Health of our children

Preface

The fact is undeniable that two-thirds of the cases of illness among young children might be prevented if those responsible for their welfare would only obey the simple laws of nature, and in their management display a reasonable amount of common sense. Realizing, after years of practice, as all other physicians do, that the appalling waste of life is, clearly due to preventable causes, and that the great majority of children who have died might have been saved had proper care been given them and reasonable precaution been taken by their parents, the writer has felt that there was no field in which he could labor with the promise of better results than this he has entered. In the simplest language possible, on the following pages, he puts before the reader the important essentials in the care and management of children. Those points especially are dwelt upon, on which mothers are most likely to be in doubt, and which experience has taught him are the first in importance in the prevention of disease. The ardent hope is indulged that his series of hints will be found instructive and of assistance to mothers in the care of their little ones. Author.

Contents

PAGE

Chapter I i

Mortality among children. — More than one-third under five years die. — The duty of every individual. — Unfortunate conceit of older mothers. — Not infrequently dangerous counsellors. — The inconsistency of their claims to unusual discernment. — The injury which they often do. — Defeating the efforts of physicians. — Honest criticism. — Delusions easily acquired and with difficulty eradicated. — Young mothers the best nurses. — The design of the author.

Chapter II

Infant feeding. — Difficulties attending the discussion of the subject. — Inviolate duty of mothers. — Child nourished at the breast. — Faults in the mother which grievously affect the health of her infant. — Mental disturbances. — Mischievous consequences of overfeeding. — Rules to be observed during the first six weeks. — No feeding during the night. — Simple expedient to save the strength of the mother. — How often to nurse the baby.

Chapter III n

Infant feeding. — Pernicious habit of many mothers. — Causes of crying. — Dangers from too frequent nursing. — Death a common consequence. — Injunction not to be disregarded. — Colic. — Plan for relief. — Troublesome infants. — Evidences of disease. — Substitute for milk. — Thirst. — Importance of water. — Cholera infantum. — Persistent vomiting. — Feeding with a spoon. — Bottle feeding. — Exceptional cases. — Peculiarities of some children.

v i CONTENTS.

PAGE

Chapter IV 16

Infant feeding. — Reasons why some mothers should n6t nurse their infants. — Moral and physical defects. — Inheritance. — Difficulties in nursing children artificially. — Selection of the nursing-bottle. — Convenient but deadly inventions. — One cause of infant mortality. — Dangers which cannot be exaggerated. — A familiar sight. — The indifferent mother and her wanton methods. — How infants are killed. — A proper nursing-bottle. — Simplest apparatus. — Approved form.

Chapter V . . 22

Infant feeding. — The nursing-bottle. — Importance of cleanliness. — How to insure it. — Rubber tips. — Dangers from milk turned sour. — The powerful poisons generated in it. — Ice-cream and cheese poisoning. — One probable cause of the terrible waste of life. — Injunctions to young mothers. — Dangerous habits to avoid. — Specially prepare each feeding. — Warming the milk. — The proper temperature.

Chapter VI 27

Infant feeding. — By the bottle. — The operation described. — Hints to mothers. — Preparation of food. — The proper quantity demanded by infants. — The limit of the capacity of the stomach. — Changes which are required in the food as age advances. — Milk. — The basis of all infants' foods. — The popular delusion regarding cows' milk. — Dishonest practice of milkmen.

Chapter VII 32

Infant feeding. — Adulterated foods. — Milkmen. — Their hardships. — The spirit of the time. — Fraud everywhere. — Food and drug adulterations. — Government protection denied the people. — Scoundrels who gain wealth by fraud. — Lust for gain killing thousands. — Milkmen's tricks. — Responsibility of the purchasers. — They invite adulteration. — Delusions. — Milk color. — How it is used. — For what purpose. — Its action on the system.

CONTENTS. vii

PAGE

Chapter VIII 38

Infant feeding. — The milk supply. — Fixing the standard. — Needed sanitary enactments. — Official inspection of dairy farms. — Reforms which should be instituted. — Unconsciousness of the public to its dangers. — Possible contamination. — How milk may become infected. — The ease with which disease is transmitted in milk. — Unhealthy state of many dairy farms.

— How cows should be kept.

Chapter IX 43

Infant feeding. — The milk supply. — Feeding of cows. — Improper substances used. — Acid milk. — Its effect on the system. — Too late milking a grievous custom. — An honest milkman. — Rigid enforcement of the laws demanded. — Common faults in milkmen. — Faults in consumers. — How milk should be kept. — Fresh twice daily for children. — Condensed milk. — How it can be advantageously used.

•Chapter X 49

Infant feeding. — Milk the basis of all foods. — Goat's milk. — How to prepare the infant's food. — The quantity of water. — Cream. — Exigencies. — Responsibility of mothers. — When to change the baby's diet. — Patented foods for infants. — Very little difference between them. — Dangers of indiscriminate use. — No food equal the mother's milk. — Precautionary hints.

Chapter XI 54

Infant feeding. — Policy of the writer. — To do good without doing harm. — Mothers generally over-confident. — Many assume by far too great responsibility. — How disease frequently manifests itself. — Symptoms of brain disease. — Diphtheria.

— Infant life ever in danger. — Send for a physician when disease threatens. — The awful consequences of experimental treatment and delay. — The terrible mortality, and who is to blame for it.

viii CONTENTS.

PAGE

Chapter XII 60

Infant feeding. — Additions to milk sometimes needed. — Indigestion. — Patented foods. — Objections to their use. — When a child does not thrive well on milk. — Death the frequent consequence of experiment on infants. — A golden rule for mothers. — Arrowroot, oatmeal, etc. — When they can be used. — How to prepare them. — Barley. — Gruels which are allowable if intelligently used.

Chapter XIII 65

Infant feeding. — The nutritious and digestible gruels. — Wheat flour. — How to prepare it. — The flour-ball. — Barley jelly. — Gelatine. — The limits of mothers. — That class which will disagree with the writer. — Some of the consequences of their methods. — Make no change in the diet while the child is doing well. — Good judgment imperative. — Rules to be observed. — Changes after the first year.

Chapter XIV. 71

Infant feeding. — In the second year. — The number of meals daily. — The proper hours. — Animal foods. — When broths may be allowed. — How prepared. — Vegetable foods. — Digestible meats. — Precautions to be observed. — Diet after the eighth month. — Progressive changes. — When a full diet may be allowed. — Important lessons which children must be taught. — The child at the table. — Its diet then.

Chapter XV 77

Children's diet. — In the third year. — Hints and necessary precautions. — Digestibility of various fruits. — Warning against sweetmeats. — The dangers from their use. — The conduct of some parents sinful in the extreme. — Tea, coffee, and chocolate. — Children should never be allowed them. — The atrocious practice of encouraging the use of stimulants. — The brain in childhood. — Tendency to disease then exists. — Hints to be remembered.

CONTENTS. i x

PAGE

Chapter XVI 82

Bathing of infants. — Cleanliness an important requisite. — Consequence of neglect. — Healthful impressions from early practices. — The virtues of the different baths discussed. — The writer digresses. — A tribute to intelligent mothers. — Thermometers. — Actually necessary in the nursery. — The temperature of the infant's bath. — When cold sponging is permissible. — Warm baths must be quickly administered. — When to bathe. — The preparations.

Chapter XVII 87

Bathing of infants. — Soaps which are forbidden. — Those which maybe used. — Washing the head. — Common delusions. — Treatment after bathing. — Expedient when a child fears the bath. — Toilet powders. — Inexpensive substitutes. — How often to bathe. — Only gradual changes in the temperature allowable. — Cold sponging. — The hot bath. — Mustard bath.

— The cooled bath. — Imperative necessity of cleanliness in the person of the mother. — Bathing the breasts.

Chapter XVIII 93

Clothing and sleep. — The mother's province invaded. — The binder. — It should be worn during the first year. — Underclothing. — The proper material. — - Essentials in children's clothing. — Night-dress. — Covering of the feet. — Of the head.

— Dangers from exposure. — Precautions when out of doors. — Common faults to be avoided. — Overburdening with clothing.

— Sleep. — Good habits to encourage. — The amount of sleep required during childhood.

Chapter XIX 99

Rest and sleep. — Rocking children a hurtful practice. — Important rules to be observed. — How to quiet the baby. — Sleeplessness caused by cold. — An indication of illness. — Sleepingmedicines. — Dangers from their use. — Soothing syrup which x CONTENTS.

has killed many. — Paregoric elixir. — Its effects. — When its use is permissible. — One occasion for a physician. — Children's sleeping-rooms. — The vital importance of pure air.

PAGE

Chapter XX 104

The sleeping-apartment. — Situation of the crib. — The amount of pure air needed by children. — Dangers from overheating during sleep. — That cooking-stove. — Sanitary requirements.

— The furnishings. — Dangers from stationary basins. — Proper ventilation too often neglected. — How to secure it. — Bed-coverings. — Expedient to prevent children from throwing them off. — Death in foul air. — The nursery. — How it should be kept. — Vile practices which are common.

Chapter XXI 109

Heating and lighting. — Serious consequences of excessive heat.

— Susceptibility to cold. — How it is invited. — The proper temperature. — Danger lurks during the teething period. — Peculiar liability to brain disease. — Keep children out of the kitchen. — Incautious mothers and sad results. — Burned to death. — Lighting the nursery. — Objections to the common methods. — Hints on the use of oil and gas. — Electric light.

Chapter XXII 114

Open air exercise. — Elderly mothers contrasted with those of the present day. — Health depends upon an abundance of pure air. — When to take the baby out. — Accustom him to sudden changes. — An important duty often neglected. — Out every-day if possible. — Protected from cold. — From the sun. — Veils forbidden. — Baby carriages. — Their use and abuses. — Spinal weakness. — Lasting injury the consequence of neglect.

— Important rule.

Chapter XXIII 119

Holding the baby. — Common faults. — How the happiness of home is threatened. — Grievous mismanagement characterize

CONTENTS. xi

many mothers. — An infant may prove a misfortune. — Who is to blame. — A picture true to life. — Keep infants in their cribs. — An idiotic practice. — Trotting on the knee. — Creeping. — Walking. — Let a child mature gradually. — Moral infirmities to be anticipated. — Teach it to be fearless and selfreliant.

PAGE

Chapter XXIV. . 125

The education of mothers. — Facts repeated for the sake of emphasis. — The terrible waste of life. — Its preventable causes. — Ignorance and neglect in all classes. — Some mothers and their opportunities. — To bring up children properly is difficult. — Easily acquired prejudices. — Elderly advisers much to answer for. — Overworked mothers. — Penalty of poverty. — The duty which is demanded of all.

Health of Our Children.

o^o

Chapter I

Mortality among children. — More than one-third under five years die. — The duty of every individual. — Unfortunate conceit of older mothers. — Not infrequently dangerous counsellors. — The inconsistency of their claims to unusual discernment. — The injury which they often do. — Defeating the efforts of physicians. — Honest criticism. — Delusions easily acquired and with difficulty eradicated. — Young mothers the best nurses. — The design of the author.

TF an effort is made to lessen the mortality of a •*■ community, it must first of all be directed to improving the condition of children, as it is their loss that swells the death rate. In France, according to Bouchut, one-sixth of all born die in the first year of life ; in Sweden and Finland, one-fifth ; in Berlin, Prussia, one-third. In Philadelphia, 1883, according to Hartshorne, there were 16,736 deaths at all ages, of which 5,121 were under one year of age, 7,151, or about one in 2.33 of all deaths, under five years of age. In the report of the board of health of Boston for 1885 is given a table showing the total number of deaths under five years of age, and five years and over, for fifteen years, commencing with 1871. It is noted that the total number of deaths at all ages was 124,833, and of this number 49,229 were children under five years old. That is, considerably over one-third of all the deaths recorded took place in children under the age stated, and yet intelligent physicians, perfectly familiar with the causes of infant mortality, do not hesitate to say that among those born with healthy constitutions, and under entirely favorable circumstances, the mortality during infancy and childhood ought to be less than at any other period of life.

In England, Dr. Farr has proved by his reports that the diseases of childhood are twice as fatal in towns as in the country. Thus it will be seen that the first step in sanitary reform should be directed to lessening, if possible, this excessive mortality among children, and that it can be lessened none can deny ; but the remedy is by no means with the health authorities ; it is within the province, and should be the duty of all to assist in the work which promises such beneficent results.

A few hints on the care of infants may be of interest to young mothers ; older mothers, as a rule, after a brief experience, conclude that they have acquired all that there is to learn, and are inclined to distrust

* MORTALITY AMONG CHILDREN. 3

the efforts of physicians to dispel the delusions which are so common among them. The value of experience is not to be underrated ; nevertheless it is a " dear teacher," as not a few have found, and not infrequently, while the mothers have been acquiring it, their infants have sadly suffered from experimental treatment, as the following case illustrates.

Recently the writer was called to attend an infant made seriously ill solely by the want of proper care. The mother was at once taken to task for her glaring faults in management, and asked from what source she had acquired such stupid notions. An elderly woman in the room came to her rescue, and said that she had taught her how to care for her baby, and having had nine children, she felt, she said, that she was competent to give instructions to the young mother. This elicited the inquiry how many of the nine were living, and it was learned that but one among them all had survived ; the others had died in childhood. The writer felt impelled to say that, in view of the methods which she had evidently employed, that one must either have had a powerful constitution or Providence had interposed to save him. It is such advisers as these who help swell the infant death rate.

An expression which one occasionally hears used is "that there are more children killed by old ladies than by disease." It is a severe thing to say, and one naturally hesitates to indorse the assertion ; still, there is a basis of truth for it, and among those people who cannot unjustly be called ignorant, many infants' lives are sacrificed by reason of improper treatment, advised by those well-meaning, but, none the less, dangerous counsellors. While they predominate in the lower classes, unfortunately they are not confined to them, and the results of their work are seen in every station in life. Not a few of them cannot read or write, and yet they are familiar with every disease and the treatment it demands, and feel competent to sit in judgment when the skill of the physician is discussed. Fortunate is the professional who wins their indorsement ; they can make or unmake him in families to which they have access, and yet his hold upon their esteem, as upon "princes'' favors," is never secure; let it once appear that he underestimates their importance, and they will soon convince themselves and others that he is lacking in professional skill and discernment.

It may be said that this brief reference shows a lack of reverence, and that a mantle of charity should be thrown over the faults of those well-meaning people, and they be excused on the ground of good intentions. Were other than health and life at issue, the criticism might be warranted ; but in this instance

MORTALITY AMONG CHILDREN.

it is not,' for there is too much at stake. Almost every physician who has been long in practice will say that, as a rule, they are more, successful in the treatment of children, the mother of which is young and inexperienced, than they are in families where the mothers are older, have had more experience, and acquired delusions which argument will not infrequently fail to dispel, and which must necessarily obstruct his efforts, and also prejudice his success.

The writer will touch here and there on points in the general management of children upon which, in his experience, mothers are most likely to err. No finished treatise will be attempted, but in a series of talks, as it were, will advice be given.

Chapter II

Infant feeding. — Difficulties attending the discussion of the subject. — Inviolate duty of mothers. — Child nourished at the breast. — Faults in the mother which grievously affect the health of her infant. — Mental disturbances. — Mischievous consequences of overfeeding. — Rules to be observed during the first six weeks. — No feeding during the night. — Simple expedient to save the strength of the mother. — How often to nurse the baby.

^PHE subject of infants' feeding is one which can- ■*■ not be understandingly treated unless it is viewed from every standpoint ; and so manifold are the conditions which must influence the food selection, many pages might be written ere the treatise were completed. First must be considered the three ways in which infants are nourished ; namely, by the mother, by a wet-nurse, and by artificial means. Then there are the laws of diet, the proper conduct of nurses, their state of health, the influences which they encounter, and their effects upon the infants they nourish ; all these must be considered, together with manifold contingencies, some of which present but slight outward differences yet widely differ in true significance. Even when these were discussed, there would remain much of importance to dwell upon.

INFANT FEEDING. y

Thus it will be seen that the subject of food selection for infants is wellnigh exhaustless. It is only permitted the writer to lightly touch upon a few points of special importance ; he will also endeavor to dispel some of the delusions of which, unfortunately, many mothers are possessed.

The assertion that every mother should nourish her child, if possible, will bear repetition. Many decline to do so through caprice ; there are but few who cannot if they choose, provided they take the right course in the beginning. To point out that is the duty of the family physician ; and if his advice is invariably followed, the advantages both to the mother and her little ones will be incalculable. A fact of prime importance which should be impressed upon all nursing mothers is this : if they expect their infants to thrive and remain well, they must themselves maintain good health.

If a mother is ailing, her infant at the breast must also be more or less ill. If she is careless about her diet, and indulges in food which causes dyspeptic symptoms, the fact is registered in her child, and colicky pains, and possibly vomiting and diarrhoea, are the consequences. If she is a woman of a fretful, irritable nature, then her infant will be troublesome, peevish, and sickly. Many a child has been made seriously ill simply because its mother gave way to a "fit of temper" ; great mental disturbance diminishes or vitiates the secretion of the mother's milk, and it becomes hurtful to the nursing child.

A very common complaint from which mothers suffer is constipation, and yet often they will persist in dosing their infants for the same disorder without ever thinking of treating themselves — the only sensible course for them to pursue. When this irregularity is common to both, then little or no medicine will be needed by the child, but the mother should employ upon herself the proper remedies, regulate her diet, etc.

It is natural, that mothers should be solicitous for their offspring ; it is, nevertheless, exceedingly unfortunate that many may not improperly be said to be over-solicitous, especially regarding bounty in feeding. In their assiduous endeavors to guard against even momentary hunger, too often they keep their stomachs overloaded both day and night. It is well for them to understand that the consumption of a large amount of food does not by any means imply that the increase in growth will be correspondingly great. For instance, if a baby takes more nourishment than it really needs, it is liable to grow thin ; while if the quantity is lessened, it will grow fat.

It must not be forgotten that there is a physical law, that activity and repose must alternate ; that is,

INFANT FEEDING. g

that periods of rest are absolutely necessary to every organ of the body. If the digestive organs are overworked, and the essential periods of rest are denied them, or they are so shortened that entire restoration does not occur, then they become weakened, are incapable of properly performing their functions, and, unless the needed relief comes to them, in time they will become powerless. Again, it should be remembered that the digestive organs of an infant are naturally feeble, and that regularity in feeding is of even more importance to them than it is to adults. The functions of those organs are so intimately concerned in the growth of the child that any impairment, if it is not soon corrected, is likely to result seriously.

During the first six weeks of life an infant should be fed every two hours during the day, but at night it should sleep at least six hours without feeding. If the mother retires at n p.m., it should then be given its food, and no more will be needed until 5 or 6 a.m. How few mothers there are who observe this rule with their little ones ! If all would follow it, far better health would be enjoyed both by the mothers and children. The custom of many who insist upon nursing their infants during the night is a most pernicious and sinful one, for it is alike destructive to the mother and babe. The former should have at least six hours unbroken sleep every night, or her

IO HEALTH OF OUR CHILDREN.

general health will soon become so impaired, or her nervous system so weakened, that she will be rendered entirely unfit to nourish her child ; and the same period of rest is equally as essential to the little one. Some infants, it is true, at first rebel, awake and cry in the night. If they do so, it is very rarely an excuse for night feeding. A bottle should be provided and a little milk and water or sugar and water given ; generally this is all that is necessary to pacify them, and by this management persisted in for a short time, the custom of sleeping six or seven hours every night will be formed, and then no further trouble will be experienced.

After the sixth week the. interval between nursings should be gradually lengthened, and when the fourth month is reached, food need not be administered oftener than every three hours. Until the period of weaning, food may be given every three or four hours, as seems best suited to the child, regularity, of course, being an absolute essential

Chapter III

Infant feeding. — Pernicious habit of many mothers. — Causes of crying. — Dangers from too frequent nursing. — Death a common consequence. — Injunction not to be disregarded. — - Colic. — Plan for relief. — Troublesome infants. — Evidences of disease. — Substitute for milk. — Thirst. — Importance of water. — Cholera infantum. — Persistent vomiting. — Feeding with a spoon. — Bottle feeding. — Exceptional cases. — Peculiarities of some children.

T^HE first thing which the average mother does A when her child cries is to feed it. This is one of the most serious of mischief-working habits, and it is one which, if persisted in, is likely to prove destructive to the child. Babies, of course, do cry from hunger, but just as often, if not oftener, they cry from some other cause. Among the most common causes are colic, and the pain and discomfort induced by indigestion. It ought not to be difficult for any mother to recognize when her child is hungry ; she must be exceedingly dull if she cannot do so, and, unless the child is hungry, it ought not to be necessary to say that food should not be given it. But unfortunately it is necessary to repeat this injunction over and over again, and to point out the dangers of disregarding it, for it is one of the rocks on which so many mothers founder.

In slightly changed language an accepted authority says on this subject : It stands without saying that the cry of hunger must be relieved by giving food ; but this is the very worst thing to do under other circumstances, for it both breaks up good habits, and produces serious mischief as well. The pain of colic and the discomfort of indigestion are chiefly due to the accumulation of gas in the intestines, resulting from the fermentation of food. Mothers soon learn, and unfortunately infants, too, that the breast milk temporarily relieves suffering. This it does in the same way as any warm liquid ; but, unlike a simple fluid, milk only adds more material to the already fermenting contents of the stomach and intestines, and every nursing is soon followed by more pain, and, between crying and nursing and nursing and crying, the infant's life is passed in misery, if not cut short altogether. Instead of continuous food, the plan for relief is to decrease the quantity of food by giving it less often and shortening the time the child is allowed to nurse, while medicines are employed to strike to the root of the evil.

Not infrequently mothers complain that their chil-

INFANT FEEDING.

dren are naturally peevish and troublesome, " always fretty," as many say, and they sleep but little and cry much. They assume that the irritable quality is inborn, and an essential part of their composition, and more often do they fail to recognize it as an evidence of disease. A troublesome, crying child cannot be healthy, and mothers should be assured of this fact and endeavor to determine the cause ; if they fail to discover and remove it, then it is clearly their duty to seek the advice of a physician. In some children the ruinous habit of too frequent feeding may become so fixed that no little trouble will be met before they can be made contented with the needed change of food at longer and regular intervals. In such cases it will be easy to substitute some simple liquid, such as milk and water, sugar-water, or, what is generally very acceptable, gum-arabic water.

. Children often cry from thirst ; that is, from a desire for water. It never need be denied them, excepting, of course, in cases where the stomach rejects it, and such cases will be found very uncommon. In cholera infantum vomiting is usually persistent, and yet not infrequently the same will be controlled if ice-water is freely given. The writer has seen cases in which remedies to check vomiting had been administered without any benefit, and

H

HEALTH OF OUR CHILDREN.

still, when ice-water was given and the children were allowed to drink deep]y, possibly nearly a glassful, not only did the vomiting cease, but all the other symptoms at once begun to subside. This suggests the need of teaching infants at as early an age as possible to take liquids directly from a spoon or cup. Some physicians maintain that this method of feeding, to which the little ones very readily conform, is much less objectionable than by the bottle. Be it as it may, the children can be reared perfectly well upon the bottle if the proper care is used.

While insisting upon the rule that regularity in feeding is an absolute essential to the welfare of infants, and that in the vast majority of cases food should be given no oftener than advised in the previous chapter, the fact is recognized that there are occasional cases in which these intervals must be shortened, and possibly it will be necessary to administer food once or twice during the night. Such cases are exceedingly rare, however, and can scarcely include healthy infants. It is not too much to say that, after they are four months old, they certainly ought not to be fed oftener than once in three hours ; at least, unless a physician deems it necessary. There are some children who need food less often than others, and even longer intervals between the