vesicles, red, hot, swollen, and continues in this state for a day or two, at the end of which time the inflammation gradually subsides. It might be well to state that the above slight symptoms are desirable, as it proves that the vaccination has had a proper effect on his system, and that, consequently, he is more likely to be thoroughly protected from any risk of catching small-pox.
54. Do you approve, either during or after vaccination, of giving medicine, more especially if he be a little feverish?
No, as it would be likely to work off some of its effects, and thus would rob the cow-pox of its efficacy on the system. I do not like to interfere with vaccination in any way whatever (except, at the proper time, to take a little matter from the arm), but to allow the pock to have full power upon his constitution.
What do you give the medicine for? If the matter that is put into the arm be healthy, what need is there of physic! And if the matter be not of good quality, I am quite sure that no physic will make it so! Look, therefore, at the case in whatever way you like, physic after vaccination is not necessary; but, on the contrary, hurtful. If the vaccination produce slight feverish attack, it will, without the administration of a particle of medicine, subside in two or three days.
55. Have you any directions to give respecting the arm AFTER vaccination?
The only precaution necessary is to take care that the arm be not rubbed; otherwise the vesicles may be prematurely broken, and the efficacy of the vaccination may be lessened. The sleeve, in vaccination, ought to be large and soft, and should not be tied up. The tying up of a sleeve makes it hard, and is much more likely to rub the vesicles than if it were put on the usual way.
56. If the arm, AFTER vaccination, be much inflamed, what ought to be done?
Smear frequently, by means of a feather or a camel's hair brush, a little cream on the inflamed part. This simple remedy will afford great comfort and relief.
57. Have the goodness to describe the proper appearance, after the falling-off of the scab of the arm?
It might be well to remark, that the scabs ought always to be allowed to fall off of themselves. They must not, on any account, be picked or meddled with. With regard to the proper appearance of the arm, after the falling-off of the scab, "a perfect vaccine scar should be of small size, circular, and marked with radiations and indentations."—Gregory.
DENTITION
58. 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."
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 incissors [cutting teeth], then the upper front, then the upper two lateral incissors, 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." [Footnote: Sir Charles Locock in a Letter to the Author.] Then the first grinders, in the lower jaw, afterwards 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 the 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 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 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 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 [Footnote: For the precautions to be used in putting a child into a warm bath, see the answer to question on "Warm Baths."] of 98 degrees Fahrenheit. If a thermometer be not at hand, [Footnote: No family, where there are young children, should be without Fahrenheit's thermometer.] 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