The same rules that we have laid down for the mother for the care of her health while nursing, are of course applicable to the hired wet-nurse, and should be insisted upon and enforced.
_Changing a nurse._--When it becomes necessary to change a nurse, for any of the reasons above mentioned, it may be done without injury to the child. For fear of the effect of the unwelcome tidings upon the mind of the nurse, and the possible influence upon the milk, she should not be informed of the projected change until a successor has been secured to take her place at once. In choosing the second nurse, the same precautions should be had as in the selection of the first.
THE CHILD.
_THE CARE OF INFANCY._
By infancy we mean that portion of the life of the child between birth and the completion of the teething--about two and a half years. The care of this period of human life is entrusted to the mother. It forms an important era in the physical life of woman. Its discussion is therefore germane to our subject. In order that the young mother may fully appreciate the responsibilities of her position, she should know something of the liability of infants to sickness and death.
Out of one thousand children born, one hundred and fifty die within the first year, and one hundred and thirteen during the next four years.
Thus two hundred and sixty-three, or _more than one-fourth, die within five years after birth_. Between the ages of five and ten, thirty-five die. During the next five years eighteen more are recorded on the death-list. Hence, at fifteen years of age only six hundred and eighty-five remain out of the one thousand born. When these figures are considered, and the additional fact that out of those who survive very many bear permanent marks of imperfect nourishment or of actual disease, the consequence of maladies contracted in early life, the importance of our present inquiry--the care of infancy--will be apparent to all mothers.
The younger the infant, the greater the danger of death. _One-tenth of all children born die within the first month after birth_, and four times as many as during the second month.
The mortality is much larger in cities than in the country. In Dublin, during 1867, very nearly one-third of all the persons who died were under five years of age. In the same year forty-three per cent. of those who died in the eight princ.i.p.al towns of Scotland were children below the age of five. In Philadelphia, during the same year, forty-five per cent. of all the deaths were of children under five years of age. In New York fifty-three per cent. of the total number of deaths occur under the age of five years, and twenty-six per cent. under the age of one year.
The danger of death lessens as the period of p.u.b.erty approaches. Yet, even in the last years of childhood there is a greater liability to disease and a larger proportionate loss of life than during youth or middle age.
CAUSES OF INFANT MORTALITY.
What are the causes of this startling mortality of infant life? Why does one child out of ten die in the first month, and only three out of four live to be five years old? And what are the means of prevention?
Some of the causes which are active in producing this mortality among the little ones cannot be successfully opposed after birth. Such, for instance, are imperfect and vicious developments of internal organs existing when born. These malformations often result from inflammation while in the womb, excited by some taint of the mother"s blood, or by some agitation of her nervous system. Means of prevention in those cases are therefore to be directed to the mother, in the manner indicated in treating of pregnancy. But other causes of death begin to act only after birth, and are to a greater or less extent avoidable. These are largely traceable to ignorance, negligence, and vice.
One cause of death to which infants are peculiarly liable, and which alone is said to have destroyed forty thousand children in England between the years 1686 and 1799, is being _overlain_ by the parents. For this reason, some physicians caution the mother against having the infant in bed with her while she sleeps.
The frightful waste of life caused by bringing children up by hand has been mentioned, and the importance of avoiding it when possible.
The natural feebleness of the system of infants is the reason why they succ.u.mb so easily to any malady. Deaths from any given disease are more numerous among infants than children, and among children than adults.
Hence the importance of timely corrective measures in infantile affections; hence, also, the need that mothers should know and practise the means best adapted to preserve the health of their frail charges.
These means we shall proceed to give in detail, commencing with directions for
BRINGING UP BY HAND.
We have already alluded to the great danger to the child, particularly in a city, that is artificially fed from birth. But as there are many mothers who are unable, on account of the expense, to have a wet-nurse for the child they cannot suckle themselves, we will give such directions in regard to the diet as are best calculated to lessen the risk invariably incurred under such circ.u.mstances.
The child"s food should be of the best quality, and prepared with the most scrupulous attention to cleanliness. The milk of the cow is preferable to that of the a.s.s or of the goat, the former of which it is difficult to procure, and the latter having a disagreeable odour. For a child under three months of age, cow"s milk should be used as the only food. It should be fresh, and if possible from one cow. When of the ordinary richness, it is to be diluted with an equal quant.i.ty of water or thin barley-water. If, however, the first milking can be obtained, which is more watery, and bears a closer resemblance in its chemical composition to human milk, but little dilution will be required. If green and acrid stools make their appearance, accompanied by emaciation and vomiting, the milk must be more diluted, and given less frequently.
If the symptoms of indigestion do not yield, milk containing an excess of cream should be used. To procure it, allow fresh milk to stand for two or three hours, and remove the upper third, to which add two or three parts of warm water or barley-water, after having dissolved in it a little sugar of milk. Should this food also disagree, any of the preparations we are about to mention may be prepared and tried.
Professor Falkland recommends the following method of preparing milk for infants, as affording a product more nearly like the natural secretion:--"One third of a pint of pure milk is allowed to stand until the cream has risen. The latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk-vessel placed in warm water. In about five minutes the curd will have separated, and the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling, to prevent it becoming sour. A further quant.i.ty of curd separates, and must be removed by straining through calico. In one-quarter of a pint of this hot whey three-eighths of an ounce of milk sugar are to be dissolved; and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. This will const.i.tute the food for an infant from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quant.i.ty required for twenty-four hours. It is absolutely necessary that a fresh quant.i.ty should be prepared every twelve hours; and it is scarcely necessary to add, that the strictest cleanliness in all the vessels used is indispensable."
Dr. J. Forsyth Meigs directs the following article of diet as one which he has found to agree better with the digestive system of the infant than any other kind of food:--"A scruple of gelatine (or a piece two inches square of the flat cake in which it is sold) is soaked for a short time in cold water, and then boiled in half a pint of water, until it dissolves--about ten or fifteen minutes. To this is added, with constant stirring, and just at the termination of the boiling, the milk and arrowroot, the latter being previously mixed into a paste with a little cold water. After the addition of the milk and arrowroot, and just before the removal from the fire, the cream is poured in, and a moderate quant.i.ty of loaf sugar added. The proportions of milk, cream, and arrowroot must depend on the age and digestive powers of the child.
For a healthy infant, within the month, I usually direct from three to four ounces of milk, half an ounce to an ounce of cream, and a tea-spoonful of arrowroot to half a pint of water. For older children, the quant.i.ty of milk and cream should be gradually increased to a half or two-thirds milk, and from one to two ounces of cream. I seldom increase the quant.i.ty of gelatine or arrowroot."
The egg is a valuable article of food for infants and young children, especially in conditions of debility. It should be given nearly raw, and is best prepared by placing it in boiling water for two minutes. It is then easily digested.
Beef-tea, prepared in the manner described on page 234, is highly nutritious and useful as a food for infants: if it produce a laxative effect, it should be discontinued. When the child shows signs of weakness or of a scrofulous condition its nutrition will be improved by mingling with its food a small piece of b.u.t.ter or mutton suet.
During the first four or five months the food should be thin, and taken through a teat, thus preventing the stuffing of the infant.
On attaining the age of twelve or fifteen months, infants are usually able to digest ordinary wholesome solid food, neatly and well cooked, when mashed or cut into fine pieces.
An article of food employed for the diarrha of infants is prepared as follows:--"A pound of dry wheat flour of the best quality is packed snugly in a bag and boiled three or four hours. When it is taken from the bag it is hard, resembling a piece of chalk, with the exception of the exterior, which is wet, and should be removed. The flour grated from the ma.s.s should be used the same as arrowroot or rice."
Infants nourished by prepared food thrive well enough during cool weather, but during the warm months of the year they are exceedingly liable to bowel complaint, of which large numbers of the spoon-fed infants of cities die each summer season. Hence the importance of taking them into the country; and keeping them there until the return of cool weather lessens the danger of city life.
WEANING.
This should take place when the child is about twelve months of age--sometimes a few months earlier, often a few later. If the mother"s health be good, and her milk abundant, it may be deferred until the canine teeth appear--between the fifteenth and twentieth month. The child will then have sixteen teeth with which it can properly masticate soft solid food.
_Time of the year for._--The infant should not be taken from the breast during or immediately preceding warm weather. If the mother, either on account of sickness or failure in her breast-milk, is obliged during the summer to give up nursing, she should at once procure a wet-nurse. If she cannot, the child must be sent into the country. To wean an infant in the city in hot weather, is to expose it to almost certain death.
_Proper method._--The process of weaning should be a very slow one. No definite day should be fixed for it. Little by little, from week to week, the amount of spoon-food is to be increased and the nursing lessened--being first given up at night. The breast should never be suddenly denied to a child unaccustomed to artificial food, but be displaced by degrees, by the bottle and the spoon. This gradual change will neither fret the child nor annoy the mother, as sudden weaning always does.
The infant may begin to be accustomed to artificial food at the age of four months. At first, only diluted cow"s milk should be given it occasionally between the times of nursing. In a tumbler one-third full of water dissolve a tea-spoonful of sugar of milk; add to the sweetened water an equal quant.i.ty of fresh cow"s milk; then, if the child"s stools are at all green, mix with this two tea-spoonfuls of lime water. Instead of pure water, barley-water made in the usual way, and boiled to the consistency of milk, may be employed in this preparation--being added, while still warm, to an equal amount of milk. Or, toast-water may be subst.i.tuted as a diluter of the milk. Cow"s milk should not be boiled, if it can be preserved in any other way. As the infant advances in months, some solid food may be allowed. After six months, pap, made with stale bread and tops and bottoms, is proper once or twice a day.
Beef-tea, made according to the recipe we have given, and chicken, lamb, or mutton broth, may now also be occasionally taken. As the quant.i.ty of milk diminishes towards the close of the first year, the spoon-food should be resorted to more frequently to supply the want. Solid food ought not to be given before the child is a year old.
The b.r.e.a.s.t.s usually cause little trouble when the weaning is performed in the gradual manner which has been recommended. The mother should during this time drink as little as possible, refrain from stimulating food, and take occasionally a little cream of tartar, citrate of magnesia, or a seidlitz powder. If the b.r.e.a.s.t.s continue to fill with milk, _they should not be drawn_. The "drying up of the milk" may be facilitated by gently rubbing the b.r.e.a.s.t.s several times a day with camphorated oil, made by dissolving over the fire, in a saucer of sweet oil, as much camphor as it will take up. Tea made from the marshmallow has also been recommended for this purpose.
TEETHING.
The period at which the teeth first make their appearance is not a fixed one. It varies considerably even within the limits of perfect health.
It may be said, as a rule, that the babe begins to cut its teeth at the age of six or seven months. Quite frequently, however, the first teeth appear as early as the fourth month, or are delayed until the eighth. In some instances children come into the world with their teeth already cut. This is said to have been the case with Louis XIV. and with Mirabeau. King Richard the Third is another example. Shakspeare makes the Duke of York refer to this circ.u.mstance in these words:
"Marry, they say my uncle grew so fast, That he could gnaw a crust at two hours old: "Twas two full years ere I could get a tooth."
It does not follow that children whose teeth show themselves early, will have, therefore, a quicker general development. Such cases are merely instances of irregularity in the time of dent.i.tion, and carry with them no particular significance. Irregularities in regard to the order in which the teeth are cut are also of frequent occurrence.
While, therefore, it cannot be maintained that all healthy children cut their teeth in a certain regular order and time, yet it is certain that those children who follow the general rule which prevails in this respect, suffer least from the difficulties and effects of dent.i.tion. As all mothers desire to know at what time they may expect the teeth, we will state the rule of their development in the great majority of cases.
The lower teeth generally precede those of the upper jaw by two to three months.
The twenty milk-teeth usually appear in the five following groups:--
_First_, Between the fourth and eighth months of life the two lower front middle teeth appear almost simultaneously; then a pause of from three to nine weeks ensues.
_Second_, Between the eighth and tenth months of life the five upper front teeth appear, following shortly upon each other, the two central preceding the two on each side of them. Another pause of from six to twelve weeks succeeds.
_Third_, Between the twelfth and sixteenth months of life six teeth appear nearly at once. They are first the two front grinding teeth in the upper jaw, leaving a s.p.a.ce between them and the front teeth which before appeared; next the two lower front teeth, situated one on each side of the central ones, which were the first to appear; and, lastly, the two front grinders of the lower jaw. A pause until the eighteenth month now ensues.