Infant treatment, under two years of age. Addressed to mothers and nurses ..

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SECTION I. Ttlfi INFANT BEFORlE AND IMMEDIATELY AFTER BIRTH

The first and most important truth, on this subject, to be impressed on mothers, is, That the constitution of their offspring depends on natural circumstances, many of which are under their own control.

A child takes its general character from its parents. If these be healthy persons, the child will also, in all probability, be healthy, provided that no deranging circumstance shall take place before the birth of the infant. If, on the contrary, the parents are unhealthy, the child will also probably be unhealthy. These principles apply to the mental part of our organisation, as well as to all the rest.

Supposing healthy parents, still the infant may prove very much the reverse, if the condition and circumstances of the mother during pregnancy be not favourable. It therefore becomes important to inquire, what is the condition, and what are the circumstances, of the mother, during pregnancy, which are calculated to affect her progeny for good or evil ?

The maintenance of her own health during this period is of the first importance, as even a woman usually

INFANT TREATMENT.

healthy may be in such a deranged state during pregnancy, as will operate greatly to the detriment of the infant. For the maintenance of health in ordinary circumstances, few people have any other guide than expe-i rience and their own share of good sense ; and these are guides not to be despised. It is to be wished, however, that all whose circumstances will allow of it, should study the organisation and functions of the human frame, as, without that knowledge, there can be no certain or consistent attention to the rules of health, while, with it, attention to those rules becomes comparatively simple. For such as may be anxious for this knowledge, and have no better means of obtaining it, we would recommend the perusal of the treatise on Animal Physiology in the present Educational Course, or, as still better, if sufficient leisure can be commanded, the works of Dr Andrew Combe* and Dr South wood Smith.t

A young pregnant woman, finding herself perhaps for the first time in her life called upon to pay particular attention to the laws of health, will probably experience some difficulty in subjecting herself to the guidance of those laws, because she has habits to overcome, and perhaps some pleasures to forego ; but she will have the aid and stimulus of maternal love, which, from the moment she becomes conscious she is to be a mother, mysteriously but powerfully possesses her. This instinctive affection leads to good or to evil, according as the mind is informed or ignorant of the conditions which govern the health of the parent and child during pregnancy. If informed, the mental and physical powers are directed aright ; if ignorant, the nervous sensibility prompts to a state of undefined fears, while physical evils are produced or increased by mistaken treatment.

In the present place, as we are writing an educational, not a medical treatise, it is not to be expected that we are to give a minute exposition of the state of pregnancy - .

* The Principles of Physiology applied to Health and Education.

The Physiolosy of Digestion, t The Philosophy of Health.

We will confine ourselves chiefly to those circumstances which bear more particularly on the constitution of the child.

That a female in this condition should maintain a serene mind,, is above all things desirable. And for this end, it is in the very first place necessary that she should be taught to regard her condition in its true light, as one perfectly natural, and for which all fitting arrangements have been made by nature. The sickness, nausea, and disordered condition of stomach, which often attend pregnancy, and also the anticipation of the pains of labour, are apt to impress a different feeling. But with all such impressions, a right-minded woman will successfully contend, if she be truly informed on the subject. So far from pregnancy being a diseased condition of the system, it is one in which pre-existing disease is often overcome, at least temporarily (though the contrary is also sometimes the case), and during which epidemics are often resisted, when other persons not more susceptible fall before them. Nature, indeed, seems to have aimed at making the system unusually strong at this period, as if to favour as much as possible an object so important as the increase of the numbers of the species.

Nausea is most frequently experienced by women of a nervous and excitable temperament, or of what are called " strong feelings," and by those more particularly who have little to occupy them. Those, also, who proceed upon the vulgar error of eating heartily, " in order to keep up their strength," are peculiarly liable to this distressing visitation. There is, however, a certain tendency to it in many cases, merely as a result of that increased excitement of the womb, which unavoidably takes place during pregnancy, in consequence of that organ requiring and receiving more blood at that period than' at other times. In all cases, nausea may be regarded as a means provided by nature for keeping down the quantity of circulating fluids at a proper amount, and thereby preventing a fullness which might, in such circumstances, have fatal effects.

With respect to labour itself, an intelligent woman will find no difficulty, we think, in regarding it under the following considerations : — It certainly is a process which, unless in very extraordinary circumstances, cannot take place without considerable pain. Some, we are aware, believe the reverse. They allege, that, if the females of the human race were to live in a perfectly natural manner, there would be no pain or difficulty in labour. That there should be any natural process from which pain is inseparable, seems also to them a kind of impeachment of divine wisdom. "We believe, nevertheless, that pain, in some measure, greater or less, is scarcely avoidable in the labour of almost any female creature, and that to acknowledge such being the case is no detraction from Almighty goodness. In the parts concerned in labour, two objects must necessarily have been in view — first, that that portion of the bony and muscular structure should possess the same firmness as the rest of the body ; and, second, that it should also be capable of an occasional distension, to admit of the birth of a new being. How to give this power of occasional distension, without dimi* nishing the necessary firmness of structure, was the point to be attained. The end certainly might have been accomplished by some peculiar natural provision ; but in nature there is an economy of means generally appa* rent. Instead of any departure from the rules which govern all organic nature, it has been seen fit to preserve those rules in their ordinary force on this point, and, as a simple and easy alternative, to subject the being to a certain pain — for the endurance of which, however, other and most wonderful arrangements have been made, in the peculiar feature of its intermission, and in that power of suffering which females seem to possess in a greater degree than males, no doubt through some peculiarity of the nervous system.

Contemplated under such considerations, the pain of labour will be looked forward to, we think, with firmness,

and without alarm. It will be regarded only as pain

a pain imposed with a design, upon the whole, beneficent

—short in duration, and which there is much to alleviate — which, moreover, in the effect which it seems to have of the more endearing the infant which has been its innocent and unconscious cause, fully repays itself in the tenderest of feelings.

For the preservation of serenity of mind, an exemption from the severer cares of life is also desirable. In many cases this may be difficult of attainment ; but it is nevertheless a point of so great importance, that every reasonable exertion and sacrifice should be made, in order to bring it about. We do not mean that a pregnant female should be set aside from ordinary duties, or that she should be allowed to spend her time in thoughtless languor. We only demand that she should be subjected to no treatment which will give her great excitement. Anxiety about the illness of a near relative — grief for his loss — the pain of severe worldly calamity — torment from the misconduct of individuals in whom she is interested — sudden frights, or excesses of joy — finally, those rarer distresses which a time of public danger occasions — such are the circumstances which are apt to have a bad effect on females about to become mothers. They also, as a necessary consequence, affect the being about to be brought into the world, producing in some instances a general weakness of constitution, in others only a certain damage of the mental organisation. Many of the eccentricities which have caused the world most to wonder, or worked it the greatest woes, have been the consequence of very simple circumstances visiting pregnant females with undue excitement.

The diet of females during this period ought to le simple. When unenlightened on this subject, they are apt to fall into errors which may greatly affect their offspring. A pampering, indolent, and generally self-indulgent mode of life, is often practised ; and many think it necessary that every casual desire that can arise in an unregulated mind ought to be gratified. A sensible woman, sincerely anxious for the good of the being about to enter the world, will be anxious to avoid such errors.

The tendency to nausea and vomiting, already alluded to, may be interpreted as the voice of nature proclaiming that, in the condition of pregnancy, less instead of more food than usual is required. The perfection of the child does not depend immediately on the quantity of nutriment taken by the mother; it depends on the supply of sound and healthy fluids, for which end, not merely judicious nutriment, but a healthy action of the whole of the functions of the body, is requisite. Overeating, or eating too nicely, is inconsistent with that healthy action, and is therefore to be avoided. Food too highly concentrated, and of too stimulating a character, is unsuitable, as also are gruel and weak broths, for these are not easy of digestion. The mother ought not to depart from her accustomed diet, whatever that may be, provided experience has shown that it is suitable for her constitution and habits of life. Animal food is not to be systematically avoided. Where the digestion is weak, the circulation languid, and the muscular frame small, flaccid, and puny, this kind of food, of a tender fibre, taken in small quantities at a time, and well masticated, will lighten present suffering and prevent future evil. The total want of this kind of food, which is often scarcely a matter of choice amongst the poor, tends to make the milk weak and of bad quality. Farinaceous and vegetable food, with a moderate portion of animal food, and of diluting fluids, may be generally recommended. Stimulating liquors are beneficial in very few instances. We present all of these maxims on diet with some degree of hesitation, for almost every particular case requires a treatment more or less peculiar to itself. For perfect safety, the advice of a judicious physician, and if possible one acquainted with the system of the patient, is desirable.

Regular and gentle exercise should he taken every day, in the open air if possible. This is one of the principal requisites for keeping up that healthy action of the system, on which the supply of sound fluids depends. When the mother pursues a contrary course, whether from indolence or from positive inability of body, her system necessarily becomes much relaxed ; its tone is abated, and the child partakes of the same character. Regard must of course be paid to peculiarities in the general condition of the mother. If she be very weak, it may be injurious for her to take much exercise, or to begin to take it abruptly ; but still the great importance of exercise to her health and that of her child should be kept in view, and, if at all practicable or prudent, exercise should be indulged in. With the healthy, it is a duty which they will not with impunity neglect. It should be practised from the first, and up to the very last. As one great inducement to it, they may be assured that, by restricting an undue and undesirable growth of the child, it tends materially to lessen their distresses at a particularly trying moment.

The ordinary occupations of life should be as little as possible interrupted. It may be necessary, from the condition of the expectant mother, that she should be kept very quiet : it often, indeed, happens that, from particular circumstances, females are enjoined by their medical attendants to lie almost continually on a sofa. But these are unfortunate cases. Where there is a fair measure of health, to have both mind and body employed is decidedly ■useful ; and a female should be glad when it is in her power to enjoy this advantage. Severe bodily labour is of course to be avoided, as too trying to the system, and apt to produce accidents ; and great mental tasks are equally undesirable, as tending to create too much excitement. But the every-day matters of life, the domestic arrangements which make home respectable and attractive, the benevolent and affectionate sentiments exercised in kindness and service towards others, the charity which acts rather than gives, the daily walk enlivened by conversation or observation, the cultivation of the intellect by reading, the preparations for the maternal office — all these are suitable means of keeping mind and body in that state of moderate activity which is required, and such are ever at command. This moderate occupation is useful in two ways. It tends to sustain that cheerfulness and serenity of mind which have already been spoken of as

INFANT TREATMENT.

so desirable during pregnancy. It is also useful as a means of keeping off and counteracting a certain tendency to nervous excitement which is sometimes experienced by pregnant females, and which manifests itself in irritability and impatience, despondency, and listless indifference. When such excitement is first felt approaching, it should be met by a vigorous determination not to yield to it ; and active employments will then be found extremely serviceable. Females often act otherwise, and, under the notion that, such nervous excitement being natural, it ought to be patiently submitted to, they resign themselves to it, and expect that others should treat it with charitable indulgence. But, in reality, it may be successfully contended with in most instances, and it is the duty of every one thus to contend with it.

It may here be remarked, that, minds being constituted differently, all do not find that the same duties and objects serve equally well for sustaining their cheerfulness and keeping off the tendency to nervous excitement. The exercise which is beneficial to one, may be irksome to another; but the main object in all cases is the same, though reached by different paths. Worldly circumstances also are various ; it is therefore impossible to lay down rules for the employment of mind and body : it is easier to point out what is to be avoided ; namely, excess, whether it regards ease or exercise, food or sleep, and the frequenting places of public resort, and close private apartments where the air is heated and vitiated. In every situation of life there are trials of temper, alternations of hope and fear, joy and sorrow, pleasure and displeasure : to regulate these emotions, to restrain them within such bounds that they shall neither over-excite nor exhaust the nervous energy, nor interrupt the healthy action of the bodily functions, is within the power of every human being, and is a discipline agreeing equally with the precepts of the moralist and the prescriptions of the physician.

As yet, we have only considered those circumstances which affect the human being before birth : we are now to treat of those which conduce to his weal after he has entered the world.

The child should be placed at the breast within from twelve to eighteen hours after birth. When this is delayed longer, the breasts are apt to be distended with milk, and the act of suckling is then attended with pain and difficulty. In such circumstances, the overloaded vessels being imperfectly emptied, inflammation is excited, and milk abscess may ensue. The milk left too long in the breast, if afterwards sucked, occasions pain and disordered bowels to the infant, or is rejected from its stomach. In the latter event, the nourishment is insufficient, and results seriously affecting the permanent health of the child may be experienced. It occasionally happens that the flow of milk in the first few days is greater than the child can take. If it do not flow away, fomentations of warm water may be applied, which is a better remedy than rubbing the breasts with spirits ; for they are rendered so tender by distension, that they easily bruise. When the abundance of milk is troublesome, the mother should drink little, and take opening medicine.

On recovering from confinement, and resuming her usual dress, there cannot be too much caution in securing perfect liberty for the breasts. The waist of the dress should be loose and long. The low stooping position in which a woman sits while suckling, encourages an enlargement of the abdomen, if not guarded against ; and injury to the figure, and untidy appearance, have been urged as reasons why mothers should not also be nurses. Such consequences are by no means necessary. The dress may be as neatly arranged as at other times, and the figure has only to be protected, and such exercise taken as will keep down the tendency to enlargement of the abdomen. There can be no other permanent increase unfavourable to beauty or utility. It sometimes happens that the nipple is small, or turned into the breast ;* a new-born infant has scarcely

* There is great reason to believe that the use of tight stays creates or increases this deformity. Artificial restraints are the cause of many of the sufferings of child-bearing. The malformation of the sufficient strength to draw it : in such cases it saves much pain to have the breast drawn by another child of about six or eight weeks old. The mechanical means often adopted are very apt to cause sore breasts. It is, however, desirable that the infant should get the first milk, as this has the effect of clearing the bowels of the meconium, or first evacuations, and generally supersedes the necessity of a purgative. A young mother is generally awkward in holding an infant ; but a little fortitude and perseverance will overcome the difficulty.

Where there is a decided inability to suckle (which may usually be decided before delivery), and a wet-nurse is to be engaged, there are two or three points requiring attention. The nurse should be as nearly as possible of the same age as the mother, because there is a relation between the constitution of a mother and her newly born babe, and, the more nearly the hired nurse resembles the mother in constitutional peculiarities, the more suitable will she be for rearing that particular child. A hired nurse should also have been confined about the same time as the mother, because the milk has a different character at different stages of nursing, being thin at first, and gradually growing stronger, so that, if a newly born babe be put to the milk of a woman any considerable time confined, it gets too strong or heavy milk, and is thereby sensibly injured.

The diet of a person engaged in nursing should be nutritious, but not heavy. What agrees and disagrees in ordinary circumstances, will then have the same effect. Diet must also have reference to constitution. A person of full robust habit will require less nutriment, and will suckle better upon diluting drinks, such as tea, toast and water, gruel, &c., while a delicate person of languid circulation will need more animal food, milk, beer, perhaps

nipples is alluded to by an old writer, who ascribes its prevalence in his day to the use of the leather stays of the period. In all circumstances, these tender organs should be guarded against pressure; and during pregnancy, when the breasts often enlarge, the stays) however soft and loose, should have an opening in the centre of each side of the bosom.

ale or porter: wine is not so desirable; it is stimulating rather than nutritious ; though, mixed with water, it may in some cases agree better than beer. The poor generally have a good supply of milk, and suckle for many months ; tea is their chief beverage. It is true their infants are often fretful ; but this is to be attributed to the indulgence of violent passions on the part of the mother, so often found among the ignorant, to exposure to cold, and deficiency of cleanliness and ventilation, rather than to the vitiation of the milk from low living.

The quality of the milk chiefly depends upon habits of mind and body ; the quantity varies in different persons, in correspondence with age, constitution, &c. In some constitutions, the food goes more into nourishment, and less into milk, than in others. In those cases, the less food is required. In other constitutions, the aliment goes more into milk, and less into nourishment ; and a woman so characterised requires to be comparatively well fed. It is necessary for a nurse who has a tendency to flatulency, to avoid viands apt to induce that ailment, not only on her own account, but that of her charge, for this and other disordered functions tell upon an infant immediately, through the medium of the milk. Where a nurse is actually affected by flatulency, her taking a little powdered ginger or carbonate of soda makes her milk agree better with the digestive powers of the child.

A mother who is also a nurse, has a double claim upon her, and a double motive to stimulate her in the observance of the laws which govern health. The immediate welfare of herself is indissolubly united with that of her child ; every transgression on her part inflicts suffering on her infant, who is the helpless victim of her errors. And not only so : unhealthy ailing children bring great afflictions upon a family. In the case of affluent persons, they bring disappointed hopes, wounded pride, and sorrowing affections. A father is naturally disposed to regard his offspring with pride, exultation, and hope ; but can he do this when he sees ailing, fretful beings, incapable of enjoying or benefiting by the advantages which his abundance

B and his affection procure ? In the case of poor people, the sorrowing affections are aggravated by the expense, the household discomfort entailed by illness, and the prospect of the sickly creatures around being hereafter incapable of earning their maintenance at all, or of doing so under the pressure of bodily and mental suffering. The faults of the mother may inflict these disappointments and difficulties upon the father. Her responsibilities are great and numerous. Yet there fortunately is a present happiness connected with the maternal duty, arising out of mere instinct, which lightens the burden, besides a continual and increasing reward springing from and experienced by the higher sentiments of her nature.

Section II

The milk of the mother is to be regarded as the most appropriate food which can be given to a newly born infant. Where a mother, therefore, has a sufficiency of milk, and is otherwise able to perform the duty, she is called upon by the voice of nature to undertake 'it. It is a duty which may be attended with some degree of inconvenience; but this is amply compensated in the delightful feelings which are developed in the course of the nursing period, and the consciousness of performing a duty of the greatest importance to one in whom she feels the deepest interest.*

* The performance of this duty by the mother is of consemience to the moral as well as physical condition of the child A hired person cannot be expected to feel like a parent : she has not the motives for subduing her passions, restraining her appetites sacrificing her pleasures and her rest — in short, for practising the selfdevotion and self-control which the office of a nurse demands No

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When the mother is unable to nurse, the next best course is to engage a substitute, selecting one as healthy, as near in age to the mother, and as nearly the same time confined, as may be obtained. It should be regarded as a sacred duty by parents to provide a wet-nurse, if their circumstances will at all permit, for by no other means can they be tolerably assured of the welfare of their child. In the next alternative of bringing up a child by the hand, or giving it cows' milk and soft food, there is danger of much physical evil. The truth is, no kind of food but the mother's milk, or that of a well-chosen nurse, assimilates with the digestive organs of an infant in the first few months of its existence. The evil of the mere unsuitableness of other food is aggravated when it chances that too much is given. While a superabundance of milk produces no harm, from its so easily being discharged from the stomach, food cannot be got up without straining, and without irritating the stomach. Children that are dry-nursed vomit less frequently than those who are suckled ; but this is no proof that the food agrees : digestion is difficult, the superabundant food ferments, becomes very acid, passes into the bowels in an improper state, irritates the mucous membrane, and occasions the loose, green, sour-smelling stools, indicative of what is termed gripes. It is a common practice to give an infant a purgative a few hours after its birth, and to feed it until the mother

doubt, many such persons are found to perforin their duties with an honourable zeal and fidelity ; but it may happen otherwise, and the employment of any other than the mother should at the best be regarded as a step involving considerable danger, and only therefore to be taken under the pressure of necessity. A child is suckled sufficiently long for its mental powers to begin to act : it observes and imitates ; its nurse awakens it earliest emotions, attaches its first affections : tenderness, gentleness, and propriety, should therefore characterise every action. When the mother is the nurse, these qualities distinguish her caresses and her attentions: the performance of the one office naturally entails the fulfilment of many others : there will be a more complete superintendence of the infant's condition, of the earliest symptoms of indisposition, of its cleanliness, its growth and form, the progress of its perceptions, and the early manifestations of temper. Such minute attentions require an intelligence and interest scarcely to be expected from the hired nurse.

has milk for it. Both these practices are contrary to nature ; the first milk causes a free natural discharge from the bowels very different from the effect of medicine, which irritates and enfeebles the alimentary canal, establishing disorders which carry off a delicate child, and cause a robust one much suffering. Whether an infant be wet or dry nursed, its stomach should he left at rest for several hours after birth : if there be crying and uneasiness, they are likely to arise from other causes besides hunger. The sudden change of situation, exposure to air, the dress with which it is necessarily encumbered, and the manner in which it is handled, are sufficient to account for uneasiness. Warmth, quiet, and repose, afford ample solacement for the first few hours of life.

When there is unusual delay in the flow of the mother's milk, or a difficulty in getting the child to suck, a small quantity of asses' or diluted cows' milk will save the infant from exhaustion ; hut on no account should farinaceous food (that is, food composed of any kind of flour from grain), be given. The greatest safety will be found in the breast : there are few situations where it would not be possible to find a mother willing and able to suckle the new-born infant until its natural food is ready. That fluid is the proper aliment for an infant, is shown by its having no teeth, and by the muscles of the mouth and jaws being too feeble for mastication, while the structure of the whole frame is lymphatic, incapable of voluntary motion, and easily excited. If a child is to be brought up by the hand, cows' milk skimmed, or diluted one-third with boiled water, and slightly sweetened, is the only nourishment that can be safely taken, unless asses' or goats' milk can be procured, these being more nearly allied to the milk of a woman. When we depart from the intentions of nature, we always encounter difficulties. With some children cows' milk will not agree at all, or only when mixed with oatmeal gruel ; sometimes the latter alone suits best. Again, in cases of relaxed bowels (a common disorder with dry-nursed children), isinglass, highly baked flour or arrow-root, mixed very thin with milk, are the best diets •

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occasionally weak animal broths are most suitable. All irregularities are better counteracted by diet than by medicine. The application of a flannel bandage to the lower part of the body is judicious in bowel complaints. A warm-bath soothes irritation and allays pain. The state of the bowels indicates the condition of the digestion. Green, watery, slimy, or sour-smelling motions, are bad, as are streaky dark stools. Two or three motions in twenty-four hours are sufficient ; less may be enough where there is no pain or symptom of disorder. Cold produces relaxation. The use of the warm-bath is in most cases highly beneficial. The facility with which it is prepared for an infant, renders it an easy remedy ; a washiDg-tub, and a pailful of boiling water, will be sufficient when lowered to 96 or 98 degrees Fahrenheit's thermometer. There are few disorders which a bath will not alleviate. There is an opinion that it exhausts. Like all other things, its use requires discretion. A very young infant should not remain in it more than six or eight minutes, and it should not go in daily. The head and loins should be supported by the bands of the nurse, so that the whole person may be at ease and entirely immersed, except the head and face : when very young, an infant is rarely alarmed by the water ; but when there is intelligence, fear is often felt. A little ingenuity in floating paper boats, corks, &c, amuses and diverts apprehension ; and after a few trials, the bath becomes agreeable.