Hygiene of childhood: suggestions for the care of children after the period of infancy to the completion of puberty

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UNITED STATES OF AMERICA.

Preface

The strength and prosperity of a community and a nation are largely influenced by the sturdy vigor of body and mind of the adult population ; and, as the oft-quoted saying that the child is father to the man is true, and as the vigor at maturity must in a great measure depend upon proper guidance during the years of development, it follows that it is of the utmost importance that parents should have correct ideas on the personal hygiene and care of their children.

Notwithstanding that the study of the period of infancy and adolescence has received especial attention of late years, and that mothers are realizing more and more the vital necessity of hygienic observances at this time of life, the physician in his round of visits is made aware of a woful lack of knowledge, or perhaps appreciation, of the laws of health by mothers and by others who have the guidance of youth; and he feels that arguments demonstrating the necessity of closely studying the requirements of childhood can not be too frequently presented.

6 PREFACE.

This little manual, on the care of children from the period of infancy to the completion of puberty, can not naturally be considered as embracing the entire question of the hygiene of childhood, but is intended merely to awaken serious thoughts in the mind of the mother relating to the care of her children ; and it is hoped that the suggestions herein contained will afford practical aid, and enable her to avoid numerous hygienic sins of omission and commission.

Newport, R. I.

Contents

PAGE

Preface 5

Introduction 11

Introduction

Until within a very recent date, nearly one half of the total mortality in the larger cities throughout our country was of children under five years of age.* This fact affords matter for the deepest consideration, and a thoughtful mind will naturally question the reason of so great a destruction of life among the young. Investigation shows that this large mortality was mainly due to a disregard of the laws of health, and that obedience to these laws will very materially reduce the death-rate. The correctness of this statement may be verified by a study of the mortuary statistics of large cities during the past fifteen or twenty years, in connection with the sanitary reforms in these cities ; and also by a comparative study of mortuary tables exhibiting the differ-

* See Appendix.

ence in the death-rate among children in large and small cities, from which tables it is evident that, wherever the laws governing life are most carefully followed, there will be found a lower mortality during early life. "When the death-rate among children in larger cities can be materially reduced by improved general sanitation, it is obvious that the health and vigor of children in their homes can also be improved by close attention to their personal hygiene.

It is interesting as well as instructive to contrast the death-rate among children living in modern cities with that among the Indians when living in their primitive state, before they were contaminated by the vices of the white man. Catlin, an earnest student of the customs and habits of the Indian tribes of North and South America, who visited one hundred and fifty tribes, containing over two million souls, tells us that he was struck with the low rate of mortality among their children. He states * that in one tribe, numbering two thousand souls, he learned from the chief that the death of a child under ten years of age was a very unusual occurrence ; and in examining the cemetery of the tribe,

* George Catlin, " Breath of Life," p. 10.

where the dead, enveloped in skins, were left resting separately on little scaffolds of poles, he could discover, among one hundred and fifty embalmments, but eleven of children. Statistics from every other tribe visited corroborated the same statement. In one of the smaller tribes, there had occurred during ten years only three deaths - among children under ten years of age. The query arises as to the cause of this wonderful difference in mortality between civilized and primitive communities. The life of the uncivilized Indian child of the past was a mere animal existence: his ancestral stock was sturdy and healthy, he breathed a pure air, was given simple food, had abundance of sleep, and nothing to excite and exhaust the nervous system. In early life he was well protected from cold, and was taught regularity of habits and self-control. How this contrasts with the personnel of most children of to-day can be best answered by each mother.

Naturally we would not advocate going back to the habits and life of the savage in order to obtain vigor of childhood, but certainly instructive lessons may be learned by studying the causes which led to vigorous health among Indian children. Owing to the requirements of civilization, which demand of us more than a mere animal existence, we can not expect the low rate of mortality that existed among the Indians in their primitive state. We can and should have, however, with the highest state of civilization, a far lower death-rate among children than generally exists. The requirements of health are all extremely simple, and can be brought into application in every household. The drawback to the modern life — as far as it affects childhood — has been that study and cultivation have been extended to what have been considered weightier matters than the physical and nerve health of the young, which has been more or less neglected. Traditional customs have been the rule for guidance rather than true intelligence.

The benefits derived from following certain laws and regulations necessary for the maintenance of health throughout the period of infancy, are appreciated by all observant mothers. They recognize the importance of the formation of regular habits at an early age, and also the necessity of a full amount of sleep at regular hours ; of a carefully selected variety of food given at stated intervals ; of the protection of the body from chill by proper clothing ; of pure air to breathe indoors ; of cleanliness and plenty of sunlight and outdoor air.

After babyhood, vigilance in following the regu-

INTRODUCTION. 15

lations observed during infancy is so often relaxed that I desire to impress upon my readers the fact that it is of equal importance to enforce these same rules during the whole period of childhood, in order that the development of the child may not be retarded or interfered with.

Infancy includes the space of time from birth to the completion of the first dentition — about two and a half years — when childhood may be properly said to begin. The little one can now make known its wants and discomforts ; the dangers incident to dentition are over; the nervous system is less susceptible to all impressions, and not so easily disturbed by injudicious feeding or exposure to cold, dangers which are so disastrous at an earlier age.

In proportion, to the proper guidance and attention given the child during the earlier years of life will be the strength of its body at maturity. This subject, the care of children, is one that should be studiously considered by all parents, and should receive more earnest thought than any duty ; for, through want of knowledge on this subject, thousands of parents are guiding to a physical perdition, and leading to an early grave, their children, for whose future happiness they would willingly sacrifice their own lives. The physical wreck in middle life, by which the usefulness of the individual in the community is thwarted, and which blights his hopes and ambitions, after years of preparation, too often originates during the years of development. Through faulty management during the period of youth, the muscles, bones, sinews, nerves, and various organs of the body, have not a hardy maturity. As a result, the apparent strength in early manhood is not enduring, the feebleness of tissue and defective nerve -force can not withstand the demands made upon them in the battle of life, and the individual, like a badly framed and timbered ship in a storm, is unable to withstand the strain, and is wrecked.

Moral, mental, and physical training of children are equally important, but I shall chiefly confine my remarks to the physical, which, if properly conducted, insures a more complete enjoyment of a good moral and mental training. I wish, however, to suggest one thought for consideration, namely, that the moral welfare of a being is very often dependent upon, or influenced by, the physical and mental condition. With a healthy body and healthy nerve-force there is far less likelihood of a low state of morals than when the physical system

INTRODUCTION. 17

is imperfect, when the digestive organs have been perverted by improper and too stimulating food, and the nerve -force exhausted by too profound mental work, and an insufficient amount of sleep during the period of youth.

In the works of Nature, unvarying regularity must be observed in order that perfection may be attained, and the workings of the human organism are no exception to this established rule. The organs of digestion acquire the habit and power of digesting food at regular intervals, the bowels of discharging the waste material, and the brain of seeking repose ; and various disturbances in their functions and in the system result if there is any interruption in their habits.

During these important years, therefore, when the child is rapidly developing, no pains should be spared to establish habits of regularity. They are essential to a healthy existence. "When once fairly established, Nature's love for order will create a desire in the child to continue these habits. That which at first may have been difficult to implant, takes deep and permanent root.

DIETAKY DUKING CHILDHOOD.

All the tissues and organs of the body require for their healthy development blood of a good, nourishing quality and of sufficient amount, to obtain which it is essential that the material from which the blood is made, food, should be suitable both in quality and quantity, and that the digestive organs which transform the food into blood should perform their functions in a perfectly healthy manner.

It is a truism that, during childhood, simplicity of food is essential to perfect digestion. In order that the functions of digestion may be properly carried on, such food only should be given as can be digested with ease, and then these functions should be allowed an interval of rest before the next meal. By rest, is meant a period of time when the glands — whose duty it is to manufacture the digestive fluids — are not in active operation.

This glandular activity ceases only when there is no food in the stomach and intestines, or when the food is in a condition for absorption. If the necessary amount of rest is not obtained, then these glands are kept too long in a state of congestion,*

* By congestion is meant that a greater amount of blood is supplied to the part in question than is the case when the part is in a and soon cease to do their work properly, and there results what is commonly called an attack of indigestion, the stomach and bowels becoming irritable, and loss of appetite and strength, fever, pain, vomiting, diarrhoea, etc., ensuing. It is just as absurd to expect that the stomach of a young child should be capable of digesting the hearty food suitable for an adult as to expect that its arms should lift as heavy a weight, or its legs should carry it as fast or as far.

Food is taken into the body for the purposes of growth, for the formation of animal heat, and for the restoration of tissues that are destroyed or used up in the maintenance of the various functions of the animal organism. It may be subdivided into three great classes — the carbonaceous, the nitrogenous, and the mineral salts and water.

The oily, fatty, and saccharine elements in food

state of repose or inactivity. When any one function of the body is called into activity, as the brain in thinking, the stomach or intestinal canal in digesting, the liver or any of the various glands or organs of the body in the performance of their duty, there instantly takes place an accession of blood at the point of increased activity, and a healthy state of congestion takes place. If, however, this congestion is too long maintained from the excessive amount of work required, the healthy action of the gland or organ is interfered with, and a diseased state is the result. Congestion is also brought about through the agency of cold, as we shall see later on.

— classed as carbonaceous— are chiefly appropriated for the formation of heat and the nutrition of the nervous system, and that which is not immediately utilized is deposited as fatty or adij)Ose tissue beneath the skin. This adipose tissue fulfils a threefold mission — it rounds out and beautifies the body ; it protects the inner organs and deeper structures from injury ; and is a reservoir for providing the heat-making powers with fuel and the nervous system with food whenever an extra amount is called for. The nitrogenous element in food is principally used in the formation of the muscular structure and the fibrous framework, and derives its chief supply from animal meat ; eggs, and some of the cereals and vegetables, however, furnish a large amount of this element.

Purely carbonaceous food can not supply material for building up strong muscular or fibrous structure, nor can purely nitrogenous food keep up the necessary degree of animal heat and vigorous nerve-force. A mixed diet, therefore, is essential to the proper development of the body. It is, moreover, important to give du,e thought to the character of food, in order that every tissue may have abundance of its own necessary nutriment. That is, the bony structure should be able to select, from the food taken in, sufficient phosphate of lime and other mineral salts for the building up of a firm, solid framework. The muscles should hare an ample amount of nitrogenous food in order that they may grow stronger. So, too, the nervous system demands a large supply of food containing fat and the phosphates in order that it may possess a healthy nerve-force and the ability to maintain the necessary degree of animal heat.

During the early months of life, milk furnishes all that is requisite for the development of every part of the little being. But with growth there is an increased demand upon the muscles and other tissues for work, so that additional and heartier food is required to maintain a sufficient supply of nutriment. Milk, however, containing as it does elements that nourish brain, muscle, and nerve, and give fuel for animal heat, should constitute one of the staple articles of diet for all children throughout the whole period of adolescence, and its use should always be encouraged. It is unequalled as an article of food for the young, since all its component parts are quickly assimilated and appropriated in the system without any undue tax upon the digestive organs. The fat of milk being in a state of fine subdivision and readily taken up by the absorbents of the digestive tract, is especially beneficial and more acceptable than the fatty elements contained in other varieties of food.

Children after leaving babyhood not unfrequently rebel against milk, manifesting a disgust for it. Parents should be careful not to yield to these whims, as in the vast majority of cases it is nothing but fancy, for this food is too valuable an article of diet to be hastily put aside. If the milk is very rich with cream, it may occasionally give rise to disordered digestion, especially with children of a so-called bilious temperament. The milk from the Alderney cow may not agree with some children on account of its richness in cream, while that from the common cow will be perfectly acceptable. In fact, with the majority of children, young and old, the milk from the common cow is preferable to that from the Alderney. "When there is an actual distaste for milk, the addition of a little salt will give it more relish, just as salt improves the flavor of meat.

Certain of the cereals rank next to milk as articles of nutriment. Oatmeal, wheaten grits, hominy, imperial granum, rice, and farina are the most valuable, and should form part of the child's diet. Of these oatmeal is the richest in nutriment.

Analysis shows that it contains a higher percentage of fat and mineral salts (phosphate of lime chiefly) than any of the other cereals, and with the exception of corn it contains more sugar. It is also rich in nitrogenous or albuminous principles, but has a smaller percentage of starch than the other grains. There is one other element in oatmeal which may become as much a source of danger as it is of benefit. I allude to the cellulose or cell structure. It contains more of this waste material than any other cereal. The danger lies in the fact that the digestive fluids can not obtain ready access to the nutriment incased in this cellular structure when insufficiently cooked, as is too often the case, and the grain is thus rendered an indigestible article of food for a delicate stomach. Oatmeal should be given at least two and a half or three hours cooking, in order to disintegrate or break up the hard, cellular envelope surrounding the true nutriment. When thoroughly cooked it will lose its granular form and assume a gelatinous appearance. The cellular or waste material is beneficial because its presence in the bowels stimulates the peristaltic action and promotes daily evacuation. In proportion to size the child requires a greater amount of food for nerve nutrition and for developing heat than the fully developed man ; this is necessary in order to supply the wants required in growth and the force expended in restless activity.

In addition to fat, there is another article which is heat-making, namely, sugar, and also to a slight degree the starch of farinaceous food, for the starch is converted into sugar in the system. The natural longing for sweets is often more than a desire to gratify the palate. It is a craving upon the part of nature for carbohydrates. It is, therefore, perfectly natural, under certain restrictions, to give sugar or molasses with food. The great danger, in giving saccharine articles of food, consists not so much in their use as in their abuse. A certain amount of sugar or candy is harmless for children, but it should be given with food, or immediately after eating, and in small quantities. "When sweets or candies are given between meals, an acid fermentation is apt to take place, the digestion becomes deranged, the appetite fails, and does not return until the sweets are abandoned. Children whose diet is largely composed of farinaceous food and milk, with a proper amount of butter, do not as a rule crave sweets as strongly as when these articles are sparingly given. The rule I would suggest is that, when a child is vigorous, with digestion in good order, and takes plenty of milk and farinaceous food, yon may give sweets and candies in moderation ; but when the digestion is defective, appetite poor, tongue coated or the child is delicate, sweets should be withheld.

Eggs constitute a concentrated and digestible nutriment. The white is composed chiefly of albumen, a nitrogenous element, and the yolk largely of fat.

Meat is essentially a nitrogenous article of diet ; it builds up the muscles, but, as muscle-making or nitrogenous elements are also found in farinaceous food, white of eggs, and milk, a large amount of meat is not necessary. On the contrary, it is actually injurious, as, if it forms the greater part of the meal, it thereby deprives the system of the fat and nerve making food, which is so essential for animal heat and nerve-force, and it, moreover, acts as an irritant upon the bowels and kidneys. Young children who are large meat-eaters are very slender, prone to have coated tongues, foul breath, and indigestion. They are also given to talking in their sleep; whereas, when the diet consists largely of milk, farinaceous food, light vegetables, and only a judicious amount of meat, children are fatter, have a healthier complexion, rosier cheeks, and are generally of a happier, brighter disposition. It is well to teach children, when they are old enough to take hearty food, that they should eat the fat of meat. Pat is important for developing nerve-force. It is also essential, as we have already stated, for keeping np animal heat, and furnishes the basis of all cell nutrition. By fat we do not mean grease. The natural fat that is taken with meat, milk, and butter is wholesome and desirable, and is very easily assimilated ; but made meat-gravies and all kinds of food fried in grease are indigestible, and should never be given to a child.

An instinct evinced by most children is the desire for vegetable acids — in the form of fruit. This desire should be indulged. Where note is taken of what nature thus craves, by supplying a sufficient quantity of good ripe fruit, the child will not resort to the sour, unripe apples, gooseberries, and other fruit which are such prolific causes of bowel trouble in summer. Ripe fruit is not only acceptable to children, but it is an important article of diet for them. When fruit is taken in moderation, the vegetable acid contained therein exerts a beneficial effect upon the digestive organs, being in itself a good tonic.

During the early years of childhood — that is, from two to six years of age — milk should constitute the greater portion of the food ; of course, farinaceous food, easily digestible vegetables, good ripe fruit, eggs, and meat should be given. The importance of the last article, meat, is however apt to be overestimated during early life. A little fresh meat once a day should be given, but, except from ill health, and by the advice of a physician, a child under seven should never have meat more than once a day.

As the child approaches the age of eight or nine years — when it is full of life and vigor — meat is generally required more than once a day — that is, meat with the dinner, and a little in the morning for breakfast. Be careful, however, not to let meat diet crowd out other varieties of food. A vigorous child of twelve or fourteen years of age requires as much nutriment as a grown man. The taste for fresh vegetables should be cultivated ; roasted and mashed potatoes, fresh peas, string beans, asparagus, boiled onions, lettuce, and spinach, are especially digestible and desirable for children over three years of age. The vegetable acids assist digestion, and the cellular matter contained in the vegetable, by stimulating the bowels to healthy action, is instrumental in eliminating from the system waste material. Celery and tomatoes raw, also the following cooked vegetables — beets, cauliflower, turnips, corn, parsnips, carrots, cabbage, egg-plant — should be given only to older children. Ham, pork, liver, tongue, corned beef, and all salted fish are difficult of digestion and should be forbidden food for young and delicate children. Fresh meat should be either roasted, boiled, broiled, or stewed, but should never be fried. Fresh fish and oysters are wholesome, and help to vary the bill of fare for older children. Pastry, fresh home-made bread, and hot biscuits are articles of food very difficult of digestion, and should never be given to young children. If a child of twelve or fourteen years of age is robust, has good digestion, and eats heartily of proper food, pastry can now and then be given, but should be absolutely avoided under any other circumstances. To a child under thirteen years of age tea and coffee should never be permitted ; indeed, it would be better to postpone their use as long as possible. They are unnecessary; besides, they are excitants, and are prone to derange the digestion. To maintain a healthy digestion all stimulating food should be rigidly avoided. Pickles, pepper, spices, and highly seasoned food should be forbidden, not only for the same reason that we forbid tea and coffee, but

DIETARY DURING CEIIDHOOD. 29

because they pervert the appetite, create in the child a desire for highly seasoned food, which desire, when fostered, leads in turn directly to intemperance in later life. If, during childhood and early youth, the stomach were kept free from the baneful influence of all stimulating food, I am convinced that there would be fewer drunkards.

A child of from three to five years of age is too frequently put to bed immediately after eating a supper consisting of milk, bread and butter, and a liberal allowance of jam. The mother or nurse comments the following morning on the restless or dreaming and startled sleep of the child, and rarely connects the supper allowance of jam with the resultant night-dreams. The supper of a child of this age should be very simple — bread and milk, or cereals and milk, with bread and butter is all that is necessarj^. The jam causes indigestion, distends the bowels with wind, and disturbs the whole circulation, especially of the brain.

Little or no harm will be experienced by permitting a child to completely satisfy the appetite, provided the food is thoroughly masticated and eaten slowly. It is only when indigestible food is taken, or when the food is " bolted," that there is danger of overfeeding and of harm ensuing.

Children during school-life must be abundantly fed, for not only is the growth rapid but there is a great wear and tear of body and mind while at work and at play. If they are not properly nourished at this critical time, they develop badly, their blood becomes poor, and hereditary tendencies are encouraged. Variety and palatability of food must be studied as well as regularity of meals. At this period — that is, after six or seven years of age — it is always important to see that the interval between meals is not too long, for by prolonged fasting many children are very much injured. A glass of milk, or a little bread and butter between breakfast and dinner, or between dinner and supper, is a great help in sustaining strength and vigor, and very important to a child who is delicate, or whose appetite is small. It is permissible, also, to give between meals, to a child who is taking a great deal of exercise, light, digestible food of the kind mentioned, provided it is given with a degree of regularity, and not near the hours for the regular meals. If, on the other hand, the child is allowed to eat at irregular intervals, whatever and whenever the appetite dictates, the functions of digestion are often so perverted that, for the remaining years of life, he is likely to become a confirmed dyspeptic; and dyspepsia, as we know, is but the starting-point of many diseases. Sir Henry Thompson, in his little monogram on " Diet in Kelation to Age and Activity," says . . . " I have for some years past been compelled, by facts which are constantly coming before me, to accept the conclusion that more mischief in the form of actual disease, of impaired vigor, and of shortened life, accrues to civilized man, so far as I have observed in our own country and throughout Western and Central Europe, from erroneous habits in eating, than from the habitual use of alcoholic drinks, considerable as I know the evil of that to be." *

If erroneous habits of eating have such a baneful effect upon adults, the effect upon those of tenderer years must be manifestly greater ; and it certainly behooves parents carefully to scrutinize the quality of food provided for their children, as well as the manner and time of taking it.

Whenever the digestion is deranged, there is not only a deprivation of a certain amount of nutriment, but the incomplete products of digestion, which are taken into the circulation, exert a deleterious effect upon the nervous system, and create

* Sir H. Thompson, " Diet in Relation to Age and Activity," p. 4.

more or less irritability of temper, or a condition of moroseness. When this state is of short duration, no serious results follow; but when frequently repeated, or if long continued, a lasting impression upon the temperament and physique is the result. Theu, again, if the digestive tract is frequently disturbed, and especially if the liver is kept in defective action, owing to irregular or improper kinds of nutriment taken during the period of youth, that time when the healthy growth and development of these parts should take place, an imperfect or morbid development is apt to ensue, which must result in impaired health and disease in later life.

During the period of school-life, meals are apt to be taken with great irregularity. Hurrying to school, and again hastening to afternoon play, cause the child to forget hunger in the eager desire to join his comrades ; then coming home with hearty appetite sharpened by exercise, he will eat often whatever he can find, however indigestible, and the true appetite for the following healthy meal is gone. The child should not only have his meals regularly, but he should be compelled to spend sufficient time at them — to eat slowly and without excitement. Food should be carefully cut in small pieces before putting it into the mouth, and masticated thoroughly, in order that, when it reaches the stomach, the digestive juices can act upon it and more readily reduce it to a solution for absorption. Hurry and excitement when eating divert the attention of the nerve-force from the act of digestion, and consequently food is not so well digested. Eepose and quietness, on the other hand, favor the digestive act. It is therefore important that a child should be compelled to eat slowly, and never be permitted to leave the table until all shall have finished ; otherwise the food is likely to be insufficiently masticated, and the habit of " bolting " his food will soon be acquired.