'H'F EALTH Y WANT LIBR RICA. The Healthy Infant, A TREATISE ON THE HEALTHY PROCREATION THE HUMAN RACE, EMBRACING THE OBLIGATIONS TO OFFSPRING; THE MANAGEMENT OF THE PREGNANT FEMALE J THE MANAGEMENT OF THE NEWLY BORN ; THE MANAGEMENT OF THE INFANT; AND THE INFANT IN SICKNESS. By TANDY L. DIX, M. D. IP' Multum in f aruo. 3X4* CINCINNATI: Peter G. Thomson, Publisher, 1880. COPYRIGHT, 1879. PETER G. THOMSON. CONTENTS. INTRODUCTORY.— Page i. PART I.— Page 5. Obligations to Offspring — Showing the Duties we owe to Posterity, growing out of the Violations of the Moral Law, and the results to the Child. — The causes of City Children being unhealthy, and the health- fulness of Country Children. — Why City Children fail to recover their health when taken to the Country. — Of Licentiousness. — Of Law and Order ; illustrated by the watch. — Of the Transmission of Pa- rental Characteristics. — Of Inorganic and Organic Matter, and Cell Structure. — Of the Formation of the Primordial Cell. — Of the Sper- matozoa. — Of the Organic and Animal Constructions of the Human Fabric. — The influence exerted by the Male and Female Parents upon the Offspring. — Of the Spiritual and Animal nature of Man ; illustrated by the ass and the horse. — The cause of Hereditary Dis- ease being more Transmissable from the Mother than from the Father. — The cause of Genius not descending from Father to Son. — Genius not a Factor in the Production of Genius. — Animal or Bodily Strength essential to the support and maintenance of a Great Mind. — The condition of the Mother that is essential to the production of a high order of Mind. — Reasons for cultivating the Organic rather than the Physical structure of the Female ; and for cultivating the Physical Powers of the Male rather than his Organic Structure. — Of the Spir- itual nature of Woman, and the Brutality of Man. — The Circum- 11 CONTENTS. stances in which the highest Order of Minds most frequently appear. — The Growth of Beard, and other features which characterize the Male, are indicative of the blood pabulum for the production of the spermatozoa. — The effeminate features of the Female characterize the Blood Pabulum for the production of the Organic Body, the cell. — Of Female Education and Pursuits. — The Same of the Male. — Mixed Schools inimical to the Preparation of the Young for the part they are to perform in the Reproduction of the Race. — Of Early Mar- riage. PART II.— Page 28. Of the Foetus in Utero. — Necessity of Protecting the Interests of the Foetus. — Of the Relation which exists between the Mother and the Foetus. — Of the Blood ; its Conservative Power in maintaining a Healthy State. — Family Characteristics Transmitted through the Blood. — Hereditary Diseases.— s-Conditions of Matter, material and dy- namic. — The Effects of Fear ; illustrations of. — The Liability of the Foetus to the Effects of Dynamic Forces, which affect it through the Organism of the Mother : (a) Alarm, dynamic force ; (b) Normal changes in the Organism of the Mother ; (c) Abnormal changes in the Organism of the Mother. — Of Mothers' Marks — Of the Siege of Landau ; an interesting case, illustrating the effects of fright. — Of the Effects of Age. — The Importance of a Healthy State of both Pa- rents at the time of Conception, and of the Mother during the entire term of uterine gestation. — Association. — Mental and Physical Exer- cise. — The food and dress of the Pregnant Woman. PART III.— Page 58. Management of the Newly- Bom. — The manner in which the Newly- born is Treated, due to the State of Cultivation. — Of Birth. — In- stinctive Desires and Reflex Action of the Nervous System. — The CONTENTS. Ill Manner in which Christianized Society receives the Newly-born. — Of the Conditions most Compatible with its Organization. — Of the Senses. — Temperature. — The Care with which Animals and Birds pro- tect their Young from Cold. — Necessity of Warmth Illustrated by the Attention of the Florist to the Temperature of his ^Green- house." — Constitutions are to be Made. — The Conditions necessary to Breathing. — Deaths from Breathing Impure Air Arrested by the adoption of Dr. Clark's Suggestion to Ventilate the Buildings. — Of Inhalation, Exhalation, and the Circulation of the Blood. — Ablution of the Newly-born. — The Importance of the Mother nursing her own Babe. — The Manner in which the Infant should be put to the Breast. — Of Colostrum. — Of Colostration. — Food for the Young. — The Phys- iological Changes which transpire in the Mother during Uterine Ges- tation.— Of the Mecomium.— Of Yellow Milk ; White Milk.— Of Sleep. PART IV.— Page 80. Infancy.— .Of Infantile Organization The Discharge of Mucus.—. Of the Muscular System. — Of Handling and Carrying the Infant. — Of Airing the Infant, and danger of Exposure. — Dentition; tooth formation. The Age at which the Several Teeth Appear. — Of Cut- ting the Gums. — Of Food for the Infant. — Of the Mother's Breast. — The Greatest Danger to the Infant Arising from Improper Feeding. — Precautionary Measures to be Taken in Feeding the Infant. — Im- properly Prepared Food the Cause of the Death of Many Infants. — Liebig's Soup.— Carrot Pap. — Of Wet Nurses. — Of Clothing the In- fant. — Of Weaning. PART V.— Page no. The Infant in Sickness. — Selection and Preparation of the Sick Chamber. — Quietude. — Temperature. — Ventilation. — The Furniture, IV CONTENTS. Bedding and Medicines. — Sending for the Physician ; His Reception ; His Examination of the Patient. — Of the Company and Nurse. — Ad- vice to the Mother in regard to her Neighbors ; and to the Neigh- bors in regard to their Conduct toward the Sick. — How Visitors to the House of the Sick should be Received. — Of the Necessity of ad- hering strictly to the Directions of the Physician. — Administration of Medicines. — Of the Condition of the Eyes, Mouth and Nose. — Relief from the Suffering of Teething. — The Rescue of a Dying Infant by Cutting the Gums. Importance of Fresh Air to the Teething Infant. — The Importance of Early Detecting the illness of the Infant, and giving it Prompt Attention. COLIC— Page 131. The Complaint with which the Infant is Most Frequently Afflicted. — Derivation of the word " Colic." — The Several Varieties of Colic. — Neuralgic, or Nervous Colic : Treatment. — Spasmodic, or Incidental Colic : Treatment. — Bilious Colic : Treatment. — Flatu- lency, or Wind Colic : Treatment — Inflammatory Colic : Treatment. ~-Colic Compounded of two or more of the Varieties : Treatment. INTRODUCTORY. In presenting a book to the public, the question naturally occurs : For what class or profession is the work designed ? This question is usually answered by the title of the book. A treatise on disease is for the medical profession; on law, for the legal profession; and another on divinity, for theolo- gians. Books are also written in the style, and with the tech- nicalities peculiar to the science upon which they are written ; and the reader is supposed to be so educated in that particu- lar science as to be able to comprehend the full force and meaning of the terms used in illustration of the subject or science. Now, who shall be the reader of "The Healthy Infant?" To this we answer: Every one who feels ANY INTEREST AT ALL IN THE PROPAGATION OF THE RACE. Therefore, this work is addressed to both sexes; to the pro- fessional and unprofessional ; and especially to the young — 2 INTRODUCTION. for a healthy posterity will depend very much upon the de- gree of self-government which the latter exercise over their own actions, and also upon a knowledge of certain laws which pertain to reproduction, and which will enable them to secure to the offspring a freedom from many evils, which, with a reck- less disregard of this knowledge, will bring misery and wretch- edness to many succeeding generations. Hence, "The Healthy Infant " is written in plain and simple language, and free from all technicalities and obscurity of expression. The author would respectfully call the attention of the reader to that portion of Part I. which treats of Sex, and the influence exerted upon the offspring by the male and fe- male parents. He also hopes that he will not be considered as teaching the doct?i?ie of materialism. The union of spirit and matter is only one of the innumerable phenomena that are beyond the comprehension of man. Although this union is so close that we cannot discover the dividing line between matter and spirit, yet there is sufficient evidence adduced in the following pages to show that there is a soul or mind or spirit, which is capable of exercising an influence over mat- ter to such an extent as to cause the death of a local part- as was the case of the man with stone in the bladder ; and on the other hand, we know that the condition of mat- ter exercises a marked influence upon the soul or mind or spirit of the man; for when his liver is torpid, or the bow- els constipated, he has the — blues, which occasionally result in suicide. We further know that the soul or mind or spirit is especially associated with the vital organs, and not with the animal or mechanical construction of the fabric, as are the extremities; for these may be wanting, and yet "the soul liveth" Therefore, as the father supplies, mainly, the me- INTRODUCTION. 3 chanical or animal construction to the offspring, and the mother the organic construction, the type of the former is discovered in the general make-up of the body, and the type of the latter in the talents and dispositions of the minds of the offspring. Those who are contemplating a change from a single to a married state, owe it to posterity, in selecting their com- panions, to keep the interests of posterity in view, rather than prostitute to their personal aggrandizement that sacred marital law which was handed from the portals of heaven di- rectly to man. This law marks the identity of families, com- munities, states, and Nations. It secures to the heir, his patri- mony ; to the prince, his crown. Yet, still more important, and in accordance with its design, is the propagation of the race. Therefore, those who enter into this relation incur the obligation of protecting every interest of posterity. THE Healthy Infant. PART I. ON PARENTAL OBLIGATIONS TO OFFSPRING. In looking abroad upon the varied conditions of our race, we find in many of our fellow-beings evidences of mental and physical incapacity. We find many instances of those who perish from diseases, transmitted from generation to generation; and of those diseases we have sad re- minders in our midst, in the shape of Asylums, Almshouses, Institutes for Feeble-Minded, and Charity Hospitals. Notwithstanding the number who suffer from debility, and the lives sacrificed by hereditary disease, mankind seems not to be satisfied ; but each successive generation magni- fies the evils it inherited by adding its proportion of those which arise from human depravity. Against this depravity, civilized society protects itself by the criminal law, prison houses, and the gallows. In view of all this, the question naturally arises, Whence cometh all these evils ? And the usual response is : " From Eve, the prime mother of us all." 6 THE HEALTHY INFANT. Thus generation after generation has endeavored to shift the burden from its conscience, to the first child-bearer ; and so avoid responsibility for its own willful and egregious sins. When the tempter prevailed on her to eat the forbidden fruit, she did not stop to look down the current of human events and behold the untold evils she might be bestowing upon innocent posterity. She knew nothing of her progeny, and certainly little, if anything, of what she was entailing upon them. Her mind was entirely engaged in the pleas- antness of the fruit to her taste, and its boasted power of making herself and consort " as Gods, knowing good and evil." Now, the present generation enjoys this knowledge, combined with the experience of thousands of years as to the terrible results accruing to posterity from our own ac- tions ; yet many daughters of Eve blindly rush into mar- riage without a thought of the misery they may be prepar- ing for their posterity — oblivious of everything but their own selfish gratification; and thinking they are nobody's chars, in the blocd. Such is the explanation of the case of a man who, having a sixth finger on each hand, and a sixth toe on each foot, transmitted the deformities to a son, whose three sons, also, were characterized by the same deformities We recognize our relation to surrounding objects by our senses; and, through these, impressions are made upon our organism, which vary greatly in character from each other — some being animating and wholesome; others displeasing, depressing, and even destructive to life itself. These im- 32 THE HEALTHY INFANT. pressions are received, and the effects are produced through the agency of the nervous system. Thus, grief and alarm have caused temporary derangements of the nervous sys- tem, and permanent lesions, such as issue in lunacy, idiocy, and death. In illustration of the effects of fear, Dr. Condie cites the case of a female child, who, having been repeat- edly threatened by her parents with being given to a sweep to take away in his bag, on accidentally encountering a sweep who had entered the house in pursuit of his avoca. cation, fell down immediately into a violent fit of convul- sions, that terminated fatally in a few hours. Sir Astley Cooper refers to a case of a young girl who, for some of- fense, was put by a school mistress into a dark cellar. Dur- ing the period of her incarceration, she was in a continued state of dreadful fright, and was returned to her parents in a similar but modified state. She passed a restless night, and in the morning was found to be laboring under fever. She constantly implored not to be put into the cellar. On the fourth day, Sir Astley Cooper saw the child, and, not- withstanding his efforts to relieve her, she was, three days afterwards, a corpse.* These are the effects of dynamic forces upon living matter; and it would be well, indeed, if these could be limited to the organism of the mother, and not involve the foetus also. The foetus is enclosed in an organ richly endowed with nerves and blood-vessels, and obtains its nourishment di- rectly from, and eliminates its effete matter through, the mother's blood. These facts make the foetus, virtually, as much a part of her organization as her heart, lungs, or brain, and equally liable to the effects of dynamic forces to which *For a history of these cases, see Condie on Diseases of Children. THE FOETUS IN UTERO. 33 the pregnant female is peculiarly liable. When we consider that the mother's organism has arrived at its fully-developed state, and power of resisting the effects of these forces, and contrast this state with the foetus, we can understand the lia- bility of the formative stage of the foetus to affections, deform- ities, and to premature birth, as the results of dynamic force, though the mother herself may escape unharmed. This brings us to the consideration of the influences which affect the off- spring through the organism of the mother, and they are the following : A. — Alarm, dynamic force. B. — Normal changes in the organism of the mother. C. — Abnormal changes in the organism of the mother. A. — There are various kinds of congenital deformities, and these consist of increased local vascularities, deposition of pigment and hair follicles, occasionally found upon the bodies of newly-born infants. These are supposed to be representations of an ax, a knife, a sword, an animal, or of some other object by which the mother had been frightened. Through a transient agitation, the implement or object had been physically photographed upon the body of the offspring. They are also supposed to represent different kinds of fruit, or other eatables, that the mother may have, through a mor- bid appetite, longed for. All this is contrary to physio- logical facts and correct observation, and is the popular, but erroneous, method of accounting for the so-called ' e mother's marks." The pregnant female is exposed to accidents oc- casioning great alarm, or to deep mental emotions, accom- panied with great agitation of her nervous system, that will do as great violence to the foetus, in the space of a few mo- ments, as the slow process of enervation by disease in a long time. Should the foetus survive the shock, it will suffer 34 THE HEALTHY INFANT. through life with some form of nervous derangement, and finally die with premature old age. These dynamic condi- tions are sometimes accompanied with local deformities. A very striking instance of this kind was told the author by an aged physician and friend, whose intelligence and purity of character place his statement far beyond question ; and as it occurred in his father's family, there can be no mistake concerning the particulars. He says : " A bee concealed in some honey my father was eating stung him on the tongue. This caused it to swell almost to suffocation. The unhappy circumstance took place, unfortunately, during the time my mother was pregnant with her second child. This child proved to be a sadly-afflicted son. His tongue was so much enlarged that he could not articulate a single word ; nor could he control the saliva within his mouth, which caused a constant slabbering. He was mentally an imbecile, and died of premature old age at only thirty years. The immediate family, and both maternal and paternal ancestry were noted for their freedom from any hereditary tendencies whatever, and this is the only instance of the kind known to have occurred with any of their relatives. The mental affliction, the premature old age, and the deformity of the tongue, were, unquestionably, the results of the as- signed cause." The causes which bring like results to the foetus are found not only in the home affairs of life, but under all cir- cumstances which may surround the pregnant female. Hence, times of public danger afford illustrative casualties, of which the following is referred to by Dr. Combe, re- lated by Baron Percy as having occurred after the siege of Landau, in 1793: " In addition to a violent cannonading, which kept the women in a constant state of alarm, the arsenal blew up with a terrific explo- sion, which few could listen to with unshaken nerves. Out of ninety- two children born in the district within a few months afterwards, it is THE FCETUS IN UTERO. 35 stated that sixteen died at the instant of birth ; thirty-three languished for from eight to ten months after birth; eight became idiotic, and died before the age of five years, and two came into the world, with numerous fractures of the bones of the limbs, caused by the con- vulsive starts in the mother, excited by the cannonading and explosion." Here, then, is a total of fifty-nine children out of ninety- two, or within a trifle of two out of every three, actually killed through the medium of the mother's alarm. It will be observed that, in every instance, the general system was affected, and there is no allusion to local manifestation, or such deformities as "mother's marks;" and this strictly ac- cords with the physiological connection which exists between the mother and the foetus. A correct understanding of this relation removes the grounds for attributing local deformities or " mother's marks " to the impressions of the instrument, or means by which the mother was frightened, or to any emo- tions of her mind or heart. This conclusion is further sup- ported by the effects upon the human organization, of a con- stant state of apprehension of evil. This retards the pro- gress of nutrition and development, and is supposed to cause a total arrest of these functions, and induce gangrene and death. A case of this kind is related by M. Ridard:* t( A man, thirty years of age, was affected with stone in the to '■ der, and saw a patient die by his side after being operated up for the same complaint. His imagination became excited, his thoughts being constantly fixed upon the operation which he himself expected to undergo, and upon the probable death that would follow ; and the result was, that without any operation at all, he died at the end of a month, affected with gangrene of both penis and scrotum." Dr. Carpenter says: "Hence, also, it is that the morbid feelings of the hypochondriac^ who is constantly directing his attention to his own fancied ailments, * Carpenter's Principles of Physiology. 36 THE HEALTHY INFANT. tend to induce real disorders in the action of the organs which are supposed to be affected." In the same category, too, may be placed those in- stances (to which any value may be attached) wherein a strong and persistent impression upon the mind of the mother, has appeared to produce a corresponding effect upon the development of the foetus in utero. In this case, the effect (if admitted to be really exerted) must be pro- duced upon the maternal blood, and transmitted through it to the foetus, since there is no nervous communication between the parent and the offspring. B. — As we advance from infancy to old age, the organ- ism passes through successive changes induced by develop- ment, education, and experience in the affairs of life; thus, " The tear down childhood's cheek that flows, Is like the dew-drop on the rose ; When next the summer breeze comes by, And waves the bush, the flower is dry." " Youth is ever apt to judge in haste, And lose the medium in the wild extreme." "These are the effects of doting age, Vain doubts, and idle cares, and over-caution." The character of these changes is determined, in a great measure, by the influences which are brought to bear upon the individual, and in a manner that, "If a reflective, aged man, were to find at the bottom of an old trunk, where it had lain forgotten fifty years, a record, which he had written of himself when he was young, simply and vividly describing his whole heart and pursuits, and reciting ver- batim many passages of the language which he sincerely ut- tered, would he not read it with as much wonder as if it had THE FCETUS IN UTERO. 37 come to him from the dead ? He would surely half lose the sense of his identity under the impression of this dis- similarity. It would appear as if it must be the tale of the juvenile days of some ancestor, with whom he had no con- nection but that of name. He would feel that the young man thus introduced to him was separated by so wide a dis- tance of character as to render all congenial association or connection impossible. At every sentence he would be tempted to repeat: 'Foolish youth, I have no sympathy with your feelings; I can hold no converse with your un- derstanding ! ' Thus, you see, that in the course of a long life a man may experience several moral individualities dif- ferent from each other ; that, if you could find a real indi- vidual that would fulfil the characteristics of these stages in their several developments down to the last, and then bring them all together into one society, as the representatives of the successive stages of one man, they would feel themselves a most heterogeneous party, would oppose and probably de- spise one another, and soon after separate, not caring ever to meet again. If the dissimilarity in mind were as great as in person, there would in both respects be a most striking contrast between the youth of seventeen and the sage of seventy. The one of these contrasts, an old, man might con- template, if he had a true portrait for which he had sat in the bloom of his life, and should hold it before a mirror in which he beholds his present countenance ; and the other he would powerfully feel, if he had such a genuine and de- tailed memoir as I have supposed." If it were possible for the circumstances of home, and of public affairs, and the state of science under which a child might be born, to con- tinue uninterruptedly through life ; his organism would pass 38 THE HEALTHY INFANT. through less and fewer changes than under the ever-changing affairs of human existence. Therefore, the greater the vicissi- tudes of a given family, the greater will be the difference in those children born at the extreme periods of the parents' life. These differences may be regarded as the expression of the several changes through which the parents may have passed. If the truth of this is admitted, it becomes a mat- ter of the highest importance to pay due regard to the char- acter of the influences which are brought to bear upon our- selves — and especially those to which our children are sub- jected. C. — The abnormal conditions of the system are caused by disease, the loss of near relatives, adverse circumstances, or a constant state of expectation of evil. These abnormi- ties become more manifest in pregnancy, because the vital organs are more active in the performance of their func- tions, and the maternal instinct is being strongly developed. The sensitive* state of the mother is, at this crisis, peculiarly intensified. To illustrate, we will suppose a young and healthy woman marries at the usual time of life, and, in due time, becomes a mother. The child proves all that the fond parents desire, and its system shows no indications of organic derangement whatever. After this first delivery, the mother's health begins to decline. The second child is born. It is puny, and continues in a delicate state through youth ; and in manhood is stunted in body and cramped in intellect. The third is as well developed as the first ; but in after life is afflicted with some form of nervous derangement. *This increased sensitiveness of the female is sometimes taken advantage of . in the maltreatment of the pregnant female for the gratification of a malicious spirit. THE FCETUS IN UTERO. 39 The fourth survives the periods of early life, but suffers from indigestion, and is a prey to nervous excitement. The fifth is still-born. After this, the mother's health being in an im- proved condition, she gives birth to the sixth child, which suffers with convulsive disorders in childhood, and in after life possesses a nervous excitability of temperament, which no regimen can palliate or remove. Finally, under a recov- ered state of health, she bears children that are of the type of the first born. Such conditions of the mother during the child-bearing period determine the destinies of her offspring. The prime cause of the normal and abnormal conditions of the members of the same family may be traced to like con- ditions of the mother's organism previous to, and during the time of, her different pregnancies. From the foregoing, and from what is known upon this subject, we may conclude, first, that the habitual psychical and physical state of both parents prior to, and at the time of conception, exercise a marked influence upon the general system of the offspring; second, that during the entire term of gestation, the foetus receives the material for its formative processes directly from the blood of the mother, and the in- tegrity of this fluid depends on the state of her own assim- ilative processes, digestion, secretion, and excretion, and that these are influenced by her own mental state. Hence, those slowly-enervating influences arising either from phys- ical derangement, or from unhappy conditions of life that disturb the mental state of the mother, also materially affect the general system of the offspring ; third, that an immediate and violent shock to the mental and nervous system of the mother will so affect her blood as to retard or pervert the developing processes of the foetus \ and when this occurs in 40 THE HEALTHY INFANT.. the early months of pregnancy, there may be a malforma- tion effected in addition to the retarded development and nervous disorder, as was the case with the child in the in- stance of the bee-sting. From the foregoing, we discover the maternal influence upon the foetus to be constitutional in its effects, rather than productive of local deformities, called "mother's marks" Therefore, keeping this in view, we perceive the great im- portance to the female of a healthy state of body and mind at the time of conception and during the term of uterine gestation. This requires a proper observance of all the conditions upon which the preservation of this state depends. Among these may be mentioned associations, mental and physical exercise, food, and dress. OF ASSOCIATIONS. The necessity of the mother's amicable relation to her associates, especially to those of her household, has already been referred to in this part. In addition to this, I remark that her companions should be such as will help her to di- minish any deficiences which mar her happiness, and divert her attention from anything which would be detrimental to an even, healthy state of her mind and body. The mother herself should guard against those ill-tempered feelings and emotions which are sometimes excited by the pregnant state, and also remember the great difference between the placid and amiable disposition of the agreeable housewife, and the tur- bulent spirit of the house-brawler, who is the cause of much unhappiness. The statesman may also ask, with great pro- priety — Is she not also the remote cause of much na- tional discontent and disorder? To the former class of THE FCETUS IN UTERO. 41 mothers we are to look for domestic happiness and national content. OF MENTAL AND PHYSICAL EXERCISE. There are few persons who are not competent to devise a plan, or to execute one which is already devised; but to be able to devise, and then to execute, requires a combina- tion of faculties which few persons possess by nature, or have acquired by persevering industry. These faculties are named, respectively, the inventive and the constructive. In the combination of them resides the highest degree of men- tal and physical development ', and the loftiest grade of useful- ness. The cooperation of the two faculties is more than useful, inasmuch as it animates the mind and stimulates the bodily functions. Thus the individual receives a life-renew- ing impulse. The spirits are saved from sadness and gloom, and the system can more effectually resist the encroachments of disease. The joint exercise of the faculties of invention and construction lead to the cultivation of many pursuits of pleasure and of profit, such as the rearing of flowers, the domestication of animals, the cutting and making of dresses, and last, not least, the art vend practice of cookery — a thorough knowledge of which constitutes the highest and most useful accomplishment a woman can attain. The woman who occu- pies her time in this way, combined with a modicum of re- ligious and secular reading, is contented and happy, beau- tiful and useful in her home, however humble it may be; and her children will be born in those "circumstances" most favorable to the production of healthy constitutions, amiable dispositions, and the highest order of intellectual endow- ments. 42 THE HEALTHY INFANT, OF THE FOOD. There is nothing of greater importance in conducting the female through the term of pregnancy than the due nourishment of her physical economy. This is of prime im- portance, not only to the mother's health, to her safe de- livery and good getting up, but also to the proper develop- ment of the foetus and its continued well-being in after life. So much depends upon the proper nourishment of the female through the term of pregnancy that she should, to some ex- tent, be informed of the physiology of digestion, absorption and assimilation. These can not be fully treated of here; but there are some particulars which can not be passed over, in justice to the aim of our work, and they are these : i st. The elaboration of matter for the remarkarble in- crease in size of the uterus, which takes place pari passu with the development of the foetus, and for the growth of the latter. 2d. The elimination of the carbonaceous matter of the foetus through the mother's physical economy. 3d. The imparting to the mother's blood of excremen- titious matter other than the carbon. 1 st. When an organ ceases its secretive function, the remaining healthy organ will supply the deficiency to the economy by taking upon itself an increased activity in the performance of its function. This same law operates in the digestive organs when additional material is demanded for the construction of the new being. This gives rise to an in- creased appetite and a demand for a more liberal diet. Such is the case with the healthy female who maintains the demand, by a continuance of her daily physical exertions, for the accustomed amount of food to supply the waste of THE FCETUS IN UTERO. 4$ her own body, and whose organs continue in the daily per- formance of their functions. When a due relation between the appetite and the powers of digestion is maintained, through the term of pregnancy, there is a healthy state, but when, from any cause whatever, the healthy state of this relation is disturbed, evil results must ensue. One of these causes is found in the encumbered state of the mother, in the latter months of pregnancy, from the enlargement of the uterus and the heaviness of its contents. This prevents her from taking the accustomed exercise; consequently the demand for nourishment to supply the waste of her own economy is greatly diminished, and, if the appetite con- tinues unabated, its indulgence will result in derangement of the digestive organs, accompanied with heart-burn, nausea, flatulence, constipation and a sense of general full- ness. The ingesta is now imperfectly elaborated and the organism insufficiently nourished. From this state of the system arises a constant craving for food and confectionaries,. and the indulgence of the female in these excesses will in- crease the fullness to oppression, and if this is not relieved by art, nature will endeavor to do so by bleeding from one of the mucous membranes. This hemorrhage sometimes takes place from the uterus. In this event the life of the foetus is endangered by a premature birth, and the mother is. subjected to serious risk from flooding. It is true that the suppression of the menses contributes to the growth of the foetus, but the amount is small, not more than one pound of organized matter, while the foetus and the growth of the womb, and the formation of the placenta, will amount to fourteen pounds. Hence there will remain thirteen pounds of new growth to be provided for by the digestive organs of the mother in the short space of nine months. 44 THE HEALTHY INFANT. 2d. The elimination of carbonaceous matter, afterbirth, takes place through the lungs, and is brought thither by the blood from every part of the body. It is different, however, with the fatus. Its lungs do not, as yet, perform their physi- ological functions. Its blood is diverted from them by arrangement, to the placenta, which may be called the fatal lung, as it performs a similar function. This organ is attached to the uterus by tufts, which permit the placental veins to bathe freely in the blood of the mother, as do the gills of fish in surrounding water. And according to the same law the excrementitious matter of fcetal blood is im- parted to the purer blood of the mother, and receives oxygen in return. The fcetal stomach, like its lungs, does not, as yet, perform its function ; hence the placenta is a substitute also for the alimentary canal as a means of supplying to the blood, nourishment for the foetus. The blood thus purified and laden with fresh stores returns to the foetus, circulates through its capillary system, deposits the necessary material for its growth, takes up the waste matter, and returns to the placenta with impurities to be again imparted to the blood of the mother. The carbon being the most important of these impurities, we particularly allude to it at present. The increased carbon in the blood renders the blood thick,* *The author was, upon one occasion, called to relieve the sufferings of a lady in the seventh month of her pregnancy, who was suffering with a derangement of the digestive organs, accompanied with a sense of fullness, as above described. There was a general pallor, attended with a sense of suffocation. It was appre- hended that the blood was too thick to circulate freely through the capillary system. As a means of relief a small quantity, a gill \ of thick, tarry blood was drawn from the arm, which, notwithstanding the smallness of the quantity, caused her to faint. A few days' abstinence from food, with opening medicines, the blood re- covered its natural fluid form, and the patient recovered to as comfortable a con- dition as could be expected for one in her condition, and after her confinement presented her husband with twins — two unusually large boys. THE FCETUS IN UTERO. 45 and gives it a tarry appearance. This increased consistency- retards circulation through the capillaries and prevents, in part, those metamorphic changes from taking place which are needful to the due nourishment of the economy. And finally, these result in derangement and disease which require medical treatment. The derangements thus produced are mainly those of the nervous system and of the digestive or- gans. The former, is in consequence of the nerve centers not receiving the necessary stimulus from the sluggish flow of the blood, and the latter, results from the deteriorated quality of the gastric, pancreatic, and biliary secretions, by which the digestive processes are more imperfectly per- formed. These conditions still further deteriorate the blood, and the economy is more inefficiently nourished. Under these circumstances, the free indulgence of a morbid appe- tite is like adding fuel to flame. But when the economy is invaded by a disturbing cause, we must not be unmindful of the fact that nature is ever upon the watch, ready to assert the supremacy of her laws; hence, she imposes upon the lungs an increased action in the performance of their function — as when one lung, or one kidney, compensates for the impaired utility of its fel- low. It occasionally happens, however, that she is not ad- equate to the emergencies of the case, and assistance must then be supplied by due attention to the diet, to the manner of dress, and by the institution of such medical treatment as the nature of the case may demand. 3d. The presence of waste matters in the system is highly prejudicial to good health, and for this reason there is ample provision made for their elimination. The bowels, kidneys, lungs, and skin, discharge their respective secre- 46 THE HEALTHY INFANT. tions. By the obstruction of any of these organs, the secretion accumulates within the system, unless thrown off by some other organ. The skin and mucous membrane sometimes perform this adventitious function. There are agencies which excite an increased action of these mem- branes and cause them to eliminate an increased amount of animal matter. Of these agencies a heated and confined atmosphere is among the most efficient. Many persons have experienced the ill effects of inhaling the breath and effluvia from the bodies of others. These effects are not only due to the carbonic acid gas, but also to animal matter of which the effluvium is partly composed. The inhalation of carbonic acid gas produces a sense of suffocation ; whereas, the animal matter causes nausea and vomiting. The sick- ening odor arising from freshly-drawn blood is due to the animal matter. This fluid is used in sugar . refineries for clarifying sugar ; and when a fresh quantity is introduced into hot syrup, the animal effluvia is so offensive that the rooms are almost uninhabitable for several hours afterward. The exhalation from the human body is necessarily contam- inated with animal matter ; and that from each individual seems to possess properties peculiar to itself. This enables the dog to trace his master among the footsteps of many persons. The occurrence of scarlatina, measles, etc., among school-children and students at college, is due to the inter- mingling of these different matters, like salts of different metals, which, when their solutions are mixed, form precipi- tates of new compounds, differing in their physical and chemical properties from the original salts. The facts just cited respecting the effluvia from the adult organism equally apply to the foetus. All its glandular THE FCETUS IN UTERO. 47 systems are actively producing their secretions. This is evidenced by the existence of bile and mucus in the bowels, urine in the bladder, and the sebaceous matter — vernix caseosa — which covers the body of the newly-born. The peculiar situation of the foetus renders it impossible for these secretions to be removed directly from the body of the foetus in like manner as after its birth ; hence there must be some other provision made for their removal, else foetal ex- istence would be of short duration, if it could exist at all. This provision is found, first, in the chemical composition of the foetal effete matters, as differing from those of the adult ; secondly, in their being in part taken up by the blood of the mother and eliminated through the emunctories of her econ- omy. These we will consider as : (a.) The alvine dejections. There is a marked difference in the physical and chemical constituents of the faeces of the foetus and that of the delivered body. The former is a blackish green, viscid, inodorous matter, composed of mucus secreted by the intestinal mucus membrane, mingled with bile, and is called meconium. It neither contains the animal matter excretions, nor does it possess other important char- acteristics which are peculiar to the latter. These the foetus imparts to the blood of the mother, and, when retained in her system, she is a fit subject for the reception of disease. (b) In consequence of the little practical importance of a knowledge of the physiological and pathological condi- tions of the urine of the foetus, it has not received the same attention from physiologists and chemists as that of the child or man. But it is shown that the constituents of the one are very different from those of the other. Urea, the nitro- genized compound which characterizes the urine of the 48 THE HEALTHY INFANT. delivered, does not exist in that of the foetus; but, instead of it, there are two nitrogenized compounds, allantoin and albumen, which do not belong to the healthy urine of the former. I cannot speak positively as to the character of the former of these substances, but regard it as strongly re- sembling the latter. It does not readily decompose, nor is it inimical to life, as is urea. Were it not for this provision against the formation of urea, foetal existence would be of short duration; its death would ensue from uraemic poisoning. (c.) The skin of the foetus also performs its function quite actively. This is evidenced by the quantity of sebaceous matter usually found upon the cutaneous surface of the newly- born infants. This is an oleaginous substance and is de- signed to lubricate the skin. The accumulation and retention of this lubricate are not inimical to the health of the foetus, hence its removal is not provided for, and there is time enough after birth, as a matter of cleanliness. In these pro- visions for the preservation of the foetus we discover marked indications of the conservatism of natural law and the work- ings of an omniscient Creator. It occasionally occurs in the latter months of pregnancy that the organs of the mother do not perform their eliminative functions sufficiently active when the effete matters of her own system, as well as those of the foetus, are permitted to accumulate in her blood. This accumulation will give rise to much inconvenience, which will demand prompt relief, as in the case already cited. OF DRESS. Of the conditions and necessities of the female which are essential to the well-being of the offspring there are none THE FCETUS IN UTERO. 49 more important and more under the control of her own will than the manner in which she should wear her clothes. An improper manner of dressing is one of those things which has contributed largely to the perils of child-bearing, and has induced some authors to believe and teach that pregnancy and child- birth are pathological or diseased conditions of the female, and not physiological or healthy processes. This, however, is a mistake. Pregnancy and child-bearing are not diseases, nor do they partake of the nature of them. They are the means by w T hich the race is propagated, and, consequently, must be governed by natural and conservative laws which have regard to both mother and offspring. Were these con- ditions of the female pathological in character it would be a perversion of natural and conservative laws, whereby the end in view would be defeated, the world could never have been peopled; but, as it is, child-bearing is conducive to female longevity, and the world is peopled. Hence we may conclude that conception, pregnancy and child-bearing are the results of the generative organs when in the active per- formance of their physiological functions. If the pregnant female could only appreciate the reality of these facts, she would be relieved of those grave and unfounded apprehensions, which induce her to regard the issue of her anticipated confinement as more than doubtful. This appreciation would not only dispel her fears and anxieties, but also cause her to take a more rational view of her situation. It would make her happy and cheer- ful. She would endeavor to inform herself of the nature of those laws of child-bearing, that the manner of her living may be more in compliance with their demands. Although science and common sense have done much 3 50 THE HEALTHY INFANT. in reforming the manner ot female dress, yet the natural laws of health are frequently violated by the vain endeavor to improve the forms which nature beautifies without any such assistance. The modern manner of dressing was not the means by which the ancient Greeks and Romans ac- quired their classic forms. It was by means which permit- ted free and easy movements of the joints and muscles. The axis of the spine was erect, with its natural and graceful curves; the shoulders were square, and the breast arched with a perfect symmetry. They permitted their muscles to develop. This gave them ease and grace of movement, as well as speedy action. It also gave them that rotundity of contour which is so beautiful to the eye. The contrasting of two drawings — one representing a well-formed female, with the various organs in their natural position, and the other representing one who has become de- formed, and the organs displaced by tight lacing, steel stays, and walking the Grecian-bend — would demonstrate so great a variety of evils, that a special chapter would be required for their elucidation. We will not, however, give the sub- ject so much space, but will mention a few of the most im- portant evils from this cause : First, undue pressure of the body is a prolific cause of determination of blood to the brain, and may be the exciting cause of disease of this or- gan; second, the action of the heart and blood-vessels is not so free and easy; third, the blood cannot flow sufficiently free through the capillaries, thereby preventing the nourish- ment and development of the parts; fourth, the respiratory organs are so compressed as to interfere with the breathing process — for this cause the female cannot take that degree of exercise which is essential to health; fifth, pressure upon THE FCETUS IN UTERUS. 5 1 the mammary glands will either cause absorption or disease of the organs; sixth, pressure over the stomach and bowels will arrest the peristaltic movements, thereby causing imper- fect digestion and constipation of the bowels; seventh, the uterus will be forced down, making a case of prolapsus uteri. Walking the Grecian-bend greatly promotes this dis- placement by lessening the lumbar curve of the spine, which brings the pelvic plane more horizontal by taking away the support which the organ receives from the pelvic arch and abdominal walls. From a consideration of the foregoing evils, which re- sult from an improper mode of dressing, it would seem to be the dictates of true philosophy to avoid them, and act in strict compliance with the demands of the human body. There should not be those infringements upon the organism, which not only impair the health, but are also the remote cause of tardy and difficult labor. But philosophy, reason, common sense, good health, and the welfare of the off- spring, are all sacrificed to the modern usages imposed upon the female. She cannot, unaided, stem the tide of fanati- cism which deluges the fashionable world. She must be supported by father and brother, husband and son; and, by not discharging this duty, they become likewise responsible for the evils incurred. Except in instances involving right and wrong, decencies and indecencies, our ideas of elegance of dress and of beauty are matters of taste and of education. The Jew, the Greek and the Roman each had his ideas of elegance, and re- garded his own style of dress and of female beauty as superior to any other. In order to produce a successful revolution in any one of the usages of society, public opinion 52 THE HEALTHY INFANT. must be in its favor, and, as the mode of dressing is conven- tional, let that opinion approve of the manner of the ancients, who wore their garments by straps passing over the shoulders, and not with a cincture around the waist, which, with the weight of the garments suspended, compress the abdominal, the spinal and the thoracic muscles. The effect of this con- tinued pressure is the attenuation of these muscles, which deprives the female, to some extent, of their assistance in the expulsive effort of child-birth. The want of this assistance is often the cause of much inconvenience and suffering. Could a woman only know how absolutely ridiculous she appeared while making strenuous, and frequently pain- ful, efforts in the preparation of her dressing, and in distorting her body to some fashionable method of walking — as the Grecian-bend — to bring about the evils we have just enumer- ated, she would not be long in loosening her stays, and in as- suming the erect posture, as designed by nature. The follow- ing case of death from tight-lacing, with post mortem results, as reported in the Londo?i Lancet, will farther illustrate the evils which result from this pernicious practice, and also show that the foregoing is not a fancy sketch, but sad reality : "Jemima H , aged twenty (appeared to me to be twenty-four), servant, complained, on returning from an errand, of some headache and intense feeling of cold, about 2 P. M., on December 21st last. Her mistress desired her to lie down for the remaining part of the af- ternoon, but the headache still persisted, and she was permitted to retire to bed for the night. As she did not "put in an appearance" at her usual hour the following morning, the mistress went to her room for the purpose of inquiring the cause, when she found the pa- tient still dressed, as on the previous evening, lying on the bed, and quite incapable of being aroused. I was sent for at 7:30 THE FCETUS IN UTERO. 53 A. M., and found her insensible on the bed, with all her clothes on, dressed, her face pale, pupils widely dilated, breathing stertorous, and on trying to remove her clothing, the task proved to be so dif- ficult a one that I was obliged to cut it off. I then considered the symptoms (from the meagre and faulty history) due to congestion of the brain membranes, arising, probably, from the intense cold of the night, acting on a weak heart. Some diffusible stimulant was ordered, if it could be taken, and fly-blisters to the nape of the neck and ex- tremities. I then left. At 10 A. M., the hour of my second visit, the patient was wildly delirious, unrestrainable, and powerfully convulsed (clonic). At 2 P. M. I was informed, on again visiting her, she had died a short time previous, after a violent convulsive seizure, appa- rently exhausted. She was removed that night to the public mortu- ary, to await a coroner's order for post mortem examination. There was no history to the case, save the evidence of the mistress, given at the inquest, which went to prove that she had frequently, but una- vailingly, remonstrated with the girl for her persistent folly in lacing so tightly. " Autopsy (forty-two hours after death) : Weather intensely cold; air crispy, dry ; sky clear; recent snow-fall. Rigor mortis com- plete ; no marks of violence ; body indifferently nourished. I was at once struck with the nude configuration of the body, which was pe- culiar from the extraordinary amount of constriction at the loins, and the " squareness " of the shoulders, which were remarkably high for a delicately-formed female, the clavicles being horizontal, straight, transversely, the form of the upper part of the body being flat and triangular, the base being formed by the square shoulders, the apex resting on the pelvis, which projected considerably, and the sides per- fectly free from contour, and sharply defined. There was little pec- toral or mammal development ; the lower extremities were cedema- tous, and the whole appearance gave me the unpleasant impression of being pinched. On opening the chest, the lungs were found to fill the cavity completely ; the right lung was adherent throughout to the chest walls, and congested ; the left lung also congested. Pleural cavity contained some fluid, but there were no adhesions. The posi- tion of the diaphram corresponded to that of extreme expiration. 54 THE HEALTHY INFANT. Heart very small ; did not weigh more than four ounces, and flabby; structure pale and weak ; right ventricle distended with black fluid blood ; left valves healthy ; pericardium contained about three-quar- ters of an ounce of fluid. Abdomen contained over a pint of serum in peritoneal cavity. Liver enormously enlarged, congested and friable, the capsule readily tearing off ; it extended completely across the abdomen, overlapping the left margin of the spleen, to which it was firmly adherent, compressing the stomach, duodenum, transverse colon, and small intestines. I should think it did not weigh less than between sixty and sixty-five ounces; gall bladder, distended with bile, descending an inch below superior margin of liver. Stomach very small, not larger than an infant's ; walls hypertrophied ; rugae considerably enlarged, and contained some dark fluid, apparently cof- fee. Duodenum much thickened ; contained some bile and digested food, as did small intestines. Spleen and kidneys intensely congested and enlarged. Brain membranes intensely congested. I do not think I have ever seen them more so. The whole surface presented the ap- pearance of a blackened mass, almost unrecognizable. There was an apoplectic spot on the surface of the right hemisphere posteriorly, with some effusions of lymph. The brain substance was considerably softer than in health, and presented a "mottled" appearance on being cut into. No fluid in ventricles. Dark-colored fluid at base of brain. Sinuses engorged, as also vena galeni.* It is true this is an extreme case, and no argument is needed to show that the death, the displacement of the several organs and their diseased conditions, as demonstrated by the post mortem examination, were the effects of the assigned cause ; hence no comments are needed but to meet the anticipated response, "Oh! I do not lace so tight as that," forgetting that injury is done in proportion to the tightness of the lacing. For a perfectly healthy state of the organs they must not be compressed at all. *See July number of the London Lancet, 1871. The case is reported by W. H. Sheehy, L. R. C. P. Ed., etc. THE FCETUS IN UTERO. 55 Keeping in view the dependence of the foetus upon the continued good health of the mother for its growth and development of a vigorous constitution, and that the pro- cesses of child-bearing are normal, and not abnormal, we now remark that it involves an increased activity, not only of the generative organs, but also of the vital organs of the mother's economy. This increased activity implies an iticreascd draft upon the capacity of these organs, and this increased draft implies an increased demand upon the vital forces ', and this in- creased demand implies an increased necessity for observing all the conditions and obeying all the laws essential to the maintenance of health. As the vital forces derive their stimulus from wholesome food, pure air, and exercise, the pregnant female must not, to the exclusion of these, be considered an invalid— to eat dainties, to lie supinely, and to breathe impure air, but let the usual course of life be continued without any sudden or radical change in her customs and habits. When any article of diet is found to produce unpleasant results let it be removed from the diet list. The mother may not only exercise herself within doors, but also in the open air, either by walking or riding in a carriage, avoiding jolting and jarring. The continuance of a walk, a ride, or of any other kind of exercise, so far as to produce fatigue, is frequently followed by serious conse- quences; therefore, she should not be subjected to fatiguing or exhausting efforts of either body or mind. The hour for exercising in the open air is to be determined by the climate, the location and the general health of the mother. As these are so varied, it is impossible to indicate one which would be alike appropriate in every instance; but the follow- 56 THE HEALTHY INFANT. ing will, to some extent, indicate the proper time for her walks and rides. Our space will not admit of a full history of the effects of cold upon the human economy ; but suffice to say that, when the mother is enjoying good health, exer- cise in a cold atmosphere for a short time will produce a temporary depression, followed by a healthy reaction and beneficial results ; whereas a prolonged exposure will pro- duce a continued depression, followed by an unhealthy reac- tion and grave results. Therefore she should not, during the cold seasons, exercise too freely in the open air, and not then in the mornings and in the evenings, but with proper wrap- pings and overshoes, let mid-day supply the desired hour. One of the most hurtful influences is miasm. This gaseous poison is generated from decomposing vegetable matter exposed to moisture and a due amount of solar heat. It is produced in such quantities in some localities as to en- title them to the appellation of miasmatic districts , from whence it is diffused through the air, and when it is inhaled into the lungs and absorbed by the skin, it causes miasmatic diseases, which are of the intermittent and congestive forms. As Spring is its favored season, and is accompanied by a damp atmosphere, the female should avoid the morning fogs and evening dews of the Spring months. Under ordinary circumstances the observance of all the conditions and laws upon which health depends is essen- tial to its maintenance. But the increased activity of the various organs consequent upon the pregnant state necessi- tates, as we have already seen, an increased vigilance in the observance of these conditions and laws. Habits of cleanliness, not only of the body and clothing, but also of the bed and of the apartments, should be strictly ob- THE FGETUS IN UTERO. 57 served. By due attention to these, with well-ventilated rooms, the animal effluvia arising from the body and from the lungs are more readily dissipated, the body is in- vigorated, the mind is made cheerful and the spirits happy. In conclusion, we may observe that the ills of child-bed are not by any means necessary attendants. They are often the results of the mismanagement of the female, either dur- ing the term of pregnancy, in her delivery, or during the lying-in month. 58. THE HEALTHY INFANT. PART III. MANAGEMENT OF THE NEWLY-BORN. The changes which the constitution undergoes in its transit through the periods of life, demand corresponding observances for the maintenance of health. It is, therefore, necessary to study the laws of health in relation to each of the periods of human existence. We have treated of the means by which an infant may be born with an organization capable of being developed into a healthy and vigorous con- stitution. The next topic is infantile existence. The treatment which the offspring meets with upon en- tering the world, depends upon the degree of intelligence and moral worth of the parents. With the unchristianized, it is the victim of the most revolting practices. The canni- bal will sacrifice his babe to his appetite. The inhabitants of India will sacrifice their babes to appease their gods. It was a practice among the Romans to leave it to the arbi- trary will of the father, whether his newly-born should sur- vive, or be left in the street to perish. The aim of the Spartans was to train it to be a soldier, and to this end they MANAGEMENT OF THE NEWLY-BORN. 59 endeavored to make it capable of great endurance of heat, of cold, and of bodily affliction. Among their laws was one requiring parents to bring their babes to a place called Lesche, to be examined by the heads of the clans, or the most ancient men of the tribe, who, upon finding them of a feeble organization, or deformed, gave directions for their de- struction by throwing them into a cavern called Apothetce. If the infant was possessed of a good organization, and not deformed, it was returned to the parents, and orders issued for its education and for its reception of one of the nine thousand shares of land. The Christian is the highest ORDER OF NATION — THE CHRISTIAN IS THE HIGHEST ORDER of man. We therefore rear and educate our children to the highest purpose of man, and this requires thorough physi- cal, mental, and moral training. Birth is that act which terminates the intra-uterine life of the infant, and ushers it into an extra-uterine existence. This event places the infant in contact with very different surroundings. From within its closed matrix, from its im- mersion in water, from a higher and an even temperature, from a dormant state of the five senses, from inaction of several of the organs in the performance of their functions, a being is at once ushered into a dry atmosphere, to a lower and an uneven temperature, to an excited state of the five senses, and to action of several of the organs in the per- formance of their functions. Thus, its entrance into the world is marked with an organization which will enable it to maintain an independent existence. The various faculties are now to be exercised. The first impression of sound is to be made upon the ear, of light upon the eye, of touch upon the skin, of heat and of cold upon the cutaneous 60 THE HEALTHY INFANT. nerves, of food upon the palate, and of odors upon the olfactory nerves. Were it possible for an adult to undergo so sudden and so great a transition as this, it is possible that the shock would prove fatal to his life. If the fcetal brain were sufficiently developed to be conscious of the transition, the same result might be anticipated. Bat this was foreseen by the Creator, and hence the brain is only developed enough to be able to preside over the feeble fcetal organization. It is not so far developed in its newly-born state as to enable it to be conscious of its necessities. Instinctive de- sires, and reflex action of the nervous system, are the agen- cies by which its feeble vitality is manifested. They are also the agencies by which the organic functions are excited to ac- tion. In addition to the feebleness of the brain, the nerve tex- tures and the muscular and membraneous tissues are ex- tremely delicate, and the bones are soft and flexible. The infant, then, is not only unconscious of its necessities, but is physically incapable of supplying the least of its wants. It comes into the world as an object of our care. We are not only to supply the necessities of life, but we are to secure to it, at the time of its birth, those circumstances which are most compatible with its organization. The "little stranger" should, therefore, meet with those conditions that are as similar as possible to those of its former state of existence. The senses must not be subjected to marked impressions, but gradually become inured to the performance of their func- tions. The sense of touch is the first to be exercised. Although the vernix caseosa is some protection to the cutaneous nerves, yet the most delicate of textures with which it is possible for the infant to come in contact, is rough and harsh in compari- son with its former smooth and watery place of abode MANAGEMENT OF THE NEWLY-BORN. 6 1 When the infant is handed to the nurse, it is usually received upon a shawl or blanket, regardless of the coarseness of tex- ture, or of the smoothness of the surface — as though any- thing would do to wrap the baby in. But instead of such rough textures, there should be provided a piece of new canton flannel, of sufficient size to envelop the babe. Even this is not sufficient to protect it from cold, and to keep it at an even temperature. The necessary additional wrappings will be determined by the season of the year and the tem- perature of the room. The mechanical impressions made upon the cutaneous nerves are of less importance, however, than those made by the coldness of an atmosphere of sixty or seventy degrees, compared with the higher and more even temperature of the womb. The atmosphere coming in contact with the body, and in close proximity to the blood by inhalation, along with the evaporation from the body, rapidly reduces the tempera- ture and depresses the vital forces. These degrees of tem- perature are higher than are usually met with by the newly- born; hence it is that there are more infants still-born in the colder than in the warmer seasons of the year. The feeble organization of the newly-born is incapable of maintaining the higher degrees of heat imparted by the mother's econ- omy, and its capacity is lessened by the fatigue of the labor, and the pressure to which the brain was subjected during the act of birth. Under these depressing influences, the infant cannot long survive its struggles for existence. The lower animals instinctively act upon these facts; and it is well to remark the wonderful care they exercise in protect- ing their young — not only from extreme cold, but from chilling influences. When young birds are removed from 62 THE HEALTHY INFANT. their nests, their temperature rapidly declines; and when the young of carnivorous animals are kept with the mother, they lose only about three degrees of heat; whereas, when they are removed from the parent, their temperature will fall several degrees lower. It is the result of daily observa- tion, that heat and its maintenance at an even temperature is not only essential to germination and reproduction in both the vegetable and animal kingdoms, but also to health de- velopment, and the prolonging of life. Notice the florist in his greenhouse — the care with which he nurses the tender plants. He has constant regard to the temperature of the nourishing air and water. Hence the thermometer and the fire when chilling winter, with his icy hand, brings the hoary frost. Then turn to the newly-born and helpless infants en- twining themselves around the parental heart, and observe — in consequence of their delicate organization — the easy sus- ceptibility to the effects of cold. We should then observe, with greater care, the temperature of our offspring, their surrounding atmosphere, their food, and their drink. From the inception of the prolific germ of the foetus until its maturity at birth, it is kept at ioo degrees temperature (Fahr). A variation of a few degrees below this point would retard its development, or blast its exist- ence. Then, taking nature as our guide, and knowing the normal temperature of our body to be ninety-eight degrees, let this temperature be maintained from the cradle to the grave. And as the debilitating influences of early life and of old age are inimical to the maintenance of the normal temperature, these must be compensated by additional cloth- ing, and avoiding exposure to cold. With barbarous cru- elty, some parents try to "harden" their infants and children MANAGEMENT OF THE NEWLY-BORN. 63 to the endurance of cold — a cruel idea that hardens many children into the grave, or sows in them the seed of disease and early decay. When the vital forces are actively exercising themselves in a healthy and vigorously-constituted individual, during the middle periods of life, the power of resisting the conse- quences of exposure to cold is at its acme. From these pe- riods, it shades off to the extremes of life — infancy and old age. It is not exposure to cold, nor the power of resisting the consequences of such exposure, that makes a healthy and vigorous constitution; but it is the accumulated effects of successive exposures that enervate and ruin such a con- stitution. In proof of this, it is a well-known fact that, dur- ing the late war, those men whose avocations were seden- tary and in-doors, as clerks and students, after becoming somewhat inured to the hardships of the soldiers' life, made more efficient and enduring soldiers than those taken from such pursuits as exposed them to the inclemency of the weather — farmers, for instance. With infants and children, constitutions are not made, but are to be formed. If exposures are enervating and ruinous to constitutions already formed, how much more so are they to those that are in process of formation? In the young, they not only bring about the immediate and remote conse- quences that the adult incurs, but the constitutions in their formative processes are stunted; and those children, at ma- turity, will be mentally and physically dwarfed. Heat and its maintenance at a uniform temperature, are so essential to the development, growth, and preservation of health in the foetus, the infant, and the adult, that nature provides means for its evolution, and carefully regards the uniformity of its 64 THE HEALTHY INFANT. temperature. But the "all-wise" man, in his self-sufficiency, says to her, This is, and this is not. Hence, the exposures and variations from the degree of heat that nature, in her most emphatic manner, tells us must be maintained. It is true, that nature can accommodate herself to the vicissitudes of heat and cold to a limited extent — as by necessity; but when wantonly persisted in, evil consequences, either im- mediately or remotely, will most assuredly follow. It is of the highest importance that due attention should be paid to the senses of hearing and seeing. The first must be scrupulously guarded against excess of sounds, and the second against excess of light. These organs, especially the latter, easily become diseased by subjecting them to deep im- pressions. The babe should, therefore, not be taken to the window, or be exposed to the direct rays of a lamp or gas flame. This is too frequently done in order to exhibit the babe to visitors. Heat is, also, injurious to the eyes, hence the infant should not be exposed to the direct rays of a fire. These facts make it quite obvious, that the chamber should be kept quiet and dark. The two remaining senses are those of smell and taste. The infant should not inhale strong vapors. There is an instance recorded of an infant dying from the effects of inhaling the vapors of a lininent that was be- ing used in the room. The infant should not, therefore, be permitted to inhale strong vapors, as camphor, ammonia, alcohol, and cologne, neither offensive odors. For this rea- son, soiled napkins should be promptly removed; and there should be daily changes of clothing. The sense of taste should be gratified only by the mother's breast. Having disposed of the senses, we will now consider the instinctive desires, and reflex action of the nervous MANAGEMENT OF THE NEWLY-BORN. 65 system. It is by these that the organism is excited to the exercise of its physiological functions, breathing, sucking, defecating, and urinating. To breathe is the first instinctive desire of the newly-born. There are several important conditions essential to perfect breathing. First, there must be a free supply of air, and it must be pure. An impure atmosphere is more deleterious to the young, than to those more advanced in age ; and when the newly-born is strug- gling for existence against the adverse circumstances attend- ing its birth, it is still more important that the air should be pure. It is at this time that the nerve centres require the stimulus of wholesome air, that the organism may not only be set in motion, but that it may continue in the healthy perform- ance of its functions. The importance of pure air in the lying-in chamber will be more apparent, when we consider the remarkable mortality which prevailed among the infants in the Dublin lying-in hospital ; and which ceased upon the adoption of Dr. Clark's suggestion, to ventilate the wards AND ADMIT FRESH AIR THROUGHOUT THE BUILDING. Prior to the adoption of this suggestion, and during the year seventeen hundred and eighty-two, there w T ere born in this institution, seven thousand, six hundred and fifty infants, of whom TWO THOUSAND, NINE HUNDRED AND FORTY-FOUR perished in a manner similar to that of carbonic acid poison- ing, which will be described presently ; third, the expansion of the chest, and the admittance of the air into the lung- cells, completes that part of the breathing process, called inhalation. The inhaled air meets a supply of blood brought by the pulmonary artery from the heart into the lungs. The blood takes up the oxygen gas and throws off the the carbonic acid gas, which is exhaled through the bron- chial tubes — this process is called exhalation. 66 THE HEALTHY INFANT. In the event of the blood failing to obtain a passage to the lungs, the carbonic acid will not be exhaled or eliminated from the system, where it will acumulate and act as a narcotic poison to the brain; and fatal results will necessarily follow, unless the little sufferer finds speedy succor. The indications that manifest the failing of the blood to arrive in the lungs are as follow : First, there will be observed a slight purplish hue in the complexion, particularly about the nose, lips, and nails, attended with drowsiness and languor. The purplish hue will gradually deepen, and the drowsiness grow to unconsciousness, followed by convulsions at short intervals, with increasing duration, until they become one continuous convulsion, gradually fading away with the in- fant's waning strength — death closing the scene. To this, the writer has frequently been a painful witness, in consequence of his being called too late to render effective aid ; but he has seen these patients, by the institution of proper measures for their relief, drawn from death's tightest grasp. Let us inquire into the cause of this failing of the blood to arrive in the lungs, and the means of its relief. There are four cavities in the heart, two auricles and two ventricles.* The former are placed above the latter, with which they communicate by valvular openings. The auricles are separated by the auricular septum, and the J\ > o! \> 30 CO < R. A., right auricle; L. A., left auricle; R. V., right ventricle; L. V., left ventricle; A S.. auricular septum; V. S., ventricular septum; F. O., foramen ovale; V., valve. \The other valves show the direction — when the foramen ovale is closed by its valve after birth — in which the blood is to flow when both auricles simultaneously contract. MANAGEMENT OF THE NEWLY-BORN. 67 ventricles, by the ventricular septum. The right auricle re- ceives the blood from the lungs ; and the left auricle receives the blood from the systemic circulation, when the blood is thus received by the auricles, they simultaneously contract, forcing the blood into their respective ventricles. The ventri- cles receive the blood; and by their contraction, force it in two directions. That from the right ventricle — passes into the left ventricle — passes, through the aorta, into the systemic or general circulation. This is not, however, the case be- fore birth. There is an opening in the auricular septum — foramen ovale — through which the blood passes from the right into the left auricle, as will be seen by the open valve, V, in auricular septum, as shown in the drawing, instead of the left ventricle, as above described. The opening ox foramen ovale is guarded by a valve upon the left side of the auricular sep- tum, so that when the auricles contract, the foramen is com- pletely closed, thereby, preventing the return of the blood into the right auricle, and thence into the right ventricle; but forces the blood into the left ventricle, so that when this ventricle contracts, the blood will be sent coursing through the systemic or general circulation, and not into the lungs, as the foetus can not, as yet, obtain an atmosphere to breathe. After birth, the valve over the foramen ovale must close and remain closed, that the blood may find its way into the right ventricle, and thence into the lungs. The non-performance of this act is the cause of the evil results above described. The only remedy is, to close this valve. This is accom- plished by placing the infant on its right side, with the head and shoulders well elevated.* In this position of the babe, a small ^The author usually advises the nurse to keep the infant in this position for a few days, as a precautionary measure ; and, like advice he has tendered, upon other subjects, has been regarded only as a superstitious or foolish idea, like tying up a lock of hair on the crown of the head to keep the palate up, 68 THE HEALTHY INFANT. quantity of blood upon the upper surface of the valve will cause it to close and keep it closed. The want of this func- tional performance occurs within the first week; or, the valve may become detached. This, usually, occurs within the first month or two. The writer saw an occurrence of this kind in a child a year old ; and there are instances re- corded of this taking place in adult life ; but these are of rare occurrence. After birth, the respiratory function marks an indepen- dent existence, and introduces a new source of heat, which, in co-operation with other processes of the economy, main- tain the desired equilibrium. In consequence of the feeble exercise of the vital forces in the tender infant, the amount of heat from this new source is not sufficient with ordinary wrappings to protect it from chilling influences; but it should be so protected as to be beyond the possibility of becoming chilled. ABLUTION OF THE NEWLY-BORN. This should be accomplished by spreading the contents of an egg over the entire body, and then place the infant in a warm bath, where it should be well and quickly cleansed, particularly the eyes % Soap should not be used about the head and face, lest it should get into the eyes, to which cause grave cases of opthalmia have been traced. Then let it be quickly dried with a soft cloth, and dusted with a dry- ing powder, such as a mixture of three parts of well-powdered starch and one part of French chalk. The belly-band is now to be well adjusted, the infant to be dressed in soft flannel, and placed in the position as above directed, and on a bed — not in a chair, to perish by some kindly visitor sitting MANAGEMENT OF THE NEWLY-BORN. 69 upon, as she may think, a little cushion. The infant will now repose for a few hours, or until the mother shall have had some refreshment from rest and food. The infant is now ready for its first meal. Inhuman is the mother who does not remember, with pleasing emotions, the first time she pressed the darling babe to her breast and felt its little mouth draw from her its nour- ishing fluid. Equally inhuman is she who is not saddened at the grievous moment when her babe "would not take the breast" but, by the unfeeling hand of death, passed from her. Thus it is that a benign Creator has made it incum- bent upon the mother to suckle her babe; and as the obli- gation of protecting the offspring begins with conception, so the obligation of the mother to suckle her babe begins with its birth. Of this end the Creator has not been unmindful, but has supplied another indication of his loving kindness — the neglect of which is not unlikely to be attended with just and severe retributive evils. The babe being now ready for its first meal, and the mother ready to serve it, they may both be placed in what may be called the nursing posture, i. e., the mother lying upon her left side, the babe upon its right, with its head and shoulders as highly elevated as is consistent with con- venience. The nipple is repeatedly placed in the infant's mouth until it " takes the breast." It draws therefrom a yellowish fluid, called colostrum, which is marked by charac- teristic effects upon the infant very different from those of the secretion when in its later stage. It is destined to meet certain exigencies, that neither milk nor any other substance can approximate in efficiency. And yet, we have daily manifestations of a disposition to turn aside from wisdom, 70 THE HEALTHY INFANT. resulting from experience and practical observation. The babe is thus victimized from the very hour of its birth, by extraneous feeding. And with what ? Cow's milk, mo- lasses, and fat bacon, are among the many pernicious things that find their way into the diet list of the newly-born ! This being only one of the crude ideas of hygienic management of the young, is it at all surprising that there should be so much sickness and mortality among infants and children ? Colostrum is a nutritious fluid, and eminently appro- priate to the necessities of the babe, until the "milk comes 17 It is a bland, yellowish emulsion, that dilates the stomach and purges the bowels, without producing colic and griping pains. The discharges, at first, consists of a blackish-green mucous secretion, called meconium. Unless this be dis- charged, it will produce serious derangements that, in some cases, have proved fatal; and, the necessity of the bowels acting at an early period is well known to mothers and nurses. When the infant is deprived of the advantages of the colostrum which nature has provided, and is fed with other articles of diet, the bowels do not act so kindly and efficiently. This is especially the case when cow's milk is substituted for nature's provision ; and as it contains more cheese than mother's milk, which coagulates and clogs up the intestines, and throws the infant into convulsions ; and should it escape the convulsions, the infant must then be sub- jected to the effects of a dose of oil, which is almost, if not quite, enough to terminate its existence. The yellow granulated corpuscles of the colostrum, to which the peculiar color of the fluid is due, as well as to the sparsity of cheese and milk globules, begin to disappear on the second day, when the two latter constituents begin to MANAGEMENT OF THE NEWLY-BORN. 7 1 increase in quantity. Thus, we have first, yellow milk, and then, white milk. The disappearance of the corpuscles is a very highly important circumstance; they have fulfilled their mission and must cease ; their continuance induces excessive purgation, which causes the body to waste away ; this affec- tion is known as colostration. Whenever such symptoms appear, the mother's milk should be examined with the microscope, and if the colostrum corpuscles should be found in the milk, the infant should at once be taken from her breast, and observe the directions for feeding the infant, given hereafter. Deep mental emotion agitating the nervous system, functional derangements of the digestive organs, and other circumstances, often cause the milk to be highly deleterious to the infant. A variety of disorders come from this source, and the mother is deprived of the pleasure of discharging one of the most important obligations due her offspring. Still more deplorable is it for the babe to have its mother wrapped in the winding sheets of death. These unfortu- nate circumstances render it necessary to feed the infant. But, with what ? The Apostle Paul manifested a high appreciation of the proper food of the young — " and are become such as have need of milk, and not of strong meat." The word strong may well be applied to milk, as well as meat, for as it is presented by nature in various species of animals, it differs in the strength of its various constituents to meet the neces- sities of the young of each species for which it was primarily intended. And we cannot feed the young of each species successfully wiih the milk of another, to do this, would be a violation of natural law, and the production of disastrous 72 THE HEALTHY INFANT. results. In the preparation of nourishment for the infant, let us imitate the beautiful workings of nature, by taking a half-pint of fresh milk of the cow, add half-pint water, and the cream of a second half-pint of milk, and sweeten with pure white sugar, and put it, while warm, into a bottle and cover with a gum nipple, we thus maintain the quantity of oily matter and sugar, and reduce the quantity of cheese to approximate the proportion contained in mother's milk. The colostrum corpuscles not being obtainable otherwise than by nature, the babe must not be deprived of their beni- ficial effects. Should the meconium not be prompt in pass- ing in sufficient quantity, half a grain of calomel repeated, if necessary, every five hours will be found the best course to pursue. Having disposed of the three most important and im- mediate necessities of the newly-born, we will consider some of the physiological changes that transpire in the mother during gestation, and those that present themselves after the birth of the babe. The unimpregnated womb is about as large as a medium sized pear, and somewhat like it in shape. It has very thick walls, as compared with the size of its cavity. When the creative power determines there shall be another living soul, nature applies herself with diligence and exactitude to the preparation of the uterine cavity for the reception of the primordial germ, which is to pass from the ovary through the fallopian tube. The germ is in the pre- pared matrix, where it very early begins to present the form of the parent in miniature. In the short space of nine months, the uterus increases to twelve inches in length, ten in breadth, and eight in thick- ness. While these rapid growths are not unattended with MANAGEMENT OF THE NEWLY-BORN. 73 their requisite drafts, and disturbing effects upon the mothers economy, there are also evidences of provision being made for the nutrition of the foetus; and, also, prospectively, for the sustenance of the infant after birth. Hence, imme- diately following impregnation, and increase in the size of the uterus, there are two sets of physiological changes that manifest themselves. First. — The digestive processes of the mother begin to elaborate, and place in her blood the various elements of the requisite pabulum for the development and sustenance of the offspring. These consist of butter, albumen, cheese, earthy phosphates, and iron. When these constituents are in super- abundance, they are eliminated by some of the emunctories. For this reason, the urine of the pregnant female frequently contains albumen, the simples of all animal products ; also, a substance called kiestine, which, perhaps, is the inter- mediate state in the metamorphosis of albumen into cheese. The non-elimination of the surplus of these albuminous compounds from the system is among the causes of the ner- vous derangements and diseases that accompany pregnancy, or attend the female in her confinement. Second. — This set of physiological changes relate to the breasts. By these, the elaborated food is separated from the blood and given to the infant. To this end, they take upon themselves increased nutrition, which is shown by their increased size, firmness, enlarged veins, coloration of the areola, prominence of the nipples, and finally, a watery dis- charge upon drawing the breasts; the colostrum, described above as yellow milk, and very soon passes into white milk, which now requires special attention, 4 74 THE HEALTHY INFANT. WHITE MILK. This is the food for the young of animals and of man. In the growth and development of the fabric, it supplies : a. The cheese or caseine. This substance is held in so- lution by the milk when fresh, and is distinguished from the other proteine compounds by its containing no phosphorus. In the construction of the soft parts, such as the skin, mus- cle, lung, liver, kidney, brain, and nerve, it supplies the carbon, hydrogen, oxygen, and nitrogen, which are the ulti- mate chemical constituents of these tissues. b. The frame-work to support and build the flesh upon is next to be considered. It consists of bone, which is formed of the phosphatic salts of lime, soda, potassa, and magnesia, held together by glue (bone glue), another one of the proteine compounds of animal matter. When there is an insufficient supply of these salts, the frame-work will be soft and flexible, producing a variety of deformitives. These salts are found in healthy, natural mother's milk in great abundance. c. We have already noticed the importance of heat in the developing processes, and in the maintenance of a healthy state of the human economy. To this end, there is a most ample provision found in mother's milk ; and consists in the sugar, one of the carbohydrates, a class of substances, which are found almost exclusively in the vegetable kingdom, and are made up of carbon, hydrogen, and oxygen. The nitrogen is omitted in this class, which is the distinction be- tween formative and respiratory food. Thus, we have a supply of carbon to unite with the oxygen brought by the air inhaled into the lungs, and of oxygen to unite with the carbon which may be set free in the changes which are constantly taking place throughout the entire body, MANAGEMENT OF THE NEWLY-BORN. 75 by which heat is produced, the temperature of which is regu- lated by physiological forces to be hereafter considered. d. The brain and nerves find an ample supply of phos- phorus (in combination with the lime, soda, and potassa) in mothers' milk. This is an essential element in their con- struction, and for the full performance of their functions. e. All chemical and vital formative processes require water for the solution of the elementary constituents which enter into the formation of the newly developed substance, and for which purpose water is supplied by the milk. Thus, efficiently, wonderfully, and wisely, mother's milk meets all the requisites of the offspring. This fluid is supplied by the mammary glands of the mother; and the physiologist studies the many formations of tissue to which milk is so well adapted ; but the interesting glandular structures by which the milk is separated from the blood and conveyed to the infant, are equally attractive of his admiration. He can not but appreciate the importance of their continued healthy state to meet the performance of their secretive functions ; and the whole period of pregnancy, attended with a con- stantly increasing efflux of blood to these glands, is a pre- paratory stage to this end. God thus plainly shows that, the proper nutriment of the babe is its mother's milk. When the infant is nourished by other means than the breast, the nursing instincts are lost ; the breasts are imperfectly drawn, the congestion increases, the cheese coagulates within the ducts, mammary abcess follows, and, perhaps, a loss of the utility of the glands as a sad result. In the healthy and well-formed infant there is usually no difficulty in getting the bowels and the bladder to dis- charge their contents. Should, however, these organs fail 76 THE HEALTHY INFAN1. to perform their functions in due time, the parts must be ex- amined for any malformation that might exist; and if there should be any discovered, the infant must be put into the hands of a competent surgeon. If the parts are found to be properly formed, then recourse must be had to remedial agents. The infant being born, and its immediate necessities supplied, its organism is so feeble through, at least, the first month as to cause it to spend almost the whole time in sleep — occasionally awaking to take its meals. This tendency to sleep is no more a special provision of nature for the infant than for the adult. The former sleeps for the want of strength of the vital forces to maintain the wakeful state; and the latter sleeps to restore the exhausted strength of the vital forces. Sleep is of the utmost importance to the infant, and should be duly managed. The position in which the infant should be placed during the hours of repose until it is, at least, a week old, has already been described. After this time, the babe may be placed on its back or either side. The objection to the former is, that the spittle is apt to trickle into the air passages and strangle the infant. It is advisable to change the position occasionally, as the babe has not the strength to relieve itself of an uncomfortable or even a painful posture, and of the cause and manner of re- lief it is even unconscious. The infant should sleep with the mother; but much care should be exercised in regard to its relation to her and the bedding. The weight of the cov- ering should not be such as to press heavily upon the infant; neither should it be permitted to slip down under the bed- clothes in such a manner as to cause it to inhale an atmos- phere contaminated with the effluvia from the body of the MANAGEMENT OF THE NEWLY-BORN. 77 mother. More than this, the infant is liable to be smoth- ered, instances of which have frequently occurred. After die first month, the infant may, in hot seasons of the year, sleep in the cradle, both night and day; but in cold weather the babe should, invariably, be the bed-companion of the mother. The cradle is a convenient piece of furni- ture, and, notwithstanding the opposition it meets with, it still retains its place in the nursery. When the babe is laid upon the bed, it is apt to roll off, or garments are apt to be thrown upon, and either injure or smother it; or, if it sleeps upon a lounge, it is liable to be sat upon by some careless visitor. The infant is secured against these accidents by placing it in a cradle or crib. In addition to this, by the portability of the crib, the babe can be placed in any con- venient place in the room. In cold weather, it should be near the fire, and never in a current of air, or near a win- dow or door, where the cold air will fall upon the sleeper. When the sheets are wet with urine, the nurse must not content herself by drying them, but they should be changed; and this rule should be observed in regard to the napkins and skirts of the infant ; and in making these changes, the newly-washed should be exposed to the fire, that perfect dryness may be insured. By the observance of this rule, the babe will never be put to bed with damp wrappings, thus avoiding this cause of disease. In the early periods of infancy, after feeding, the babe will fall into a state of re- pose ; whereas, when older, it will be necessary to "put the babe to sleep." Some people, to avoid the loss of time and trouble, place the infant in a cradle, and tell it, ' ' Now go to sleep." This seems harsh and unmotherly, and is not the treatment the infant expects to receive from the parent. But J 8 THE HEALTHY INFANT. rather let the sleep steal over the closing eyes under the in- fluence of a lullaby song. It is not sufficient for the infant to sleep, but the char- acter of the sleep is of much importance. It should be calm and sweet, otherwise, it cannot be refreshing, or effective in the development of the vital forces. The sleep must be profound and undisturbed, consequently, there should be no confusion in the nursery. The necessity of sleep makes it important that it should be attended with those conditions, which favor its continuance, until the wakeful state ensues from natural causes ; and never be put to sleep unless it is naturally sleepy. The infant is occasionally victimized to the convenience of the mother, or nurse, by the administration of an opiate, which is criminally wrong ; and another great wrong, is to awake the infant to be bathed and dressed, at the convenience of the mother. Light, being inimical to profound sleep, should be excluded. It is better to accom- plish this exclusion by use of the window curtains or shut- ters, than by surrounding the crib with curtains, which deprives the babe of the advantages of a free circulating atmosphere. Through the smallness of the stomach and the feebleness of the digestive organs, the infant cannot receive and digest the quantity of food necessary to sustain the organism through eight successive hours of sleep. The sleep will, therefore, cease, the respiratory muscles will become exhausted, and the infant becoming uncomfortable, will awaken hungry, and eagerly seek the mother's breast. Infants differ, however; some will sleep all night, awaking only early in the morning to take their meal, while others, again, will require the breast two to four times during the night; much of this depends upon habit. If the infant MANAGEMENT OF THE NEWLY-BORN. 79 sleep much through the day, it will be more wakeful during the night; and if not put to bed until it is quite wearied and sleepy, and retires with a full meal, the sleep will be pro- longed, profound, and refreshing. So THE HEALTHY INFANT, PART IV. INFANCY. At about the end of the first month, the impressions that have been made upon the senses will have disclosed in the infant the possession of those faculties with which it enters upon its life-time of discoveries. It will gradually- become familiar with those who administer to its daily wants, with surrounding objects, and with the sound of the language it is to speak. The transition of the organism, through the organic changes peculiar to this period of life, is not only- interesting, but a knowledge of them is highly important to the better understanding of the proper management of the babe. It is also interesting to observe, that while the infant is undergoing the organic changes consequent upon devel- opment, its constitution is becoming adapted and moulded to the manner of its future life. The formative processes of the bones and of the soft tissues, in addition to the demands made by the usual waste of the general economy, requires INFANCY. 8 1 a liberal supply of nutriment. Hence it is, that every part of the infant's economy is more freely supplied with blood than that of the adult. The pulsation of the heart is more frequent, it being one hundred and twenty-five to one hun- dred and thirty per minute. The skin is soft, tender, and sensitive. The head is proportionately larger, as is also the liver. The digestive organs feebly perform their functions, and the mucous membrane of the alimentary canal is quite sensitive — so much so that convulsions are easily induced by the presence of indigestible matter within the stomach or bowels. It is, perhaps, for the more perfect protection of this sensitive membrane that there is a thick coating of mu- cous spread over its surface in such manner as to give the appearance of a false membrane. The discharge of this mucous takes place, occasionally, in such quantities as will excite a suspicion of a diseased condition of the bowels, and the infant is placed under treatment for the supposed dis- ease, when, in fact, the symptom is nothing more than one of nature's sanitary measures. During the term of pregnancy, the foetus is in such a compressed state, that those muscles which flex or draw up the limbs, and double the body upon itself, are in a constant state of contraction ; and those which extend the limbs, and support the body in an erect posture, are necessarily drawn out to their full length. This relation of the flexor and ex- tensor muscles obtains during our sleeping hours, especially after much physical exertion during the day, when the ex- tensor muscles gradually relax, and the flexor muscles slowly contract, like a piece of gum-elastic when slightly drawn out and then laid upon a table; this slow contraction is occasionally attended with a spasmodic action, by which 82 THE HEALTHY INFANT. the sleeper is started, and sometimes awakened from his slumbers; and when we arise from our night's repose, we must flandiculate or stretch, in order to restore the equipoise of these two sets of muscles. This uneven state of the mus- cles is persistent long after birth, and exercise is necessary to equipoise them, so that the infant can extend the arm, as in reaching forth for an object; to extend the leg, as in walking ; and to keep the body erect, as in standing. By proper management, the muscular system will be sufficiently equipoised and developed, at the expiration of twelve months, to enable the babe to walk, and to present a beautiful and graceful figure; whereas, if improperly managed, the infant will be sluggish in its movements, and present an ungraceful appearance — if not absolutely de- formed. In the early months of infancy, the exercise must necessarily be passive, and this will be afforded by the handling to which the infant is subjected in its nursings, dressings, and ablutions, as well as by the voluntary move- ments of its extremities. It is highly important that the babe should be handled with the utmost gentleness and care. The necessity of this is made more patent by an appreciation of the feebleness of its organism. The bones are soft, loosely and feebly con- nected with each other. The muscles are too small and feeble to support the head and to keep the spine erect. It is through the feebleness of the muscles that the infant's head falls helplessly upon its shoulders, and that the spine curves upon itself unless otherwise supported. For these reasons, it is highly reprehensible to toss or throw the infant up and down or dandle it upon the knee. Infants are oc- casionally subjected to such violent treatment, either to INFANCY. S3 amuse them or to quiet their cries — when it is neither amus- ing nor any relief to their sufferings. On the contrary, it augments their sufferings, and may become the exciting cause of disease and deformities. Instead of such rough handling — the carrying of the infant constantly in the arms of the nurse, whereby its extremities are restricted in their movements — common sense would dictate the cradle or the floor as the place, and its clothing being so arranged as to permit free motion of its extremities. It is by the instinctive throwing about of its arms and legs that its muscles become evenly developed. Infants delight in the open air and sunshine, in riding in the baby carriage, drawn over a smooth pathway; while the inhalation of fresh air, the warmth of genial sun- beams, the change of scenery combined with exercise, add greatly to the healthy development of both body and mind. Therefore, the infant should be taken into the open air as often as the state of the weather will admit — re- membering, however, that exposure to an atmosphere of low temperature, without sufficient wrappings, will bring about catarrhal fever, bronchitis, and pneumonia; and that exposure to a damp atmosphere is an efficient cause of rheumatic affec- tions. These diseases are also brought about by exposure to draughts of wind, and those draughts or currents are formed by the streets. Thus it is that the idle habit of "standing on the corner" is productive of " bad colds " When the nurse takes the babe into the streets for an airing, she should be instructed not to stand on the corner, and to keep on the lee side of the buildings. In complying with these instructions, the infant may be saved from sickness, and perhaps death. However, when the weather is inclem- 84 THE HEALTHY INFANT, ent, it is far better that the babe should be within doors. It is quite refreshing to the babe to be taken from one apart- ment to another, and to be shown objects it has not recently seen. When taken in the arms of another, the nurse or at- tendant should enforce the proper manner in which it should be carried. The infant should be carried alternately upon each arm, that the pressure may be equalized, and thereby preventing any deformity that might arise from this cause : as, when the babe is carried constantly upon the same arm, one side would grow, and the other be stunted. Because of the softness of the spine, the body of the infant must be sup- ported by the shoulder and hands, while the extremities are left unrestrained. The infant should not be permitted to bear its entire weight upon its legs until it is at least nine or ten months old. At this age, it will begin to climb up by a chair, then to stand alone, and then to walk. The infant will occasion- ally get a fall, and a little fright, by which it will learn there is danger in falling. Without the trials and mishaps of early life, the child would grow up timid and irresolute. Infants who are not afforded nurses are more resolute and self-reliant, and require less attention, than those who are constantly under the supervision of an attendant. Of the many processes of infantile development, that of dentition brings with it the greatest anxiety, because of its painfulness, and of the danger of its becoming the excit- ing cause of grave complications and general derangements of the whole economy. There are none that should invite our closer attention, and lead us to more careful provision against its perils. Dentition is a normal process, and is governed by natural laws; hence, well-developed and healthy INFANCY. 85 infants, and those free from hereditary diseases, will pass its periods with little inconvenience or suffering. But those of feeble organizations, and those affected by hereditary ail- ments are apt, through teething, to fall victims to disease. It is both interesting and important to know the history of teeth formation; but only an outline of the process is al- lowed by the limits of this work. At the sixth and seventh week of intra-uterine existence, the mucous membrane of the jaw-bone forms a groove along the edge of the maxillary arch, where the teeth are to appear. A papilla for each tooth is then formed in this groove, which is called the pa- pillary stage. The groove is developed into a follicle, which finally closes the papillae. This is the second, or follicular, stage. The papillae begin to grow quite rapidly. At about the thirteenth week they become pulpy, and receive the forms of the future teeth. At the fifth month of foetal ex- istence, the dentine begins to form upon the pulp of the teeth, preparatory to the ERUPTION OF THE DECIDUOUS, TEMPORARY, OR MILK TEETH. These are twenty in number, of which eight are in- cisors , four canine, and eight molars. The incisors are so named from their presenting a sharp edge for cutting the food, and situated in front of the mouth, four in each jaw, two central, and two lateral. The canine teeth, from cam's, a dog, are also called cuspidati, from cuspido, to point or make sharp at the end. There are two in each jaw, one placed behind each lateral incisor. Those in the upper jaw are commonly called eye-teeth, and those in the lower jaw, stomach teeth. The molars, or grinders, so called from the Latin &6 THE HEALTHY INFANT. mola, a mill, number four in each jaw, two being placed be- hind each of the canine teeth. These are distinguished as the first and second, or anterior and posterior molars. DENTITION. Dentitio (the breeding or cutting of teeth), begins and proceeds in the following order, viz. : Sixth to seventh month, central incisors. Seventh to tenth month, lateral incisors. Twelfth to fourteenth month, anterior molars. Fourteenth to twentieth month, canine. Eighteenth to thirty-sixth month, posterior molars. Instances of great deviations from the above periods of eruption occasionally occur. When there is a premature de- velopment of the bones, dentition will also take place ear- lier than usual; while, on the other hand, in cases of slow- ness of bone formation, dentition is apt to meet with a cor- responding delay. When these latter conditions obtain, es- pecially when associated with a puny or an unhealthy state, the infant should be placed under treatment. In such cases, the administration of the hypophosphates is of great ad- vantage. The deciduous or temporary teeth subserve the purpose of mastication until the sixth or seventh year, by which time the roots are absorbed by the pressure of the permanent teeth, which now begin to develop, and become complete about the twentieth year. The process of eruption of the deciduous teeth is divisible into two stages, viz. : The first consists in an expansion of the capsule and its pressing against the gum, which gives rise to INFANCY. 87 an unpleasant or itching sensation, and relief is obtained by counter -pressure, or rubbing the gum. Hence, the babe will, almost constantly, have its fingers in its mouth, and will carry there everything it can grasp, with a view of relieving itself of the uneasiness. The irritation will extend to other parts of the mouth, and the effect upon the salivary glands is manifested by an increased flow of saliva, which, heretofore, was quite inconsiderable. As the expansion of the capsule progresses, the irritation will extend to other parts, until the general economy is affected. The infant now becomes restless. It will cry at one mo- ment, and laugh the next. These two expressions of oppo- site emotions will become so intermingled that it will often be difficult to distinguish between them. Twitchings and wakefulness disturb the sleep. The appetite becomes im- paired, and the bowels relaxed. The infant is much relieved of these disturbances by incising the gum, although the tooth may not appear above the gum for several weeks. This stage terminates by a cessation of all indications of teething, and the constitutional disturbances will lull for a month or six weeks, to be again excited by the Second stage: This commences by the renewal of the above symptoms in a more aggravated form. The tooth now rises out of the capsule, and pierces the strong fibrous tissue of the gum, which becomes much harder, and under the lancet imparts a sensation similar to that of cutting sole- leather. The arrest of the circulation in the gum from the pressure of the tooth, gives the gum a blanched appear- ance, and this, combined with its hardness, makes the gum have somewhat the appearance of true cartilage. When the tooth is well advanced, the gum becomes relaxed, the cir- 88 THE HEALTHY INFANT. culation returns, a red spot forms at the place where the tooth is to appear, and then the gums become swollen and tender. Relief is no longer obtained by pressure, or by rubbing the gum; on the contrary, such treatment is quite painful; hence, the babe will not put its fingers into the mouth, nor permit the gums to be touched. The irritability increases; the babe will take its toys and immediately throw them aside. Even the breast is only taken to be rejected. Neither is the babe quiet in any position in which it may be placed. There is a constant irritable fretfulness, which is extremely wearying to the attendant. Although such is the ordinary course of a well-marked case of teething, yet cases occur in which every degree of inconvenience and suffering is experienced, from those who pass through the stages, with- out attracting the attention of the parents or attendants un- til the tooth is discovered to be through the gum — to those who succumb to the complications of difficult dentition. There is also a difference in the degree of suffering conse- quent upon the eruption of the several teeth. The central incisors are quite easy in their eruption, while the lateral in- cisors occasion more suffering, and the molars rather less than the latter. The canine are usually attended with the greatest difficulty, and their process of eruption during the hot months is the cause of the infant suffering through its second summer. The most natural inquiry that arises in the mind of the parent is: Are there any means by which the sufferings and perils of dentition may be averted? Happily, observation, experience, and science reply : There are, and they may be employed with much efficacy. A happy issue out of the teething periods is much dependent upon the quality of the INFANCY. 89 food the infant eats, of the air it breathes, and the manner of its dressing, previous to the beginning of the eruptive processes. OF THE FOOD. The natural source of nourishment for the newly-born has already been considered — the mother's breasts. And there is no kind of food which is so well adapted to the wants of the constitution, and none so agreeable to the taste of the infant, until the appearance of the deciduous teeth, as mother's milk. These two facts become more patent when it is considered that the peculiarities of the constitu- tion and of the blood of the mother are transmitted to the infant, by which a natural correlation is established between the mother and her offspring, which is strengthened by habit and co-adaptation, to a degree that cannot obtain between the babe and another woman. Thus, in compliance with physiological law, as well as natural love and regard for the welfare of the offspring, it not only becomes the duty of the mother to suckle her babe, but also to supply a sufficient quantity of good milk. And in order that this end may be attained, the mother must be instructed as to the regimen best suited to the nursing female. This information, how- ever, would be of little advantage to the infant, unless the mother should cheerfully comply with all that the regimen may demand. Reference has already been made to the several con- stituents of a normal secretion from the mammary glands of the nursing female, and the part they perform in the nutri- tive processes of the offspring. But a knowledge of their physical and chemical properties is not only essential to the 90 THE HEALTHY INFANT. proper management of the mother through the nursing pe- riod ; but also for the proper treatment of the babe. When the milk is fresh from the mother's breast, it is a white, opaque, sweet, and slightly alkaline fluid, consisting of water, holding in solution salines, sugar, and caseine, with a quan- tity of oleaginous matter, and butter suspended in an emul- sified or milk-like form; and when taken into the infant's stom- ach, it is easy of digestion and highly nutritious, without dis- turbing the economy by nausea and vomiting, purging and griping pains. Its efficacy as a nutriment for the babe cannot be equalled by any other fluid or article of diet that art can produce. The salines consist of phosphate of iron, soda, lime, potassa, and magnesia, with a trace of chloride of so- dium and of potassium. The salines are derived from the blood of the mother, and are nearly identical with the salts of that fluid; and as the quantity is proportionally greater in the milk, springs and wells should, therefore, supply the nursing mother with the water by which she slakes her thirst, and not cisterns, into which water is gathered from eaves-drippings; for such water does not contain those salts which, as we have seen, is so essential to \hs young. So long as the milk retains its alkaline reaction, the caseine is held in solution; but when the milk becomes sour, the caseine is precipitated. This change in the milk necessarily takes place in the stomach, as the first step in the digestive pro- cess; and when the infant has taken large quantities of milk into its stomach, or when the digestive organs have be- come enfeebled from some irritating cause, such as teething, flakes of coagulated cheese will appear in the ejections; whereupon, the anxious mother unnecessarily has the babe treated for diseased bowels. The proper course, however. INFANCY. 91 is to let the babe alone, unless there should be some general disturbance. Then the babe should be restrained from nursing too freely; and should the disturbance continue, an aperient, such as half a grain of calomel, or a teaspoonful of spiced syrup of rhubarb, should be administered. The caseine of mother's milk is not so readily precipitated upon the addition of acids as that of cow's milk; from which it may be inferred that the former is more soluble than the latter. This difference between the two kinds of caseine is in favor of mother's milk, and strongly supports the opinion of its better adaptation to the digestive organs of the infant than the milk of the cow. The milk-globules consist of a peculiar fatty substance, known as butter, and is composed of glycerine, united with various acids, which form butyrate, capronate, caprate, and oleate of glycerine. The first of these is the one to which the odor of butter is due. Milk sugar, found only in animal milk, supplies the babe with the carbon which, in its con- version into carbonic acid by the inhaled oxygen of the air, aids in producing and maintaining the necessary temperature of the body. We have already seen that the milk which is secreted immediately after delivery, is widely different, both in its properties and in its constituents, from that which is secreted a few days after the birth of the infant. This alter- ation in the properties and in the constituents of the milk, is attended with a gradual increase of the salines and of the caseine, to meet the increased demands of the infant. These two constituents continue to increase until about the second month, after which time any change in their proportional quantities will depend upon the diet of the mother, and the state of her health. The oil-globules attain to their niaxi- 92 THE HEALTHY INFANT. mum quantity within the first month. After this time, the relative proportion of milk-globules will depend upon the quantity of fatty matter which enters into the mother's diet. It also appears from analysis that the sugar attains to its maximum quantity within the first month, and that each suc- ceeding month, until the sixth, the milk has less and less sugar. It is of the highest degree of importance to the healthy development of the infant, for the milk to be secreted in sufficient quantity and of good quality. As regards the first of these, the quantity secreted in a given length of time cannot be definitely ascertained, because the infant can draw a larger quantity of milk from the breast than can be drawn with fingers or a breast-pump. A knowledge of the exact amount of milk secreted in a given length of time is, however, of little practical importance, inasmuch as infants differ in the amount of food required for their sustenance and growth; and the quantity for the nourishment of the in- fant also depends upon the exact degree of the richness of the milk in its various constituents. Therefore, the question is not, How much milk is secreted? but rather, Does the babe obtain a sufficient amount of nourishment from the mother's breast? As the infant cannot express itself vocally, we must learn to interpret the manner of expression peculiar to them; and there is nothing which will elicit from an infant stronger manifestations of displeasure than an insufficient supply of milk to fill its stomach, for the infant does not crave the breast so much to satisfy hunger, as to fill the stomach ; and when it accomplishes this, it is quite satisfied; and when this organ is emptied, either by the digestive pro- cess, or by regurgitation, it will again demand the breast INFANCY. 93 And when the quantity of milk obtained is insufficient to fill the stomach, the infant will fret at the breast; and it now becomes a difficult task, indeed, to divert its mind from the partially-filled stomach. How differently it will behave when the supply is adequate to its wants ! It will quit its meal fully satisfied, and will fall asleep, or return to its amusing frolics, without exhausting the supply in the breast. We will consider only a few of the causes of a dimin- ished flow of the secretion. Cases in which the breasts are insufficiently developed are of rare occurrence. But when this occurs, we then have an example of the promptness with which nature responds to calls when made upon her, for when the infant is put to the breasts, they will increase in size until they are sufficient to secrete the quantity of milk adequate to the wants of the infant. The excitement of the nutritive nerves of the mammary glands, caused by the infant sucking the nipple, is not only helpful to their farther development, but it is also the most potent means of inducing a flow of the secretion. Even men have been enabled to act as wet-nurses, by the frequent application of the infant to the breasts. An opposite condition is sometimes met with — in enlargement of the glands. This enlargement of the glands may be due to an increase in size of the glandular structure itself, or to an accumulation of fat about it. This deposi- tion of fat presents no impediment to the act of nursing, nor to the infant obtaining an adequate quantity of milk. The nipple is sometimes so contracted as to prevent the in- fant from grasping it with the mouth. Such contracted nip- ples can be drawn out with a breast-pump, a nipple-glass, or by taking a vial with a mouth sufficiently large, immerse it in boiling water for a few moments, and then, when empty 94 THE HEALTHY INFANT. and the rim of the mouth is cooled a little, by dipping in cold water, apply to the nipple and press a small wet cloth over the vial, which, upon cooling, will draw the nipple out sufficiently for the infant to draw. The author has fre- quently resorted to this little expedient with perfect success. A more painful and annoying complication of the breast, is an inflammatory action, terminating in mam?nary abscess. While this complication is met with in any period in the course of lactation, it most usually occurs shortly after the "milk comes" or when the caseine and milk globules appear in increased quantity. There is no disease more tractable than mammery abscess in the lying-in female ; provided the treatment be commenced sufficiently early, properly con- ducted, and, above all, the patient be properly nursed. Among the most efficient remedies for this affection is, fluid ext. poke. Twenty drops to be given every three hours until relief is obtained. The writer has had many occasions to be grateful for an agent so efficient as this one article. In further consideration of the mammary glands, we find there are conditions of other organs of the economy, which lessen the quantity of the secretion ; but a full ac- count of them would be too extensive for our present pur- pose. Among the most important, however, are the follow- ing, viz. : Intense and often repeated mental emotion, acute inflammatory disease, dyspepsia, pregnancy, and a re- turn of the menstrual discharge, and issues of whatever kind. All these will affect the quantity and quality of the milk, and in a sad degree disqualifies the mother to act as a nurse for her babe. Agalaxy. This word implies either, a deficiency sup- ply, or an absence of the milk; and a galactagogue, is INFANCY. 95 a medicine, or an agent, by which the glands are excited to the performance of their secreting function. The application of the infant to the breast has already been mentioned as a potent means of inducing a flow of milk.* M. Becquerel used electricity as a gozlactagogue ; and succeeded in restoring the secretion after a total suspension in one of the glands, while there was but little remaining in the other. The inhabitants of Cape de Verde Islands, highly esteem the castor oil plant for this purpose. The plant is used by making a strong decoction of the leaves, with which the breasts are bathed for a short time, and then some of the leaves are laid upon the breasts, and permitted to remain until they become dry. It is said, there are two varieties of this plant: viz. — white and red. The natives use the former, and regard the latter as possessing no galacta- gogue milk-producing virtues whatever. The milk as supplied by the mother's breasts may be sufficient in quantity, to fill the stomach of the nursling ; and ) r et, be insufficient to nourish the general economy, and then the infant is said — "not to thrive at the breast," So long as the nourishing fluid is sufficient to meet the immediate necessities of the infant, i. e., to fill its stomach, it will no longer ex- press itself in the manner as above described, although the milk may be deficient in its inherent properties, and the infant suffering the consequences. The effects of this latter condition of the milk upon the infant will be such as are pro- duced by a slow process of inanition or starvation. These effects will steal so slowly upon the little sufferer as to pass unnoticed until the more marked results ensue, such as extreme emaciation, diarrhoea, or an eruption upon the cutaneous surface. *See Braithwait Retrosp. Part 36. $6 THE HEALTHY INFANT. And for these supposed acute diseases, the mother obtains professional advice; whereupon the case is learnedly named and classified, and the poor sufferer is victimized to dosings of cod-liver oil with whiskey, astringents, alter- atives, and tonics; whilst the true nature and cause of the afflictions are wholly lost sight of by both mother and physician, and the infant dies. Under this slow process of starvation, the brain does not receive its due stimulus, and the nervous system is not sustained. The subject, therefore, becomes less animate and displays less energy in its frolics. The sleep becomes less refreshing and more disturbed. The fat now ceases to in- crease in quantity, and then begins to be absorbed to supply the deficiency of combustive material in the nourishing fluid obtained from the mother. Anorexia or loss of appetite sets in. The organs cease to perform, with due regularity, their daily functions. The effete matters, which, as we have already seen, are incompatible with a continued healthy state of the economy, now remain in the system, and there supply the pabulum for the virulent growth of pestiferous diseases. This is graphically presented in the following quotation : "A deficiency of food, especially of the nitrogenous part, quickly leads to the breaking up of the animal frame. Plague, pestilence, and famine are associated in the public mind, and the records of every country show how closely they are related. The medical history of Ireland is remarkable for the illustrations of how much mischief may be occasioned by a general deficiency of food. Always the habitat of fever, it every now and then becomes the very hot-bed of its propa- gation and development. Let there be but a small failure in the usually imperfect supply of food, and the lurking seeds of pestilence are ready to burst into frightful activity. The famine of the present century is but a too forcible illustration of this. It fostered epidemics which had not been witnessed in this generation, and gave rise to scenes of INFANCY. / 97 devastation and misery which are not surpassed by the most appalling epidemics of the Middle Ages. The principal form of the scourge was known as the contagious famine fever (typhus), and it spread, not merely from end to end of the country in which it had originated, but, breaking through all boundaries, it crossed the ocean, and made itself painfully manifest in localities where it was previously unknown. Thousands fell under the virulence of its action, for wheresoever it came, it struck down a seventh of the people, and of those whom it attacked, one out of nine perished. Even those who escaped the fatal influence of it were left the miserable victims of scurvy and low fever. Another example not less striking, of the terrible consequences of what may be truly called famine, was the condition of our troops during the early part of their sojourn in the Crimea, in 1854. With only just enough of food to maintain the integrity of the system at a time of repose, and at ordinary temperatures, they were called upon to make large muscular exertions, and to sustain the warmth of the sys- tem, in the midst of severe cold."* The whole matter of feeding the offspring should be en- trusted to the mother, who should be qualified by the posses- sion of a thorough knowledge of all the practical details of feeding the young, and to be able to quickly apprehend whatever may go amiss. Such a mother will, when it be- comes necessary to have professional advice, be able to place before the physician such facts as will lead him to a correct diagnosis of the case and to such treatment as will bring about a cure. The author has met with such women, and they were, in the true sense of the word, mothers. There is scarcely a circumstance in the affairs of in- fantile existence that affords more serious grounds of regret than that the infant should be deprived of its mother's breasts as its source of nourishment. And this becomes a matter of greater moment when we consider the imperfectly developed *See Aitken, Science and Practice 0/ Medicine, vol. 1, p. 737. 5 98 THE HEALTHY INFANT. state of those glands which supply the secretions which are essential to the conversion of food into chyme, and then into chyle ; and then the absorbents are not yet capable of per- forming their function in a vigorous manner. Take, for in- stance, the salivary glands. The secretions from these organs are of the highest importance in the digestion of certain substances, for which purpose it flows freely into the mouth and is mixed with the food during mastication. Whereas, with the infant, as we have already seen, the mouth is quite dry until the eruptive process begins, when the irritation caused by the coming teeth excites a flow of saliva preparatory to the digestion of food stronger than milk. And if we were to continue our investigations of the secretions of all the digestive organs of the infant as we have that of the salivary glands, we^ would not be long in arriving at the conclusion that we might as well expect a rich harvest from seed sown upon a sandy plain, as to expect the infant to thrive when fed upon food so unsuited to the physiology of its organism. Such articles of food consist of soups, pap, panada and gruel, made of water, flour, oat meal, corn-meal and molasses, which require for their digestion, the powers of the adult organism. What results then may we expect to accrue to the infant from such unnatural feedings, other than gastric irritation, diarrhoea, enlargement of the mesenteric glands, hepatic derangements, emaciation, jaundice, con- vulsions, and death? Doubtless there are mothers and nurses who will regard all this as the product of a fertile imagina- tion ; but when we review the practical results obtained from the efforts that have been made to "bring up children by hand" we find the above to be an appalling reality. In institutions provided for the benefit of foundlings, INFANCY. 99 and where it is imposible to provide wet nurses for such great numbers of these little dependents, the death rate resulting from this one cause only, viz.: the unfitness of the food to the manner in which the digestive organs perform their functions in early life — kill from forty to ninety in one hundred of those suffering infants. Is not this alarming ? Do we not learn from this a lesson sufficient to keep mothers and nurses from cramming their infants with vile amylaceous (or starchy) compounds, under the false idea that mother's milk, als>ne, is insufficient to sustain and to nourish the infantile organism? It is true, that, in the rural districts, where the infant obtains a pure atmosphere, wholesome waters from springs and wells, pure fresh milk supplied at all times by the same cow, and the undivided attention of the mother or nurse, the mortality among children reared by hand is much less than among those who dwell in cities and especially in asylums. However great these advantages may be, all observers and authors are agreed as touching this one point, viz. : the rearing of infants by hand is attended with great risk to the health, and life itself, of the infant ; and for these reasons should be conducted with the utmost care, attention and precaution. We have already considered the necessity of providing for the unfortunate infant an article of food, possessing, as nearly as possible, all the properties belonging to mother's milk j and that this is obtained by mixing a quantity of cow's milk with its bulk of water, and the richness of cream main- tained by the addition of that which is taken from a like quantity of milk, and the sweetness, by the addition of pure, white sugar. Let it be remembered, that the caseine of cow's milk is not so soluble as that of mother's milk, and as car- bonate of soda exercises the power of promoting the solu- IOO THE HEALTHY INFANT. bility of caseine, therefore, a trace of this substance may, with great propriety, be added to the fluid. After the food is thus prepared, let it be warmed and then put in a con- veniently sized bottle that is absolutely clean and dried in the sun or heated by the fire, and when covered with a gum nip- ple it is ready to be given to the infant, who, if healthy and in good condition as regards all the circumstances which con- stitute comfort, will eagerly seize the bottle and carry the nipple to its mouth, and relish a hearty meal. And let this be repeated as often as the infant asks for its meals iu the lan- guage which the mother or nurse so soon learns. The healthy infant should be the sole judge as to the quantity to be taken at a meal, and that will be when its stomach is full. Now, this whole proceeding seems, to many mothers, to be quite simple, in fact, so much so, that they will entrust the preparation of the food, and the feeding of their off- spring to a careless, slip-shod servant woman, or even to a little girl employed in the family as a nurse. Were it possible for all the dead infants to arise from their graves, and tell the world what had been the prime cause of their death, the number of those who would point to the careless manner in which their food had been prepared, and the condition of their nursing bottles, would be appalling ! astounding ! ! over- whelming ! ! ! Therefore, mothers, do not let your infants perish for the lack of your personal care and supervision. For this is a duty that Nature's God imperatively imposes upon you. The importance of exercising great care, and of taking the utmost precaution in feeding the young, are of such moment as to demand special notice. In the preparation of the food, as above described, the first step is to obtain fresh cow's milk, and at all times sup- INTANCY. IOI plied by the same cow. The mother must, if possible, and of her own knowledge, know these to be the real conditions of the milk. It is of equal importance for her to know that the milk has been properly handled. All the vessels, and strain- ers into, and through which the milk is to pass, should be ab- solutely free from the slightest trace of old milk adhering to any part of the vessels. This degree of cleanliness can be obtained, only by having a number of vessels sufficient to admit of daily changes, and after a thorough scalding and washing, let them lie a day exposed to the sun aud air. The water should be obtained from a spring or well, that the quantity of earthy salts may be maintained in the food, whereas, if soft water is used, it is quite obvious that the proportion of these salts would be reduced to just one-half the quantity that nature has designed to be sufficient to sup- ply the necessities of the offspring. There should be only a small quantity of the food prepared at one time. Three or more druggists' prescription vials of four or six ounces ca- pacity, with a like number of gum nipples should be obtained, and kept constantly at hand. And the same constant care should be exercised in regard to the cleanliness of the nurs- ing bottles and nipples as is bestowed upon the milk-vessels. As gum-tubes can not be cleansed and aired so readily and perfectly, let thern be expunged from the nursery as you would poison, for doubtless they have been the prime cause of the death of many infants; and for this reason, their use in feeding children can not be condemned in language too strong. When indications of teething begin to appear, the saliva increases with the advancing teeth until the flow is quite free, which is an indication that the organism is approaching that stage of development preparatory to the digestion of food 102 THE HEALTHY INFANT. other than milk. If, however, the infant is thriving on the "nursing-bottle" or at the breast, let well enough alone; but if in connection with the beginning of the teething process, and the increased flow of saliva, there should be any indi- cations of the infant becoming dissatisfied with its food, or of its getting into a bad condition, it would be expedient to introduce a change of diet. The milk may now be less di- luted with water, or, thickened with arrow-root. Liebig's soup is represented, by those who have had experience in its use, as being admirably suited to the wants of the infant, and is made as follows : — Take of wheat flour and dried malt, each, one-half ounce; bicarb, potassa, seven and one-half grains; water, one ounce; mix, and add milk, five ounces. Put the vessel on a fire, and, with constant stirring, heat slowly until the mixture begins to thicken; then the vessel is to be removed from the fire, and the stirring continued for ten minutes. This process is to be repeated the second time. The mix- ture will become still thicker; and the third time, place the vessel upon the fire, and let the mixture come to a boil. The bran of the malt is now to. be separated by passing the fluid through a fine sieve. The soup is now ready for use. Concentrated milk is a most excellent article of diet for the infant, and the author is happy to say that he has found marked beneficial results from its use in many instances. Carrot pap is recommended by Dr. Grumprecht, of Hamburg, and is prepared by mixing one ounce of finely- grated, full-grown carrots with two cupfuls of water, and let stand for twelve hours, frequently stirring in the meantime._ INFANCY. 103 It is now to be strained, and the residue compressed, that the juice may also be obtained. To the fluid thus obtained is to be added finely-powdered biscuit, crackers, or farina, that a pap may be made, and then placed on a slow fire, and heated short of the boiling point, that the albumen may not be coagulated. Sweeten with pure white sugar, and it is ready for use. It is advised not to use the carrot pap if there is any tendency to diarrhoea. Another method of preparing the pap is, to take one ounce of grated yellow carrot, and two drachms of pow- dered biscuit, with two cupfuls of soft water. Mix and let stand in a cool place for twelve hours; then strain, add a little salt, and sweeten with sugar-candy. Warm the pap, and let the infant take its meal from the nursing -bottle. The author has found the following preparation to agree well with the infant, and also useful as a curative in diar- rhoea: Take a teacupful of dry flour, and tie it up closely in a cloth or rag, and then boil constantly for two consecutive hours, at the end of this time, the flour will have been formed into a ball (the centre of which will be hard and dry), which is to be grated into a powder, sweetened, and mixed with milk to the consistency of gruel when it is ready for use. Water that is cool, not absolutely cold, is as necessary, as much desired, and as agreeable to the infant as to those who are more matured, especially during the teething pro- cesses when the gums are irritated, and the mouth hot and feverish. Wet nurses are sometimes obtained to supply the mother's place to the unfortunate infant, but it is almost impossible to to find one, just at the time she is wanted, who will suitably 104 THE HEALTHY INFANT. fill all the necessary conditions, as these are numerous; and the attempt to comply with them all, opens up so many avenues to deception, that, even those who are most skilled in the selection of such a nurse are easily imposed upon. But, if it is determined to employ a wet nurse, let it be re- membered that the milk changes, as we have already seen, in both its qualities and properties with the increasing age of the infant, therefore, it is one of the essential conditions that the nurse should be the mother of an infant that is of the same age as the one deprived of its own mother's breast. If this condition is not complied with, evil, rather than bene- ficial results, will ensue. A newly-born infant, if nursed by a mother whose babe is several months old, is likely to be- come scrofulous. The nurse, and the mother whose place she is to supply, should be of the same build and tempera- ment; as the babe of a short, heavy-set woman, will not thrive at the breast of a tall, spare woman ; and the reverse of this is also true. It is quite easy to be deceived in re- gard to the quantity and quality of the milk. If the infant of the nurse is in a thriving condition, it is evidence that the milk is of sufficient quantity, and of a quality that agrees with her own babe; but when she takes another infant to her breast, it does not necessarily follow that these condi- tions of the milk will continue to be adequate to the neces- sities of both infants ; on the contrary, the milk may become deteriorated in quality, while it increases in quantity, and neither of the infants will thrive so well as the nurse's own did, before taking the second one to her breast. Under these circumstances, the nurse will naturally, in a grad- ual and an unconscious manner, be led to favor her own babe. The one will seem to thrive, while the effect of this INFANCY. 105 slow process of starvation on the other, will be attributed to other causes, for the nurse, honestly thinking, but egre- giously mistaken, declares her impartial treatment of the two infants. These effects will gather upon the little sufferer, and hurry it off to its final resting-place before the parents are aware of the perils which surround their offspring. It is scarcely necessary to observe that the nurse should be a healthy woman. And this is not, at all times, an easy mat- ter to determine, as disease, either hereditary or acquired, may exist in the blood in a latent form, or the history of the nurse may be so imperfect, or lacking altogether, as to de- ceive those who are most expert in such examinations. Therefore, the only method of securing the infant from be- coming infected, is not to employ a wet-nurse. The bosom should be full, round, and plump, with not the least sore about the nipple. It is of the utmost importance that the nurse should be kind, gentle, quiet, willing, and subservient in the discharge of all her duties, honest and faithful in all of her trusts. It is only by a certainty that the nurse possesses these qualities that the infant is saved from the effects of many hurtful and deceptive irregularities of the nursery. She should be free from the habit of flying into fits of passion and outbursts of temper, as these conditions of the mind exercise very de- leterious effects upon the blood, and, consequently, the nourishing fluid. The following instance constitutes a marked illustration of the effects of passion upon the milk and the consequent results to the offspring, mentioned by the physican to the king of Saxony, in his work previously referred to: 11 A carpenter fell into a quarrel with a soldier, billeted in his house, and was set upon by the latter with his drawn sword. The 106 THE HEALTHY INFANT. wife of the carpenter at first trembled with fear and terror, and then threw herself furiously between the combatants, wrested the sword from the soldier's hand, broke it in pieces, and threw it away. Dur- ing the tumult some neighbors came in and separated the men. While in this state of strong excitement, the mother took up her child from the cradle, where it lay playing, and in the most perfect health, never having had a moment's illness, she gave it the breast, and in so doing sealed its fate. In a few minutes the infant left off sucking, became restless, panted, and sank dead on Us viother's bosom. The physician, who was instantly called in, found the infant lying in the cradle as if asleep, and with its features undisturbed ; but all his re* sources were fruitless. It was irrecoverably gone."* This, although an extreme case, should be a warning to those mothers and nurses who indulge in outbursts of pas- sion, for such conduct will surely bring evil to the offspring. OF THE AIR THE INFANT BREATHES. The absolute necessity of the infant breathing a pure atmosphere has been duly considered, and clearly shown by the success which attended the adoption of Dr. Clarke's sug- gestion to ventilate the wards and admit pure air through- out the building of the Dubfai Lying-in Hospital. ■ of the clothing. In clothing the body, we have two objects in view : first, to conceal nakedness; second, to maintain that degree of temperature which is normal to a healthy state of the economy. In attaining the first of these, care is to be taken that the garments are so constructed and adjusted to the body as not to prevent the free movements of the extremities, the move- ments of the chest- walls in breathing, or to interfere with the circulation of the blood. The second object is to be consid- ered in determining the kind of material of which the gar- ments are to be made, and the amount of clothing with which *See Combe on Infancy. INFANCY. I07 the infant is to be clad. The necessity of duly regarding the temperature of the young is rendered more manifest, when we consider : first, that the normal temperature of the infant is somewhat higher than that of the adult. It is this fact that causes the nurse to exclaim : i 6 Why, how hot the baby is ! A baby is as hot as an oven." Second, the smallness of the quantity of blood, and the thinness of the tissues which intervene between the blood and the atmosphere afford less protection against chilling influences. From these circum- stances, the infant will, when exposed to a low temperature, become chilled much sooner than the adult. As is the case with water, a drop exposed to a low temperature will freeze immediately, whereas a large body will require a much lower temperature, and a longer period of time to accomplish its consolidation. Many infants are annually lost for the want of a strict attention to these facts, and although fashion and custom are blindly followed, and, with procrustean cruelty, rigidly adhered to, instead of being adapted to the wants of the infant, mothers wonder why their children do not thrive! " Certainly, says Dr. Meigs, I have reason to think that thousands of lives are annually sacrificed to mere fashion in dress, whether of those that are born in hot, or those that come into the world in the cold seasons." This immense sac- rifice of human life can easily be arrested by supplying the necessities of the infant, instead of using it as a toy to dis- play a foolish, extravagant expenditure of money, in order to gratify a morbid taste in dress. It is impossible to indicate the quantity of clothing the infant should wear, because the several latitudes vary so widely in degrees of temperature, as well as in the seasons of the year, and of the extent of comfort supplied by the house in which the infant may dwell. These circumstances, Io8 THE HEALTHY INFANT. when duly considered in connection with the degree of tem- perature normal to infantile life, will be the best guides as to the amount of clothing the infant should wear. The or- ganization of the adult, as we have already seen, is not so easily impressed by the changes of temperature as that of the infant; hence, the nurse cannot determine, by her ^wn feelings, as to the warmth of the infant, but must examine by touch, and observe every manifestation of cold, and clothe the infant according to its necessities. The head should be left bare, except when taken out of doors; then a hood, cap, or bonnet, should be used to protect the head from the sun, wind, or cold; and these will determine the character of the head-covering. Experience has taught us it is best for the infant to wear a flannel or woolen skirt through the first two years, as the changes of temperature in the infant take place too suddenly when it is exposed f> a higher or lower degree of temperature. When the infart has arrived at the hot days of its third summer, the flannel may be replaced by lighter garments, as the continuance of the flannel skirt would become oppressive. OF WEANING. Many evils of dentition may be averted by strict atten- tion to the time and manner of weaning the infant. When the incisors are through, which, as we have seen at page 8*, is during the tenth month, the infant should be allowed iood, in very small quantities and at long intervals, other than mother's milk. Such feeding is not only harmless, but is actually demanded by the workings of nature in the infant. Early feedings may consist of bread boiled in milk, with a pinch of salt added, a roasted potato mixed INFANCY. I09 with gravy, chicken broth, soft-boiled eggs, rice pudding, arrow-root boiled in water with an addition of milk. Such feeding may be continued until the appearance of the ante- rior molars, which takes place from the twelfth to the four- teenth month, when a stronger diet may be introduced by way of meats and vegetables. If these are found to agree with the infant, its hunger will be appeased with a dietary that is more agreeable to its taste and compat- ible with its organism, and the withdrawal of the breast becomes an easy matter. It must be observed that this is to be done in the fall, winter, or early spring, and never during the hot months. The infant who is blessed, by having all these conditions fully and properly filled, will pass through the teething pro- cess with but little trouble, whereas, the one who has not been so fortunately circumstanced, will suffer more or less severely, if not removed by death. IIO THE HEALTHY INFANT. PART V. THE INFANT IN SICKNESS. However healthy and free from hereditary taints the par- ents may be, and healthy and vigorous the infant may come into the world, and actively its organs may perform their func- tions, the healthy infant is liable to be overtaken by sickness or disease. And when this unfortunate circumstance occurs, it then becomes necessary to provide means for the comfort and restoration of the infant to a state of health. To supply it with those things which are essential to its comfort, is the duty of the mother, or nurse, and constitutes nursing; whereas the means of restoration consists in the medica- tion or treatment of the case, and this is the duty of the medical attendant. When the infant is discovered to be ailing, the first duty of the nurse is to provide a chamber suitable for a "sick-room." There are several circumstances which add materially to the fitness of the chamber for the habitation of the sick. Its THE INFANT IN SICKNESS. Ill location on the second or third floor will secure a purer at- mosphere, and a better circulation of air throughout the room, than if situated on the first floor of the building. The air should be admitted in such a manner that it will not fall upon the patient, when the bed is placed near a window, and the sash lowered from above. Neither should the patient be placed in a draft, as between two open windows. A circumstance that is in the highest degree essential to the welfare of the infant in sickness, is quietude, that the nervous system may be tranquil and the sleep refreshing. These will render the medicines prompt and efficient in their action upon the system, and, therefore, a chamber should be selected in which the stillness is undisturbed by noise from any cause whatever, such as a busy street. In conducting the household affairs, the ringing of the door-bell, the tread of footsteps in the hall, and the constant inquiries in regard to the condition of the patient, should be avoided. The maintenance in cold weather of a uniform temper- ature throughout the room, is a matter of the utmost im- portance, and the author has met with more than one in- stance in which he was forced to ascribe the cause of the illness and death of his patient to a lack of uniformity in the temperature of the apartment which the infant occupied. The lack of a uniformity in the temperature of the chamber may be due either to the very high ceiling, badly-fitting doors or window-sash, the construction of the chimney, or the setting of the grate. A chamber so imperfectly warmed will be un- comfortable as we go towards, or farther from, the fire; "one side will burn, and the other freeze." Such rooms are wholly unfit to be inhabited by either the young or older persons, even when in health. If the grate is faulty, let a stove be in- 112 THE HEALTHY INFANT. troduced into the chamber, and an open vessel filled with water kept constantly on the stove, that a due amount of vapor may be maintained in the atmosphere. The tempera- ture of the room should range from 6o° to 70 Fahr., ac- cording to the condition of the patient. After the selection of a room in the residence that is most susceptible of being made to comply with the above conditions, it should be thoroughly cleansed, made inviting and cheerful by brightening the ceiling, and the distribution of a few pictures about the walls, and supplied with those articles of furniture that are necessary only to the welfare of the patient and the convenience of the attendants. These should consist of a bed, a table, a few chairs, and a wash- stand with drawers; book-case and books, sofa and lounge, are only to be tolerated in the sick room. The bed should consist of a child's crib, with rockers, furnished with a mat- tress — never with a feather-bed — a pillow, sheets and blank- ets. The portable furniture should consist of a ewer, con- stantly filled with soft water, a basin, a slop-bowl, a supply of towels, clean rags, soap, and a bathing sponge. On the table there should be a pitcher of water for the administer- ing of medicine, several tumblers — not goblets — table, des- sert, and teaspoons, a bowl of sugar, writing paper, pen and ink — and the medicines to be used should also find place on the table. If the family should be in the country, or re- mote from a drug-store, there should be conveniently at hand a camphor bottle, filled, with the gum dissolved in alco- hol instead of whiskey, a vial of laudanum, paregoric, cas- tor oil, sweet oil, syrup of ipecac, a box of mustard, and a small quantity of good whiskey. After the chamber has been thus selected, prepared- THE INFANT IN SICKNESS. 113 and furnished, let the infant be undressed and reclothed with a clean, dry napkin, a flannel gown, extending six inches below the feet, with sleeves, and a single button at the throat, and a like garment made of muslin will complete the dress- ing. The infant is now ready for the physician. Instead of this systematic course of preparation, it occasionally occurs that the family, in a sudden manner, concludes that "it is best that the doctor should see the baby," and precipitately sends a messenger "for the doctor," who, upon his arrival, finds the family and servants busily engaged in making hur- ried preparations for his reception, and the infant bundled, buttoned, and pinned up in half a dozen skirts, in a manner to make it almost impossible to get at the chest or the ab- domen with a view of making an exploration of the parts, and, in place of hearing a quiet and concise history of the case, he must, with the patience of Job, listen to many apologies for the house being so much out of order, and for the baby being so untidy. And if the physician should chance to be a man of little experience in practice, and in meeting with such precipitate calls, he will become so confused as to know neither how or where to commence his investigations. The foregoing preparations for the sick may be con- sidered as altogether superfluous, and the infant is suf- fered to pass from health into the midst of a fever of several weeks duration, whereas, if the family should be expecting an entertainment of only a few hours, there will be several days spent in making preparations. But the infant must pass through its sufferings without the slightest preparation what- ever having been made for its illness, and, perhaps, for the lack of which, it may perish. Very much, indeed, will de- 114 THE HEALTHY INFANT. pend upon the orderly manner in which we enter upon the management and treatment of a case of sickness, that every- thing may move along smoothly and well-timed, otherwise everything will be done roughly out of time and place. There will be many things in the room occupying space that ought to be given to pure and wholesome atmosphere for the benefit of the patient, and many kindly visiting neighbors polluting the air with the effluvia from their lungs and bodies, and, still worse, with their many ignorant and incongruous suggestions as to the management and treatment of the case, by which the nurse is diverted from her immediate duties, and is led to disregard her instructions, and the physician is so annoyed that it is impossible for him to follow up his train of reflections in the analysis of the his- tory and symptoms of the case, that he may arrive at a cor- rect diagnosis; and rather he will be caused to omit the due consideration of one or more symptoms, as the conditions of the fontanel,* the pupils, the rythm of the respiratory move- ments, the pulse, the temperature, the mode of attack, and many other circumstances that are of equal importance. Or, in case the infant should be seized with a spasm, and an assistant is directed to obtain the mustard, a plate and a knife, for the preparation of a plaster to be applied for the relief of the sufferer, she will go stumbling over chairs or other articles that crowd the room, or be hindered by visit- ing friends w T ho have just come in to see the baby, and she goes down stairs to the pantry, and finally, when she returns, it is discovered that another trip is necessary, as the assistant had forgotten one of the articles, or, in her haste, had brought the salt cellar instead of the mustard. *The space between the bones of the cranium. THE INFANT IN SICKNESS. IIS When the physician arrives, he should be met by the mother, who will give him a full history of the case — i.