INFANTS, Their Chronological Progress, WITH COMPLIMENTS OF ny Prof. STANFORD E. ORVILLE, M. D.. Tulani Univeksity of Louisiana. From the June Number 1887, of the New Orleans Medical and Surgical Journal. INFANTS, Their Chronological Progress, BY STANFORD E. CHAILLE, A. M., M. D., Professor Physiology, Pathological Anatomy and Hygiene, Ti'lane University of Louisiana. “At first, the infant _ Mewling and puking in the nurse’s arms.*’' Life’s first requirement is nutrition or self-maintenance, and the second is reproduction or maintenance of the spe- cies. No living thing can escape the bondage of the for- mer, and few adults do escape tribute to the latter. The result, for most men and women, is co-partnership in a baby. Many of these co-partners, misled by love and vanity, attribute superlative merits to their own offspring; some few, timid and inexperienced, are distressed by idle fears of deficiencies; so that, on the whole, few parents estimate aright the progress which the ordinary average baby, especially if their first one, ought to make. Doctors and nurses have better knowledge, but even doctors, if as ignorant as myself, must have often deplored their inability to answer with satisfactory accuracy the very natural ques- tions, frequently propounded by parents, concerning the age at which this, that, and the other indication of progress 1 2 should be developed. For this reason it is worth while to- note, more fully than is recorded in any book which I have found, the progress which should be expected of the aver- age baby. But, however desirable it may be to restrain within proper bounds the vanity and fears of parents, the evolu- tionist finds graver reasons still for a more accurate record of baby-progress. Forced to regard the various wondrous stages of development, inside the womb, either as an inex- plicable mystery or as a recapitulation of the progress of animal life from its lowest to its highest manifestation, and, therefore, as a memorial of man’s ante-human ancestry ; the evolutionist is also forced to regard life, outside the womb, as a mere recapitulation of man’s ancestral pro- gress upwards from his primitive savage condition, through the stages, termed barbarous and semi-barbarous, which every people and every infant must traverse to attain civil- ization. So that the careful study of the infant’s progress, especially its mental and moral progress, justifies the para- dox of a distinguished evolutionist who claims, that this research possesses a “peculiar antiquarian interest.” All parents who have little children can see any day if they look aright, the sight, which the dying gladiator, “butch- ered to make a Roman holiday”, saw only in a vision, “his young barbarians all at play.” Having long enter- tained this view, I have been forced, as to even the babies in which I have enjoyed a co-partnership, to substitute, for the common expression “dear little angel,” the more truth- ful phrase “darling little savage.” And the sooner all parents recognize that their infants are, in truth, born-sav- ages, for whose gradual development into civilized adults they are responsible, the better will it be for the future of these infants. This view would not, at any rate, increase the number, at present very great, of the class now termed “hoodlums,” who are no more than savages living in the midst of, yet left undeveloped by, civilization. For reasons now given, evolutionists have been prompted, in recent years, to investigate more thoroughly the phe- 3 nomena of infant progress, and even Charles Darwin was induced to contribute, ten years ago, a few instructive pages entitled “A Biographical Sketch of an Infant.” Such re- searches have already conferred some and are destined ultimately to confer far greater benefits on that important branch of the science of education, termed pedagogics. Teachers greatly need more accurate knowledge of the mental and moral faculties of the average child at different ages. To what extent are these various faculties developed, what peculiarities and what deficiencies characterize differ- ent ages? For instance, a more thorough but still incom- plete study of the faculty of attention, or capacity to con- centrate the mind, has proved that teachers have habitually expected from children more than the brain of the average child is capable of; that no ordinary child of seven years of age should be expected to concentrate the mind, con- tinuously on one subject, more than fifteen minutes, and if under eighteen years not more than thirty minutes. Should memory ever be duly studied, it will no doubt be proved that too great a burthen is usually imposed on this faculty also. It is also believed that, while attention and memory are imposed upon, the training of the senses or of observation, of the judgment, and of the imagination is habitually and greatly neglected. If this introduction has induced the reader to regard the study of infant progress from my own point of view, he will probably be disappointed, as I have been, with the results, about to be submitted, of my study of the subject. Not only are there regrettable omissions and deficiencies, but there are also statements for which I decline any responsi- bility except that of citing them correctly from good authorities. I have attempted to record specially the aver- age baby only and not the exceptional one; and I have confined myself to very brief statements of subjects to be found in the text-books, such as teething, the pulse, etc. I shall be content if this imperfect article should serve to add to the lively emotional interest, always felt in the infant and its progress, a greater intellectual interest, and should stim- 4 ulate others to study the subject and record the results as thoroughly as should be done. Since it would be tedious and less convenient for refer- ence to record, in the chronological order adopted, the facts gathered in regard to the interesting subjects, the eyes and the hair, and that most important subject, the growth of the body, these facts have all been transferred to the close of this article. First Four Weeks of Life.—The cord begins to wither on the first, dries up by the third, sloughs off about the seventh, and cicatrizes about the tenth to twelfth day. Exfoliation of the epidermis begins the first week and continues usually to the fortieth day. The pulse beats per minute about 140 times at birth; 128 at six months; 120 at one year; no at two years; and 90 to 100 at three years. From birth, the reflex acts, sucking, crying, sneez- ing, hiccoughing, yawning, stretching, etc., are all well done. The nervous phenomena presented are those merely of a reflex automatic machine, with very little active volition and little distinct perception of external objects. One must descend low down in the scale of animal life to find an adult prototype of the new born infant, whose chief instinct is gluttony and whose sole apparently intelligent voluntary act is to suck. All the senses are incapable of the delicate appreciations familiar to adults. For some days, taste, touch and smell are apparently better developed than hearing and sight. But even taste, which appears to be the sense best develop- ed at first, is very inferior to the adult’s, and continues so at least to the sixth month ; babies will swallow, without apparent disgust and even with relish, things nauseous to adults. While there is common sensation, yet touch is so imperfect that it is long, probably some months, before a new born baby can appreciate the -place on its own body where it may be touched and still less the nature of the thing which may touch it. Sensitiveness to bad smells or to odors of any kind is seldom shown before the fifth week. 5 Babies are at first apparently deaf, but, during the first fortnight, susceptibility to sound is usually observed; sud- den sounds causing them to start and to blink. They take months to learn to appreciate the direction and the distance of sound. During even the first week babies probably distinguish light from darkness, but not until the second week will their eyes follow a candle. In fact, nothing except a candle or a light will cause them to fix their eyes, from usually about the tenth to even the forty-fifth day. It is alleg- ed that ordinarily they do not begin to distinguish objects, even confusedly, until about the end of the fourth week. Physiology justifies the belief that the baby must see two images, both flat and upsidedown, of every object looked at; and it is certain that months are taken to acquire appreciation of the solidity and distance of visual objects. Fear may be indicated during the first weeks, but is not usually very manifest before the third month. Babies usually first smile after three weeks of age. At fifteen days old, and probably earlier, a feather, passed over the eyes and nose, may cause the eyes to close,, nasal contraction and a frown. Darwin says that the first tear is shed from the twentieth to the one-hundreth day. I have trustworthy evidence of one baby who shed its first tear before it was fourteen days old, and I have now under observation a baby who shed its first tear, a solitary one and out of one eye only, on the ninety-eighth day; yet this infant has never lacked the usual baby accomplishment of crying often and vocifer- ously. The lachrymal glands usually begin to secrete dur- ing the third and fourth month, and the salivary glands during the fifth and sixth months. These facts justify the inference that the pancreas and other conglomerate glands gain slowly their power to secrete. One Month (30 to 60 days) Old.—Before the fortieth day the hands are moved awkwardly but voluntarily to the mouth, but other movements of limbs and body continue to be vague, jerky, purposeless. 6 At thirty to forty days luminous objects give manifest pleasure. About the fifth week repugnance to some bad smells may be shown, and at six to eight weeks some odors attract while others repel. About the fifth week the mouth and tongue begin to move in crying, instead of this being exclusively laryngeal as heretofore. The first expression of disgust has been noted at the seventh week. Two Months Old.—Babies begin to acquire some idea of distance, so that they less frequently scratch their faces without intending it. At eleven weeks old a baby may take a bottle in the right hand and a week later in the left. At two months old no appreciation may be shown of ordinary sounds, such as a footstep in the room ; and no color be noticed except red. At this age anger may be shown and there may be a frown due, not as heretofore to physical pain, but to men- tal displeasure. At two and one-half months old a bottle of water, instead of milk, may be refused with an expression of disgust. A genuine laugh, that is a merry expression with sound, is not apt to be observed before the sixty-fifth day. In one case the first little chuckle occurred on the eighty-seventh day. Three Months Old. The head can usually be held erect, when a baby is three to three and a half months old. About the end of the third month the distinct color of the skin, whether blonde or brunette, is usually es- tablished. Tears are usually shed the third or fourth month. The hands are voluntarily lifted to the face much oftener; they are stretched out also to near objects, and the arms are held out to the mother. Heretofore, hearing and sight have been the senses 7 chiefly employed in self education, but at the third month the infant begins to employ touch, to take hold of and feel everything. Sounds, if rythmical, are apt to give pleasure. At three to five months old, babies are fond of brilliant colors only, as are adult savages, and may be amused with some pictures. From the third to the tenth month, fear is very plainly showm, and is aroused far more through the ear than the eye. When three months old, there maybe evidence of dream- ing, also of jealousy, and also of anger indicated by push- ing away things disliked. When three and a half months old, a baby7 may be amused by the play of covering and uncovering the face. Also at this age, though usually not until six or seven months old, there may be varying cries and joymus bab- blings, but only vowel sounds, and there may be capacity to distinguish several parts of the body; for instance, if asked “ where are yrour feet ? ” the baby may have learned to look at them. Thus there mav be shown, even when three and a half months old, the germ of an effort at lan- guage and power to comprehend it. Four Months Old.—A baby can sit upright and can execute a few special actions with his hands although he may still often fail to seize objects brought close to him. The use of hands and arms is developed much sooner than is the use of the feet and legs. At four to six months old, all babies like being sung or played to, and some even when one month old. They do not readily direct their eyes to the source of a sound. They look intently at their own hands or other objects close to them, and are then apt to squint. Fear, the first emotion manifested, is apt to be very plainly shown when four and a half months old; also violent anger, with rush of blood to face and scalp. Darwin observed a very distinct sob on the 138th day. 8 At four and a half months old (even on the I02d day,,, in one case) a baby may smile at an image in a mirror, but is not likely to show, before the sixth month, any ap- preciation of the fact that what is seen is only an image, indicated, for instance, by turning away from the mirror to look at the person who causes the image to make a grimace. Infants enjoy looking at their own image, but the higher apes get angry, which is not astonishing when their ugli- ness is considered. May not their anger indicate that apes have an aesthetic sense, similar to man’s? Though not usual, there may be evidence at four and a half months, that a voice is recognized, and such sounds may be made as ap, pa, mam, ma. Five Months Old.—Saliva usually begins to flow, as is stated, at the fifth or sixth month and apparently as a pre- liminary to dentition. However, I have seen it flow freely at the close of the second month, and without apparent connection with dentition. A baby may attempt to move in time with music when five months old, and he may associate his own name with himself, and his eyes may seek his nurse if her name be called. Further evidence of the dawn of ideas and asso- ciated ideas may be manifested by a baby’s anger, if not taken out of doors as soon as its cloak and hat have been put on. In one case Darwin observed at five and a half months, the first articulate sound “da,” without attachment there- to of any meaning. Six Months Old. — At this age a babysits up; arms, hands and fingers can accomplish many delicate move- ments, and playthings are enjoyed. A baby may be induced, even when six months old, to swallow disagreeable things, merely by changing the color. Lively music gives more pleasure than grave, sweet music; however, a musical education can rarely be begun before the fifth or sixth year. The drum, then the trumpet are the first instruments of primitive man and the favorites of children. 9 There may be evidences of painful dreams, and also of efforts to imitate. There is some comprehension of the meaning and feel- ings of others by means of their facial expressions. Some faces please while others displease. Sympathy may be manifested by a baby’s expression, when, for instance, the mother cries or pretends to do so. Babies respond with jumps and other evidences of grati- fication to attempts to amuse them; will stroke the mother’s face and babble inarticulate sounds of admiration. They are apt to begin to make a series of sounds with the vowel a ( long not short ), ai, au, etc. In first efforts at speaking there is always marked preference for a and other vowels. Seven Months Old.—Teething is often irreular. Its usual progress will be stated: Generally it begins at the end of the sixth or beginning of the seventh month and ter- minates about the twenty-fourth month. Should there be no teeth by the tenth or twelfth month, the cause should be sought for, and will usually be found in defective nutrition and sanitation. The twenty teeth of infancy are usually cut in the following order, viz: Two central incisors of lower jaw when 4 to 8 months old. Two central incisors of upper jaw when 8 to 10 months old. Two lateral incisors of upper jaw when 8 to 10 months old. Two first molars of upper jaw when 12 to 15 months old. Two lateral incisors of lower jaw when 12 to 15 months old. Two first molars of lower jaw when 12 to 15 months old. Four canine or eye-teeth when 16 to 20 months old. Four last molars when 20 to 30 months old. After the sixth month, babies sleep less in the day and chiefly at night. Usually at the seventh and eighth month they begin to crawl on the floor. A baby may be able to shake its head when told to do 10 so ; but even at seven and a half months old it is usually un- able to follow with the eyes an object swinging rapidly. At this age the nurse is usually associated with her name. If not at the sixth month then by the seventh month babies usually begin to mumble, m, m, m andp, p,p, which soon become mamma and papa. Eight Months Old. — At this age the infant usually begins to imitate sounds, and may articulate several sylla- bles. Speech is at first always of monosyllables and of these reduplicated, dyssyllables come slowly, at about the twentieth month, and polysyllables still more slowly. Nine Months Old. — By the ninth or tenth month babies to rise on their feet, by clinging to some to learn to walk. They [associate their own names with their image in a mirror, and begin to look behind to discover the cause of a'shadow. Darwin says that at this age an infant’s capacity to ac- quire associated ideas surpasses that of the cleverest full grown dog. Ten Months. — A vivid appreciation of odors is mani- fested from the tenth to the fifteenth month. At this age a child may be taught to understand that it is naughty to cry in order to get what is wanted; and also taught, even earlier than the tenth month, to make itself understood about making a mess in its cradle, and to be afraid to do so. Usually only two or three words can be spoken. Eleven Months (335-365 days) Old.—The anterior fontanelle should not be as large as a dime, and by the twentieth to [twenty-fourth month it ought to have closed sufficiently to be imperceptible; however, complete ossifica- tion, which may occur from the fourteenth month to three and a half years][of age, usually occurs during the second year. At the age of eleven months violent passion may be shown, as by pushing*away and beating playthings. Many actions mayj be imitated, and the child may have been taught to be afraid of fire.