_Fourth_, Between the eighteenth and twenty-fourth months of life the canine teeth cut through (the upper ones are called eye-teeth). Again a pause until the thirtieth month.
_Fifth_, Between the thirtieth and thirty-sixth months the second four grinders finally make their appearance.
This concludes the first teething. The child has now twenty milk-teeth.
We have mentioned that children are sometimes born with teeth. It is also true that sometimes they never acquire any. Instances are on record of adults who have never cut any teeth. Dent.i.tion has been known to take place very late in life. A case is related, on excellent authority, of an old lady aged eighty-five, who cut several teeth after attaining that age.
APPEARANCE OF THE PERMANENT TEETH.
Between the fifth and sixth years of life the second dent.i.tion begins.
The front grinders are the ones first cut through. Between the sixth and tenth years all the front teeth appear, followed by the canines before the twelfth year. At this time the second grinders show themselves; and finally, between the sixteenth and twenty-fourth year, the wisdom-teeth complete the dental furniture of the mouth.
VACCINATION.
This operation, to which every infant should be subjected, is one of great practical importance. The attempt has been made of late to shake the public faith in its efficacy, and to revive the old fabulous stories and foolish notions as to the production of serious affections of the blood and skin in this manner. At the same time, the increasing frequency and virulence of small-pox are becoming only too evident. We therefore consider it our duty, in treating of the maternal management of infancy, to lay some stress upon the necessity for vaccination as a preservative of life and health. If observation and experience ever taught anything, they have taught the protective power of this operation against the most loathsome and one of the most fatal diseases that ever afflicted the human race. And that mother who is careless and indifferent in this matter neglects for her children a means of preventing disfigurement and saving life, compared with which all other means are scarcely worthy of mention.
In order to appreciate the value of vaccination, it is only necessary to consider what small-pox was before its discovery,--to look at that disease through the eyes of our fathers and grandfathers. Until the close of the last century it was the most terrible of all the ministers of death. It filled the churchyards with corpses. When Jenner published his great discovery, about seventy years ago, the annual death-rate from small-pox in England was estimated at three thousand in the million of population. In other countries of Europe the rate reached as high as four thousand in the million. And these fatal cases must be multiplied by five or six, to give the entire number of persons annually attacked by the disease. It spared neither high nor low. Macaulay informs us that Queen Mary, the wife of William III., fell a victim to it. Those in whom the disease did not prove fatal, carried about with them the hideous traces of its malignity; for it "turned the babe into a changeling at which the mother shuddered," and made "the eyes and cheeks of the betrothed maiden objects of horror to the lover." Few escaped being attacked by this fell disease. Nearly one-tenth of all the persons who died in London during the last century died of this one cause. Children were peculiarly its victims. In some of the great cities of England more than one-third of all the deaths among children under ten years of age arose from small-pox. Two-thirds of all the applicants for relief at the Hospital for the Indigent Blind had lost their sight by small-pox.
The number of hopeless deafened ears, crippled joints, and broken-down const.i.tutions from the same cause cannot be accurately computed, but was certainly very large. Vaccination is all that now stands between us and all these horrors of the last century.
Is the strength of this barrier doubted?--Its efficacy is readily proved. In England, during the twelve years (1854-1865) in which vaccination has been to a certain extent compulsory, the average annual rate of deaths by small-pox has been two hundred and two in the million of population. Contrast this with the annual death-rate of three thousand to the million, which was the average of thirty years previous to the introduction of vaccination. Mr. John Simon, medical officer of Her Majesty"s Privy Council, one of the best statisticians in England, has collected a formidable array of figures, "to doubt which would be to fly in the face of the multiplication-table." From his mountain-height of statistics Mr. Simon says: "Wheresoever vaccination falls into neglect, small-pox tends to become again the same frightful pestilence it was in the days before Jenner"s discovery; and wherever it is universally and properly performed, small-pox tends to be of as little effect as any extinct epidemic of the Middle Ages."
Are other diseases ever produced by vaccination?--The popular belief would answer this question in the affirmative. All affections of the skin and swelling"s of the glands noticed in children soon after vaccination, are attributed by parents in many cases to this operation.
They forget that such diseases are met with constantly in infancy and childhood, as often among the unvaccinated as the vaccinated.
Observation does not show that they occur with greater frequency among the vaccinated. An English physician has been at the trouble to examine and record a thousand cases of skin disease in children: he found no evidence whatever that vaccination disposes the const.i.tution to such affections. It has been stated with apparent justness, that parental complaints of this kind frequently arise from their unwillingness to believe there is anything wrong in their offspring. Hence, when other diseases follow, vaccination gets blamed for what is really and truly due to other causes. So far from doing any harm to the system, it has been observed in those countries where vaccination has been most thoroughly practised, that, leaving small-pox out of the question, there have been fewer deaths from other maladies. This is especially true of two of the most important cla.s.ses of diseases, namely, scrofulous affections and low fever. For this reason, some medical statisticians have attributed to vaccination an indirect protective influence against these disorders.
At what _age_ should the child be vaccinated?--If the health permit, the operation should always be performed in very early infancy. The chief sufferers from small-pox are young children. One-fourth of all who die from this fatal disease in England are children under the age of one year. In Scotland, where until recently vaccination has been much more neglected than in England, the proportion even amounted to nearly one-third; and of these, one-fourth were under the age of three months.
The great risk, particularly in large towns, where small-pox is seldom absent, of delaying vaccination is obvious. City children, if hearty, should be vaccinated when a month or six weeks old. Rarely or never ought it to be delayed beyond two or three months. This early period of life is also particularly suitable to vaccination, because the accompanying fever will then be over before the disturbing influence of teething begins.
RE-VACCINATION.
If the first vaccination be found imperfect in character, that is, if it has not properly "taken," the operation should be repeated at the earliest opportunity. It has been recommended, in all cases, to perform a second vaccination not later than the sixth or eighth year. If small-pox be prevailing, it is proper to vaccinate all who have not been vaccinated within three or four years. In any event, re-vaccination at or after the period of p.u.b.erty is of extreme importance. It will give additional security even to those whose original vaccination was perfect. In some cases, the susceptibility to small-pox is not wholly exhausted by one vaccination. Inasmuch as it is desirable for every one to escape this disease, even in its most modified form, re-vaccination should always be performed, as it affords a very sure and trustworthy means of such escape. After successful re-vaccination, small-pox, even in its mildest shape, is rarely met with. In girls especially, in whom the changes which occur at p.u.b.erty are most marked, re-vaccination should be performed about the age of fourteen.
GROWTH AND DEVELOPMENT.
During infancy the body grows with great rapidity. About the end of the third year one-half of the adult height of the body is attained. After this period growth is more gradual; for in order to reach the remaining half, about eighteen years more are required. At twenty years of age the height is somewhat more than three and a half times that at birth, and the weight about twenty times. Development does not go on at an equal rate in all parts of the body. The lower limbs, small at birth, increase proportionally more rapidly, while the head, relatively large at birth, developes more slowly. The muscular system is gradually strengthened. At the end of the third month the infant is able, if in good health, readily to support its head; at the fourth month it can be held upright; at the ninth month it crawls about the floor; by the end of the year it is able with a.s.sistance to step; and between one and two years, at different times, according to its vigor and activity, it acquires the power of standing and walking alone. The periods of greatest and least growth of the child are, on the one hand, spring and summer; on the other, autumn and winter. It has long been known that animals grow more rapidly in the spring than at any other season of the year. This has been attributed to the abundance of herbage they are then able to obtain. It has been ascertained by actual measurement, that children grow chiefly in the spring.
At six months of age the child begins to lisp, and at twelve months it is usually able to utter distinct and intelligible sounds of one or two syllables. The development of the senses and of the mind proceeds gradually. The sense of hearing is more active and further advanced than that of sight. Sounds are appreciated sooner than light or bright colored objects. The next sense which is developed is perhaps that of taste; then follow smell and touch.
THE FOOD OF INFANTS AND CHILDREN.
The diet of children is frequently improper either in regard to quant.i.ty, quality, or variety. In 1867, a committee, of which Professor Austin Flint, Jr., was chairman, was appointed in New York city to revise the "Dietary Table of the Children"s Nurseries on Randall"s Island." In the report rendered, attention was forcibly called to the fact that in childhood "the demands of the system for nourishment are in excess of the waste, the extra quant.i.ty being required for growth and development. If the proper quant.i.ty and variety of food be not provided, full development cannot take place, and the children grow up, if they survive, into young men and women, incapable of the ordinary amount of labor, and liable to diseases of various kinds. This is frequently ill.u.s.trated in the higher walks of life, particularly in females; for many suffer through life from improper diet in boarding schools, due to false and artificial notions of delicacy or refinement. After a certain period of improper and deficient diet in children, the appet.i.te becomes permanently impaired, and the system is rendered incapable of appropriating the amount of matter necessary to proper development and growth."
Charlotte Bronte has drawn, in _Jane Eyre_, a graphic and physiologically true picture of the effects upon young girls of long-continued insufficiency of food. Let mothers bear in mind that proper food cannot be too abundantly eaten by children, and that the greatest danger to which they are exposed arises from defective nutrition. We would again urge the value of a large amount of _milk_ in the dietary of young people. The disorders of the bowels, which are not uncommon in infancy and childhood, are due to errors in diet by which improper food is supplied, and not to an excess of simple and proper nourishment.
We have already given some directions for the preparation of infants"
food in treating of "bringing-up by hand." In addition to the various subst.i.tutes for the mother"s milk there mentioned, we wish to note that known as _Liebig"s soup_. This great chemist thus describes the method of making it:
"Half an ounce of wheat flour, half an ounce of malt meal, and seven and a half grains of bicarbonate of pota.s.s, are weighed off. They are first mixed by themselves, then with the addition of one ounce of water, and lastly, of five ounces of milk. This mixture is then heated upon a slow fire, being constantly stirred until it begins to get thick. At this period the vessel is removed from the fire, and the mixture is stirred for five minutes, is again heated and again removed when it gets thick, and, lastly, it is heated till it boils. This soup is purified from bran by pa.s.sing it through a fine sieve (a piece of fine muslin), and now it is ready for use."
Barley-malt can be obtained at any brewery. First, it is separated from the impurities, and then ground in an ordinary coffee-mill to a coa.r.s.e meal. Care should be taken to get the common fresh wheat-flour, _not the finest_, because the former is richest in starch.
In practice, the troublesome weighing of the materials may be dispensed with, as a heaped table-spoonful of wheat-flour weighs pretty nearly half an ounce, and a like table-spoonful of malt-meal, not quite as heaped, weighs also half an ounce. The bicarbonate of pota.s.s can be obtained from the druggist put up in powders of seven and a half grains, each ready for use. The amount of water and of milk prescribed can be attained with sufficient accuracy by means of the table-spoon; two table-spoonfuls will give the quant.i.ty of water (one ounce), and ten table-spoonfuls the quant.i.ty of milk (five ounces). These directions will enable any sensible mother to make the preparation without difficulty. The soup tastes tolerably sweet, and, when diluted with water, may be given to very young infants.
Although the method of preparing Liebig"s soup is a somewhat tedious one, yet, as it is a combination which has long been so highly recommended by physicians of the largest experience for having visibly saved the lives of many wasting children, it deserves a trial in all cases in which the ordinary kinds of food disagree.
On page 276 are recorded the directions given by Dr. J. Forsyth Meigs for an article of diet, consisting of gelatine and arrowroot, which he prefers to all other kinds of artificial infant food. Another method of preparing a useful arrowroot mixture is as follows:--
Place a tea-spoonful of arrowroot in a porcelain vessel, with as much cold water as will make it into a fine dough; then add a cupful of boiling milk or of beef-tea; stir the mixture a little, and allow it to boil for a few minutes until the whole acquires the consistency of a fine light jelly.
The _manner_ in which nutriment is administered to infants is not immaterial. The custom of feeding them from a small spoon, or from a cup with a snout, is objectionable. The use of a sucking-bottle most nearly imitates the way in which nature designed the nursling to obtain its nourishment. By the act of sucking, the muscles of the face are exercised in an equal manner, and the saliva is mixed with the food to an extent which is not possible if any other mode of feeding be resorted to. Children drink very readily out of the perforated rubber nipples, which are now so popular for this purpose: they are made to fit over the mouth of the bottle, and are especially to be recommended on account of their cleanliness. The bottle should never be refilled until both it and the rubber cap have been thoroughly cleansed in warm water. A white gla.s.s bottle only should be employed in order that any want of cleanliness may readily be detected. It should be recollected that milk very quickly sours when kept in this way in a warm room; it is therefore better always to empty the bottle and fill it afresh each time it is given to the child, rather than to wait until its contents are exhausted before replenishing it.
We have hitherto been treating mainly of the diet proper for the first year of life. In the second year children may be permitted to have soft, finely-cut meat. Fresh ripe fruit in season ordinarily agrees excellently well. But boiled green vegetables and husk fruits are very apt to cause indigestion and diarrha. Fruit for children should be freed from the stones and skins; which latter are indigestible, and often do harm.
As an example of a diet suitable for a child two years of age we append the following:--In the mornings, between six and seven o"clock in summer, or between seven and eight in winter, milk-gruel; between nine and ten o"clock, a piece of wheat bread with a little b.u.t.ter on it; at twelve o"clock, well-prepared beef-tea, or chicken, lamb, mutton broth, or meat with a little gravy; or in place of the meat, a meal-broth prepared with eggs, but with very little fat; green vegetables to be allowed very rarely, and in very small quant.i.ties. At this noon meal a mealy well-mashed potato is un.o.bjectionable; so also is rice pudding for a change. In the afternoon, between three and four, bread and milk, with the addition in summer of fresh ripe fruit; in the evening, at seven, bread and milk.
It will be observed that this dietetic table calls for five meals a day.
Should the child eat so frequently? We answer yes. But the meals should be at regular intervals. A child, in order to replace the waste of the system, and to furnish over and above sufficient material to build up the growing body, requires a much larger proportionate amount of food than an adult. It also requires its food at shorter intervals. By observing the hours for meals stated above, _regularity_, which is of so much importance to the health of the digestive organs, will be secured.
If a young child be allowed only the three ordinary meals of the family, it will crave for something between times, and too often have its craving met with a piece of cake or other improper food. Its appet.i.te for dinner or supper will in this manner be destroyed, and the stomach and the general health suffer.
After the third or fourth year children are able to eat all kinds of vegetables. They may then very appropriately be allowed to eat at the table with the family. It is only necessary to refuse them very salt, sour, and highly-spiced victuals. Of all others they may partake in moderation. Neither wine nor any malt liquor should be given them. Tea and coffee are also, to say the least, unnecessary. They should have a regular luncheon between the meals which are furthest apart. This must be at a regular hour, and consist of bread and b.u.t.ter, with milk or water.
Pains should be taken to see that children do not fall into the habit of eating rapidly. Too often this pernicious habit, so destructive to healthy digestion, is formed in early life, and becomes the source of that dyspepsia which is the bane of so many lives. Food that is gulped down enters the stomach unmasticated, and unmixed with the secretions of the mouth. A dog may bolt his food without injury, but a human being cannot.
A child should be taught to eat everything that is wholesome, and not be permitted to become finical or fastidious in its appet.i.te. It ought not, however, to be forced to eat any particular article for which it is found that there is an invincible dislike. Variety of diet is good for a child, after the second or third year.
THE POSITION OF THE CHILD WHEN FED.
An infant, no matter how young, should not receive its meals when lying.
Its head should always be raised in the nurse"s arm, if it be too young to support it itself. The practice of _jolting_ and _dandling_ the infant after eating is a wrong one. Rest of the body should be secured by placing the child on a bed, or holding it on the mother"s knee, for a half hour or so. Observe the inclination which all animals show for repose and sleep after a full repast, and respect the same inclination in the infant.
In our remarks upon bathing we pointed out the importance of the mother herself performing for her child this office. So again, in connection with children"s food, we must notice the necessity of the mother being always present at their meals, in order that they may be taught to take them quietly, with cleanliness and without hurry. Such advice is not needed by the poor nor by women of moderate fortune, who ordinarily have their children constantly under their eyes. But affluence brings with it many occupations which are frequently deemed of more moment than presiding over a child"s dinner.
CONCERNING SLEEP IN EARLY LIFE.
There is a natural desire for much sleep during infancy, childhood, and youth; and there is reason for its free indulgence. Infants pa.s.s the greater portion of both day and night in sleep. Children up to the age of six years require, as a rule, twelve hours of repose at night, besides an hour or more in the middle of the day. About the sixth year the noon nap may be discontinued, but the night sleep ought not to be abridged before the tenth year, and then only to a moderate extent until the age of p.u.b.erty. From this time the period of slumber may be gradually reduced to nine or ten hours. No further diminution should be attempted until the completion of growth, when another hour or two may be taken away, leaving about eight hours of daily sleep as the proper amount during middle life.
It is wrong, therefore, to wake a young child in the morning. It should be allowed to sleep as long as it will, which will be until the wants of the system are satisfied, if it be not aroused by noise or light.
When after a few months the infant is awake a considerable portion of the day, it should be brought into the habit of taking its second sleep near the middle of the day, say from eleven to one o"clock, and again, from half an hour to an hour, about three o"clock. It should not be permitted a nap later than this in the afternoon, as it would be very apt to cause a disturbed night. Although some physicians recommend that the sleep during the day be discontinued after the infant has attained the age of fifteen months, the wisdom of such advice may well be doubted. As soon as the child begins to walk, not only are its movements very constant and active, but its mind is busily employed and its nervous system excited. It therefore thrives better if its day be divided into two by sleep for an hour or two.
_Should the infant sleep alone?_--We have mentioned the danger of being overlain to which it is exposed when in bed with its mother or nurse. On the other hand, it must be remembered that an infant keeps warm with difficulty even when well covered, and that contact with the mother"s body is the best way of securing its own warmth. Hence, during the first months the child had better be allowed to sleep with its mother. How, then, can the risk of being suffocated, which is no imaginary one, be lessened? The following rules are those given by a physician of reputation, to prevent an infant from being accidentally overlain.