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Introduction-, . The Newborn Infant, Dressing, . Food, Sleep, Constipation, Weaning, Clothing, Bathing, . Exercise, . Walking, Ventilation, Government, Conclusion, PAGE 5 7 11 13 15 20 22 24 30 37 39 42 43 46 48 PREFACE. In presenting my readers with this little work, it has been my endeavor to condense into the smallest space all the requisite and most necessary information relative to the management of infants and young children. The widespread ignorance and the almost criminal neglect which many of our young children are exposed to, must be due to a want of knowledge on the part of their parents. Hence the introduction of this little book, which is intended to be within the compre- hension of all those to whom the manage- ment of young children is intrusted. G. G. W. December 1st, 1875. ( * ) INTRODUCTION. First, I shall devote a few words in behalf of the subject I am about to discuss, the im- portance of which some are slow to admit, but the many have commenced to realize. The first requisite for success in life is a thorough knowledge of the occupation to be pursued. When the gardener assumes man- agement over his garden, can he expect suc- cess unless he full}" understand the nature and properties of the plants he cultivates ; need he expect success if he is ignorant of the time to sow his seed, and when to trans- plant ? And so it is with the 3 T oung mother, and the inexperienced nurse. The Creator places ( 7 ) o INTRODUCTION. in their arms a tender plant to be nurtured and cared for; no garden plant or flower is so tender or so delicate — none requires so much gentleness, so much dexterity in the hand- ling, and j^et whilst we seek knowledge in taking care of our gardens we are too ready to place this precious plant, the infant, in the hands of ignorance and quackery. Dr. Getchell says : " Statistics go to prove that nearly one-half of the children born, die before they are five years of age, and that more than one-fourth die before they can lisp their mother's name." We ask, wiry is this so — can it be traced to any other cause than improper management? true, diseases kill them, but what are the causes of disease ? Is there not always some predisposing cause for disease to lay hold on ? Health is only loaned to us, so long as we take care of it. Nature teaches us how to observe laws for its preservation, and just as soon as we depart from those laws, health is withdrawn, and disease, the direct enemy of health, lays waste our bodies. INTRODUCTION. V So it is with rearing infants ; we too often resort to art, when nature should be the only guide, and as nature is departed from disease comes in to claim the prize. A few rules for employing a physician, and I shall enter on my subject proper. Employ a physician in whom you have confidence, and then trust to him implicitly. Send for him as soon as dis- ease makes its appearance, and follow his di- rections closely. Do not change your physician unless for very good reasons. The knowledge he gains of the peculiarities of members of your family is too precious to be sacrificed for a whim. Do not change his directions without his leave or knowledge. Do not add or omit treatment on your own responsibility unless there is a great emer- gency. Finally, co-operate with him in all that he does. Hattagement 0fj ittfattfe* The Newborn Infant. The child when handed over to the nurse should be washed and dressed as soon as possible ; to do this with dispatch everything wanted should be prepared beforehand, so that no delay is necessary. The infant should be carried rolled in soft flannel to the fire, where the washing should take place. Infants are usually covered with a white cheesy coating (vernix caseosa). This coating is due to a secretion from the sebaceous follicles, a perfectly natural condi- tion for the skin of the newborn infant, but unfortunately this coating is sometimes diffi- cult to remove. The nurse should seat her- self near the fire, with the infant on her lap ; ( n ) 12 MANAGEMENT OF INFANTS. she should be provided with a sponge, cas- tile soap, sweet oil, soft towels,, and an abundance of warm water. The child should be first well oiled all over its body, followed by the soap and warm water. There will be no difficult} 7 in removing this coating by this method. Clean unsalted lard may be used as a substitute for the sweet oil; great care should be used in cleansing the flexures of the joints and ears. The e} 7 es and face should not be washed till last, and then only with pure water and a clean cloth, not the cloth and water used for washing the bod} 7 , bear in mind. Also the nurse should re- member that the skin of the infant is ex- ceedingly delicate, and will not bear hard usage, without great danger of tearing the cuticle, and thus subjecting it to great dis- comfort. The washing completed its skin should be dried by means of a soft towel or soft warm flannel; not by rubbing, remember, as is the habit of some nurses. This done, and the infant is ready to be dressed. MANAGEMENT OF INFANTS. 13 Dressing the Newborn Infant. The first article of dress should be a binder of soft flannel, about six inches wide with no hem on its edges, and long enough to go twice around the body of the infant. This should be comfortably fastened either with tape or pins, care being taken that the binder is not applied too tight, lest it do more harm than good by interfering with its breath- ing. Many infants are compelled to do all their breathing with their chests in conse- quence of a too tight bandage around their abdomen. This is entirely against nature, for if notice is taken the breathing will be found to be carried on almost entirely by the rising and sinking of the abdomen or belly, and not so much by the chest, as in after- life. The remainder of the clothing should be light, soft, and warm, and so made that it can be easily put on or taken off. Dr. Churchill in his work on Diseases of Children lays down for mothers the following in re- 14 MANAGEMENT OF INFANTS. gard to dressing their infants: " The infant requires softness, looseness, and . warmth, and as regard to handling, gentleness and dexterity." The feet and legs to the knees should be covered with soft woollen socks or stockings ; the head should be left bare, on account of the great tendency to nervous excitement, and rapid circulation in early life. In win- ter especially the infant's neck and arms should be well protected. I am inclined to urge this matter as also being advisable in summer ; it stands to reason, that it is at least dangerous ; and what sense is there in endangering the life of a child for the sake of displaying its bare neck and arms to an admiring multitude ? A writer truly says, in speaking of clothing children : " Had we a little more common sense, more sleeves and sacks, and high dresses, and less vanity and fashion, mothers would have fewer little graves to weep over." In summer the child should not be dressed too warmly, but cool enough to be at least comfortable. It is MANAGEMENT OF INFANTS. 15 mainly clue to the excessive heat of summer that so many children die during that season. Thousands are carried away every summer in our cities from diseases consequent on excessive heat ; keep your infants therefore warm in winter, and cool in summer. As soon as the infant is dressed and the mother made comfortable, it should be placed at the breast, as it will be more likely to take the nipple then, than if you wait for several hours to intervene. Food for Newborn Infants. The subject of proper food for the newly born infant is full of interest, and has been investigated by learned physicians to the uttermost ; yet there is no subject which the plrysician is more liable to err in, or which he is in more danger of being overruled b} 7 nurses or mothers. The general impression is that the infant is born into the world in a state of starvation, and that its first cries are for food, whereas, it has just concluded a full meal, and its plump appearance would 16 MANAGEMENT OF INFANTS. indicate that its food had agreed with it^to perfection, and had not come from a land of starvation, as the anxiety of the nurse to feed it would lead us to suppose. The newborn infant as soon as born com- mences to lead a new existence ; its organs must support it alone now ; not only must it breathe for itself, but it must eat and di- gest its own food. But nature has not yet prepared its digestive organs for the recep- tion of food. There is a peculiar secretion from a healthy woman's breast, which is called colostrum ; this is present in the milk for two or three days, and then disappears. This colostrum acts in two ways, first as a nourishment, and second as a purgative. Placing the infant at the breast as soon as dressed as already directed, it feeds upon this material, which cleanses the bowels of that dark-green matter first passed by the infant called meconium. After waiting, and this colostrum does not act in the way that nature has intended, then, and not until then, is it advisable to employ some artificial MANAGEMENT OF INFANTS. 17 means to that end, and fresh castor oil is the only safe physic, given in half teaspoonful doses, repeated if necessaiy in six hours. If this has not the desired effect a physician should be consulted at once. Generally then the infant should be given the breast within three or four hours after birth, provided the mother has done well. If she has no milk by that time she soon will have. Let the infant depend upon its mother for nourishment, unless there is good reason to believe that it cannot be raised in that way, as is often the case. But the mo- ther being healthy, on no account resort to artificial food ; do not give it sugar and water, or flour and water, or catnip-tea, or anything, unless 3011 want to have it afflicted with colic. The closer we imitate nature in all these matters the better. Should it be found necessary to provide food for the infant on account of the various causes that ma} 7 arise, we will find that the best substitute for mother's milk is goat's or good cow's milk. The cow should be fresh or nearly so, and the milk unskimmed ; it is 2 18 MANAGEMENT OE INFANTS. known to farmers as new milk. Two parts of this new milk, and one part, of water, with a little sugar added, makes it very much like human milk. It should be about the same temperature as the body, ninety-five or ninety-eight degrees F. The infant should not be allowed to nurse oftener than once every two or three hours. If a wet-nurse is employed, the following rules should be observed in selecting one. She should be perfectly healthy ; have no constitutional taint; have plenty of milk. She should be temperate in her habits of eating and drinking, and her babe should be of the same age as the one she takes to nurse. If the nursing-bottle is used, one with a large gum nipple to fit over the mouth of the bottle is far preferable to those with gum- tubes, on account of the latter being so hard to keep clean ; in fact it is impossible to keep them as clean as they should be. With the former all that is necessary to cleanse them perfectly is to turn them inside out. To recapitulate what I have said in regard MANAGEMENT OF INFANTS. 19 to feeding infants, first let me urge upon mothers, when practicable, to nurse their own children. Do not trust them to wet-nurses unless necessary. Do not put them upon the mercies of a nursing-bottle unless you have to, and what is still more imperative, do not let them starve trying to live upon the many artificial preparations said to be sub- stitutes for milk. In newborn infants milk of some kind is the only food suitable for their powers of assimilation ; when nature provides teeth for the infant, then it will be soon enough to feed it upon farinaceous articles of diet. Nothing will more quickly derange an infant's digestive organs, nothing will more quickly predispose it to attacks of dj T senteiy, diarrhoea, cholera infantum, and other sum- mer diseases, which fill our churchyards and cemeteries with so many little graves, than using patent infant food, which our chemists delight to prepare as the result of theory but not of practice ; they might just as well prepare that vital fluid which we call blood because they know its analysis, and after in- 20 MANAGEMENT 0E INFANTS. jecting it into our veins, expect it to sus1>am life, and call it a substitute for blood. Sleep. An infant must have plenty of s^ep. It can sleep three-fourths of its time without injury. Great regularhYv should be observed in putting it to sleep. It should not be held in the nurse's arms whilst sleeping, but should be laid down, and warmly cov- ered. In commencing thus early there will be no difficulty experienced, but if no rules are observed bad habits will be formed which are hard to get rid of. The habit of sleeping is very much like the habit of eat- ing. At the hour we are in the habit of dining, our appetites will call for food ; at the usual time of our going to bed we will experience a desire for sleep ; so will it be with the infant if the right commencement is made. If we commence with irregularity it will always be irregular in its habits. Let the child awake itself. You can starve it for want of sleep as well as for want of food. MANAGEMENT OF INFANTS. 21 Light and noise should be carefully excluded from a room where an infant is reposing. It is wrong to suppose that noise is not injuri- ous as long as the child is not awakened. The first few months, especially in winter, the infant should sleep at night with its mo- ther, on account of its feeble powers of gen- erating animal heat. In summer after the first few weeks it does not make so much difference ; after that the child should be transferred to a crib, standing close to the bed of the mother 'or nurse, and if its desire to return to the bed be discouraged for a few nights there will be no further trouble. The bed should be properly aired, and also it should stand in the sunshine for a couple of hours each day. If care and management are used little so- licitation will be necessary to put infants to sleep. The desire for repose will occur at regular intervals, and if this regularity is persisted in there will be no necessity in em- ploying any artificial means, for they will drop to sleep themselves when the hour ar- 22 MANAGEMENT OF INFANTS. rives. For no reason whatever administer any narcotics unless on the advice 'of a phy- sician. If the child is restless and sleepless, there are other causes at work than want of sleep. If laudanum, paregoric, or some "soothing syrup," so-called, which is only another name for an opiate, is used to pro- duce sleep, it is at best an artificial sleep, and is productive of no good ; on the contrary it is productive of much harm, for it will re- quire a larger dose the next day to produce the same effect ; the appetite is destroyed, digestion interfered with, the child becomes puny, and sinks under the first malady with which it may be attacked. It is startling when we consider how common it is for mo- thers and nurses to administer opiates in the shape of cordials, anodynes, and soothing syrups to produce sleep and quiet in their children ; and yet we pretend to not know why there is such great mortality among in- fants and children. Shame! Constipation. Many children are troubled from birth MANAGEMENT OF INFANTS. 23 with constipation or costiveness of the bowels. It is a mistake for parents to be continually giving laxatives and purgatives, for according to a certain law well known to physicians, the more cathartics you use the more you ma}' ; besides, all purgatives given by the mouth have a tendency, when often repeated, to break down the digestion. A little wedge of castile soap placed in the rectum of the infant, or an injection of tepid water, given at precisely the same hour in the da} T , so as to produce an evacuation once in twentjvfour hours, is usually sufficient to remove the trouble. If this does not pro- duce the desired effect a physician should be consulted. Colic is often caused by consti- pation, or at least aggravated by it. It may be also due to the formation of gas in its little intestines. In many instances it may be relieved by the application of a hot flannel cloth over its abdomen, or the administration of peppermint or fennel-water. Pressing gently its little stomach with the hand often relieves it for a time. 24 MANAGEMENT OF INFANTS. Weaning. Weaning should be effected in from nine to fourteen months, or as soon as the teeth show sufficient development to masticate the food ; this usually occurs at fifteen months at the latest. It should be done gradually, that is, artificial food should replace the milk more and more frequently until the breast is only given at night, and at last not given at all. It is not well to wean a child when it is ailing ; a favorable opportunity must , be sought. Neither should it be weaned during the hot summer months. The best months in the year are April, May, September, and October. There is no objection to the winter months. Exercise in the open air is of the greatest importance to the child at this time ; nothing tends more to soothe the nervous irritability so often cou sequent on this change. It exerts a decided influence on the general health, gives tone to the diges- tive organs, and enables them the better to bear the change of nutriment. The food as MANAGEMENT OF INFANTS. 25 a rule that best agrees with the child should be used and adhered to. The crumb of bread boiled in milk, and sweetened a little, is a good food. Another is, mix two parts of wheat flour with one part of oat-meal well baked ; take two tablespoonfuls, with half a pint of milk, and this well boiled and sweet- ened, is a capital food for a weaning child. The change from milk diet to that of solid food should be very gradual. For some time after the child is weaned it should subsist on liquid substances, such as gruel, pulverized cracker dissolved in milk, and the different prepara- tions of arrowroot ; these and other articles of like nature should constitute the entire diet for several months after weaning. Xo difficulty need be experienced in changing from fluid to solid food if the stomach be- come accustomed to it gradually, but if the change is made abruptly, indigestion will be the result. Until the child is past two } T ears of age it will require very little solid food. The child should eat slowly, and be fed at regular in- 26 MANAGEMENT OF INFANTS. tervals, eat slowly, that its food may^be thoroughly masticated and mixed with the saliva of the mouth before swallowing, for this is the first act of digestion. It should eat slowty, because if it eats fast it will eat too much, and thus paralyze the stomach from overdistension How much more injuri- ous must be this habit on the child with its delicate frame and organs than on the adult, and we all know the influence of bolting food at the rate of sixty miles an hour on the latter. By feeding it at regular intervals, I mean not to be feeding it continuously, as is the habit of some mothers ; neither do I mean that it must eat only three meals a day, for the growing child requires more food com- paratively than the adult ; but what I do mean is to divide its waking hours equally into four meals ; its last meal, which should be taken a short time before going to bed, should be food of the blandest and most di- gestive character. Children should not have too great a variet}', for as a rule those chil- MANAGEMENT OF INFANTS. 27 dren that subsist upon a few of the more di- gestible kinds of food are much healthier than those allowed a great variety. Vegetables should enter sparingly into the nutriment of the young child, and once a day a reasonable quantity of animal food, well prepared, will be found to agree with it. Beef, mutton, fowl, and fresh fish are the most suitable ; veal, pork, and all kinds of preserved meats should be avoided. Ripe fruits are very good for children when taken in moderation, but the seeds and skins should be removed, lest they excite irritation in the bowels and stomach. The following bill of fare for children older than those I have spoken of will serve as a guide to those parents who believe, like m} T self, in systema- tizing the management of children. For Breakfast. Half pint of hot new milk poured on a slice of bread ; a little sugar may be added to it if the child prefers, or bread and butter and chocolate, mixed with plenty of milk. 28 MANAGEMENT OF INFANTS. Chocolate is very nutritious, and children learn to like it. For Dinner. Beef tea, chicken-broth, or mutton-broth, with crackers broken in, flavored with pepper and salt, makes an excellent soup. Rice, custard, sago, tapioca, corn-flour, and light puddings generally may be set before the child. Fresh fish, boiled rather than fried, roast mutton, roast beef, chicken, pigeon, rabbit, turkey, and fresh meats used spar- ingly. Yegetables as a rule are hard to di- gest in the child's stomach, and should be employed carefully. Milk or water as a bev- erage, and ripe fruits. For Supper. Gruel, rice pudding, corn-starch, arrow- root, with bread and butter, and weak tea. As a child should eat more frequently than the adult, it is advisable to give them a lunch at some regular time, which may be made up from the above list. Four. meals are MANAGEMENT OF INFANTS. 29 all that they require in a day, and in observ- ing perfect regularity with them, there will be no difficulty in keeping the child from eating more frequently, which is so injurious. The following recipes are intended for spe- cial forms of diet ; the} 7 have been highly recommended by the Obstetrical Society of Philadelphia, and I think are worthy of trial. Boiled Flour, or Flour Ball. Take one quart of good flour, tie it up in a pudding-bag so tightly as to get a firm solid mass ; put it into a pot of boiling water early in the morning, and let it boil until bedtime; then take it out and let it dry. In the morning peel off from the surface and throw away the thin rind of dough, and with a nutmeg grater grate down the hard dry mass into powder. Of this from one to three teaspoonfuls may be used, by first rubbing it into a paste with a little milk ; then adding to it about a pint of milk, and finally by bringing the whole to just the boiling-point ; it must be given through a nursing-bottle. 30 MANAGEMENT OF INFANTS. An excellent food for children who^are costive in their bowels, may be made by using bran meal or unbolted flour, instead of the white flour, preparing it as above directed. Rice-water. Wash four tablespoonfuls of rice ; put it into two quarts of water, which boil down to one quart, and then add sugar and a little nutmeg : this makes a pleasant drink. A half pint or a pint of milk added to this just be- fore taking it from the fire, and allowed to come to a boil, gives a nourishing food suit- able for cases of diarrhoea. Sago, tapioca, barley, or cracked corn can be prepared in the same manner. Beef Tea. Take one pound of juicy, lean beef, say a piece of the shoulder or round, and mince it up with a sharp knife on a board or mincing- block; then put it with its juice into an earthen vessel containing a pint of tepid water, and let it stand for two hours. Strain MANAGEMENT OF INFANTS. 31 off the liquid through a clean cloth, squeezing well the meat, and add a little salt. Place the whole of the juice thus obtained over the fire, but remove it as soon as it has become browned ; never let it boil, otherwise most of the nutritious matter of the beef will be thrown down as a sediment. Prepared in this way the whole nourishment of the beef is re- tained in the tea, making a pleasant and palatable food ; a little pepper or allspice may be added if preferred. Mutton tea may be prepared in the same way; it makes an agreeable change when the patient has be- come tired of beef tea. Raw Beef for Children. Take half a pound of juicy beef, free from any fat ; mince it up very finely ; then rub it up into a smooth pulp, either in a mortar or with the ordinary potato-masher. Spread it out upon a plate, and sprinkle over it some salt or some sugar if the child prefers it. Give it with a teaspoon, or upon a buttered slice of stale bread ; it makes an excellent food for children with dysentery. 32 MANAGEMENT OF INFANTS. Clothing. I have already spoken of the manner of dressing infants, and the rules that should govern mothers and nurses in that respect. Now I shall discuss the subject of dressing children. What sense is there for mothers to so dress their children that their necks, arms, and legs shall be bare, when they are told almost daily by their physician, that such a course will be sure almost to deprive it of health, yea, even of life. But mothers will say, if I dress it differently it will Lok horrid, and what is still worse unfashionable. Fashion is good in its place, but when it comes in to destroy or at least counteract the wisdom and common sense of our chil- dren's mothers, then I say it should be ban- ished from society and the land ; to put it still more strongly, it is simply infanticide and nothing else, for mothers to persist in such a course. Lung diseases are much more common and fatal in childhood than in adult life be- MANAGEMENT OF INFANTS. 33 cause of greater susceptibility to atmospheric changes. Children are less able to resist such diseases as pneumonia, croup, bronch- itis, coryza, and catarrh. As we have already seen that the treat- ment of the digestive organs during infancy gives them their character for life, so does the treatment of the respiratoiy organs dur- ing infancy determine with the same cer- tainty whether there shall be a predisposi- tion to pulmonary disease thereafter. These facts have a great deal of significance when we connect them with the alarming preva- lence of consumption among our j'oung. Alas, how many of the most promising .young men, how many of the brightest and fairest young women who are laid in premature graves, owe the seeds of their dread disease to improper management in childhood. It is well as parents to ask ourselves this ques- tion, and, if possible, help stem the current which is carrying the world's best jewels to the sea of eternity. Many mothers will say the}^ desire to harden the constitution of their child, so 3 34 MANAGEMENT OF INFANTS. that it will not take cold so easily, and for that purpose they wish to commence early, the earlier the better; and they will draw your attention, by way of an argument, to the life of exposure which the Indians lead, and how healthy and hardy they are ; she thinks she has convinced you, until you ex- plain to her, that few Indian children live to adult life; that the exposure and hard life they lead kill the majority of their children; and that it is onlv the few who are strong enough to go through it. Thus of necessity almost the adult Indian is strong and healthy. If the same circumstances surrounded our lives also, there would be none but strong men and women survive. No ; in civilized life childhood is not the time to harden constitu- tions ; if harden you must, wait until their bodies have obtained sufficient stamina to withstand shock, and the hardening process you propose. Dr. Charles D. Meigs says, in relation to this subject : " I have invariably for a long series of years combated, as far as in me lay, MANAGEMENT OF INFANTS. 35 this vicious custom. I have found a few sensible mothers who would listen to my in- junctions, but I have found a vast number of children to suffer, and a multitude to perish, from the disregard to the dictates of common sense; one pretext for this imprudent ex- posure of the infant is that it should be early hardened ; but I submit to the intelligent mother, the question whether the surest way to harden the child is not that way which will conduct it through the first six years of its existence?" Dr. Condie says : " To leave the neck, shoulders, and arms nearly or quite bare, however warmly the rest of the body may be clad, is a sure means of endangering comfort and health, and it is not impossible that the foundation of pulmonaiy consumption is laid during childhood. It is an important pre- caution therefore to have the dress worn by children so constructed as to protect the neck, breast, and shoulders, and with sleeves long enough to reach to the wrists." The mother's motto should be, plenty of air inside 36 MANAGEMENT OF INEANTS. of the chest, but warmth outside, for trreir in- fants. In clothing children we should en- deavor to preserve the natural temperature of the skin ; to do this, " soft flannel should be worn next the skin the year round ; in summer it should be of the lightest variety." Flannel has a great many advantages over cotton or linen, the main one is that it is a very poor conductor of heat, thus retaining nearly all the animal warmth. The clothing should be loose, light, and simple, so that it may easily be put on or taken off without great annoyance to the child. The legs in winter should be covered with worsted stockings which extend above the knees. Until the child walks it should wear socks ; after that it should be provided with shoes of soft leather. No caps or cov- ering should be allowed whilst in the house, because of its tendency to accelerate the cir- culation in the head. The frock should have long sleeves, and be high in the neck. It should be very light and simple in its con- struction, should be heavier in winter than MANAGEMENT OF INFANTS. 37 in summer. Do not load the poor infant down with all the ruffles and flounces which your fashion-book tells you, but have it made plain and comfortable. Too much clothing is of course to be avoided, since by accumu- lating warmth and relaxing the vessels of the skin debility is produced. Our atmospheric changes are so sudden and great that mothers have to be constantly on the alert. Our clothing is the greatest protection we have against such vicissitudes, and the best rule that may be followed by all, both parents and children is, u dress ac- cording to the weather." Bathing. The health of a child will depend very much on its being kept clean. It is one of the first laws of nature, and therefore should be strictly observed. Children that have been taught from experience the necessity of fre- quent ablutions will keep up the habit in after-life much to their benefit. The young infant should be bathed in pure 38 MANAGEMENT OP INFANTS. soft tepid water at least once a day; 4he water should be about the temperature of the blood. It is better to use a thermometer than depend on telling the temperature by the nurse's hand, which is far from certain. The elbow is a much better guide than the hand. The water should not be too warm or too cold : if too warm, it will have a debili- tating influence ; if too cold, it will drive all the blood from the surface to the internal organs. The bath should be given in the morning two hours at least after a meal. All but the head should be immersed ; many mothers immerse only the lower part of the body, which is very wrong, as the upper part is likely to become chilled, and thus give rise to catarrh and bronchitis. It may be allowed to remain in the bath from three to five minutes ; as it grows older the time ma}^ be extended. After being taken out it should be wiped dry with a soft flannel cloth, followed by a brisk gentle friction for a few minutes, care being taken that the skin MANAGEMENT OF INFANTS. 39 is not injured, for an infant's skin is quite tender and delicate. Soap should not be used at all for young infants ; for older ones the white castile is much to be preferred, as it is made with a vegetable oil instead of an animal oil. In winter-time a bath every other day will be sufficient. Where the nurse washes the infant in her lap, the greatest care should be taken that it does not not take cold. One portion of its body should be washed, dried, and the clothing put on, before the other part is uncovered. Everything pertaining to the cleanliness of the child should be strictly attended to ; soiled linen or portions of dress should be removed as soon as possible. Exercise. Exercise may be divided into indoor and outdoor; indoor exercise is very important, just as important in its way as the outdoor. For the first few months, the exercise of the infant should be passive; extreme care should be taken that its motions are not 40 MANAGEMENT OF INFANTS. made abruptly, or with violence ; too much gentleness cannot be used in handling a young infant. When carried it should be in the re- clining position, with its little head supported. In fact the reclining posture is the only posi- tion for the infant until it is four or five months old; before that the upright position is dangerous for the future welfare of the child, because the spinal column is too weak to support the weight of the head and shoulders ; spinal curvature or humpback is frequently the result if this matter is lost sight of. In lifting them we should place our hands on each side of the chest below the armpits, and under no consideration catch hold of their arms for that purpose, as the arms may easily be wrenched or pulled out of their sockets, or the collar-bone distorted and fractured. In lifting the infant from the cradle or bed the head should always be supported; all rough usage, romping, tossing it into the air to catch again, is always dangerous. MANAGEMENT OF INFANTS. 41 A good way for a child to exercise, at the same time give temporary rest to the mother, is to place the infant on the floor, on a pillow or small mattress, lying on its back; this allows it a chance to throw and kick its limbs around at will with no danger of fall- ing. During summer, in pleasant weather, after it is three weeks old, it ma} T be taken out for an airing almost daily; protecting it well from all the changes of temperature, and covering its face with a green veil to protect its eyes from too strong a light. When the child has acquired sufficient strength for more active exercise, a playground should be provided for it in nice weather, and a play- room for bad weather; it should have an abundance of toys and games, so that when tired of one another can be quickly substi- tuted. By this method all the muscles in its body will be called into activit} 7 , and health, vigor, and growth will be the result; its disposition will not become peevish and fretful near so readily as where these measures are neg- lected. 42 MANAGEMENT OF INFANTS. The trouble and expense of providing ample means of amusement for children will be more than repaid, by the good health and cheerful dispositions which will surely be de- veloped if this principle is followed. Walking. Before the child will be strong enough to walk it will make efforts to creep; these at- tempts should be discouraged as much as possible, because the act of creeping calls into play but half the muscles of its body ; these muscles will become strengthened at the expense of the rest, and the symmetry of its form will be lost. Again, creeping is objectionable on account of its soiling its clothes so much that it will be almost impos- sible to keep it clean. The efforts of a child to walk should never be stimulated or encouraged by parents ; it will be time enough for them to walk when their limbs are strong enough to support the weight of their bodies. In childhood, it should be remembered, that the bones are MANAGEMENT OF INFANTS. 43 far from hard ; that they are soft arid pliable, will bend very easity; therefore, if a child walks too soon its legs will bend under the weight, and remain so, making what is popu- larky known as a bow-legged child, which de- formity will remain in spite of surgical in- terference. All contrivances invented for the purpose of teaching a -child to walk should be burned. As I have already said, when the proper time arrives for the child to walk it will not need assistance. There is a disease called rickets which scrofulous children are liable to ; the bones remain soft for a long while, the legs be- come bowed, and grow so if allowed to walk; this should be guarded against by applying supports, and if used in time will prevent it. Ventilation. TVe all know the importance of having pure good air to breathe. There has been so much attention paid to this subject of late, both in books and on the forum, that the public should be as well informed on it as 44 MANAGEMENT OF INFANTS. they are upon the latest novel, so I shall say but little ; will endeavor only to impress its importance more fully upon the minds of parents in reference to the management of children. The child can live for a few days without food, but it cannot live at all without air. Vitiated air in rooms where children are kept cannot but be a fruitful source of disease to them. At no time in life are the effects of impure air more injurious than during childhood, for childhood is the seed-time of life. What- ever is sown then will be reaped fourfold. It is not so much the rooms in which the child is kept during the day that demand at- tention as it is their sleeping apartments. The former are usually well ventilated by the running in and out at the door, but the latter have no such advantages. The child is often compelled to breathe the air again and again at night whilst sleeping; it thus becomes loaded with impurities. Children's sleeping-rooms can best be ventilated b3 r opening the window for a few inches from MANAGEMENT OF INFANTS. 45 the top ; the blind will prevent any draft from being carried to the child, and if the weather is cold, a little more fuel or clothing will keep it from catching cold. Another means of ventilation is leaving the door open into another room which is ventilated property. With such ventilation there is no danger of the child taking cold ; of course the child must have sufficient bed-clothing to keep it warm. With attention to ventilation the air in a room heated with a stove can be kept pure enough. The best kind of a fire, however, for a sleeping-room is that with an open fire- place. In concluding this subject I would draw } T our attention to what Dr. Hartshorne says on it : "Every zjmiotic disease is rendered more fatal, if not more prevalent, by foul air. Any sanitarian might designate in a city what wards, blocks, courts, alle3 T s, and houses will always afford the largest number of deaths from scarlet fever, measles, and cholera infantum. The great importance of 46 MANAGEMENT OF INFANTS. the impurity of the atmosphere as a factor in the mortality of infants has been fully recognized in times past." Government. Dr. Gretchell says: "During the first few years of life it is by authority alone that the child should be governed. The parent's word should be the child's law, and never should be questioned. At this tender age the child is incapable of reasoning, and in- stead of taking the long and circuitous path of an argument, much happiness will be gained and many tears prevented, if we ar- rive at the same point by the simple princi- ple of you must and you can't." We should never bribe the child to obey, neither should we frighten it. If the infant is taught from the first to do as told it will fall into a habit of cheerfully obeying. Parents should be gentle and considerate in their commands, but firm as a rock. If we would have our children grow up gentle and true we must continually exhibit MANAGEMENT OF INFANTS. 47 these qualities to them, for they are the greatest imitators in the world. Dr. Combe says: "If we cannot restrain our own passions, but at one time overwhelm the young with kindness and at another con- found them by caprice or deceit, we may as well expect to gather grapes of thorns or figs of thistles, as to develop moral purity and simpleness of character in the child." Harshness is never necessary for the gov- ernment of children. By kindness and firm- ness we shall be able to do all that is re- quired with them. When the proper time comes instruction from books is required, but the child's body should have time to develop itself before we undertake to cultivate its mind. By thus waiting much advantage will be gained, the child will be more able to accomplish its tasks without danger of ruining its body and mind, as is too often the result when they are put at their books at so tender an age. It matters very little whether the child can 48 MANAGEMENT OF INFANTS. read and write at ten years. But it k of considerable consequence if by cramming the brain its health is destined. Dr. Caldwell says : " From an unwise at- tempt to convert their flowery spring into a luxuriant summer, that summer too often never arrives, the blossom withers ere the fruit is formed." Whilst children can be sent to school too soon, so can their minds be too much neg- lected ; like every subject it has two ex- tremes, and it is for us to choose midway between, that we make no error. A child's questions should always be answered in good faith ; they should not be told, you cannot understand it. Remember, when they ask a question, that it is their only way of gaining information. Therefore do not bluff them off, or seek to fill their little brains with nonsense. Conclusion. In concluding this little volume I shall ap- pend a report of a committee appointed by MANAGEMENT OF INFANTS. 49 the Obstetrical Society of Philadelphia, " to consider the causes and prevention of infant mortalit} 7 during the summer months." These rules are so full of good instruction that I cannot resist the temptation to pre-' sent them to m} T readers entire ; they are as follows : Rule I. Bathe the child once a day in tepid water. If it is feeble, sponge it all over twice a day with tepid water, or with tepid water and vinegar. The health of the child depends much upon its cleanliness. Rule II. Avoid all tight bandaging ; make the clothing light and cool, and so loose that the child may have free play for its limbs. At night undress it, sponge it, and put on a slip. In the morning remove the slip, and dress the child in clean clothes. If this cannot be afforded, thoroughly air the day clothing by 50 MANAGEMENT OF INFANTS. hanging it up during the night. Use clean diapers, and change them often. Never dry a soiled one in the nursery or in the sitting- room, and never use one the second time without first washing it. * EULE III. The child should sleep by itself in a cot or cradle. It should be put to bed at regular hours, and be early taught to go asleep with- out being nursed in the arms. Without the advice of a physician never give it any spirits, cordials, carminatives, soothing syr- ups, or sleeping drops. Thousands of chil- dren die every year from, the use of these poisons. If the child frets and does not sleep, it is either hungry or ill; if ill, it needs a physician. Never quiet it by candy or cake; they are the common causes of diar rhoea, and of other troubles. Rule IY. Give the child plenty of fresh air. In the cool of the morning and evening send it out MANAGEMENT OF INFANTS. 51 to the shacly sides of broad streets, to the public squares, or to the park ; make frequent excursions on the river. Whenever it seems to suffer from the heat, let it drink freely of water, or ice-water. Keep it out of the room in which washing or cooking is going on. It is excessive heat that destroj~s the lives of young infants. Rule V. Keep your house sweet and clean, cool, and well aired. In very hot weather let the windows be open day and night. Do your cooking in the yard, in a shed, in the garret, or in an upper room. Whitewash the walls every spring, and see that the cellar is clear of all rubbish. Let no slops collect to poison the air. Correct all foul smells by pouring carbolic acid or quicklime into the sinks or privies. The former article can be got from the nearest druggist, who will give the need- ful directions for its use. Make every effort yourself, and urge your neighbors to keep the gutters of your street or court clean. 52 MANAGEMENT OF INFANTS. Rule VI. Breast-milk is the only proper food for in- fants. If the supply is ample and the child thrives upon it, no other kind of food should be given while the hot weather lasts. If the mother has not enough, she must not wean the child, but give it besides the breast goat's or cow's milk, as prepared under Rule VIII. Nurse the child once in two or three hours during the day, and as seldom as pos- sible during the night. Alwa}^ remove the child from the breast as soon as it has fallen asleep. Avoid giving the breast when } x ou are overfatigued or overheated. Rule VII. If, unfortunately, the child must be brought up by hand, it should be fed on a milk diet alone, and that warm milk out of a nursing- bottle as directed under Rule VIII. Goat's milk is best, and next to it cow's milk. If the child thrives upon this diet, no other kind of food whatever should be given while MANAGEMENT OF INFANTS. 53 the hot weather lasts. At all seasons of the 3'ear, but especially in summer, there is no safe substitute for milk to an infant that has not cut its front teeth. Sago, arrowroot, potatoes, corn-flour, crackers, bread, eveiy patented food, and every article of diet containing starch can- not and must not be depended upon as food for very young infants. Creeping or walk- ing children must not be allowed to pick up unwholesome food. Rule VIII. Each bottleful of milk should be sweetened Iry a small lump of loaf sugar, or by half a teaspoonful of crushed sugar. If the milk is known to be pure, it may have one-third part of hot water added to it ; but, if it is not known to be pure, no water need be added. When the heat of the weather is great the milk may be given quite cold. Be sure that the milk is unskimmed ; have it as fresh as possible, and brought very early in the morn- ing. Before using the pans into which it is to be poured, alwa} r s scald them with boiling 54 MANAGEMENT OF INFANTS. suds. In very hot weather boil the milk as soon as it comes, and at once put away the vessels holding it in the coolest place in the house, upon ice, if it can be afforded, or down a well. Milk carelessly allowed to stand in a warm room soon spoils, and becomes unfit for food. Rule IX. If the milk should disagree, a tablespoon- ful of lime-water may be added to each bot- tleful. Whenever pure milk cannot be got, try the condensed milk, which often answers admirably. It is sold by all the leading druggists and grocers, and may be prepared b}^ adding, without sugar, one teaspoonful or more, according to the age of the child, to six tablespoonfuls of boiling water. Should this disagree, a teaspoonful of arrowroot, of sago, or of corn starch, to the pint of milk may be cautiously tried. If milk in any shape cannot be digested, try for a few days pure cream diluted with three-fourths or three-fifths of water, returning to the milk as soon as possible. MANAGEMENT OF INFANTS. 55 Rule X. The nursing-bottle must be kept perfectly clean, otherwise the milk will turn sour, and the child will be made ill. After each meal it should be emptied, rinsed, and taken apart, and the tube, cork, nipple, and bottle be placed in clean water, or in water to which a little soda has been added. It is a good plan to have two nursing-bottles, and to use them by turns. Rule XI. Do not wean the child just before or during the hot weather, nor, as a rule, until after its second summer. If suckling disagrees with the mother she must not wean the child, but feed it in part out of a nursing-bottle on such food as has been directed. However small the supply of breast-milk, provided it agrees with the child, the mother should carefully keep it up against sickness ; it alone will often save the life of a child when every- thing else fails. When the child is over six months old the mother may save her strength 56 MANAGEMENT OF INFANTS. by giving it one or two meals a day of stale bread and milk, which should be pressed through a sieve, and put into a nursing-bot- tle. When from eight months to a } T ear old, it may have also one meal a day of the yolk of a fresh and rare boiled egg^ or one of beef or mutton broth, into which stale bread has been crumbled. When older than this it can have a little meat finely minced, but even then milk should be its principal food, and not such food as grown-up people eat. Manuals FOR Practitioners and Students, PUBLISHED BY LINDSAY & BLAKISTON; No. 25 South Sixth Street, Philadelphia, Pa. Copies sent by mail, free, upon receipt of the price attached. ATTHILL'S Clinical Lectures on Diseases Peculiar to Women. Second Edition, revised and enlarged, with Illustrations. $2.25 BRADLEY'S Manual of Comparative Anatomy and Physiology. With 60 Illustrations. 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