whole of his first set of teeth, that is to say, when he is about two years and a half old, he might, if it be likely to become a habit, be readily cured by the following method, namely, by making a paste of aloes and water and smearing it upon his thumb. One or two dressings will suffice, as after just tasting the bitter aloes he will take a disgust to his former enjoyment, and the habit will at once be broken.
Many persons, I know, have an objection to children sucking their thumbs, as, for instance—
“Perhaps it’s as well to keep children from plums,
And from pears in the season, and sucking their thumbs.”
My reply is—
P’rhaps ’tis as well to keep children from pears;
The pain they might cause is oft followed by tears;
’Tis certainly well to keep them from plums;
But certainly not from sucking their thumbs!
If a babe suck his thumb
’Tis an ease to his gum;
A comfort; a boon; a calmer of grief;
A friend in his need, affording relief;
A solace; a good; a soother of pain;
A composer to sleep; a charm; and a gain;
’Tis handy at once to his sweet mouth to glide;
When done with, drops gently down by his side;
’Tis fixed like an anchor while the babe sleeps,
And the mother with joy her still vigil keeps.
67. A child who is teething dribbles, and thereby wets his chest, which frequently causes him to catch cold; what had better be done?
Have in readiness to put on several flannel dribbling-bibs, so that they may be changed as often as they become wet; or, if he dribble very much, the oiled silk dribbling-bibs, instead of the flannel ones, may be used, and which may be procured at any baby-linen warehouse.
68. Do you approve of giving a child, during teething, much fruit?
No; unless it be a few ripe strawberries or raspberries, or a roasted apple, or the juice of five or six grapes—taking care that he does not swallow either the seeds or the skin—or the insides of ripe gooseberries, or an orange. Such fruits, if the bowels be in a costive state, will be particularly useful.
All stone fruits, raw apples, or pears ought to be carefully avoided, as they not only disorder the stomach and the bowels—causing convulsions, gripings, etc.—but they have the effect of weakening the bowels, and thus of engendering worms.
69. Is a child, during teething, more subject to disease, and if so, to what complaints, and in what manner may they be prevented?
The teeth are a fruitful source of suffering and of disease, and are with truth styled “our first and our last plagues.” Dentition is the most important period of a child’s life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching. When we consider how the teeth elongate and enlarge in his gums, pressing on the nerves and on the surrounding parts, and thus how frequently they produce pain, irritation, and inflammation; when we further contemplate what sympathy there is in the nervous system, and how susceptible the young are to pain, no surprise can be felt at the immense disturbance and the consequent suffering and danger frequently experienced by children while cutting their first set of teeth.
The complaints or the diseases induced by dentition are numberless, affecting almost every organ of the body,—the brain, occasioning convulsions, water on the brain, etc.; the lungs, producing congestion, inflammation, cough, etc.; the stomach, exciting sickness, flatulence, acidity, etc.; the bowels, inducing griping, at one time costiveness, and at another time purging; the skin, causing “breakings-out.”
To prevent these diseases, means ought to be used to invigorate a child’s constitution by plain, wholesome food, as recommended under the article of diet; by exercise and fresh air; by allowing him, weather permitting, to be out of doors a great part of every day; by lancing the gums when they get red, hot, and swollen; by attention to the bowels, and if he suffer more than usual, by keeping them rather in a relaxed state by any simple aperient, such as either castor oil or magnesia and rhubarb, etc.; and, let me add, by attention to his temper. Many children are made feverish and ill by petting and spoiling them. On this subject I cannot do better than refer you to an excellent little work entitled Abbott’s Mother at Home, wherein the author proves the great importance of early training. The young of animals seldom suffer from cutting their teeth—and what is the reason? Because they live in the open air and take plenty of exercise, while children are frequently cooped up in close rooms and are not allowed the free use of their limbs. The value of fresh air is well exemplified in the Registrar-General’s Report for 1843: he says that in 1,000,000 deaths from all diseases, 616 occur in the town from teething, while 120 only take place in the country from the same cause.
70. Have the goodness to describe the symptoms and the treatment of Painful Dentition.
Painful dentition may be divided into two forms—(1.) the Mild; and (2.) the Severe. In the mild form the child is peevish and fretful, and puts his fingers, and everything within reach, to his mouth; he likes to have his gums rubbed, and takes the breast with avidity; indeed, it seems a greater comfort to him than ever. There is generally a considerable flow of saliva, and he has frequently a more loose state of bowels than is his wont.
Now, with regard to the more severe form of painful dentition: The gums are red, swollen, and hot, and he cannot, without expressing pain, bear to have them touched; hence, if he be at the breast, he is constantly loosing the nipple. There is dryness of the mouth, although before there had been a great flow of saliva. He is feverish, restless, and starts in his sleep. His face is flushed. His head is heavy and hot. He is sometimes convulsed. (See answer to Question 63.) He is frequently violently griped and purged, and suffers severely from flatulence. He is predisposed to many and severe diseases.
The treatment of the mild form consists of friction of the gums with the finger; with a little “soothing syrup,” as recommended by Sir Charles Locock; a tepid bath of about 92 degrees Fahrenheit, every night at bedtime; attention to diet and bowels; fresh air and exercise. “‘Soothing Syrup.’ Some of them probably contain opiates, but a perfectly safe and useful one is a little nitrate of potassa in syrup of roses—one scruple to half an ounce.”—Communicated by Sir Charles Locock to the Author. For the mild form, the above plan will usually be all that is required. If he dribble and the bowels be relaxed, so much the better; the flow of saliva and the increased action of the bowels afford relief, and therefore must not be interfered with. In the mild form lancing of the gums is not desirable. The gums ought not to be lanced unless the teeth be near at hand, and unless the gums be red, hot, and swollen.
In the severe form a medical man should be consulted early, as more energetic remedies will be demanded; that is to say, the gums will require to be freely lanced, warm baths to be used, and medicines to be given, to ward off mischief from the head, from the chest, and from the stomach.
If you are living in the town and your baby suffers much from teething, take him into the country. It is wonderful what change of air to the country will often do, in relieving a child who is painfully cutting his teeth. The number of deaths in London from teething is frightful; it is in the country comparatively trifling.
71. Should an infant be purged during teething, or indeed, during any other time, do you approve of either absorbent or astringent medicines to restrain it?
Certainly not. I should look upon the relaxation as an effort of nature to relieve itself. A child is never purged without a cause; that cause, in the generality of instances, is the presence of either some undigested food, or acidity, or depraved motions that want a vent.
The better plan is, in such a case, to give a dose of aperient medicine, such as either castor oil or magnesia and rhubarb, and thus work it off. If we lock up the bowels, we confine the enemy, and thus produce mischief. [“I should put this in capitals, it is so important and so often mistaken.”—C. Locock.] If he be purged more than usual, attention should be paid to the diet—if it be absolutely necessary to give him artificial food while suckling—and care must be taken not to overload the stomach.
72. A child is subject to a slight cough during dentition—called by nurses “tooth-cough”—which a parent would not consider of sufficient importance to consult a doctor about; pray tell me if there is any objection to a mother giving her child a small quantity either of syrup of white poppies or of paregoric to ease it?
A cough is an effort of nature to bring up any secretion from the lining membrane of the lungs, or from the bronchial tubes, hence it ought not to be interfered with. I have known the administration of syrup of white poppies, or of paregoric, to stop the cough, and thereby to prevent the expulsion of the phlegm, and thus to produce either inflammation of the lungs or bronchitis. Moreover, both paregoric and syrup of white poppies are, for a young child, dangerous medicines (unless administered by a judicious medical man), and ought never to be given by a mother.
In the month of April, 1844, I was sent for in great haste to an infant, aged seventeen months, who was laboring under convulsions and extreme drowsiness, from the injudicious administration of paregoric, which had been given to him to ease a cough. By the prompt administration of an emetic he was saved.
73. A child who is teething is subject to a “breaking-out,” more especially behind the ears—which is most disfiguring, and frequently very annoying; what would you recommend?
I would apply no external application to cure it, as I should look upon it as an effort of the constitution to relieve itself; and should expect, if the “breaking-out” were repelled, that either convulsions, or bronchitis, or inflammation of the lungs, or water on the brain would be the consequence.
The only plan I should adopt would be, to be more careful in his diet: to give him less meat (if he be old enough to eat animal food), and to give him, once or twice a week, a few doses of mild aperient medicine; and, if the irritation from the “breaking-out” be great, to bathe it occasionally either with a little warm milk and water, or with rose water.
