The maternal management of children, in health and disease

by Thomas Bull

THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT COMPLAINTS TO WHICH INFANTS ARE LIABLE.

Artificial food, from mismanagement and other causes, will now and then disagree with the infant. The stomach and bowels are thus deranged, and medicine is resorted to, and again and again the same thing occurs.

This is wrong, and but too frequently productive of serious and lasting mischief. Alteration of diet, rather than the exhibition of medicine, should, under these circumstances, be relied on for remedying the evil. Calomel, and such like remedies, "the little powders of the nursery," ought not to be given on every trivial occasion. More mischief has been effected, and more positive disease produced, by the indiscriminate use of the above powerful drug, either alone or in combination with other drastic purgatives, than would be credited. Purgative medicines ought at all times to be exhibited with caution to an infant, for so delicate and susceptible is the structure of its alimentary canal, that disease is but too frequently caused by that which was resorted to in the first instance as a remedy. The bowels should always be kept free; but then it must be by the mildest and least irritating means.

It is a very desirable thing, then, to correct the disordered conditions of the digestive organs of an infant, if possible, without medicine; and much may be done by changing the nature, and sometimes by simply diminishing the quantity, of food.

A diarrhoea, or looseness of the bowels, may frequently be checked by giving, as the diet, sago thoroughly boiled in very weak beef-tea, with the addition of a little milk. The same purpose is frequently to be answered by two thirds of arrow-root with one third of milk, or simply thin arrow-root made with water only; or, if these fail, baked flour, mixed with boiled milk.

Costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in hot water, and a small quantity of milk added, or prepared barley,—mixed in warm water and unboiled milk.

Flatulence and griping generally arise from an undue quantity of food, which passing undigested into the bowels, they are thus irritated and disturbed. This may be cured by abstinence alone. The same state of things may be caused by the food not being prepared fresh at every meal, or even from the nursing-bottle or vessel in which the food is given not having been perfectly clean. In this case weak chicken-broth, or beef-tea freed from fat, and thickened with soft boiled rice or arrow-root, may be given.

Sect. II. WEANING.

THE TIME WHEN TO TAKE PLACE.—The time when weaning is to take place must ever depend upon a variety of circumstances, which will regulate this matter, independently of any general rule that might be laid down. The mother's health may, in one case, oblige her to resort to weaning before the sixth month, and, in another instance, the delicacy of the infant's health, to delay it beyond the twelfth. Nevertheless, as a general rule, both child and parent being in good health, weaning ought never to take place earlier than the ninth (the most usual date), and never delayed beyond the twelfth month.

I should say further, that if child and parent are both in vigorous health, if the infant has cut several of its teeth, and been already accustomed to be partially fed, weaning ought to be gradually accomplished at the ninth month. On the other hand, that if the child is feeble in constitution, the teeth late in appearing, and the mother is healthy, and has a sufficient supply of good milk, especially if it be the autumnal season, it will be far better to prolong the nursing for a few months. In such a case, the fact of the on-appearance of the teeth indicates an unfitness of the system for any other than the natural food from the maternal breast.

And again, if the infant is born of a consumptive parent, and a healthy and vigorous wet-nurse has been provided, weaning should most certainly be deferred beyond the usual time, carefully watching, however, that neither nurse nor child suffer from its continuance.

THE MODE.—It should be effected gradually. From the sixth month most children are fed twice or oftener in the four-and-twenty hours; the infant is in fact, therefore, from this time in the progress of weaning; that is to say, its natural diet is partly changed for an artificial one, so that when the time for complete weaning arrives, it will be easily accomplished, without suffering to the mother, or much denial to the child.

It is, however, of the greatest importance to regulate the quantity and quality of the food at this time. If too much food is given (and this is the great danger) the stomach will be overloaded, the digestive powers destroyed, and if the child is not carried off suddenly by convulsions, its bowels will become obstinately disordered; it will fall away from not being nourished, and perhaps eventually become a sacrifice to the overanxious desire of the parent and its friends to promote its welfare.

The kind of food proper for this period, and the mode of administering it, is detailed in the previous section, on "Artificial Feeding."[FN#12]

[FN#12] The kind of food after the sixth month to the completion of first dentition, p. 44.

Much exercise in the open air (whenever there is no dampness of atmosphere) is highly necessary and beneficial at this time; it tends to invigorate the system, and strengthens the digestive organs, and thus enables the latter to bear without injury the alteration in diet.

THE DRYING UP OF THE MOTHER'S MILK.—This will generally be attended with no difficulty. When the weaning is effected gradually, the milk will usually go away of itself without any measures being resorted to. If, however, the breasts should continue loaded, or indeed painfully distended, a gentle aperient should be taken every morning, so that the bowels are kept slightly relaxed; the diet must be diminished in quantity, and solid nourishment only taken. The breast, if painfully distended, must be occasionally drawn, but only just sufficiently to relieve the distention. In either case they must be rubbed for five or ten minutes, every four or five hours, with the following liniment, previously warmed:—

Compound soap liniment, one ounce and a half;
Laudanum, three drachms.

Sect. III. DIETETICS OF CHILDHOOD.

Childhood, as has been before intimated, extends from about the second to the seventh or eighth year, when the second dentition is commenced.

No precise rules of diet can be laid down for this period, as this requires to be adapted in every case to the particular constitution concerned. There are, however, certain general principles which must be acted upon, and which can be easily modified by a judicious and observant parent, as circumstances and constitution may require.

GENERAL DIRECTIONS, AND OF ANIMAL FOOD.—The diet of the latter months of infancy is still to be continued, but with the important addition of animal food, which the child has now got teeth to masticate. This must be given in small quantity; it should be of the lightest quality, only allowed on alternate days, and even then its effects must be carefully watched, as all changes in the regimen of children should be gradual.

A child at this age, then, should have its meals at intervals of about four hours:—thus its breakfast between seven and eight o'clock, to consist of tops and bottoms, steeped in hot water, a little milk added, and the whole sweetened with sugar; or bread may be softened in hot water, the latter drained off, and fresh milk and sugar added to the bread. Its dinner about twelve o'clock, to consist, every other day, of a small quantity of animal food (chicken, fresh mutton, or beef, being the only meats allowed) with a little bread and water; on the alternate days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow- root pudding, containing one egg; or farinaceous food, with beef-tea. Its afternoon mealy about four o'clock, the same diet as formed the breakfast. At seven, a little arrow-root, made with a very small proportion of milk, or a biscuit, or crust of bread, after which the child should be put to bed.

The child must be taught to take its food slowly, retain it in it's mouth long, and swallow it tardily. Nothing must be given in the intervals of the meals. The stomach requires a period of repose after the labour of digestion; and if the child is entertained by its nurse, and its mind occupied, there will be no difficulty in following out this important direction.

As the child grows older, the quantity at each meal should be increased; the tops and bottoms changed for bread and pure milk, boiled or not; meat may be taken daily, except circumstances forbid it; and a small quantity of vegetable also.

If a child, then, be of a sound constitution, with healthy bowels, a cool skin, and clean tongue, the diet may be liberal, and provided it is sufficiently advanced in age, animal food may be taken daily. Too low a diet would stint the growth of such a child, and induce a state of body deficient in vigour, and unfit for maintaining full health: scrofula and other diseases would be induced. At the same time let the mother guard against pampering, for this would lead to evils no less formidable, though of a different character. And as long as the general health of this child is unimpaired, the body and mind active, and no evidence present to mark excess of nutriment, this diet may be continued. But if languor at any time ensue, fever become manifested, the skin hotter than natural, the tongue white and furred, and the bowels irregular, then, though these symptoms should bebonly in slight degree, and unattended with any specific derangement amounting to what is considered disease, not only should the parent lower the diet, and for a time withdraw the animal part, but the medical adviser should be consulted, that measures may be taken to correct the state of repletion which has been suffered to arise. For some time after its removal, care should also be taken to keep the diet under that, which occasioned the constitutional disturbance.

But if the child be of a delicate and weakly constitution (and this is unfortunately the more common case), it will not bear so generous a diet as the foregoing. During the three or four earliest years, it should be restricted chiefly to a mild farinaceous diet, with a small allowance only of meat on alternate days. The constant endeavour of the parent now should be, to seek to increase the digestive power and bodily vigour of her child by frequent exercise in the open air, and by attention to those general points of management detailed in the after- part of this chapter. This accomplished, a greater proportion of animal food may be given, and, in fact, will become necessary for the growth of the system, while at the same time there will be a corresponding power for its assimilation and digestion.

A great error in the dietetic management of such children is but too frequently committed by parents. They suppose that because their child is weakly and delicate, that the more animal food it takes the more it will be strengthened, and they therefore give animal food too early, and in too great quantity. It only adds to its debility. The system, as a consequence, becomes excited, nutrition is impeded, and disease produced, ultimately manifesting itself in scrofula, disease in the abdomen, head, or chest. The first seeds of consumption are but too frequently originated in this way. A child so indulged will eat heartily enough, but he remains thin notwithstanding. After a time he will have frequent fever, will appear heated and flushed towards evening, when he will drink greedily, and more than is usual in children of the same age; there will be deranged condition of the bowels, and headach,—the child will soon become peevish, irritable, and impatient; it will entirely lose the good humour so natural to childhood, and that there is something wrong will be evident enough, the parent, however, little suspecting the real cause and occasion of all the evil. In such a child, too, it will be found that the ordinary diseases of infancy, scarlet fever, measles, small pox, etc., will be attended with an unusual degree of constitutional disturbance; that it will not bear such active treatment as other children, or so quickly rally from the illness.

"Strength is to be obtained not from the kind of food which contains most nourishment in itself, but from that which is best adapted to the condition of the digestive organs at the time when it is taken."

SUGAR.—This is a necessary condiment for the food of children, and it is nutritious, and does not injure the teeth, as is generally imagined. "During the sugar season," observes Dr. Dunglison, "the negroes of the West India islands drink copiously of the juice of the cane, yet their teeth are not injured; on the contrary, they have been praised by writers for their beauty and soundness; and the rounded form of the body, whilst they can indulge in the juice, sufficiently testifies to the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats, on the other hand, are most indigestible, and seriously injurious.

[FN#13] Elements of Hygiem. Philadephia, 1835.

SALT.—This is necessary for the health of a child; it acts as a stimulant to the digestive organs, and if not allowed in sufficient quantity with the food, worms will result.[FN#14] It may, therefore, be added in small quantity, and with advantage, even to the farinaceous food of infants. Salted meats, however, should never be permitted to the child; for by the process of salting the fibre of the meat is so changed, that it is less nutritive, as well as less digestible.

[FN#14] Lord Sommerville, in his Address to the Board of Agriculture, gave an interesting account of the effects of a punishment which formerly existed in Holland. "The ancient laws of the country ordained men to be kept on bread alone, un-mixed with salt, as the severest punishment that could be inflicted upon them in their moist climate. The effect was horrible: these wretched criminals are said to have been devoured by worms engendered in their own stomachs."

"The wholesomeness and digestibility of our bread are undoubtedly much promoted by the addition of the salt which it so universally receives. A pound of salt is generally added to each bushel of flour. Hence it may be presumed, that every adult consumes two ounces of salt per week, or six pounds and a half per annum, in bread alone."

Dr. Paris on Diet.

FRUITS.—These, and of all kinds whether fresh or dried, a delicate child is better without; except the orange, which when perfectly ripe may be allowed to any child, but the white or inner skin should be scrupulously rejected, as it is most indigestible.

A healthy child may be permitted to partake of most fresh fruits. Of the stone-fruits, the ripe peach, the apricot, and nectarine, are the most wholesome; but cherries, from the stones being but too frequently swallowed, had better not be allowed. Apples and pears, when ripe and well masticated, are not unwholesome; and the apple when baked affords a pleasant repast, and where there is a costive habit, it is useful as a laxative. The small-seeded fruits, however, are by far the most wholesome. Of these, the ripe strawberry and raspberry deserve the first rank. The grape is also cooling and antiseptic, but the husks and seeds should be rejected. The gooseberry is less wholesome on account of the indigestibility of the skin, which is too frequently swallowed.

Dried fruits a child should never be permitted to eat.

WATER.—This should be the only beverage throughout childhood. Toast- and-water, if the child prefer it, which is rendered slightly more nutritive than the more simple fluid. The water employed in its preparation, however, must be at a boiling temperature, and it ought to be drunk as soon as it has sufficiently cooled; for by being kept, it acquires a mawkish and unpleasant flavour.

WINE, BEER, etc.—The practice of giving wine, or, indeed, any stimulant, to a healthy child, is highly reprehensible; it ought never to be given but medicinally.

The circulation in infancy and childhood is not only more rapid than in the adult, but easily excited to greater vehemence of action; the nervous system, too, is so susceptible, that the slightest causes of irritation produce strong and powerful impressions: the result in either case is diseased action in the frame, productive of fever, convulsions, etc.; wine, accordingly, is detrimental to children.

An experiment made by Dr. Hunter upon two of his children illustrates, in a striking manner, the pernicious effects of even a small portion of intoxicating liquors in persons of this tender age. To one of the children he gave, every day after dinner, a full glass of sherry: the child was five years of age, and unaccustomed to the use of wine. To the other child, of nearly the same age, and equally unused to wine, he gave an orange. In the course of a week, a very marked difference was perceptible in the pulse, urine, and evacuations from the bowels of the two children. The pulse of the first was raised, the urine high coloured, and the evacuations destitute of their usual quantity of bile. In the other child, no change whatever was produced. He then reversed the experiment, giving to the first the orange, and to the second the wine, and the results corresponded: the child who had the orange continued well, and the system of the other got straightway into disorder, as in the first experiment.[FN#15]

[FN#15] Marcellin relates an instance of seven children in a family whose bowels became infested with worms, from the use of stimulants. They were cured by substituting water for the pernicious beverage.

In this town, spirits, particularly gin, are given to infants and children to a frightful extent. I have seen an old Irish woman give diluted spirits to the infant just born. A short time since one of those dram-drinking children, about eight years of age, was brought into one of our hospitals. The attendants, from its emaciated appearance, considered the child was dying from mere starvation; which was true enough in a certain sense. Food was accordingly offered and pressed upon it, but the boy would not even put it to his lips. The next day it was discovered that the mother brought the child very nearly a pint of gin, every drop of which before night he had consumed.

It is easy to discover when children have been fed upon spirits: they are always emaciated; have a lean, yellow, haggard look: the eyes sunk, the lips pale, and the teeth discoloured, the cadaverous aspect of the countenance being most fearful. They are continually suffering from bowel complaints and convulsive disorders; which, under these circumstances, terminate invariably in an early death.

Sect. IV. SLEEP.

DURING INFANCY.—For three or four weeks after birth the infant sleeps more or less, day and night, only waking to satisfy the demands of hunger; at the expiration of this time, however, each interval of wakefulness grows longer, so that it sleeps less frequently, but for longer periods at a time.

This disposition to repose in the early weeks of the infant's life must not be interfered with; but this period having expired, great care is necessary to induce regularity in its hours of sleep, otherwise too much will be taken in the day-time, and restless and disturbed nights will follow. The child should be brought into the habit of sleeping in the middle of the day, before its dinner, and for about two hours, more or less. If put to rest at a later period of the day, it will invariably cause a bad night.

At first the infant should sleep with its parent. The low temperature of its body, and its small power of generating heat, render this necessary. If it should happen, however, that the child has disturbed and restless nights, it must immediately be removed to the bed and care of another female, to be brought to its mother at an early hour in the morning, for the purpose of being nursed. This is necessary for the preservation of the mother's health, which through sleepless nights would of course be soon deranged, and the infant would also suffer from the influence which such deranged health would have upon the milk.

When a month or six weeks has elapsed, the child, if healthy, may sleep alone in a cradle or cot, care being taken that it has a sufficiency of clothing, that the room in which it is placed is sufficiently warm, viz. 60 degrees, and the position of the cot itself is not such as to be exposed to currents of cold air. It is essentially necessary to attend to these points, since the faculty of producing heat, and consequently the power of maintaining the temperature, is less during sleep than at any other time, and therefore exposure to cold is especially injurious. It is but too frequently the case that inflammation of some internal organ will occur under such circumstances, without the true source of the disease ever being suspected. Here, however, a frequent error must be guarded against,— that of covering up the infant in its cot with too much clothing throwing over its face the muslin handkerchief—and, last of all, drawing the drapery of the bed closely together. The object is to keep the infant sufficiently warm with pure air; it therefore ought to have free access to its mouth, and the atmosphere of the whole room should be kept sufficiently warm to allow the child to breathe it freely: in winter, therefore, there must always be a fire in the nursery.

The child up to two years old, at least, should sleep upon a feather bed, for the reasons referred to above. The pillow, however, after the sixth month, should be made of horsehair; for at this time teething commences, and it is highly important that the head should be kept cool.

DURING CHILDHOOD.—Up to the third or fourth year the child should be permitted to sleep for an hour or so before its dinner. After this time it may gradually be discontinued; but it must be recollected, that during the whole period of childhood more sleep is required than in adult age. The child, therefore, should be put to rest every evening between seven and eight; and if it be in health it will sleep soundly until the following morning. No definite rule, however, can be laid down in reference to the number of hours of sleep to be allowed; for one will require more or less than another.[FN#16] Regularity as to the time of going to rest is the chief point to attend to; permit nothing to interfere with it, and then only let the child sleep without disturbance, until it awakes of its own accord on the following morning, and it will have had sufficient rest.

[FN#16] The amount of sleep necessary to preserve health varies according to the state of the body, and the habits of the individual. As already observed, infants pass much the greater portion of their time in sleep. Children sleep twelve or fourteen hours. The schoolboy generally ten. In youth, a third part of the twenty-four hours is spent in sleep. Whilst, in advanced age, many do not spend more than four, five, or six hours in sleep.

It is a cruel thing for a mother to sacrifice her child's health that she may indulge her own vanity, and yet how often is this done in reference to sleep. An evening party is to assemble, and the little child is kept up for hours beyond its stated time for retiring to rest, that it may be exhibited, fondled, and admired. Its usual portion of sleep is thus abridged, and, from the previous excitement, what little he does obtain, is broken and unrefreshing, and he rises on the morrow wearied and exhausted.

Once awake, it should not be permitted to lie longer in bed, but should be encouraged to arise immediately. This is the way to bring about the habit of early rising, which prevents many serious evils to which parents are not sufficiently alive, promotes both mental and corporeal health, and of all habits is said to be the most conducive to longevity.

A child should never be suddenly aroused from sleep; it excites the brain, quickens the action of the heart, and, if often repeated, serious consequences would result. The change of sleeping to waking should always be gradual.

The bed on which the child now sleeps should be a mattress: at this age a feather bed is always injurious to children; for the body, sinking deep into the bed, is completely buried in feathers, and the unnatural degree of warmth thus produced relaxes and weakens the system, particularly the skin, and renders the child unusually susceptible to the impressions of cold. Then, instead of the bed being made up in the morning as soon as vacated, and while still saturated with the nocturnal exhalations from the body, the bed-clothes should be thrown over the backs of chairs, the mattress shaken well up, and the window thrown open for several hours, so that the apartment shall be thoroughly ventilated. It is also indispensably requisite not to allow the child to sleep with persons in bad health, or who are far advanced in life; if possible, it should sleep alone.

Sect. V. BATHING AND CLEANLINESS.

DURING INFANCY.—Too much attention cannot be paid to cleanliness; it is essential to the infant's health. The principal points to which especial attention must be paid by the parent for this purpose are the following:—

TEMPERATURE OF THE WATER.—At first the infant should be washed daily with warm water; and a bath every night, for the purpose of thoroughly cleaning the body, is highly necessary. To bathe a delicate infant of a few days or even weeks old in cold water with a view "to harden" the constitution (as it is called), is the most effectual way to undermine its health and entail future disease. By degrees, however, the water with which it is sponged in the morning should be made tepid, the evening bath being continued warm enough to be grateful to the feelings.

A few months having passed by, the temperature of the water may be gradually lowered until cold is employed, with which it may be either sponged or even plunged into it, every morning during summer. If plunged into cold water, however, it must be kept in but a minute; for at this period, especially, the impression of cold continued for any considerable time depresses the vital energies, and prevents that healthy glow on the surface which usually follows the momentary and brief action of cold, and upon which its usefulness depends. With some children, indeed, there is such extreme delicacy and deficient reaction as to render the cold bath hazardous; no warm glow over the surface takes place when its use inevitably does harm: its effects, therefore, must be carefully watched.

DRYING THE SKIN.—The surface of the skin should always be carefully and thoroughly rubbed dry with flannel,—indeed, more than dry, for the skin should be warmed and stimulated by the assiduous gentle friction made use of. For this process of washing and drying must not be done languidly, but briskly and expeditiously; and will then be found to be one of the most effectual means of strengthening the infant. It is especially necessary carefully to dry the arm-pits, groins, and nates; and if the child is very fat, it will be well to dust over these parts with hair-powder or starch: this prevents excoriations and sores, which are frequently very troublesome. Soap is only required to those parts of the body which are exposed to the reception of dirt.

NAPKINS.—The frequency of the discharges from the bowels and bladder requires a frequent change of napkins. A nurse cannot be too careful of this duty from the first, so that she may be enabled to discover the periods when those discharges are about to take place, that she may not only anticipate them, but teach the child, at a very early age, to give intelligent warning of its necessities. Thus a habit of regularity with regard to those functions will be established, which will continue through life, and tend greatly to the promotion of health. As the child grows older, the system of cleanliness must in no particular be relaxed, and it will be found the best preservative against those eruptive disorders which are so frequent and troublesome during the period of infancy.

DURING CHILDHOOD.—When this period arrives, or shortly after, bathing is but too frequently left off; the hands and face of the child are kept clean, and with this the nurse is satisfied; the daily ablution of the whole body, however, is still necessary, not only for the preservation of cleanliness, but because it promotes in a high degree the health of the child.

PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.—A child of a vigorous constitution and robust health, as he rises from his bed refreshed and active by his night's repose, should be put into the shower-bath, or, if this excites and alarms him too much, must be sponged from head to foot with salt water. If the weather be very cold, the water may be made slightly tepid, but if his constitution will bear it, the water should be cold throughout the year. Then the body should be speedily dried, and hastily but well rubbed with a somewhat coarse towel, and the clothes put on without any unnecessary delay. This should be done every morning of the child's life.

If such a child is at the sea-side, advantage should be taken of this circumstance, and seabathing should be substituted. The best time is two or three hours after breakfast; but he must not be fatigued beforehand, for if so, the cold bath cannot be used without danger. Care must be taken that he does not remain in too long, as the animal heat will be lowered below the proper degree, which would be most injurious. In boys of a feeble constitution, great mischief is often produced in this way. It is a matter also of great consequence in bathing children that they should not be terrified by the immersion, and every precaution should be taken to prevent this. The healthy and robust boy, too, should early be taught to swim, whenever this is practicable, for it is attended with the most beneficial effects; it is a most invigorating exercise, and the cold bath thus becomes doubly serviceable.

PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.—If a child is of a delicate and strumous constitution, the cold bath during the summer is one of the best tonics that can be employed; and if living on the coast, sea-bathing will be found of singular benefit. The effects, however, of sea-bathing upon such a constitution must be particularly watched, for unless it is succeeded by a glow,—a feeling of increased strength,—and a keen appetite, it will do no good, and ought at once to be abandoned for the warm or tepid bath. The opinion that warm baths generally relax and weaken, is erroneous; for in this case, as in all cases when properly employed, they would give tone and vigour to the whole system; in fact, the tepid bath is to this child what the cold bath is to the more robust.

In conclusion: if the bath in any shape cannot from circumstances be obtained, then cold saltwater sponging must be used daily, and all the year round, so long as the proper reaction or glow follows its use; but when this is not the case, and this will generally occur, if the child is delicate and the weather cold, tepid vinegar and water, or tepid salt water, must be substituted.

Sect. VI. CLOTHING.

IN INFANCY.—Infants are very susceptible of the impressions of cold; a proper regard, therefore, to a suitable clothing of the body, is imperative to their enjoyment of health. Unfortunately, an opinion is prevalent in society, that the tender child has naturally a great power of generating heat and resisting cold; and from this popular error has arisen the most fatal results. This opinion has been much strengthened by the insidious manner in which cold operates on the frame, the injurious effects not being always manifest during or immediately after its application, so that but too frequently the fatal result is traced to a wrong source, or the infant sinks under the action of an unknown cause.

The power of generating heat in warm-blooded animals is at its minimum at birth, and increases successively to adult age; young animals, instead of being warmer than adults, are generally a degree or two colder, and part with their heat more readily; facts which cannot be too generally known. They show how absurd must be the folly of that system of "hardening" the constitution (to which reference has been before made), which induces the parent to plunge the tender and delicate child into the cold bath at all seasons of the year, and freely expose it to the cold, cutting currents of an easterly wind, with the lightest clothing.

The principles which ought to guide a parent in clothing her infant are as follows:—

The material and quantity of the clothes should be such as to preserve a sufficient proportion of warmth to the body, regulated therefore by the season of the year, and the delicacy or strength of the infant's constitution. In effecting this, however, the parent must guard against the too common practice of enveloping the child in innumerable folds of warm clothing, and keeping it constantly confined to very hot and close rooms; thus running into the opposite extreme to that to which I have just alluded: for nothing tends so much to enfeeble the constitution, to induce disease, and render the skin highly susceptible to the impression of cold; and thus to produce those very ailments which it is the chief intention to guard against.

In their make they should be so arranged as to put no restrictions to the free movements of all parts of the child's body; and so loose and easy as to permit the insensible perspiration to have a free exit, instead of being confined to and absorbed by the clothes, and held in contact with the skin, till it gives rise to irritation.

In their quality they should be such as not to irritate the delicate skin of the child. In infancy, therefore, flannel is rather too rough, but is desirable as the child grows older, as it gives a gentle stimulus to the skin, and maintains health.

In its construction the dress should be so simple as to admit of being quickly put on, since dressing is irksome to the infant, causing it to cry, and exciting as much mental irritation as it is capable of feeling. Pins should be wholly dispensed with, their use being hazardous through the carelessness of nurses, and even through the ordinary movements of the infant itself.

The clothing must be changed daily.—It is eminently conducive to good health that a complete change of dress should be made every day. If this is not done, washing will, in a great measure, fail in its object, especially in insuring freedom from skin diseases.

IN CHILDHOOD.—The clothing of the child should possess the same properties as that of infancy. It should afford due warmth, be of such materials as do not irritate the skin, and so made as to occasion no unnatural constriction.

In reference to due warmth, it may be well again to repeat, that too little clothing (that state of semi-nudity which the vanity of some parents encourage) is frequently productive of the most sudden attacks of active disease; and that children who are thus exposed with naked breasts and thin clothing in a climate so variable as ours are the frequent subjects of croup, and other dangerous affections of the air- passages and lungs. On the other hand, it must not be forgotten, that too warm clothing is a source of disease,—sometimes even of the same diseases which originate in exposure to cold,—and often renders the frame more susceptible of the impressions of cold, especially of cold air taken into the lungs. Regulate the clothing, then, according to the season; resume the winter dress early; lay it aside late; for it is in spring and autumn that the vicissitudes in our climate are greatest, and congestive and inflammatory complaints most common.

With regard to material (as was before observed), the skin will at this age bear flannel next to it; and it is now not only proper, but necessary. It may be put off with advantage during the night, and cotton maybe substituted during the summer, the flannel being resumed early in the autumn. If from very great delicacy of constitution it proves too irritating to the skin, fine fleecy hosiery will in general be easily endured, and will greatly conduce to the preservation of health.

It is highly important that the clothes of the boy should be so made that no restraints shall be put on the movements of the body or limbs, nor injurious pressure made on his waist or chest. All his muscles ought to have full liberty to act, as their free exercise promotes both their growth and activity, and thus insures the regularity and efficiency of the several functions to which these muscles are subservient.

The same remarks apply with equal force to the dress of the girl; and happily, during childhood, at least, no distinction is made in this matter between the sexes. Not so, however, when the girl is about to emerge from this period of life; a system of dress is then adopted which has the most pernicious effects upon her health, and the development of the body, the employment of tight stays, which impede the free and full action of the respiratory organs, being only one of the many restrictions and injurious practices from which in latter years they are thus doomed to suffer so severely.

Sect. VII. AIR AND EXERCISE.

IN INFANCY.—The respiration of a pure air is at all times, and under all circumstances, indispensable to the health of the infant. The nursery therefore should be large, well ventilated, in an elevated part of the house, and so situated as to admit a free supply both of air and light. For the same reasons, the room in which the infant sleeps should be large, and the air frequently renewed; for nothing is so prejudicial to its health as sleeping in an impure and heated atmosphere. The practice, therefore, of drawing thick curtains closely round the bed is highly pernicious; they only answer a useful purpose when they defend the infant from any draught of cold air.

The proper time for taking the infant into the open air must, of course, be determined by the season of the year, and the state of the weather. "A delicate infant born late in the autumn will not generally derive advantage from being carried into the open air, in this climate, till the succeeding spring; and if the rooms in which he is kept are large, often changed, and well ventilated, he will not suffer from the confinement, while he will, most probably, escape catarrhal affections, which are so often the consequence of the injudicious exposure of infants to a cold and humid atmosphere."[FN#17] If, however, the child is strong and healthy, no opportunity should be lost of taking it into the open air at stated periods, experience daily proving that it has the most invigorating and vivifying influence upon the system. Regard, however, must always be had to the state of the weather; and to a damp condition of the atmosphere the infant should never be exposed, as it is one of the most powerful exciting causes of consumptive disease. The nurse-maid, too, should not be allowed to loiter and linger about, thus exposing the infant unnecessarily, and for an undue length of time; this is generally the source of all the evils which accrue from taking the babe into the open air.

[FN#17] Sir James Clark on Consumption.

Exercise, also, like air, is essentially important to the health of the infant. Its first exercise, of course, will be in the nurse's arms. After a month or two, when it begins to sleep less during the day, it will delight to roll and kick about on the sofa: it will thus use its limbs freely; and this, with carrying out into the open air, is all the exercise it requires at this period. By and by, however, the child will make its first attempts to walk. Now it is important that none of the many plans which have been devised to teach a child to walk, should be adopted—the go-cart, leading-strings, etc.; their tendency is mischievous; and flatness of the chest, confined lungs, distorted spine, and deformed legs, are so many evils which often originate in such practices. This is explained by the fact of the bones in infancy being comparatively soft and pliable, and if prematurely subjected by these contrivances to carry the weight of the body, they yield just like an elastic stick bending under a weight, and as a natural consequence become curved and distorted.

It is highly necessary that the young and experienced mother should recollect this fact, for the early efforts of the little one to walk are naturally viewed by her with so much delight, that she will be apt to encourage and prolong its attempts, without any thought of the mischief which they may occasion; thus many a parent has had to mourn over the deformity which she has herself created.

It may be as well here to remark, that if such distortion is timely noticed, it is capable of correction, even after evident curvature has taken place. It is to be remedied by using those means that shall invigorate the frame, and promote the child's general health (a daily plunge into the cold bath, or sponging with cold salt water, will be found signally efficacious), and by avoiding the original cause of the distortion—never allowing the child to get upon his feet. The only way to accomplish the latter intention, is to put both the legs into a large stocking; this will effectually answer this purpose, while, at the same time, it does not prevent the free and full exercise of the muscles of the legs. After some months pursuing this plan, the limbs will be found no longer deformed, the bones to have acquired firmness and the muscles strength; and the child may be permitted to get upon his feet again without any hazard of perpetuating or renewing the evil.

The best mode of teaching a child to walk, is to let it teach itself, and this it will do readily enough. It will first crawl about: this exercises every muscle in the body, does not fatigue the child, throws no weight upon the bones, but imparts vigour and strength, and is thus highly useful. After a while, having the power, it will wish to do more: it will endeavour to lift itself upon its feet by the aid of a chair, and though it fail again and again in its attempts, it will still persevere until it accomplish it. By this it learns, first, to raise itself from the floor; and secondly, to stand, but not without keeping hold of the object on which it has seized. Next it will balance itself without holding, and will proudly and laughingly show that it can stand alone. Fearful, however, as yet of moving its limbs without support, it will seize a chair or anything else near it, when it will dare to advance as far as the limits of its support will permit. This little adventure will be repeated day after day with increased exultation; when, after numerous trials, he will feel confident of his power to balance himself, and he will run alone. Now time is required for this gradual self-teaching, during which the muscles and bones become strengthened; and when at last called upon to sustain the weight of the body, are fully capable of doing so.

IN CHILDHOOD.—When the child has acquired sufficient strength to take active exercise, he can scarcely be too much in the open air; the more he is habituated to this, the more capable will he be of bearing the vicissitudes of the climate. Children, too, should always be allowed to amuse themselves at pleasure, for they will generally take that kind and degree of exercise which is best calculated to promote the growth and development of the body. In the unrestrained indulgence of their youthful sports, every muscle of the body comes in for its share of active exercise; and free growth, vigour, and health are the result.

If, however, a child is delicate and strumous, and too feeble to take sufficient exercise on foot,—and to such a constitution the respiration of a pure air and exercise are indispensable for the improvement of health, and without them all other efforts will fail,—riding on a donkey or pony forms the best substitute. This kind of exercise will always be found of infinite service to delicate children; it amuses the mind, and exercises the muscles of the whole body, and yet in so gentle a manner as to induce little fatigue.

The exercises of horseback, however, are most particularly useful where there is a tendency in the constitution to pulmonary consumption, either from hereditary or accidental causes. It is here beneficial, as well through its influence on the general health, as more directly on the lungs themselves. There can be no doubt that the lungs, like the muscles of the body, acquire power and health of function by exercise. Now during a ride this is obtained, and without much fatigue to the body. The free and equable expansion of the lungs by full inspiration, necessarily takes place; this maintains their healthy structure, by keeping all the air-passages open and pervious; it prevents congestion in the pulmonary circulation, and at the same time provides more completely for the necessary chemical action on the blood, by changing, at each act of respiration, a sufficient proportion of the whole air contained in the lungs,—all objects of great importance, and all capable of being promoted, more or less, by the means in question.

And be it remembered that these remarks apply with equal force to the girl as to the boy. She should be allowed, and even encouraged, to take the same active exercise. Fortunately, this course is followed during childhood; not so, unfortunately (in the majority of cases, at least), after this period. Young females are then subjected to those unnatural restraints, both in exercise and dress, which fashion and vanity impose, to be followed by effects which, though not immediately obvious, are capable of laying the foundation of evils that cannot afterwards be remedied.

A good carriage is the point aimed at (and to which I particularly refer), and the means adopted for its cultivation fail, after all, in their end, just in proportion to their rigid employment. For this purpose the head is kept erect, and the shoulders drawn back, and they are to be kept in this position not for an hour or so, but continually. To preserve, however, this unnatural and constrained position, requires considerable muscular powers, such as no girl can exercise without long, painful, and injurious training; nor even by this, unless other measures be resorted to in aid of her direct endeavours. For instead of the muscles obtaining increased power and strength by these efforts (to enforce a good carriage), they are enfeebled, and soon become more and more incapable of performing what is required of them. This fact soon becomes perceptible; weakness is noticed; but instead of correcting this by the only rational mode, that of invigorating the weakened muscles, mechanical aid is called in to support them, and laced waistcoats are resorted to. These undoubtedly give support—nay, they may be so used as almost wholly to supersede the muscular efforts, with the advantage of not tiring, however long or continuously employed. Improvement of carriage is manifested, the child is sensible of relief from a painful exertion, the mother is pleased with the success of her management, and this success appears to superficial observation fully to confirm the judgment which superintends it. Yet what are the consequences to which her measures tend, and which such measures are daily and hourly producing? The muscles of the back and chest, restrained in their natural and healthful exercise by the waistcoat called in to aid them, and more signally, in after-life, by the tightly- laced stays or corsets, become attenuated, and still further enfeebled, until at length they are wholly dependent on the mechanical aid, being quite incapable of dispensing with it for any continuance.

By and by a taper waist becomes an object of ambition, and the stays are laced more closely than ever. This is still done gradually, and, at first, imperceptibly to the parties. The effect, however, though slow, is sure; and the powers of endurance thus exercised come in time to bear, almost unconsciously, what, if suddenly or quickly attempted, no heroism could possibly sustain. This increased pressure impedes the motion of the ribs. For perfect respiration these motions should be free and unrestrained, and perfect respiration is necessary to those changes in the blood which fit it for nutrition, and the other purposes of the animal frame. In proportion as respiration is impeded, is the blood imperfectly vitalised, and in the same ratio are the nutrient and other functions dependent on the blood inadequately performed. Here, then, is one source of debility, which affects the whole frame, reducing every part below the standard of healthful vigour. Quickened respiration soon ensues, the heart becomes excited, the pulse accelerated, and palpitation is in time superadded.

There are still further evils produced by tight lacing. For the pressure being chiefly made on the lower part of the chest, the stomach and liver are necessarily compressed, to the great disturbance of their functions; and being pressed downwards too, these trespass on that space which the other abdominal viscera require, superinducing still further derangements. Thus almost every function of the body becomes more or less impeded.

And again, the girl not being able always to have her body cased in the tight-laced stays, some relaxation must take place. Under it the muscles of the back, deprived of their accustomed support, and incapable of themselves to sustain the incumbent weight, yield, and the column of the spine bends, at first anteriorly, causing round shoulders and an arched back; but eventually inclines to one or other side, giving rise to the well-known and too frequently occurring state of lateral curvature. This last change most frequently commences in the sitting posture, such females being, through general debility, much disposed to sedentary habits. Such, though but very slightly sketched, are a few of the evils attending this baneful practice.

But how, then, is a good carriage to be obtained; which is not only pleasing to the eye, but is, when natural, absolutely conducive itself to health? To insure a good carriage, the only rational way is to give the necessary power, especially to the muscles chiefly concerned; and this is to be done, not by wearying those muscles by continual and unrelieved exertion, but by invigorating the frame generally, and more especially by strengthening the particular muscles through varied exercise alternated with due repose. Attention to general health, suitable diet, regular bowels, moderate but regular exercise, not of particular muscles only, but of the whole frame, cold-bathing or sponging, and other such measures, will maintain a good carriage, by giving that power which the more direct means so generally practised serve but to exhaust.[FN#18]

[FN#18] The above remarks on "good carriage" are almost wholly taken from a valuable article of Dr. Barlow's, in the "Cyclopaedia of Practical Medicine."

Chap. II.