liii iiiiiifci V^spPwji ■$wfi■c|!:.r|!i,i;1Sj;:^.:!-<»';-'*;'«;i!:h«vif.» J PROPERTY OF THE IPMDENTJAL INS. CO iNPAFT TREA-T-ifENT: WITH DIRECTIONS TO MOTHERS FOR SELF-MANAGEMENT FORE, DURING, AND AFTER PREGNANCY. Addressed to Mothers and Norses. BY MRS. BARWELL. FIRST AMERICAN EDITION. VKED, ENLARGED, AND ADAPTED TO HABITS AND CLIMATE IN THE UNITED STATES, BY A PHYSICIAN OF NEW YORK, UNDER THE APPROVAL AND RECOMMENDATION OF VALENTINE MOTT, M.D. NEW-YORK : LISHED BY JAMES MOWATT & CO 'OLD BY ALL PERIODICAL AGENTS AND BOOKSELLERS. A 1844. Yvi£ £cb<|U 1*44- Entered according to Act of Congress, in the year 1844, by James Mowatt & Co. in the Clerk's OfEce of the District Court of the Southern District of the State of New-York. BEDFORD, PRINT. 138. FULTON ST. STEREOTYPED BY CHAS. HOBBS, 111 FDXTON ST. DR. MOTT'S RECOMMENDATION. From an examination which I have made pf Mrs. Bar- well's work on " Infant Treatment," as Revised and Enlarged by a Physician of New-York, I feel great plea- sure in recommending it, and I think I can do it with con- fidence, to the careful perusal of all mothers, as containing sound and salutary lessons for the management of their children in infancy, as well as valuable instructions for themselves, before and after they become mothers. VALENTINE MOTT. New York, Jan. 1844. • New York, Dec. 21, 1843. I have read with great satisfaction Mrs. BarwelFs Treatise, " On Infant Treatment," addressed to mothers and nurses ; and it gives me much pleasure to recom- mend it to the attention of American mothers, as one of the best works on the subject with which I am ac- quainted. The advice is in the highest degree judicious, and in accordance with the established principles of phy- siological science j and if generally carried ioto practi- cal effect, I have no doubt will be the means of sav- ing thousands of young children in our country, every year. By the numerous additions, also, by the American editor, the work has been rendered still more valuable as its precepts are adapted to infant treatment, as modi- fied by those peculiarities of climate, habits of living, &c. which distinguish the United States from most other countries. In short, I know no work which embodies so large an amount of valuable information on the subject of the proper management of infants, within so small a space, in the English language. CHARLES A. LEE, M.D. PREFACE: The present work is addressed to mothers and nurses; and the subjects treated of are evidently such as could be thoroughly and satisfactorily discussed only by a mother. We have several able and judicious treatises on Infancy by medical men ; but they are inevitably deficient on ma- ny points, to which a woman alone is competent to do justice. That the volume now offered to the public is of a cha- racter that gives it a claim to the attention of every intel- ligent mother in the land; that its advice is sensible and salutary ; and that its circulation is calculated to do much good, we are assured, on the highest medical authority. The original publishers, in their preface, remark:— " that they were most anxious that any work upon the management of infants, coming forth under their care, should be prepared on principles thoroughly philosophical, at the same time that it was composed in such a manner that every intelligent mother in the country might be able to take advantage of it. They therefore confided the task X preface. of composing the work to Mrs. Barwell, of Norwich, a lady who unites to practical experience a thorough know- ledge of, and reliance upon, the more enlightened modern doctrines respecting the treatment of infants, together with the requisite degree of literary skill. The result is the present volume, which the editors submit to the world in the confident hope, that it will be found to contain a com- plete code of instruction for the mothers and nurses of young infants, expressed in the most direct language which the nature of the subject admits of. " In addition, there is given a Summary of the leading doctrines or directions, expressed in such brief and pithy terms, as might, without any great difficulty, be commit- ted to memory j but with the wish that the reader should, in all cases, read and digest the corresponding passages of the work itself, so that the understanding may be tho- roughly satisfied, before any one shall begin to act upon the rules. " In education—considered in its largest sense as the means of developing the human faculties to the utmost extent, and regulating them to the best purposes—a place of great importance must be assigned to that branch which regards the constitution of the human being at the first and the treatment of it in those early years, or rather months, when it is most delicate, and most liable to be af- fected for good or evil. Then is physical education pro- preface. xi perly commenced; and upon the treatment in those years depends much of the success which is afterwards to be striven for in education, not only physical, but intellectual and moral." The numerous additions by the American editor, which the work now exhibits, will be found materially to en- hance its value. Indeed, it would be imperfect without them; inasmuch as diversities of climate and of habits ren- der different modes of treatment sometimes advisable.— The picture of the increasing mortality among infants in this country, is an alarming one; but the errors in treat- ment to which we owe the deplorable result, are pointed out with sagacity; and we trust that the present volume may contribute something towards alleviating the evil. Our thanks are due to the most eminent of living prac- titioners^—Dr. Valentine Mott, of this city—for his exa- mination of the work, and his ready and hearty acknow- ledgment of its merits; and also for his kindness in indi- cating to us the excellent source whence we have procu- red the additions, which will so much augment its in- terest and value. & CONTENTS. CHAPTER I. The Infant before and immediately after Birth . IS chapter n. Food..........25 chapter iii. Sleep..........37 CHAPTER IV. Clothing.......- . 39 chapter v. Washing and Dressing ......48 chapter vi. Ventilation and Light......51 chapter vii. Medicine........-.04 chapter viii. Vaccination . :......°y CHAPTER IX. Deformities and Distortions.....64 chapter x. Stammering . •........'4 CHAPTER XI. Squinting........."^ CHAPTER XII. Teething.........82 chapter xiii. Exercise.........85 CHAPTER xiv. Moral Government . .....91 CHATTER XV. Earliest Intellectual Education . . • .110 XVI. SUPPLEMENTARY CHAPTER. Infantile Diseases and Treatment in the United States 120 Summary.........138 INFANT TREATMENT UNDER TWO YEARS OF AGE. CHAPTER I. THE rNFANT BEFORE AND IMMEDIATELY AFTER BIRTH. The first and most important truth, on this subject, to be im- pressed on mothers, is, That the constitution of their offspring depends on natural consequences, many of which are under their own control. A child takes its general character from its parents. If these be healthy persons, the child will also, in all probability, be healthy, provided that no deranging circumstance shall take place before the birth of the infant. If, on the contrary, the parents are unhealthy, the child will also probably be unhealthy. These principles apply to the mental part of our organization, as well as to all the rest. Supposing healthy parents, still the infant may prove very much the reverse, if the condition and circumstances of the mother during pregnancy be not favourable. It therefore be- comes important to inquire, what is the condition, and what are the circumstances, of the mother, during pregnancy, which are calculated to aiFect her progeny, for good or evil ? The maintenance of her own health during this period, is of the first importance, as even a woman usually healthy, may be in such a deranged state during pregnancy, as will operate greatly to the detriment of the infant. For the maintenance 16 INFANT TREATMENT. of health in ordinary circumstances, few people have any other guide than experience, and iheir own share of good sense; and these are guides not to be despised. It is to be wished, how- ever, that all, whose circumstances will allow of it, should study the organization and functions of the human frame, as without that knowledge, there can be no certain or consistent attention to the rules of health, while, with it, attention to those rules becomes comparatively simple. A young pregnant woman, finding herself perhaps for the first time in her life, called upon to pay particular attention to the laws of health, will probably experience some difficulty in subjecting herself to the guidance of those laws, because she has habits to overcome, and perhaps some pleasures to forego; but she will have the aid and stimulus of maternal love, which, from the moment she becomes conscious she is to be a mother, mysteriously but powerfully possesses her. This instinctive affection leads to good or to evil, according as the mind is informed or ignorant of the conditions which govern the health of the parent and child during pregnancy.— If informed, the mental and physical powers are directed aright; 11 ignorant, the nervous sensibility prompts to a state of unde- fined fears, while physical evils are produced or increased by mistaken treatment. In the present place, as we are writing an educational, not a medical treatise, it is not to be expected that we are to give a minute exposition of the state of .pregnancy. We will confine ourselves chiefly to those circumstances which bear more par- ticularly on the constitution of the child. That a female in this condition should maintain a serene mind, is above all things desirable. And for tnis end, it is in the very first place necessary, that she should be taught to re- gard her own condition in its true light, as one perfectly natur- al, and for which all fitting arrangements have been made by nature. The sickness, nausea, and disordered condition of stomach, which often attend pregnancy, and also the anticipa- tion of the pains of labour, are apt to impress a different feel- ing. But with all such impressions, a right-minded woman will successfully contend, if she be truly informed on the subject. So far from pregnancy being a diseased condition of the sys- tem, it is one in which pre-existing disease is often overcome at THE INFANT BEFORE AND IMMEDIATELY AFTER BIRTH. 17 least temporarily, (though the contrary is also sometimes the case,) and during which, epidemics are often resisted, when other persons not more susceptible, fall before them. Nature, indeed, seems to have aimed at making the system unusually strong at this period, as if to favour as much as possible an object so important as the increase of the numbers of the species. Nausea is most frequently experienced by women of a ner- vous and excitable temperament, or of what are called " strong feelings," and by those more particularly, who have little to occupy them. Those, also, who proceed upon the vulgar er- ror of eating heartily, "in order to keep up their strength," are peculiarly liable to. this distressing visitation. There is, however, a certain tendency to it in many cases, merely as a result of that increased excitement of the womb, which unavoidably takes place during pregnancy, in conse- quence of that organ requiring and receiving more blood at that period than at other times. In all cases, nausea may be regar- ded as a means provided by nature for keeping down the quan- tity of circulating fluids at a proper amount, and thereby pre- venting a fullness which might, in such circumstances, have fatal effects. * With respect to labour itself, an intelligent woman will find no difficulty, we think, in regarding it under the following con- siderations :—It certainly is a process which, unless in very ex- traordinary circumstances, cannot take place without consider- able pain. Some, we are aware, believe the reverse. They allege, that if the females of the human race were to live in a perfectly natural manner, there would be no pain or difficulty in labour. That there should be any natural process from which pain is inseparable, seems also to them a kind of im- peachment of divine wisdom. We believe, nevertheless, that pain, in some measure, greater or less, is scarcely avoidable in the labour of almost any female creature, and that to acknow- ledge such being the case is no detraction from Almighty good- ness. In the parts concerned in labour, two objects must necessarily have been in view—first, that a portion of the bony and mus- cular structure, should possess the same firmness as the rest of the body ; and, second, that it should also be capable of an oc- casional distension, to admit of the birth of a new being. How 18 INFANT TREATMENT to give this power of occasional distension, without diminishing the necessary firmness of structure, was the point to be at- tained. The end certainly might have been accomplished by some peculiar natural provision; but in nature there is an economy of means generally apparent. Instead of any depar- ture from the rules which govern all organic nature, it has been seen fit to preserve those rules in their ordinary force on this point, and, as a simple and easy alternative, to subject the be- ing to a certain pain—for the endurance of which, however, other and most wonderful arrangements have been made, in the peculiar feature of its intermission, and in that power of suffering which females seem to possess in a greater degree than males, no doubt through some peculiarity of the nervous system. Contemplated under such considerations, the pain of labour will be looked forward to, we think, with firmness, and with- out alarm. It will be regarded only as pain—a pain imposed with a design, upon the whole, beneficent—short in duration, and which there is much to alleviate—which, moreover, in the effect which it seems to have of more endearing the infant which has been its innocent and unconscious cause, fully repays itself in the tenderest of feelings. For the preservation of serenity of mind, an exemption from the severer cares of life is also desirable. In many cases this may be difficult of attainment; but it is nevertheless a point of so great importance, that every reasonable exertion and sacri- fice should be made, in order to bring it about. We do not mean that a pregnant female should be set aside from ordinary duties, or that she should be allowed to s^end her time in thoughtless languor. We only demand that she should be sub- jected to no treatment which will give her great excitement.__ Anxiety about the illness of a near relative—grief for his loss__ the pain of mere worldly calamity—torment from the miscon- duct of individuals, in whom she is interested—sudden frights, or excesses of joy—finally, those rarer distresses which a time of public danger occasions—such arc the circumstances which are apt to have a bad effect on females about to become moth- ers. They also, as a necessary consequence, affect the bein^ about to be brought into the world, producing in some instan- ces a general weakness of constitution, in others only a certain damage of the mental organization. THE INFANT BEFORE AND IMMEDIATELY AFTER BIRTH. 19 Many of the eccentricities which have caused the world most to wonder, or worked it the greatest" woes, have been the con- sequence of very simple circumstances visiting pregnant females with undue excitement. The diet of females during this period ought to be simple.— When unenlightened on this subject, they are apt to fall into errors which may greatly affect their offspring. A pampering, indolent, and generally self-indulgent mode of life, is often prac- tised ; and many think it necessary that every casual desire that can arise in an unregulated mind ought to be gratified. A sen- sible woman, sincerely anxious for the good of the being about to enter the world, will be anxious to avoid such errors. The tendency to nausea and vomiting, already alluded to, may be interpreted as the voice of nature proclaiming that,-in the condition of pregnancy, less instead of more food than usual is required. The perfection of the child does not depend imme- diately on the quantity of nutriment taken by the mother; it depends on the supply of sound and healthy fluids, for which end, not merely judicious nutriment, but a healthy action of the whole of the functions of the' body, is requisite. Over-eating, or eating too nicely, is inconsistent with that healthy action, and is therefore to be avoided. Food too highly concentrated, and of too stimulating a cha- racter, is unsuitable, as also are gruel and weak broths, for these are not easy of digestion. The mother ought not to depart from her accustomed diet, whatever that may be, provided ex- perience has shown that it is suitable for her constitution and habits of life. Animal food is D.ot to be systematically avoided. Where the digestion is weak, the circulation languid, and the muscular frame small, flaccid, and puny, this kind of food, of a tender fi- bre, taken in small quantities at a time, and well masticated, will lighten present suffering and prevent future evil. The to- tal want of this kind of food, which is often scarcely a matter of choice amongst the poor, tends to make the milk weak and of bad quality. Farinaceous and vegetable food, with a moder- ate portion of animal food, and of diluting fluids, may be gen- erally recommended. Stimulating liquors are beneficial in very few instances. We present all of these maxims on diet with some degree of hesitation, for almost every particular case s 20 INFANT TREATMENT. requires a treatment more or less peculiar to itself. For per- fect safety, the advice of a judicious physician, and if possible one acquainted with the system of the patient, is desirable. Regular and gentle exercise should be taken ever*y day, in the open air if possible. This is one of the principal requisites for keeping up that healthy action of the system, on which the supply of sound fluids depends. When the mother pursues a contrary course, whether from indolence or from positive ina- bility of body, her system necessarily becomes much relaxed ; its tone is abated, and the child partakes of the same character. Regard must of course be paid to peculiarities in the general condition of the mother. If she be very weak, it may be injuri- ous for her to take much exercise, or to begin to take it abruptly; but still the great importance of exercise to her health and that of her child should be kept in view, and, if at all practicable or prudent, exercise should be indulged in. With the healthy, it is a duty which they will not with impunity neglect. It should be practised from the first, and up to the very last. As one great inducement to it, they may be assured that, by restricting an undue and undesirable growth of the child, it tends materi- ally to lessen their distresses at a particularly trying moment. The ordinary occupations of life should be as little as possi- ble interrupted. It may be necessary-, from the condition of the expectant mother, that she should be kept very quiet: it often, indeed, happens, that from particular circumstances, females are enjoined by their medical attendants to lie almost continu- ally on a sofa. But these are unfortunate cases. Where there is a fair measure of health, to have both mind and body em- ployed is decidedly useful; and a female should be glad, when it is in her power, to enjoy this advantage. Severe bodily labour is of course to be avoided, as too tryin" to the system, and apt to produce accidents; and great mental tasks are equally undesirable, as tending to create, too much excitement. But the every-day matters of life, the domestic arrangements which make home respectable and attractive, the benevolent and affectionate sentiments exercised in kindness and service towards others, the charity which acts rather than gives, the daily walk enlivened by conversation or observation, the cultivation of the intellect by reading, the preparations for the maternal office—all these are suitable means of keeping THE INFANT IMMEDIATELY BEFORE AND AFTER BIRTH. 21 mind and body in that state of moderate activity which is re- quired, and such are ever at command. This moderate occupation is useful in two ways. It tends to sustain that cheerfulness and serenity of mind which have al- ready been spoken of as so desirable during pregnancy. It is also useful as a means of keeping off and counteracting a cer- tain tendency to nervous excitement which is sometimes expe- rienced by pregnant females, and which manifests itself in irritability and impatience, despondency, and listless indiffer- ence. When such excitement is first felt approaching, it should be met by a vigorous determination not to yield to it; and ac- tive employments will #then be found extremely serviceable. Females often act otherwise ; and, under the notion that such nervous excitement being natural, it ought to be patiently sub- mitted to, they resign themselves to it, and expect that others should treat it with charitable indulgence. But, in reality, it may be successfully contended with in most instances, and it is the duty of every one thus to contend with it. It may here be remarked, that, minds being constituted dif- ferently, all do not find that the same duties and objects serve equally well for sustaining- their cheerfulness and keeping off the tendency to nervous excitement. The exercise which is beneficial to one, may be irksome to another; but the main object in all cases is the same, though reached by different paths. Worldly circumstances also are various ; it is therefore impossible to lay down rules for the employment of mind and body : it is easier to point out what is to be avoided ; namely, excess, whether it regards ease or exercise, food or sleep, and the frequenting places of public resort, and close private apart- ments, where the air is heated and vitiated. In every situation of life there are trials of temper, alterna- tions of hope and fear, joy and sorrow, pleasure and displea- sure : to regulate these emotions, to restrain them within such bounds that they shall neither over-excite nor exhaust the ner- vous energy, nor interrupt the healthy action of the bodily functions, is within the power of every human being, and is a discipline agreeing equally with the precepts of the moralist and the prescriptions of the physician. As vet, we have only considered those circumstances which affect "the human being before birth: we are now to treat of 22 INFANT .TREATMENT. those which conduce to his weal after he has entered the world. The child should be placed at the breast within from twelve to eighteen hours after birth. When this is delayed longer, the breasts are apt to be distended with milk, and the act of suckling is then attended with pain and difficulty. In such circumstances, the overloaded vessels being imperfectly emptied, inflammation is excited, and milk abscess may ensue. The milk left too long in the breast, if afterwards sucked, occasions pain and disordered bowels to the infant, or is rejected from its stomach. In the latter event, the nourishment is insufficient; and results seriously affecting the permanent health of the child may be experienced. It occasionally happens that the flow of milk in the first few days is greater than the child can take. If it do not flow away, fomentations of warm water may be applied, which is a better remedy than rubbing the breasts with spirits; for they are ren- dered so tender by distension, that they easily bruise. When the abundance of milk is troublesome, the mother should drink little, and take opening medicine. On recovering from confinement, and resuming her usual dress, there cannot be too much caution in securing perfect li- berty for the breasts. The waist of the dress should be loose and long. The low stooping position in which a woman sits while suckling, encourages an enlargement of the abdomen, if not guarded against: and injury to the figure, and untidy ap- pearance, have been urged as reasons why mothers should not also be nurses. Such consequences are by no means necessary. The dress may be as neatly arranged as at other times, and the figure has only to be protected, and such exercise taken as will keep down the tendency to enlargement of the abdomen. There can be no other permanent increase unfavourable to beauty or utility. It sometimes happens that the nipple is small, or turned into the breast ;* a new-born infant has scarcely sufficient strength * There is great reason to believe that the use of tight stays creates or increases this deformity. Artificial restraints are the cause of many of the sufferings of child bearing. The malformation of the nipples is allu- ded to by an old writer, whp ascribes its prevalence in his day to the use of the leather stays of the period. In all circumstances, these tender orgaus should be guarded against pressure ; and during pregnancy, when THE INFANT BEFORE AND IMMEDIATELY AFTER BIRTH. 23 to draw it: in such cases it saves much pain to have the breast drawn by another child of about six or eight weeks old. The mechanical means often adopted are very apt to cause sore breasts. It is, however, desirable that the infant should get the first milk, as this has the effect of clearing the bowels of the meconium, or first evacuations, and generally supersedes the necessity of a purgative. A young mother is generally awk- ward in holding an infant; but a little fortitude and perseve- rance will overcome the difficulty. Where there is a decided inability to suckle (which may usually be decided before delivery,) and a wet-nurse is to be engaged, there are two Or three points requiring attention. The nurse should be as nearly as possible of the same age as the mother, because there is a relation between the constitution of a mother and her newly born babe ; and the more nearly the hired nurse resembles the mother in constitutional peculiarities, the more suitable will she be for rearing that particular child. A hired nurse should also have been confined about the same time as the mother, because the milk has a different character at different stages of nursing, being thin at first, and gradually growing stronger, so that, if a newly born babe be put to the milk of a woman any considerable time confined, it gets too strong or heavy milk, and is thereby sensibly injured. The dipt of a person engaged in nursing should be nutritious, but not heavy. What agrees and disagrees in ordinary cir- cumstances, will then have the same effect. Diet must also have reference to constitution. A person of full robust habit ■will require less nutriment, and will suckle better upon diluting drinks, such as tea, toast and water^ gruel, &c, while a deli- cate person of languid circulation will need more animal food, milk, beer, perhaps ale or porter : wine is not so desirable ; it is stimulating rather than nutritious ; though, mixed with wa- ter, it may in some cases agree better than beer. The poor generally have a good supply of milk, and suckle for many months ; tea is their chief beverage. It is true their infants are often fre'tful; but this is to be attributed to the indulgence of violent passions on the part of the mother, so often found the breasts often enlarge, the stays, however soft and loose, should have au opening in the centre of each side of thebosom. 24 INFANT TREATMENT. among the ignorant, to exposure to cold, and deficiency of clean- liness and ventilation, rather than to the vitiation of the milk from low living. The quality of the milk chiefly depends upon habits ol mina and body; the quantity varies in different persons, in corres- pondence with age, constitution, &c. In some constitutions, the food goes more into nourishment, and less into milk, than in others. In those cases, the less food is required. In other con- stitutions, the aliment goes more into milk, and less into nour- ishment ; and a woman so characterised requires to be compar- atively well fed. It is necessary for a nurse who has a tenden- cy to flatulency, to avoid viands apt to induce that ailment, not only on her own account, but that of her charge, for this and other disordered functions tell upon an infant immediately, through the medium of the milk. Where a nurse is actually affected by flatulency, her taking a little powdered ginger or carbonate of soda makes her milk agree better with the diges- tive powers of the child. % A mother who is also a nurse, has a double claim upon her, and a double motive to stimulate her in the observance of the laws which govern health. The immediate welfare of herself is indissolubly united with that of her child; every transgres- sion on her part inflicts suffering on her infant, Avho is the help- less victim of her errors. And not only so: unhealthy ailing children bring great afflictions upon a family. In the case of affluent persons, they bring disappointed hopes, wounded pride, and sorrowing affections. A father is naturally disposed to re- gard his offspring with pride, exultation, and hope ; but can he do this when he sees ailing, fretful beings, incapable of enjoyin°- or benefiting by the advantages which his abundance and his affection procure ? In the case of poor people, the sorrowing affections are ag- gravated by the expense, the household discomfort entailed by illness, and the prospect of the sickly creatures around being hereafter incapable of earning their maintenance at all, or of do- ing so under the pressure of bodily and mental suffering. The faults of the mother may inflict these disappointments and dif- ficulties upon the father. Her responsibilities are great and numerous. Yet there fortunately is a present happiness con- nected with the maternal duty, arising out of mere instinct, FOOD. 25 which lightens the burden, besides a continual and increasing reward springing from and experienced by the higher senti- ments of her nature. CHAPTER It FOOD* The milk of the mother is to be regarded as the most appro- priate food which can be given to a newly born infant.— Where a mother, therefore, has a sufficiency of milk, and is oth- erwise able to perform the duty, she is called upon by the voice of nature to undertake it. It is a duty which may be at- tended with some degree of inconvenience; but this is amply compensated in the delightful feelings which are developed in the course of the nursing period, and the consciousness of per- forming a duty of the greatest importance to one in whom she feels the deepest interest.* When the mother is unable to nurse, the next best course is to engage a substitute, selecting one as healthy, as near in age * The performance of this duty by the mother is of consequence to the moral as well as physical condition of the child. A hired person cannot be expected to feel like a parent; she has not the motives for subduing her passions, restraining her appetites, sacrificing her pleasures and her rest—in short, for practising the self-devotion and self-control which the office of a nurse demands. No doubt, many such persons are found to perform their duties with an honourable zeal and fidelity; but it may happen otherwise ; and the employment of any other than the mother should at the best be regarded as a step involving considerable danger and only therefore to be taken under the pressure of necessity. A child is suckled sufficiently long for its mental powers to begin to act: it ob- serves and imitates; its nurse awakens its earliest emotions, attaches its first affections : tenderness, gentleness, and propriety, should therefore characterise every action. When the mother is the nurse, these qualities distinguish her caresses and her attentions: the performance of theone office naturally entails the fulfilment of many others: there will be a more complete superintendence of the infant's condition, of the earliest symptoms of indisposition, of its cleanliness, its growth and form, the progress of its perceptions, and the early manifestations of temper, bucn minute attentions require an intelligence and interest scarcely to be expect- ed from the hired nurse. 26 INFANT TREATMENT. to the mother, and as nearly the same time confined, as may he obtained. It should be regarded as a sacred duty by parents to provide a wet-nurse, if their circumstances will at all per- mit, for by no other means can they be tolerably assured of the welfare of their child. In the next alternative of bringing up a child by the hand, or giving it cows' milk and soft food, there is danger of much physical eVil. The truth is, no kind of food but the mother's milk, or that of a well-chosen nurse, assimilates with the digestive organs of an infant in the first few months of its existence. The evil of the mere unsuitableness of other food is aggravated, when it chances that too much is given. While a superabundance of milk produces no harm, from its so easily being discharged from the stomach, food cannot be got up without straining, and without irritating the stomach. Children that are dry-nursed vomit less frequently than those who are suckled; but this is no proof that the food agrees: digestion is difficult, the superabun- dant food ferments, becomes very acid, passes into the bowels in an improper state, irritates the mucous membrane, and occa- sions the loose, green, sour-smelling stools, indicative of what is termed gripes. It is a common practice to give an infant a purgative a few hours after its birth, and to feed it until the mother has milk for it. Both these practices are contrary to nature; the first milk causes a free natural discharge from the bowels very differ- ent from the effect of medicine, which irritates and enfeebles the alimentary canal, establishing disorders which carry off a delicate child, and cause a robust one much suffering. Whether an infant be wet or dry nursed, its stomach should be left at rest for several hours after birth ; if there be crying and uneasiness, they are likely to arise from other causes be- sides hunger. The sudden change of situation, exposure to air, the dress with which it is necessarily encumbered, and the manner in which it is handled, are sufficient to account for uneasiness. Warmth, quiet and repose, afford ample solace- mentfor the first few hours of life. When there is unusual delay in the flow of the mother's milk, or a difficulty in getting the child to suck, a small quan- tity of asses'or diluted cows'milk will save the infant from exhaustion ; but on no account should farinaceous food (that is, FOOD. 27 food composed of any kind of flour from grain), be given. The greatest safety will be found in the breast; there are few situ- ations where it would not be possible to find a mother willing and able to suckle the new-born infant until its natural food is ready. That fluid is the proper aliment for an infant, is shewn by its having no teeth, and by the muscles of the mouth and jaws being too feeble for mastication, while the structure "of the whole frame is lymphatic, incapable of voluntary motion, and easily excited. If a child is to be brought up by the hand, cows' milk skim- med, or diluted one-third with boiled water, and slightly sweet- ened, is the only nourishment that can be safely taken, unless asses' or goats' milk can be procured, these being more nearly allied to the milk of a woman. When we depart from the in- tentions of nature, we always encounter difficulties. With some children, cows' milk will not agree at all, or only when mixed with oatmeal gruel; sometimes the latter alone suits best. Again, in cases of relaxed bowels, a common disorder with dry-nursed children, isinglass, highly baked flour, or ar- row-root, mixed very thin with milk, are the best diets: occa- sionally weak animal broths are most suitable. All irregularities are better counteracted by diet than by medicine. The application of a flannel bandage to the lower part of the body is judicious in bowel complaints. A warm bath soothes irritation and allays pain. The state of the bow- els indicates the condition of the digestion. Green, watery, slimy, or sour-smelling motions, are bad, as are streaky dark stools. Two or three motions in twenty-four hours are suffi- cient ; less may be enough when there is no pain or symptom of disorder. Cold produces relaxation. The use of the warm bath is in most cases highly beneficial. The facility with which it is prepared for an infant, renders it an easy remedy ; a washing-tub, and a pailful of boiling water, will be sufficient when lowered to 96 or 98 degrees Fahren- heit's thermometer. There are few disorders which a bath will not alleviate. There is an opinion that it exhausts. Like all other things, its use requires discretion. A very young in- fant should not remain in it more than six or eight minutes, and it should not go in daily. The head and loins should be sup- ported by the hands of the nurse, so that the whole person 28 INFANT TREATMENT. might be at ease and entirely immersed, except the head and face. When very young an infant is rarely alarmed by the wa- ter; but when there is intelligence, fear is often felt. A little ingenuity in floating paper boats, corks, &c, amuses and di- verts apprehension; and after a few trials, the bath becomes agreeable. For the first five or six weeks at least, the mother is usually able to support her infant from her breast, and it will be desirable to continue to do so for three or four months. Food is some- times required before that time ; but the rule is, that children for the first three months are better suckled. At that period, skimmed cows' milk may be given safely, when the natural food is not sufficiently abundant. The suckling pot or bottle is the best means of feeding, for sucking exercises the muscles of the mouth and jaws, and pro- motes the flow of the saliva, and that admixture of it with the food which is necessary to digestion; whiie an infant feeding from the spoon only swallows. The form of the suckling ves- sel permits but a small quantity to enter the stomach at a time, and thus another necessary law is obeyed. Sucking is attend- ed with healthy exertion and consequent fatigue, and is one of the few means of exercise intended for young infants. Care and cleanliness are important in using these bottles. The sponge or leather soon gets sour and hard, and it is then dis- tressing to the mouth. After six months, a gradual approach to solid diet may be made by a slight addition of* farinaceous food in the form of boiled or baked flour, arrow-root, ground rice, mixed very thin and smooth, bread or hard biscuits soaked or boiled, the water poured away, and the sop beaten till it is wholly free from lumps, when it may be mixed with milk till it is very thin and smooth, and slightly sweetened. Sugar often turns acid, and should be used sparingly. The first change of food sometimes disorders the system. Two or three days should be allowed for the experiment, and if the diet does not agree, some other form of farinaceous food may be tried as likely to prove more suitable. Should all be found equally improper, weak chicken, veal, or calf s-foot broth, beef tea, freed from fat, and thicken- ed with soft boiled rice or arrow-root, may be tried. The great point is to begin by slow degrees, giving a small POOD. 29 quantity of the thickened food, once in twenty-four hours, and that in the forenoon, in order that its effects may be observed, and the night's rest remain undisturbed. Food should always be given about the warmth of the milk as it comes from the breast; when too hot, it weakens digestion, and is distressing to the child ; and if too cold, it does not digest so quickly. When infants are fed by the spoon, it is not unusual for the nurse to ascertain the warmth, by putting every spoonful to her own mouth, a habit equally disagreeable and unnecessary. After feeding, the child should be raised up, when it will more easily get rid of the air which is generally introduced into the stomach during eating. Where there is much disposition to flatulency, an infant should be carefully watched, the accumulation of air occasion- ing what are called stoppages. If these occur in sleep, they may prove fatal to life, and even when the child is awake they are dangerous, as when affected by them it cannot cry out, and its breath is for the time stopped. The practice of giving caraway seeds, aniseed, carminatives, or distilled waters of any kind, is decidedly pernicious. They irritate the coats of the stomach, and, though they may give temporary relief, they create future evil. They are frequently put into the food to make it sit easy on the stomach ; but when food does not sit easy, we may presume that it is of an impro- per kind, or given in too large quantities at a time, or too often. If medicine is at any time required, it should be given as me- dicine, and not with food. It cannot be too strongly urged, that as the disorders (there is a distinct difference between disorders and diseases) proceed from some mismanagement, they cannot be permanently removed by medicine, but only by the adoption of good management. Continual recourse to medicine weakens and irritates the powers of the adult; the effect upon the ten- der excitable organs and soft frame of infancy is even more des- tructive of health. Over-feeding and improper diet are the main causes of the ailments of children. During the first few weeks of life, infants endure none but physical evils ; they are exempt from anxieties, from disappointments, from hopes and fears ; but unfortunately their sorrows, pains, or anger, are always traced to hunger, and eating is adopted as the universal panacea. This goes on till 30 INFANT TREATMENT. the child is of an age to comprehend and believe that to eat and drink is the greatest happiness and the greatest good. There is no doubt that the easiest method of stopping crying is to stop the mouth, especially where the senses are not active enough to find pleasure from observation. The means of relief are then necessarily limited ; yet change of position, loosening the dress, giving the legs and thighs entire liberty, chafing them, gentle exercise by the nurse moving her knees from side to side, while the child lies across them, or walking about the room, and pressing it to the bosom, are all of them expedients which may easily be resorted to, and which often have the desired ef- fect. Rough jolting and patting on the back provoke rather than allay pain. It is difficult to lay down rules for the regulation of an in- fant's appetite, since this depends upon rapidity of digestion, which differs in different children. In two months the mother may pretty nearly ascertain how often her infant requires the breast, and it will greatly advance her own convenience and the child's comfort if something like regularity be established. Habit very soon asserts its influence—so soon, and "so impercep- tibly, that it is desirable to be governed by its power as soon as the mother is convalescent. If a child be brought up wholly at the breast, the mother must not be absent at the hour she will probably be wanted ; for a crying hungry child offers a great temptation to a servant to quiet it by food. Every three hours is the average number of times a child from two to four months old requires to suck. A good sleeper may, during the night, rest as long as six hours together ; but regularity may be attained by night as well as by day. Suppose an infant to wake at seven in. the morning and to suck; after washing and dressing, it will take another meal and a long sleep, bringing it to noon, when it is again refreshed, and, if the weather be warm, carried abroad ; sleep usually follows upon going into the air, and three o'cjock may have arrived be- fore it again requires the breast. From this time until undress- ed for the night, it should not be lulled to sleep; but if the child be much inclined for repose, it should not be prevented. It is desirable to give a child the habit of sleeping through- out the night. At six, preparations are made for bed : the un- dressing and washing produce a certain fatigue, and, when the FOOD. 31 child has again sucked, it will probably fall asleep, and remain in that condition four hours. It is a good plan to accustom an infant to suck just before the mother goes to bed, and this it Will do, even if asleep. Its linen should then be changed; and if it wake up, allowing it to stretch its limbs before'the fire, rubbing its loins, thighs, legs, and feet, give exercise and re- freshment, and prepare for another long sleep. Between this and seven, it will wake once or twice again, and require nour- ishment. As the power of observation increases, and muscular strength induces exercise, the infant sleeps less by day, and more by night; it requires the breast less frequently, and takes more at a time, the digestive powers being more active, and all the func- tions stronger. If a child feeds as well as sucks, there should be a regular time for both. The time of waking in the morn- ing, and the middle of the day, are perhaps the most favourable periods, the stomach being then comparatively empty, and the digestive power brisk. Mothers may in these cases make ar- rangements suited to their convenience, without prejudice to the infant. Two circumstances govern the progress to solid and animal food —the appearance of the teeth, and the growth of muscular pow- er. Mastication and exercise are necessary when strong nour- ishment is presented to the system. Medical men are of opinion that the time of weaning should be regulated by the appearance of the teeth ; but in different children this period varies considerably. In the same family, one child has been known to cut teeth before five months, ano- ther not till after a year. There may be, circumstances render- ing it desirable to wean, even if the teeth have not appeared. The health of the child, and the season (winter is a time of dif- ficulty), will be considerations. The mother's health should al- so be taken into account. If the child be strong, and the mother weak, weaning be- comes unavoidable; but if all goes well on both sides, the child should have every advantage, and not be weaned upon the prin- ciple that six, eight, or ten months, are long enough, but for some good and sufficient reason connected with the circumstan- ces of the mother. If her infant be strong and healthy, and likely, after seven or eight months, to thrive equally well up- 32 INFANT TREATMENT. on food, and if the office of a nurse prevents the mother from giving the necessary care to equally important duties, she will be justified in weaning. Under any circumstances, the general principle must be kept in view, that the health of an infant de- pends mainly upon the nature of its diet; and if there be any reason to think that the loss of the breast will be attended with risk, the mother will gain nothing in time or diminution of care by weaning. It is advised to avoid weaning in severe weather, and to do it gradually, giving the breast less frequently, and discontinu- ing it at night. The digestion thus gets accustomed to the change, and the temper is less tried : the milk diminishes in quantity, and the mother suffers less inconvenience. Another advantage of a gradual cessation is, that, should the infant lose its health, suckling may be resumed. Weaning has been considered a great trial to mother and child. The latter suffers when the privation is sudden and un- prepared ; but when it is gradual, the infant healthy, and the food agreeable, it will soon cease to care for the breast. The mother naturally regrets to relinquish so tender an office, and her feelings are the more distressed when she finds that she cannot even be in the presence of her infant without giving it additional pain. But it will be well that, at this time, she keeps out of its sight, if she be perfectly satisfied as to the trust- worthiness of those to whom she commits it. If she cannot rely upon another for attentive and rational nursing, her child had better be tantalised by the sight of her, than neglected or mis- managed. For herself, she will take some cooling purgative, and refrain from fluids and stimulating diet. The following application to the breasts will assist in drying up the milk:—Three ounces compound soap liniment, three drachms laudanum, one drachm camphor liniment; or if this be too irritating, fomentations of warm water, or poppy heads and camomile flowers boiled together in water, give great re- lief. Pressure or tightness occasioned by the dress must be carefully guarded against. The distension of the milk vessels occasions great irritation and tenderness ; a slight blow, pres- sure, or roughness in rubbing them, may produce an abscess. It is better to get rid of the milk by its natural absorption into the system, than to draw it artificially; for the latter method food. 33 keeps up the action of the vessels. Exposure to cold is danger- ous, the system being in an excited state. The diet of a child after weaning must be regulated by the strength of the digestive powers, by the teeth, and by the mus- cular condition of the child. Upon the principle that diet should assimilate with the powers of the system, the gradual change from the soft lymphatic forms of infancy to the firmer condi- tion of childhood, dictates a gradual change in the aliment. If a child thrives on farinaceous food, milk, and light broth, there can be no need of change. Something depends upon growth: there are children whose rapid increase of stature, and incessant ac- tivity, produce a waste which calls not only, for frequent sup- plies of food, but also for food of a more nourishing quality.— With such, animal food once a-day (always supposing the teeth are in a condition to masticate it), may be necessary; but if a high degree of excitability, a violent temper, and impatience, prevail, nourishing food must be given with discrimination : the mother will ascertain whether these qualities are increased [or diminished thereby, and regulate the diet accordingly. A lymphatic, fat, white-looking child, whose mind and tem- per are sluggish and indifferent, should not be fed wholly' up- on fluid or soft diet; more concentrated food will probably cor- rect the temperament. In all cases, the state of the bowels, of the skin, and the temper, will indicate whether the food nour- ishes too much or too little. Fat is no positive criterion of health; a very active child, after three years of age, is rarely very fat, but the muscles may nevertheless be large ; their size, compared with that of the bones, and with the age and growth, determines whether the child be properly nourished. Emaciation is a certain indication of imperfect nutrition — a consequence of over-feeding as much as under-feeding; if the digestion be overtasked by quantity or quality, the chyle is vi- tiated, and nutrition insufficient, while, if the supply is not in proportion to waste and growth, there is a deficiency in the for- mation of all the tissues, the bones remain soft, the muscles flaccid and shrunken, the skin covered with eruptions, the nerves weak, yet so excitable that all impressions are painful, and a constant fretfulness or moping inactivity prevails. It.has been ascertained that scrofula and consumption are produced both by over-feeding and want of sufficient nutriment. 34 INFANT TREATMENT. A soft, clear, pliant skin, accompanies a healthy action of its functions. It is not transparent in all cases, because complex- ion makes a difference both in colour and thickness. Its condi- tion is better ascertained by its texture than by its hue. A dry, harsh, scurfy skin, indicates something wrong in the alimenta- ry canal, to be corrected by the diet, or an inactive state of the skin itself, to be overcome by exercise and warm baths. The temper is a very sure index of health ; cheerfulness, mirth, and freedom from anxiety, are the peculiar privilege of early childhood; the past and the future are nothing, the present ev- ery thing. The absence or interruption of these sentiments de- notes deranged health. It is true that what is called a spoiled child is troubled by bad temper; for where there is moral mis- management, there will also be physical mismanagement: the petted child will have what it desires to eat and drink, will go to bed only when it pleases, will submit to no regulations, while the irritation to which it is continually subject from the contradictions it must encounter, and from its own unrestrained feelings, wears the nervous system, and exhausts the energy which is required for the healthy action of all the functions. The general rules for diet after weaning, then, are these :— mild nourishing food given at regular intervals of time, the qua- - lity to be more animalised as the waste of the system is increas- ed by growth and exercise; observation to be made of the ef- fect of any new substance, such as fruit, meat, mild beer, &c, that it may be discontinued if hurtful, and wholly abstained from (for a time) when found to be so. Seasoned dishes, fried and salted meats, pastry, uncooked vegetables, unripe fruits, wine, and rich cake, to be altogether avoided: mastication to be insisted on, and no viand to be eaten in large quantities be- cause it is liked, while nothing disagreeable should be forced upon the appetite. Whenever there is a disinclination for food, the feeling should be indulged, since it bespeaks a state of stomach in which food would be injurious. Tempting the appetite is phys- ically pernicious, while morally it is the first step to needless, sensual indulgence. Children require to eat more frequently than adults. A healthy active child of two years, needs food every three or four hours, while awake, provided the stomach be not loaded: but continual eating allows no time for the re- FOOD. 35 pose which the digestive apparatus requires, and establishes a bad habit. Variety is also desirable ; not that children should eat of several dishes at one meal, but they cannot be fed judi- ciously every day alike. Farinaceous food is capable of great variation. The animal food given to a child should be of a ten- der fibre, and eaten with a due proportion of salt, vegetables, and bread. Every thing should be well dressed. Good cookery means the preparing food in the best way. However simple the fare, it should be dressed with attention to cleanliness, kept free from grease, neither over nor under done, neither burned nor dried, the proportions mixed and flavoured by rule—not by guess-work. An ill-dressed dish is not only unpalatable, but indigestible.— Bad cookery causes waste and discomfort. The dinner of a child, however simple, should, for both these reasons, be carefully prepared. Disagreeable food is tossed about on the plate and spoiled, and thus children learn to be wasteful and indifferent to the true value of food. They may not perceive its indigestible properties by their taste; but a fit of sickness or fretfulness, is no unfrequent consequence of an ill-dres.ed meal. There is a natural perception of good and bad food, intended to save the stomach and the system from in- jury, quite as much as to ensure a reasonable gratification from eating. The sense of taste may be trained to discriminate be- tween what is Avholesome and unwholesome in cookery, yet no undue love of eating inculcated. There are various opinions as to the propriety of giving chil- dren beer. Many do not require it, but thrive sufficiently upon milk. There are others for whom it is heating and heavy; but there are also some who are thought to need the nourishment it bestows. Mild beer, well hopped, is said to act upon some constitutions more as a tonic than a stimulant, and to assimilate with animal diet better than any other beverage. We feel some doubt on this point, and would recommend bread and milk, varied by tea and coffee, diluted with milk, as a good breakfast and supper. New bread is decidedly unwholesome ; it swells in the stom- ach, causing distension and oppression. Sweetmeats and con- fections, when habitually eaten^ turn acid upon the stomach, and destroy the appetite for plain food. But, given occasionally 36 INFANT TREATMENT. in moderate quantities, and of a good quality, they are a harm- less indulgence of the palate, and may be made the innocent means of promoting amusement, and even intelligence. Young children are delighted to play with sugar-plums, and the variety of their forms and colours, contributes to their amusement: when the gratification of eating has not been en- couraged as a chief source of delight, they will be as much sought for the pastime they afford, as for the pleasure of appe- tite : they should not be given as incentives or rewards. In training the very young, it is to be remembered that nat- ural inclinations and impulses are evil only in their abuse, and that the desire for food, like all other desires, is intended to be a source of reasonable gratification. Eating is made pleasura- ble, because it is necessary to life. During infancy, the mosf*ready means of giving and obtain- ing quiet, is food; a constant habit of eating, and looking to it for comfort, is one of the earliest impressions an infant receives: a child evinces an anxiety for any viands it may see, and this desire is laid hold of as a bribe or a reward. Eating thus be- comes the chief aim and object; a child learns to eat too much and too often—is satisfied with mere animal gratification, and is most attached to those who pamper him the most. This is the abuse of a natural propensity, and the first step to , sen- suality. But if an infant be fed only when hungry, instead of when uneasy, and as it grows older, eats upon the same principle, with such habitual regard to neatness, order, and good cookery, as shall accustom it to discriminate between what is fit and what is unfit, wholesome and unwholesome, there will be no undue value attached to food. SLEEP 37 CHAPTER III. SLEEP. All young animals sleep much. The child partakes of this instinct so fully, that there is no necessity to promote it, but on- ly to prevent its disturbance. Physical comfort is all that is needed; and this is to be obtained by whatever secures health —namely, proper diet, warmth, cleanliness, and the fatigue which follows upon the exercise proper to infancy. During the first few weeks of life, the sense of hearing is so dull, that noise does not disturb: sudden noises, however, are sometimes distressing, occasioning a weakness of the nervous system. But the continuous sounds produced by talking, the noises of the street, or the voices and sports of other children, seldom rouse infants in the first month or six weeks, and it saves much trouble if they become accustomed to them. Sleep- ing in the arms, or on the lap, is for every reason to be avoided; no child accustomed to this indulgence, will rest long in its bed: neither ought they to be lulled to sleep; they maybe early habituated to be put into bed awake, and so left, with the necessary caution of watchfulness. Although it is not practicable to adhere strictly to rules at first, there should always be an endeavour to form good habits, and this from the beginning: those which relate to sleep, should be established while the disposition for repose is strongest. On laying an infant down, it should be ascertained that the feet, hands, and face, are comfortably warm, and that every part of the body is supported, and the limbs uncramped ; the head and shoulders being raised a little by the pillow sloping gradually to the bed. Blankets are better than sheets. The covering should be so arranged that, while there is sufficient space to breathe freely, the face is kept warm. It is better not to take up a child the instant it wakes, (parti- cularly if it have not been long asleep), nor if it cries after be- ing laid down: change of posture, gentle rocking, or slight pat- B 38 INFANT TREATMENT. ting on the back, should be tried. If these fail, it should be ta- ken out of bed, and quieted in the arms. Change of linen may be necessary: in short, patience, perseverance, and ingenuity, should be put in practice, with a view to produce comfort with- out entailing bad habits. In rearing children, it is well to bear in mind that present evils ought never to be overcome by wrong means. It is best that infants should lie alone, for the air of a bed in which one or more grown-up persons are sleeping becomes im- pure ; the child imbibes the perspiration produced by sleep, and is in danger of being overlaid—an accident by no means uncommon. Children, lying alone, sometimes become cold in the course of the night, and it may then be necessary, in order to restore warmth, to take them into bed ; but when warmth has been restored, they should be again put into their own cot or crib.— It is difficult to overcome that natural instinct which leads a child to lie at the breast; but they sleep alone in the day for hours at a time, and may therefore be trained to do so at night. Darkness is favourable to repose, and it has its influence upon the young, although not at the beginning of life. The object, then, is to cultivate a habit of sleeping throughout the night. Mothers must expect their rest to be disturbed, until the exer- cise and fatigue of the day increase the necessity, and the de- sire, for night sleep. Refreshment and change of linen are needful at night, and these should be given very quietly; no amusement should be offered, or wakefulness will be encour- aged, and a child will regularly rouse itself for a game of play. Every mother will remember that she has duties as a wife and the mistress of a household, and that in providing for the comfort of her child, she must not sacrifice that of her husband, or the rest of the family. A wakeful, fretful child, is a trial to patience; and disturbed rest is hard to bear. Every arrange- ment that circumstances permit, that can prevent this infliction, ought to be made and adhered to. Wherever, therefore, it is possible, an infant should sleep in its nursery, and only be brought to its mother's room at the stated times when suckling is necessary. After the first three or four months, if suckled when the mother retires to rest, as already recommended, the child will wake but once more, provided the management be judicious. CLOTHING. 39 A child should never be kept awake when fatigued, under the idea that it will rest better at night. Over-fatigue produ- ces general irritability, pain in the limbs, fretfulness, and rest- lessness. For this reason, however apparently disinclined, when the fixed hour arrives, there should be no delay about preparing for bed, and this practice should be maintained du- ring childhood as well as infancy. The habit of sleeping in the day is of great service, even during the first four years, and longer where there is delicacy of constitution or great activity. Sleep is the only means of giving rest to the system of a child: in health there is no repose except during sleep: in warm wea- ther, it is very acceptable to active children of five or six, and frequently relieves them from a weariness which assumes the appearance of indisposition, or takes the form of ill temper and disobedience. An hour's nap will be found a safer physical and moral remedy, than a dose of medicine, or punishment. CHAPTER IV. CLOTHING. Warmth is essential to the health of a new-born infant, and this is chiefly to be obtained through the medium of clothing, for in the first stage of infancy there is no muscular exercise. What renders warmth by artificial means so necessary, is the fact that infants, having a languid circulation, produce little heat naturally, and easily part with what they do produce; for which reasons, they are liable to suffer far more from exposure than adults. A certain degree of warmth is essential to the performance of all the functions, and protection to the skin assists materially in maintaining this warmth, which should be sufficient to keep up the insensible perspiration, yet not so high as to produce .continual sensible perspiration. The latter state relaxes the system, and renders it liable to be affected by cold draughts or changes in the weather, while it exhausts the strength, and by b2 40 INFANT TREATMENT. increasing the action of the blood on the surface, deprives oth- er organs of their necessary quantity. Clothing therefore must be regulated by age and by the season. The sudden change in the situation of a new-born infant calls for great care in the protection of the skin: this should be entirely covered for at least the first month; even the face and hands should be but gradually exposed. Lightness, as well as warmth, is requisite in all articles of clothing. Flannel and calico possess these more than any other material. But flannel, even of the finest texture, may be too irritating if worn next the skin, and it is desirable to give the infant a shirt of fine linen or cotton under the flannel, to protect the cuticle. Another reason for the use of linen or cotton next the skin is, that flannel cannot be wash- ed Often without injury to its texture; and there is also dan- ger that, as it does not show the dirt so quickly, it may be con- tinued to be worn too long. Linen and cotton take little harm from frequent washing, and are so much cheaper than flannel, that a larger stock may be provided for the same expense. At no season can flannel be dispensed with, though in hot weather it should be thinner than in cold. Looseness is another requisite in an infant's dress: there should be a free circulation of air between the skin and the clothes, as well as a slight friction upon the surface. All con- finement distresses, and, when it amounts to tightness, it may occasion deformity, before the evil is suspected. Full room should be allowed for the increase which is continually and ra- pidly going on. For this reason, every part should fasten with strings; and in tying these strings, the greatest care should be taken not to draw them too tight. It is a good precaution, af- ter every string has been tied, particularly those under the chin and round the waist, to put in the finger, to ascertain that it is not too tight. In comparison with strings, buttons and hooks and eyes are not to be commended; they have but one advantage, that of putting it out of the power of a hasty or negligent nurse to fix the dress too tight, as may be the case with strings. It is ne- cessary frequently to ascertain whether a child has outgrown its clothes. Growth is so rapid during the first two years, that a few weeks will make enough of difference in the relative size to produce pressure or restraint; clothes, therefore, should al- CLOTHING. 41 ways be made so as easily to let out or enlarge, particularly round the waist, throat, and arm-holes, and across the chest and back. It must ever be kept in mind, in regard to clothing, as well as other circumstances in the economy of an infant, that the babe can itself give no explanation of the inconveniences which it suffers. Bearing this in mind, and remembering how con- tinually adults are annoyed by trifles which they have the per- ception to discover, and the ability to remove, it will readily be acknowledged that nothing is too insignificant for the con- stant and regular attention of a mother. Articles of dress contract, or otherwise lose their shape; a ruck forms, a hook bends, or a button turns and presses upon the flesh; any one of these accidents occasions pain, and frets the temper of an in- fant. The more easily the dress can be put on and off, the better; there should be no other fashion than what is dictated by con- venience and comfort.* The fashion of long-clothes, such, for instance, as measure a yard or more in the skirt, leads to need- less expense, both in material and in washing, besides encum- bering and overweighing the child. There need be no more length than is necessary to cover the feet, so that the cold will not draw underneath the clothes, and to conceal the under clo- thing. The change observable in a child when the long-clothes are laid aside, sufficiently proves that the limbs have been con- fined and activity restrained. The frequent dressing and un- dressing which the use of ornamental attire necessarily entails, irritates so much that the slightest sign for changing the appa- rel is a signal for crying, and a habit of fretfulness during dress- ing is formed, unfavourable to the tempers of both child and nurse. Loose gowns, fastening in front, are therefore preferable to * The very vicious practice which in some places still prevails of swad- dling up children tightly in a rnass of clothes, and covering their heads with double and even triple caps, renders it necessary to enforce atten- tion to the above very important part of a nurse's duty. In some parts of France infants are swathed up like little mummies, and carried occasional- ly on the back or under the arm of the mother; a custom which is known to have a most prejudicial effect upon the growth and strength of the popu- lation In most cases in our own country, from a mistaken tenderness of feelin", infants are overcJothed, and both their bodies and heads are con- sequenrty kept in a too highly heated condition.—Ed. b3 42 INFANT TREATMENT. frocks, (for the first two months,) however less elegant or fash- ionable. All unnecessary folds should be avoided, because they may press painfully upon the muscles or bones ; and the materials should be of a soft yielding nature. Harsh seams and hems or rough tapes, especially where coming in contact with the skin, will be avoided by the skilful seamstress. Where pecuniary means are not abundant, the mother, in ma- king her baby linen, should remember that quantity is more important than quality, and that cleanliness can scarcely be ob- served where the stock of clothing is scanty. One of the most important parts of an infant's clothing is a band to support the abdomen, familiarly called the belly-band. This should be made of soft flannel or calico, that is to say, of material having some elasticity. It is intended to give sup- port to the abdomen, especially to the navel: and it protects the internal covering of the intestines from any sudden disten- sion. The umbilical cord is usually divided at birth about three inches from the abdomen of the infant, close to which it is securely tied, or the child will bleed to death. The final separation of the remaining portion of the chord is the work of nature, and takes place at various periods, sometimes in five days, or even less, sometimes not till the fifteenth day. The child is more comfortable when this is over; the unpleasant smell alone, which of course attends the decay of the part, is distressing; but there is always a good deal of tenderness, which sometimes amounts to ulceration and pain. In ordinary cases, as soon as the separation has taken place, a split raisin and a piece of singed linen should be applied to the part, and changed daily. It occasionally happens, that, after a feAv weeks, the navel starts; in such a case, a common ball of sewing cotton, half used, so that what remains is soft and yielding, should be laid upon the navel, and confined by strips of strapping-plaster placed crosswise. If any thing more serious appear, such as redness, ulceration, discharge, &c, medical advice is immedi- ately necessary. The vessels of the umbilical cord pass through the abdomen, making a passage which for the most part closes quickly and soundly after the separation of the cord ; but un- usual size in the opening, indisposition to close, or screaming, straining, sneezing, or any sudden violent effort, may interrupt CLOTHING. 43 the natural process, and force the intestines through the open- ing. A steady protection, which shall gently resist these ef- forts, yet not compress the cavity of the abdomen so as to ob- struct the healthy action of the viscera, is required. The band affords this protection. In putting it on, it must be remember- ed that there is a distinction between support and pressure ; the former is indispensable, the latter dangerous. If the cavity o£ the abdomen be diminished, its contents are compressed, and when any action takes place that strains the parts, there is no room for the necessary distension, and the weakest give way.— The action of the bowels is impeded by compression, occasion- ing pain and constipation. Medical writers dwell upon the im- portance of the band, and decide that rupture is frequently the consequence of neglect or ignorance in regulating its use. It re- quires to be taken off and re-arranged morning and night, and a clean one put on every other day, as it gets rucked, and so unfit- ted for use. It is often wetted, and is then likely to create pain and disturbance of the bowels; for which reason, the same should not be worn both day and night. With some children the band is necessary for many months : when it is discontinu- ed, the slay or waistcoat, usually worn as a sort of support to the rest of the clothing, should reach two inches below the na- vel : it prevents an enlargement of the abdomen, and sustains the child in its attempts to sit up. Caps are best made of thin material, with no under cap." The custom of keeping the head warm is gradually disappearing.— The bones of the skull are not all united at birth; the parietal bones are divided, and the soft matter of the brain on the top of the head is perceptible to the touch. This opening was sup- posed to give a liability to cold, and the head was kept very hot; an injurious practice, increasing the action of the blood- vessels of the head to a dangerous extent, and impeding the junction of the bones. As soon as the hair begins to grow, caps should be discon- tinued, especially if the season be summer; when the hair be- comes thick, nightcaps also may be laid aside, or at the utmost only a cotton net, which admits the air freely, should be worn. When a child is to be carried about the house, however se- curely it may be clothed, the cold draughts which prevail even in mild weather should be guarded against by the addition of a B4 44 INFANT TREATMENT. light handkerchief or shawl. The disorders arising from check- ed perspiration will thus be avoided. On the other hand, a child should never be presented naked too near the fire, as a scorching heat injures the texture of the skin and deranges its functions. On bringing an infant too near the fire on any occa- sion, it may be well to screen its face and hands, in order to protect it from this evil. There is little doubt that the eruptions to which the infants of the poor are subject, chiefly arise from want of cleanliness and warmth. In this country, where changes of temperature are sudden, and continual judicious clothing is the only safe- guard, summer apparel cannot be safely adopted ancllaid aside at a given period, nor can the same dress be always worn at noon and in the evening. However warm the clothing, infants should not be carried abroad in cold weather: their lungs can- not bear a low temperature, and there is no exercise to keep the blood equally distributed. Where ventilation is attended to, no other change of air is wanted but what may be obtained by moving from room to room. An infant usually falls asleep when carried abroad ; cold increases the disposition to do so, and renders it dangerous, while no good can be derived from the external air, since common prudence dictates that the whole person must be completely enveloped. If carried about a well-ventilated room, at a moderate temperature, the child breathes freely and without risk. No child can be taken into the open air in very cold weather with safety, until it is able to take so much exercise as shall keep the blood at the surface.— Before this period, the quantity of necessary clothing impedes activity. This, with the state of the air, benumbs the limbs; the blood is driven from the surface, and loads the lungs, stom- ach, and brain, &c. ; the child returns home, is brought sud- denly into a room with a fire, and probably close to a grate, for the sake of restoring warmth; violent reaction follows; the harmony of the system is disturbed, and the functions sustain at least temporary injury. The daily repetition of the distur- bance tries the strongest constitution severely, and, where there is predisposition to disease, active disorders follow. How much better to put a child into a swing, to toss him about, encourage him to use his voice, throw a ball along the floor, and creep or run after it; all of which, and much more, may be done in a CLOTHING. 45 room properly warmed and ventilated.* By such means, men- tal and bodily energy is kept up; the blood is equally distribu- ted ; there is neither stagnation nor over-action; fatigue fol- lows upon the exercise, and then comes healthful repose, in- stead of the torpor which succeeds the combined effects of cold and inactivity. When the period of infancy is passed, the clothing must still be attended to : if insufficient, children creep to the fire, and are very unwilling to face the cold or to exert themselves ; properly clad, weather seems to make little difference to them. When a child can run alone, and express its wants and wishes by signs or sounds, it should (in cold weather especially) wear loose drawers : they may be cut so as to be no impediment to activity or cleanly habits ; if the lower part of the body and the loins are exposed to cold, weakness of the urinary organs is often induced, very distressing and difficult to cure. The warmth of a pair of drawers more than equals that of two pet ticoats, so that their adoption need cause no additional expense. The care of the feet is for many reasons desirable. The practice of keeping them uncovered is not to be recommended. There is danger of laceration from the many hard and sharp substances lying on the ground, and exposure is not favourable to general health. Chilblains are frequent with those whose feet are exposed in cold weather. The only advantage gained is freedom of gait; but this is an advantage which the wear- ing of shoes ought not necessarily to deprive us of. If shoes were made with a due regard to the shape of the feet, and a liberal consideration of other circumstances, no harm would ensue. It is to be observed, that the foot in its natural condi- tion, as to be seen in a nursing baby, expands regularly from the heel to the situation of the smallest toe, from which point it contracts rapidly in an oblique direction towards the great toe. Shoes are not made in this form, but after expanding to a point a little short of the smallest toe, they contract on both sides equally, thus crushing the outer toes towards the centre. It is also to be observed, that the sole is naturally formed on a perfect level from heel to toe. Shoes, however, are formed * Those whose means are insufficient, have in most towns the resources of an infant-school: the advantages they afford to physical welfare are not the least they bestow. B5 46 INFANT TREATMENT. with an inequality of from half an inch to a whole inch, or even more (we allude to grown-up persons.) between the heel and the front of the foot. Thus, the body is thrown forward from a strong point, the heel, to a weak point, the toes ; the limbs are prevented from ever keeping a straight position ; and the whole figure and walk are deranged. If we were to reflect for a moment on the exquisite adaptations of all things in nature, we should instantly see the absurdity of this conduct; if there had been any advantage in making the heel somewhat higher than the front of the foot, would nature, which has made every thing so nicely suitable, have failed to fashion the foot accord- ingly ? Perhaps it is not to be expected that, either for child- ren or adults, shoes without some elevation behind are to be adopted; but it may at least be said, that the lower the heel in all cases, the shoe will be the better. Shoes should neither be too roomy, nor too tight, though the latter is the worse fault. The unavoidable results are corns, bunions, and distorted and turned-in toes, all of them evils of no small magnitude. When we are thus affected, free motion is impeded; the foot, instead of being placed firmly on the ground, is set down in any way that will best avoid pain; the whole person droops; the chest is contracted ; and, perhaps, worst of all, the temper is rendered fretful. A mother, sincerely anxious for the welfare of her children, will cause their shoes to be made of a proper shape and consistence, to allow of perfect freedom. When an infant is to make its first advance from woollen socks, the best plan is to cause the shape of the sole of the foot when standing to be traced, and the sole of the shoe to be made from the outline. On the general subject of protection from cold, some remarks may here be made. There is an opinion that children should be made hardy from the first, and that it is therefore proper to plunge them into cold-baths, and otherwise expose them to rigours which are obviously disagreeable to them. The practi- ces of savage nations are cited in support of these opinions, but no attempt has ever been made to show that they are support- ed by any philosophical principle. When the practice of a savage nation is cited, we should guard against mistaking a pe- culiarity of their constitution for a general principle. It is now known that the nations in question do not possess the same CLOTHING. 47 amount of nervous sensibility as the European races, and that this is the true cause of their enduring so many tortures uncom- plainingly at the stake. What their infants may not be affected by, may greatly injure the comparatively tender structure of an European infant. There are certainly differences of the same nature amongst infants in our own country, and some of these might be little the worse of the rigorous treatment prescribed. But there can be no doubt, that as a general principle, infants require warmth, and ought not to be unnecessarily exposed. In them, the cir- culation is languid; consequently, little heat is generated in their bodies naturally. Without being kept warm, there can be no healthy action of the functions in their case ; and with- out a healthy action of the functions, the sound formation of the various parts of the frame will be obstructed. By the con- trary treatment, the foundations cf glandular and pulmonary disease are often laid. Infants, therefore, should be sufficiently, though of course not cumbrously, clad. In reply to the argu- ment that the children of the poor are necessarily exposed, and have the best possible health, it can only be said they live in spite of the exposure, not in consequence of it; those who are accustomed to visit the poor testify to the comparative sickly condition of the children, while the bills of mortality show that the large proportion of deaths are those of young children; and the observations of the best informed attest the fact, that much suffering, great increase of disease, and an augmented mortality, are the consequences of injudicious expo- sure to cold. 48 INFANT TREATMENT. CHAPTER V. WASHING AND DRESSING. For the health and comfort of an infant, washing is an im- portant requisite. It should be performed every morning and evening, and not in a slovenly, but in a complete though gentle manner. The physiological reasons for such frequent ablutiona are these :—The pores of the skin convey superabundant mat- ter from the system ; and that matter is apt to remain upon the skin, so as to clog up the pores, and prevent them from performing their functions, unless it be washed off. The pores also act as absorbents, and this function likewise is impeded when the skin is not clean. In the case of an infant, washing is moreover necessary, in a more particular manner, for the removal of all impurities, the contact of which is very unfavourable for health. For reasons which have been adduced under the head of " Clothing," the water in which infants are to be washed should be warmed. Cold water is further objectionable as tending to drive the blood inwards, and overstimulate the organs, the unavoidable consequence of which is disorder, and often death. For the same reason, when the business of bathing infants is to be per- -formed, great care should be taken to prevent draughts of cold air from coming upon them. They can only be safely undress- ed beside a fire for the first four months. . A new-born infant is covered with a pasty greasy substance, which must be removed, otherwise it will irritate and excoriate the skin, and occasion a disagreeable smell. Soap and fine flan- nel or sponge are the best applications ; every fold of the skin, the joints, armpits, &c., must be carefully examined and wash- ed. It is by no means uncommon to rub a new-born babe with spirits, to prevent its taking cold after washing ; but the stim- ulus thus given to the skin is injurious and must be painful, while the rapid evaporation occasioned by the application of spirits, tends to produce instead of to prevent cold. On preparing for dressing and washing, every necessary ar- WASHING AND DRESSING. 49 tide should be near at hand ; it is a sign of mismanagement when a nurse has to rise to fetch any thing: the horse or screen, with the clean linen conveniently placed, will keep off draughts : the basket, basin, soap, sponge, and towel, should be laid with- in reach, and in such order that there can be no confusion, and that the clothes shall not fall into the water, nor the wet sponge and towel find their way into the basket. The nurse, being thus prepared, with the addition of a flannel apron and a low chair, strips the infant, and having washed its head with soap, rubs It dry and puts on a cap. The face, throat, chest, arms, and hands, are then successively sponged as plentifully as the child can bear (soap is not always required), and tenderly but thoroughly wiped. The infant is turned over, and the back, loins, and legs, are abundantly covered with water; the left hand holding the child, its legs hanging over the knee, so that the water flows from them into the basin. The thighs, groins, &c, require great attention both in washing and wiping. The Gorner of the apron should then be turned up, so that there is a dry surface for the child to rest on, while it is carefully wiped. The rolls of fat and creases in the neck, arms, and thighs, the bend of the arms, hamstrings, and the ears, must be thorough- ly washed and dried. As the friction between the parts in- creases the perspiration and the liability to excoriation, they should, after wiping, be slightly powdered with unscented hair-powder or pounded starch. If occasional heat creates red- ness and chafing, a small quantity of plain pomatum or lip- salve is often serviceable. N After washing and drying, the skin should be rubbed with the hand or a flannel glove; this restores the circulation to the sur- face, and is agreeable and soothing. Morning and night, this washing, from head to foot, must be repeated, while every im- purity, from whatever cause, should be immediately removed from the skin during the day. If a child throws up its food, or there is much flow of the saliva from teething, the face and throat should be washed once or twioe during the day. Before the clothes are put on, the child should be allowed to kick and stretch its limbs upon the lap; this affords an op- portunity of ascertaining its healthy condition. At no period of childhood should this attention be omitted; any little defect in walking, running, or even sitting, should be inquired into, and the cause ascertained. 50 INFANT TREATMENT. The clothes of an infant should be made with reference to convenience and speed in dressing, without requiring any pins for the fastenings. The band, shirt, and back skirt or flannel, may be arranged while the infant lies on its stomach: turning it on its back, they may be fastened in front, and a diaper and flannel square folded and secured. Raising the child on its seat, the frock and petticoat may be put over its head, the arms put through the arm-holes of both at once, the palm of the right hand of the nurse supporting the infant across the chest, while the fingers assist the left hand. The child is then again turned over (if the frock fasten behind), and the strings tied. Putting the arms through the sleeves is a nice part of the task : in order to avoid injury or pain, thenurse should ascertain how the joint moves, remembering the extreme delicacy of the limb she di- rects. The cap should always be drawn ready to the size of the head, and the strings of the runners tacked up, so that they cannot get loose and irritate the face and eyes. The clothes which are taken off should be examined; those that are not dirty, but moist, should be well dried before Using them again, and nothing retained that has an unpleasant smell. Where economy is important, "the offensive part may be washed out. The strings and borders of the cap get hard, strained, and crum- pled, in which state they are apt to chafe the corners of the eyes, and beneath the chin, besides smelling unpleasantly. An infant usually cries considerably while washed and dress- ed. When not violent and continuous, crying is serviceable: it gives the only exercise to the lungs, voice and respiration, that infants can bear or take. As they grow older, and ac- quire other powers, crying is diminished. Tenderness and dexterity are nevertheless in all cases needful; when roughly handled, the sight of the basin and the sound of the water are the signals of suffering and sorrow, and it may be years before a child can regard washing as a source of comfort. This it is, and ought to be ; every pains should therefore be taken to sof- ten its discomforts to the young and tender. When the child is old enough to be amused, a playful gentle manner on the part of the nurse will render the operation so pleasurable, that all painful recollections will fade away, and agreeable recollec- tions only remain. As soon as children acquire the power of voluntary motion, they necessarily make themselves dirty; a VENTILATION. 51 habit of frequent washing renders it uncomfortable for them to remain in that state; but at an early age, pleasure in washing mainly rests upon the way in which they are handled; if roughly pulled and twitched, and wiped with no regard to com- fort, tears, rebellion and dislike, naturally accompany the ef- forts to keep them clean. Every kind of clothing should be aired before a fire previous to being put on; and all flannel garments, in particular, require to be carefully dried in this manner. Either damp linen or flannel, dried upon the person, must of necessity produce evil consequences, especially where, as with infants, there is little exercise. The quantity of clean linen they require makes caution upon this point still more important. CHAPTER VI. VENTILATION. The organs of respiration are constructed in accordance with the nature of the atmosphere, or what is called pure air; they are therefore deranged, and the blood becomes vitiated, by any departure from this n atural order. As air that has been fre- quently breathed is deprived of its oxygen, and charged with carbon, and thus is unfit for respiration, there should always be a means of admitting fresh air, or renewing the air of an apartment inhabited by children. To do this where there is no proper arrangement for ventil- ation, without creating draughts, is a difficulty. In mild wea- ther, a window may always be left open during the day ; and if this be insufficient, or the weather unfavourable, opportuni- ties thould be taken to change the atmosphere by a thorough draught of air when the children leave the room. A window open at top, about an inch, will do something towards keeping 52 INFANT TREATMENT. the air wholesome, without much risk, particularly if the win- dow be so high, that a stream of cold air does not descend at once upon the children. When the attention is directed to the importance of pure air, occasions continually offer when rooms may be ventilated without danger of cold. Sleeping-rooms are more particularly liable to deficient ventilation; three or four children probably sleep in the same chamber, and, going early to bed, the air is perhaps unchanged, or only changed in a small degree, for ten hours. It is scarcely possible to lay down pre- cise rules for preventing such an evil. Those who possess the means, ought to avoid placing sever- al children in the same bed-room; and those who labour under the difficulties of small houses and large families, will meet the evils of close rooms by taking care that there is some aperture, either the chimney, or a ventilator in the ceiling, door, or window, which shall admit air with the least possible draught. It is a greater evil when the same room serves for day and night; but here an exercise of ingenuity and care may serve the desired end. Where there are difficulties, let them be met by that determination which, when springing from conviction, is generally able to accomplish its object. Bedding needs daily Ventilation. Every morning, all the beds should be thrown open, and freely exposed to the air, until perfectly cool; the perspiration, which is generally abundant during sleep, occa- sions a necessity for this precaution. Heated impure air has a bad effect upon the tempers of young children ; they grow lan- guid, uneasy, and fractious; the nervous energy is checked; and thus all the functions, those of the brain especially, are enfeebled. Children evince uneasiness by crying, passive fretfulness, or active violence, as they are differently constituted. A con- stant recurrence of irritating causes renders them habitually fret- ful: they are therefore morally as well as physically injured by breathing an impure atmosphere. The mother or nurse be- ing subject to the same influences, their tempers are in no con- dition to soothe the fractious little beings around them; mutu- al and increasing irritability prevails, destructive of true mater- nal and filial feeling. A proof of this state of temper may be seen in winter, in an ill-regulated nursery, the houses of the poor, and in the play or dame schools, where there is inces- VENTILATION. 53 sant crying, quarrelling, and scolding. Impure air is not the only cause of this miserable state of things, but it is one which aggravates all the other evils. Considering the defective food and clothing of the children of the poor, and also the badly ventilated and generally filthy condition of their dwellings, it is evident that much of that health which they possess is owing to their spending the great- er part of their time during the day in the open air. This fact, in itself, ought to impress upon all mothers the* propriety of preserving a constant freshness and purity of atmosphere in the apartments of their children; at the same time, however, ta- king care to prevent the rushing of cold draughts from the doors or windows, as these cause catarrhs and other illnesses perhaps as dangerous as the maladies which may arise from the want of necessary ventilation. There are many points connected with pure air, which re- quire ^constant attention, where there are children. Amongst these may be cited the instant removal of dirty linen, and all other offensive matter; forbearance from drying or airing clothes, bedding, &c, after they require washing; neatness with regard to utensils; in short, minute attention to cleanli- ness, which is not only essential to health, but has its influence upon morals; for dirt and indelicacy are frequent companions, and a disregard for the decencies of life is a step towards in- difference to its virtues. For these reasons, as well as for se- curity to health, habits of cleanliness and delicacy should be formed early; children acquire or disregard these in propor- tion as the manners of those associated with them is indifferent or careful. When their mother or nurse is systematic and rea- sonable in her attention to the personal necessities of her children, they feel the influence of such habits, although they neither reason nor reflect upon them; after a time, a sense of comfort and self-respect is associated with the observances to which they have been accustomed, and a sense of propriety even- tually becomes part of their character. In addition to a proper temperature, regard should also be paid to light; as it exerts an important influence upon all animated beings. Dr. Edwards has shewn that the development of animals is due, to a great extent, to the influence of this physical agent, and every one must have observed that the same holds true in relation to the 54 INFANT TREATMENT. vegetable kingdom. It is a rule, then, which admits of gener- al application, that an infant, as soon as its eyes lose their ex- treme sensibility, should be freely exposed to the light, and the nursery should never be darkened by shutters or curtains, either during the day or the night. CHAPTER VII. MEDICINE. Immediately upon the birth of the child, it is a frequent cus- tom with nurses, to administer some purgative medicine, in or- der to prepare the digestive organs for the reception of the mother's milk. This is both an unnecessary, as well as injuri- ous practice, inasmuch as the milk itself is a mild laxative, and generally sufficient to accomplish the desired object. Should the meconium not be sufficiently expelled, which is shown by the discharges continuing of a dark colour, a few tea-spoonfuls of molasses and water, or sugar and water, or half a tea-spoon- ful of fresh drawn Castor oil, may be administered, but calo- mel, and all other active medicines, should be withheld. As the child grows older, it is also a very common practice with mothers and nurses, to administer strong and dangerous medicines, even on the most trifling occasions, and often to the great detriment, if not with fatal consequences to the child. It appears from a report made to the English House of Commons, of all inquests held in England and Wales in 1837 and 1838, in cases of death from poison, that 72, or nearly one-seventh of the whole number, resulted from the carelessness of mothers and nurses in administering medicines in inordinate doses with the properties of which they were unacquainted. More than fifty deaths occurred from an over-dose of laudanum, or some of the other preparations of opium; and twenty by means of the same article, given through mistake. To show how perfectly reckless some nurses are in giving medicine, we may mention the following case which lately MEDICINE. 55 came under our observation, as an example. A child two years old caught a slight cold from exposure during the illness of its mother. The nurse, an experienced woman of fifty-five years of age, commenced the treatment with large and often repeated doses of senna tea, which were continued for two or three days. This was followed by a large dose of calomel; then six doses of cowhage; then twelve doses of castor oil (in one day;) then two bottles of Taylor's Balsam of Liverwort; besides Rhubarb, Magnesia,«Salts, and two or three other articles. For the space of two weeks, the child, a fine hearty boy, had swallowed, at least, six doses of medicine daily, and when, at the end of this time we were summoned, we found him reduced nearly to a skeleton, the power of digestion entirely destroyed, and he was labouring under a serious disease of the bowels, caused solely by the medicines. After an illness of several weeks he was fortunately restored to health. Here was a case of slight in- disposition, which required no active treatment at all, but which had well nigh proved fatal through the agency of the in- tended remedies, but which proved actual poisons. It is high time that mothers and nurses should learn that there is nothing more pernicious than this system of drugging children, upon every slight ailment. Because a child is fretful or complains, it does not therefore follow that it needs active medicine; it is probable that its stomach is overloaded, and needs abstinence; at any rate, if the child be well managed and its food properly regulated, medicine of any kind will rarely be required. Nearly all cathartic medicines, it should be recol- lected, produce their effects, by causing an unnatural degree of irritation of the intestinal mucus membrane, which is followed by an increased secretion, the result of the previous irritation; and according to an established law of the system, this will ne- cessarily be followed by a corresponding degree of inaction or torpor, inducing a state of costiveness, which, in its turn, calls for a repetition of the cathartic dose. During the first few weeks of infancy, there should be from two to four discharges from the bowels, every twenty-four hours; and these should be of a light yellow colour, without any fetid or acid smell, and free from lumps or white curdy matter, and passed without pain or wind. Should these condi- tions not exist, medical interference may occasionally be re- 56 INFANT TREATMENT. quired; but this may often be prevented by changing the diet of the mother. Should this, however, not have the desired ef- fect, the nurse may venture upon the administration of a tea- spoonful of fresh castor oil, or a dessert spoonful of a mixture, formed of a couple of drachms of manna dissolved in an ounce of fennel or carraway water, and repeated every hour until the bowels are opened. These, with calcined magnesia, are the only nursery medicines which we would allow. Under five years of age, calomel should rarely be given to chiidren under any circumstances, and never, except by medical advice. We dwell the longer on this subject, because it is one of very great importance, and one, in relation to which, very incorrect notions generally prevail. Dr. Combe has very justly remark-l ed, that a propensity exists to consider disease as an extraneous something thrust into the system, which must be expelled by force, before health can be restored, and with which the mode of management has little or nothing to do. Whereas, disease is nothing more than an aberration from the regular mode of action of the organization, generally caused by errors in regi- men, and often to be removed by a return to a right course. The consequence of viewing disease as arising from some- thing in the system requiring to be removed, is, that on the first symptom of its appearance, medicine is resorted to for its ex- pulsion, while the cause or error in diet is apt to be left in un- disturbed operation. The evil is consequently aggravated in- stead of being cured, and many children are thus carried off by medicine alone, who might have been restored to health by pa- tient and well-directed care, without the aid of a single dose. It is the commonest of all remarks heard in a nursery, that "the child was uneasy, or griped, or feverish, and I gave it so and so," without the smallest allusion being made to why it was uneasy or feverish, or whether any thing was done to remove the offending cause. In my opinion, a more pernicious habit than that of constantly giving medicine to children does not ex- ist ; and I would hold the mother or nurse, who should make frequent use of it without advice, as utterly unfit for the duties imposed upon her. It is much to be regretted that physiology, or the laws which regulate the actions of living beings, does not constitute a neces- sary part of female education.—It is indeed remarkable that it MEDICINE. 57 is not deemed a matter of any great importance, that those to whose lot it falls, to guard and nurture the physical, as well as moral well-being of our race, during the most helpless period of existence, should understand the conditions on which that well-being depends, and the laws which control that existence. — As long as such notions prevail, and such ignorance exists and is fashionable, we need not wonder at the abuses which are witnessed in relation to the medical treatment of infants and young children. To illustrate:—a child is seized with convul- sions,—but how few mothers or nurses seek for the cause, in order for its prompt removal. The first enquiry is, what is the best thing for fits ; and they never stop to ask whether the con- vulsions are owing to the irritation of teething, worms, or some indigestible article of food; the removal of which is usually fol- lowed by a removal of the consequences. Reason, in these ca- ses, seems to have fled to brute beasts, whose untutored in- stincts furnish them a far safer guide. Upon the occurrence of measles, hooping cough, or any of those diseases to which infants are liable, the family physician should be immediately summoned, and the whole medical treat- ment committed to his hands. The mother and the nurse, have now no other duties, than faithfully to conform to his instruc- tions and carry out his advice. No remedy should be given, without his knowledge, no medicine given, except by his pre- scription. Every reasonable physician will listen tp any sug- gestions which may be made, and give them their due weight and consideration. Under judicious treatment, disease will rarely prove fatal to children, especially where their previous management, in relation to diet, exercise, clothing, &c. has been proper, and they are favourably situated as to external circum- stances. The progress and result of infantile diseases, are, there- fore, in a great degree, under the maternal control. How impor- tant, then, that that control be guided by wisdom and know- ledge ! There is one thing, moreover, of very great importance in the treatment of infantile complaints, and that is, the proper regu- lation of the diet. It is here that the advice of the physician is too often disregarded, and often, with serious, if not fatal con- sequences to the child. As a general rule, a very mild diet is required in the diseases of children, even when reduced to a 58 INFANT TREATMENT. state of great debility, for the digestive organs are in that con- dition, that the blandest food, only, can be properly assimila- ted. The nervous and vascular systems of children are highly irritable, and consequently nearly all their disorders are attend- ed with more or less fever; it is for this reason, that animal food, which exasperates such a condition, is not often admissi- ble. The physician is frequently thwarted in his efforts to overcome disease, in consequence of the imprudence of the mo- ther or the nurse, in either giving such food as has been forbid- den, or in too large quantities, that which has been allowed ;— in either case, to the almost certain exasperation of the exist- ing malady. There is another point to which we would call the attention of mothers, as it is a great evil, and that is the practice of ren- dering the physician a bug-bear, or object of terror to the child, to frighten it into obedience, when other measures have failed. It would seem that the least reflection would show, that such a practice must inevitably destroy the usefulness of the physi- cian, whose presence should rather soothe and tranquillize, than irritate and frighten. The approach of a practitioner, whose name has been frequently invoked " in terrorem" over a little flock of innocents, if not enough to frighten them into epileptic convulsions, will certainly suffice to neutralize any treatment which he may devise; to say nothing of the difficulty under which he may labour, of distinguishing the symptoms, caused by the fright, from those which are the result of disease. " It is both injustice to the physician and positive cruelty to the child," says Dr. Bell, "for the parents to impress the latter with fear of its medical adviser, whom, if left to the promptings of its own feelings, it will soon regard as its best friend. Among the most pleasurable parts of social intimacies created and strengthened by the practice of medicine, is the affectionate in- tercourse which is soon established between the children and the physician of the family. It is rich compensation to the lat- ter for days and nights of anxiety and watching at the bed-side of the rich. Children have a ready, it may be called an in- stinctive perception, of the sincerity of regard towards them by those into whose company they are thrown. A rough exterior and general cold manner will not deter them, if the eye and mouth of the individual express the natural language of inter- VACCINATION. 59 est for them; as on the other hand a fair and bland but insin- cere manner and speech, will fail to attract them. They soon discover when they are benefited, even though it be by a rough process. How rarely, for example, will a child manifest fear and dislike towards a physician who has lanced its gums !— Much less pain, inflicted carelessly and in other ways, would produce a mistrust and dislike long in being overcome." CHAPTER VIII. VACCINATION. The small-pox was formerly the most fatal disorder known in this country. Early in the eighteenth century, its ravages were greatly abated by the introduction from Turkey of the process of inoculation, or a voluntary infliction of the disease by its virus being introduced into the system. A much more effectual means of prevention was ascertained, towards the con- clusion of the same century, by the celebrated Dr. Jenner. It had been observed in some districts of England, that an erup- tion which occasionally took place on the udders of cows, being communicated to the hands of the milkers through accidental punctures in the skin, seemed to have the effect of preventing those persons from becoming afflicted by small-pox. To make this matter clear, a series of experiments and ob- servations was made by the above enlightened physician, who ultimately satisfied himself, and the public generally, of the following fact—namely, " that the virus of cow-pox may be propagated from one human subject to another, through several gradations, and still retain the power of producing the affection regularly in all its stages, and of rendering those constitutions which are infected secure against the attacks of small-pox." The inoculation of cow-pox, or vaccination, accordingly be- came prevalent, and for many years small-pox was compara- tively of rare occurrence. During the last few years, so many instances have occurred of small-pox attacking persons who 60 INFANT TREATMENT. had been vaccinated, that confidence in the efficacy of cow-pox has been somewhat shaken. Various opinions exist as to tfie cause of this apparent change in the preservative power of vaccination. The following extract from the Report oi the National Vaccine Establishment, dated 1839, and signed bj four eminent medical practitioners, states the causes of failure rationally and temperately, and shows that there is no real ground for any loss of confidence in the protective power - cow-pox. " We are convinced that the indiscriminate vaccination whicl has been practised in this country by ignorant and unqualified persons, with but little or no regard to the condition of body of the person to be vaccinated, to the selection of the vaccine lymph, or to the progress and character of the vesicle to be formed, are to be regarded amongst the main causes of the oc- casional failure of vaccination. "We have the opportunity of bearing our most-ample tes- timony to the continuance of the efficiency of the original va& cine lymph introduced by Dr. Jenner, through nearly a million of subjects successively, of whom many thousands have been exposed with entire impunity to small-pox in its most malig' nant form." If any proof were wanting in our own country, to show the efficacy of vaccination in preventing small-pox, it may be found in our own public institutions for the reception of children. Ac cording to Dr. Stewart, in the OrpTian Asylum of Charleston, S. C, which in the year 1829, contained 150 children, not! single case of small pox or varioloid occurred during the preva lence of that disease, although no additional restriction was iro posed upon their intercourse with the citizens. The aggregate number of children received into the differem Orphan Asylums of Philadelphia, since their establishment the beginning of the year 1841, is 1,009, and among the whole, there has been but one death from small-pox; this occurred some years since, out of 65 casesrrf the disease. On examine tion, ten of these were found without the usual cicatrix left bj the vaccine vesicle, and the child that died was one of the number destitute of this mark. In the City of New-York, the total number received in a! the orphan asylums, is 2,384; and although the small-pox ap- VACCINATION. 61 peared in two or three of them, yet it was in a greatly modifi- ed form, and no deaths have occurred from this cause. A simi- lar result is also obtained from the House of Refuge, which ex- hibits an aggregate number of 2.657 children, received during 16 years. If to the above, we add the number of children re« ceived into the New York Alms House, and the Long Island Farms, we have a sum total during the last 30 years of about 18,000, with but eight deaths from small-pox contagion; all the fatal cases having occurred in the New-York Alms House. Although we cannot ascertain the results of vaccination after the children have left these institutions, yet we may form a very just estimate of the benefits, by comparing them with the ravages of small-pox among the young, before the introduction of the kine pock. But even admitting that vaccination does not entirely prevent an attack of §mall-pox, it nevertheless de- prives it in a great measure of its terrors, and reduces the mor- tality, which once made it one of the greatest scourges of man- kind, to a very small amount.—For example, during the preva- lence of epidemic small-pox in Philadelphia, in 1823 and 1824, out of 248 cases of small-pox and varioloid, 155 were unpro- tected, of whom 85 died; 64 vaccinated, of whom 1 died; 9 inoculated, of whom 3 died ; 7 previous small-pox, of whom 3 died; 13 unknown ; no deaths. Such facts should strengthen our confidence in the salutary influence of a remedy, which has proved one of the greatest blessings to man. Nothing can be more satisfactory than these statements, showing plainly that it is the duty of parents still to avail themselves of this simple means of protection to their children from a dangerous disease, loathsome in its nature, and, which, where it does not kill, is sure at least to disfigure. The necessity of procuring proper lymph, and of ascertain- ing that the pustule produced by vaccination manifests the pro- per character in all its successive changes, implies the proprie- ty of employing a competent operator. Medical men rarely make a large charge for vaccination; the incurrence of expense can therefore be no valid objection against resorting to it. In order that mothers may aid in observing the progress of the vesicle, we will describe the appearances it ought to assume, together with a few other particulars connected with the pro- cess of vaccination. 62 INFANT TREATMENT. It is first desirable that the child should be in a healthy state, free from all humours; that it should have passed over the first month or six weeks of life, and that the first manifes- tations of teething should not have appeared. If small-pox prevail in the neighbourhood, great risks are run by postponing vaccination. The operation is usually performed on the upper part of the arm, near the point of the shoulder; the sleeves of the dress should be loose and tied up, so that they may not chafe the part; and as soon as the incision has been made, care should be taken that nothing touch the puncture until the virus is dry ; washing the place must also be avoided. During the whole stage of the eruption, pressure, friction, or any other violence, must be guarded against, lest inflammation or ulcera- tion should ensue. One perfect vesicle is sufficient for safety; but it is prudent to make two punctures; and when the danger of receiving small-pox is imminent, both arms may be punctured. One ves- icle should always be permitted to go through its course undis- turbed. When vaccination succeeds, a small red spot appears on the third day. This spot gradually enlarges; and before the sixth day, a circular vesicle or pustule appears. The colour is at first of a light pink, sometimes of a bluish tint, and changes by de- grees to a pearl colour, the centre being somewhat darker than the other parts.* The vesicle increases till the tenth 01 eleventh day. It has an inflamed ring around its base, which about the ninth day spreads rapidly, and is somewhat hard and distended. After this ring is formed, the vesicle begins to de- cline ; the centre turns brown, and the whole gradually changes into a hard smooth scab, which drops off about the end of the third week, leaving a permanent scar. No preparatory medicines are necessary before vaccination, and commonly no cathartics are required afterwards. The con- stitutional symptoms are in general slight and transient, and such as require no remedy. They are usually drowsiness rest- lessness, and sickness, occurring from the seventh till the eleventh day. In a great proportion of cases there is no per- ceptible indisposition; but the child is not the less secure from * The bluish, pearly, yellowish, or purulent pock, is not to be depended on tor producing the proper protecting vesicle.—Ed. r VACCINATION* 63 the future infection of small-pox, provided the progress of the vesicle has been regular and complete. Some parents object to vaccination upon the ground that it introduces into the system any disease to which the person from whom the virus has been taken is subject. This notion is fal- lacious, since it is impossible to communicate more than one disease at a time. The protective power of vaccination is fully proved by the decrease of the number of deaths, in proportion to the increase of population ; while its good effects are corro- borated by the comparative disappearance of small-pox in those countries in which the system of vaccination has been intro- duced. It is scarcely necessary to impress upon parents that it is their duty to save their children from death, disease, and dis- figurement, by a means so simple, safe, and natural, inflicting no suffering, and incurring no risks. We would only caution them not to be deterred by the objections raised by ignorance and prejudice against a system, which may be justly pronounced as one of the most beneficial discoveries of modern times. Our explicit direction is, let the child be vaccinated from six weeks to two months after birth, and by a proper medical attendant. 64 INFANT TREATMENT. CHAPTER IX. DEFORMITIES AND DISTORTIONS. Some children at birth exhibit deviations from the ordinary structure of the body. In some cases such defects are capable of cure. It is the province of the surgeon to determine what may or may not be done; but it is the obvious duty of parents to avail themselves of the power of art in such cases, and to sanction any operation which may promise to relieve their chil- dren from awkward and annoying peculiarities of form.* The proper period for such operations must also be determined by the surgeon. A mother's apprehensions are naturally excited, lest the tender frame of an infant should be unequal to support the infliction of pain; but she will be reconciled to the pro- priety of early adopting the necessary remedies, when she is aware that the increasing intelligence of the infant renders it more sensible to the pain and fear attendant upon operations, and that its comparatively passive and quiescent state is favour- able to the cure of a wound. * Some children are born tongue-tied, the tongue being too much bridled to the bottom of their mouth, by which they are prevented from sucking properly. If not remedied, this pecu- liarity will impede their utterance in after life. It is the duty of the nurse to mention to the medical attendant that there is such a defect, and he will remove it by a slight cut with a pair of scissors. Some mothers are so heedless as to see their chil- dren suffering for weeks and months, and even languishing, from this easily remedied evil, without taking the trouble to correct it. In the event of children being born with a hare lip, as it is called, or any similar malformation, or wuh a redun- dancy in the number of fingers or toes, the medical attendant * Very erroneous ideas are entertained by the less enlightened clashes respecting congenital deformities. They are generally the result of a dis eased condition of the mother, and have nothing more wonderful or alirm" ing about them than any disfigurement which disease produces in adults DEFORMITIES AND DISTORTIONS. 65 must be permitted to remedy the defect at the time he thinks proper, but, generally speaking, the more early that all such peculiarities are removed, the better.* The deformities and malformations found at birth* are not so frequent as those which occur afterwards. These are either the consequences of predisposition to disease, inherited from parents, and increased by bad nursing, or are altogether the re- sult of accidents, neglect, or injudicious management. Parents are obviously bound to take every reasonable precaution, in or- der to guard their children from the occurrence of these inflic- tions, and, should they occur, to endeavour to repair or subdue them. To possess a perfect frame of body is unquestionably one of the greatest of blessings, if it were for no other reason than its rendering us agreeable objects to our fellow-creatures. The want of it has the contrary effect, and is apt with some natures to lead to moral deformity also. It is a melancholy truth, that a personal defect, instead of exciting compassion and kindness, but too often makes the individual so afflicted a mark for ridicule and contempt. No one can be wholly callous to the effects of such a misfor- tune. A man of amiable temper feels the pang inflicted, even if he forgive it. The mere dread of ridicule has irritated many minds into a sentiment allied to misanthropy, impelling them to peevishness> pitilessness, malevolence, and all the peculiarities implied in the term bad temper—to splenetic views of life, with its attendant doubts and dissatisfaction. The conduct of the idiots and deformed beggars who frequent our towns and vil- lages, a mark for the gibes and assaults of the ignorant, testi- fies to the truth of these remarks; whilst there are evidences amongst the educated and the talented of the mental deformity caused by bodily malformation. In addition to these considera- tions, it may be observed, that deformities very much limit the power of self-maintenance. * This remarl«will perhaps not apply to operations o any considerable importance, in children. For example, Professor Liston observes, speak- ing of hare-lip, " it can be performed at any period of life, but in young children it is not advisable to have recourse to more severe operations on these or other parts. Children bear the loss of blood badly, and their ner- vous system is apt. to be shaken, convulsions are induced, and often ter- minate fatally. The most proper age for removing deformity by operation is from two and a half to four years ; there is then no danger incurred, and during the growth of the individual the parts recover more and more their natural and healthy appearance."—p. 263. 66 INFANT TREATMENT. Parents who are themselves afflicted with hereditary disease* or are aware of ancestors and kindred who have showed symp- toms of such disease, are particularly under the obligation to watch their children, in order that the first bad appearances may be met by the proper remedies. Scrofula often affects the bones of young children. From other causes, there may be a deficiency of the earthy element in the bones, rendering them soft, and thereby more liable to injury. The necessity of giving support to the back and loins in carrying an infant, and not al- lowing it to put its weight upon the legs on first learning to walk, will be afterwards treated, asMvell as the danger of forcing children to use muscular exertion. Wherever there is hereditary predisposition to disease, in- creased vigilance is needed, and increased attention to the laws which have been found to promote health. The effects of a want of pure air, warm unconfined clothing, regular hours, proper diet, and cleanliness, are seen in local weaknesses, as well as in internal and cutaneous disorders. The d isease called the rickets, which is a modification of scrofula, and may be pro ductive of distortion of the person and limbs, is to be counter' acted by peculiar medical treatment, calculated to invigorate the frame; and in aid of this, as well as of simple weakness of the legs, some kind of mechanism may be applied. Weak- ness of the legs, whether proceeding from the poor stale of health of the mother before the birth of her infant, or from any other cause, must be carefully watched, so that the earliest op portunity of preventing curvature may be taken. In every case the medical attendant should be consulted; but it is proper to state here the result of experiments which have come under our own observation—that if the child whose legs are bent be able to walk, and cannot be kept from the ground, the limbs should be subjected to a constant but gentle constraint from a steel and leather apparatus, which generally brings them in a few months, or a year, to a perfectly straight condition. If this be neglected, the child will in all likelihood have%ent limbs for life. Children often contract injury unperceived at the time ot concealed by individuals* immediately in charge of them* and * The following cases can be attested by the writer:—A medical man Visiting at the house of a relative, asked one of the family, a "irl of about DEFORMITIES AND DISTORTIONS. 67 maladies may begin to affect them, which do not appear con- spicuously till they have made considerable progress. When children are undressed at night, it is advisable to encourage them to run about the room, stoop, kneel, sit down, and rise again, &c. The mother may then herself observe the action of the muscles and joints, and so be enabled to detect the first symptoms of any injury, the marks of any hurt, or the evi- dences of any contractions or distortions, whether they arise from weakness or bad habits of muscular action. If the cause can be traced, a remedy may be more easily applied. In some cases surgical aid may be necessary, and it should be obtained without delay ; but if it be clearly ascertained that the weak- ness originates in an insufficient use of the part, a gentle but steady application of exercise will probably be found a suita- ble remedy. The following fact will illustrate our mean- ing:— A boy of seven years of age was observed by his father to turn in the left knee in Avalking, so as to limp slightly ; the child was undressed, and watching the action of the limb, it was found that the boy had, from some cause or other, contracted this ha- bit, and that he avoided as much as possible all use of the left knee; the muscles were consequently weakened, slightly shrunk, and comparatively useless. An exercise was immedi- ately adopted, which brought the weak muscles into gentle fifteen, when she had broken her collar bone ? The question was received as a jest, but the surgeon declared himself in earnest, and directed the mo- ther's attention to the fact, that the left collar-bone was thickened in the middle, bent, and quite different in form from the right. After some re- flection, the mother recollected, that, when three or four years old, her daughter had complained that the nurse had jerked her suddenly and vio- lently by the arm from a low stool, (a most dangerous practice, and too common), and that she suffered for several days afterwards whenever she moved the limb, but that no further attention was paid to the matter. "' A child of about four years old had a small pimple on her thigh ; it was unobserved, and became chafed by a tape which suspended her stocking.— The servant applied spirits of turpentine to the part, and erysipelas, a pain- ful and dangerous disorder, ensued. The mother remained in ignorance of the whole affair, until the state of the limb alarmed the nurse so much that she explained the circumstances. A little girl of two years old being ill, the surgeon ordered an application of hot water. The nurse scalded the child, Said nothing of the accident, and used some remedy of her own ; the part grew worse, and finally mor- tified ; the evil was discovered too late to save the life of the child. Mothers should impress on the nurse-maids, for their own sakes as well as the child's, never on any account to conceal an injury. 68 INFANT TREATMENT'. continuous use, and at the end of six weeks the lirtlb was peT« fectly restored. It is necessary to add, that the father himself superintended the exercise. Had the altered gait escaped early notice, it is probable that bandages or irons would have been required as remedies. This fact will serve as an example of the kind of attention and treatment recommended to parents. Similar instances could be added to show that incipient distor- tions may often be overcome by attention, good sense, and per- severance. Bad habits, or tricks, as they are called, often produce distor- tions during the whole period of growth. Before running alone, infants often creep along the floor; a salutary practice when the limbs are employed equally. It is not unusual to see a child make use of one leg only to help itself along, dragging the oth- er after it, as if it were useless: the muscles of the unused liml consequently become flaccid and weak ; and when the attempt to walk is made, a limping gait is contracted, and the weak limb becomes permanently debilitated. In such a case, creep ing should be wholly prevented, or at least suspended until the injurious habit is forgotten. On first running alone, a fall may produce a slight injury, the pain from which may be escaped hy avoiding the use of the injured part. If the gait thus adopted escape observation, it becomes a habit, and the diseased mus- cles grow weak, while those which receive the additional work become so strong that they retain the limb or joint in the assu- med position, and thus lameness is established, to be removed only by severe remedies. Children are apt to accustom themselves to use the left hand more readily than the right, and so become what is termed left-handed. Left-handedness is always a mark of careless nurture ; for no species of imperfection may be so easily guarded against. When the child begins to use a spoon, or to handle any object, let care be taken to make it use the right hand chiefly, and also accustom it to shake hands only by that hand. By these means it will soon learn that the rio-ht is the proper hand to employ, and in this respect will o-row uv faultless.* , to * On lately calling upon a lady the mother of a child, a boy of three years of age, we observed the child was amusing himself ?.,;,)A . -i drawing figures with it on paper with the left hangd We caTle] 5JS££ DEFORMITIES AND DISTORTIONS. 69 The tricks contracted by children create unexpected evils. It is by no means unusual for them to stuff substances up their nostrils, or into their ears, producing tumours and deafness, or rupturing some of the smaller vessels of the nose. All habits which distort the features (as, for instance, over distension of the mouth by using a too large spoon, or otherwise,) are better checked in their earliest manifestation; they are not only disa- greeable to witness, but they confer an unpleasant expression on the countenance. All persons are influenced by physiogno- my ; and there can be no doubt that the preservation of the graceful forms of feature, so often found in children, ranks amongst the duties of a mother. The doing this, does not cul- tivate personal vanity; self-respect demands a certain care of the person, and this care naturally extends to the avoidance of every habit destructive of general propriety of appearance. It is of great importance, in rearing children, to prevent all physical calamities; but as this is not always possible, the next important step for parents to adopt is a speedy and judi- cious employment of remedies. Mechanical contrivances are found to be very effective in restoring the strength and shape of the limbs. Their application, though apparently distressing to the patient, should be persevered in, upon the principle that any suffering they inflict is short and trifling in comparison with the unceasing trouble, ill health, and helplessness, en- tailed by lameness. Steel and leather bandages present a dis- agreeable appearance ; but, as the mother knows their utility better than the child can do, it is her part to set an example of patient fortitude. And while she soothes the patient, she must be careful that her tenderness does not weaken the power of endurance ; nor must she resign the control which is not only necessary to the moral welfare of the child, but to his bodily restoration. Curvature of the spine is the most frightful of all distortions. The danger to which the spines of infants are liable, arises chiefly from carelessness or ignorance on the part of their nur- tion of the mofherto the circumstance, and her despondent reply was, " Ay, poor thing, he's left handed, but it cannot be helped ;" and she was surprised when we told her that she had only herself to blame for the imperfection. How many children are spoiled by mothers of this easy and accommodating disposition!—Ed. 70 INFANT TREATMENT. ses. Hurts from a fall or blow have often serious consequen- ces ; but these are sooner discovered than the slow but unceas- ing destruction proceeding from bad nursing. A child who is constrained to keep the same position for more than a few minutes, who falls asleep while carried erect, who is wearied out by irregular hours, is always in danger of loss of health It depends upon the nature of the constitution what form the evil takes. Paralytic disorders of the lower limbs of children generally proceed from some spinal affection. When disease of the spine affects a child who has been able to walk, the. loss of the use of the legs is gradual, though not very slow. He at first complains of fatigue, and is unwilling to move about, and soon after frequently trips and stumbles, although there be no impediments in his way. In attempting to move briskly, the legs involuntarily cross each other, and he frequently falls; while in trying to stand erect, even for a few minutes, the knees give way, and bend forward. As the disorder advances, the child can with difficulty direct his feet to any precise point. Where children have not begun to walk, there is debility in the lower limbs, which forbids their use. Two striking instances of deformity, occasioned by hurts of the spine, have fallen within our own observation. In the first, the child had crept under a pianoforte, and on returning from beneath it, rose before he had cleared the edge of the instru- ment. He struck the middle of the spine, and in a few years became hump-backed to a deplorable extent. In the second case, a child who had just acquired the power of running alone, was placed on his feet suddenly and violently by his nurse: he cried with pain for a while, m a short time lost the use of his legs, and ultimately became a cripple and deformed. Curvature of the spine is not so often found in very young children as in girls of six or eight and upwards. It is mostly found to arise from tight-lacing, sedentary employment, insuffi cient exercise, and undue mental occupation. The disorder has hitherto mostly afflicted the daughters of the higher classes; but it has been observed of late by an intelligent individual employed in making mechanical contrivances for the correction of distortions, that curvature of the spine is frequent with tin daughters of small tradesmen and artisans, who, having only one or two children, desire to advance them in life beyond their DEFORMITIES AND DISTORTIONS. 71 • own class. To this end they laudably and rationally desire to bestow on them what they understand to be a good education. The error lies in the misconception of the term. The girls are spared from active household duties, and sent to school, with the impression that they must study hard. Exercise and fresh air are neglected. The impure atmosphere, the hard narrow benches of the school-room, and the stooping position assumed in writing, ciphering, and needle-work, together with the long hours passed at the pianoforte, add to the probability of injury. On leaving school, the tight-lacing is increased, and this necessarily forbids sufficient exercise. In many cases, girls on leaving school are apprenticed to some business, where they ply the needle from ten to twelve hours daily, with an interval of an hour for dinner, and half an hour for tea. In London and other large towns, dressmakers and milliners at particular seasons are frequently at work the greater part of the night, and this at an age when girls are growing rapidly. Parents will do wisely to consider how far the welfare of their daughters is likely to be advanced where the risks of disease are so great. A defect, however slight, should never be regarded as too in- significant to deserve attention; neither should a deformity or malformation be looked upon as incurable, till time and experi- ence have proved every endeavour useless. It is quite certain that much may be done by mechanical means, and it is equally so that care and attention will prevent the further progress of a distortion, even if they do not remedy it. Facts are more convincing than arguments. A delicate girl of six years of age falling into weak health, her parents obser- ved that one of the vertebrae of the neck started out beyond the rest. This was attributed to general debility ; and change of air, with increased nourishment, was adopted. Notwithstand- ing these measures, the other vertebra; of the neck gradually curved outward, the chest contracted, the head leaned forwards, and growth was apparently stopped, while the general health became so materially worse, that death seemed inevitable. The probable effects of mechanical aid had been overlooked or deemed hopeless ; although four years had elapsed since the first symptom of distortion was observed, they were now re- sorted to. The child was laid upon a mattrass, with weights 72 INFANT TREATMENT. attached to the neck and around the body, so arranged as to keep the Avhole person elongated, and the chest expanded. At the end of five weeks there was an alteration of form sufficient to justify the hope that if the child's health improved, the de- formity might be greatly if not wholly overcome. At present, the general health is in a better state than when the child was first placed on the mattrass. A premature use of the brain in childhood is a fertile source of weakness and disease. Precocious children generally die before they attain maturity, or dwindle below the ordinary standard of intellectual power. Precocity is frequently the re- sult of disease. Whenever it is manifested, parents will do wisely to repress the love of study, and to encourage bodily ex- ercise. The brain, during infancy and childhood, is very soft, and almost liquid under the finger, yet supplied with more blood in proportion to its size than at any subsequent period, and consequently highly excitable. The nervous system is con- nected with the brain, and is early developed; it is the source of all vital movement, and gives energy to those actions which tend to the growth of the body. When growth is rapid, as in childhood, there is a great draft of nervous energy upon the brain; if, therefore, the mind is worked much at this time, a deficient supply of this energy is sent to the frame, and, as a natural consequence, the progress of growth is checked. The disease called rickets is often attended by a premature developement of the faculties; the brain is particularly active; and if such activity be not checked, there can be little hope of recovery from the disorder, inasmuch as the use of the brain tends to exhaust the vital powers. The same reasoning applies to all other diseases of the bones, and plainly shows, that, to ensure the perfect physical developement which nature intends to prepare during childhood and youth, the brain should have but a comparatively small amount of labour. It is the opinion of many men of high medical celebrity in this and other countries, that no intellectual labour, no studg, should commence till after seven years of age, and that a con- trary course injures the body, while it affords no permanent ben- efit to the mind: much may be learned without study. As this subject will be reverted to, it is only necessary to repeat that where there are original delicacy of health, predisposition to DEFORMITIES AND DISTORTIONS. 73 disease, injuries from accident or undefined causes, the brain must be employed sparingly, and never fatigued or excited. Healthy children are continually in motion, ever changing their position and amusements. A few minutes' steady atten- tion to one object is all that ought to be expected until seven years of age are attained ; and where there is delicate health, this freedom of mind and body ought to be continued longer. Dr. Arnott observes, "To the well-being of the higher classes of animals, exercise of their various parts is as necessary as their nourishment; and if it be withheld-by any cause during the period of growth, the body is often crippled, or at least never acquires its due form and proportion. The sedentary em- ployment of girls, and the unfortunate notion thai all active sports and exercises are indecorous, occasion early weakness of the body, especially in the back. To remedy or prevent this, strong stiff stays are put on at an early age to support the back, as it is said, but which, in reality, by superseding the ex- ercise of the muscles intended by nature as supports, cause these to lose their strength, so that when the stays are withdrawn, they are unable to support the body."* The constant change of position which children adopt, is evi- dently to give alternate exercise and repose to the muscles. To sit still and upright is really painful to them; left to them- selves, they rarely carry their exertions beyond the point of healthy fatigue; and as soon as they feel this, they spontane- ously throw themselves on the floor to obtain the necessary re- pose. It is not the doing this, but the way in which it is done, which constitutes indecorum; and it is this point whereon a mother's instructions may advantageously be given. The ill-health or temporary ailments of children, often prove a source of moral evil to the sufferers. Indisposition renders them fractious and impatient; the indulgence of violence or fretfulness necessarily impedes recovery; and to avoid arousing these feelings, parents often humour and coax their children. Additional tenderness and unremitting attention are necessary from the mother or nurse ; but these may be afforded without the slightest relaxation of moral discipline. The control of the parent is as needful in sickness as in health. An ailing child is * Arnott's Elements of Physics. C 74 INFANT TREATMENT. often a spoiled child; expecting the gratification of every Avhim, and yielding to alternate fits of violence or peevishness. A sick child is but too often persuaded or deceived into taking medi- cine, when he should be directed by the calm, honest steadfast- ness of a parent's authority. If he once obtain the victory, or has reason to suspect himself imposed upon, he will become unmanageable, or meet deceit with deceit. The observance of the duties of obedience during illness is no source of pain, but produces that calm reliance upon the sense, affection, and pow- er of the parent, most favourable to recovery. To these re- marks we may add, that the severity and coercion necessary to restore a convalescent child to the good conduct which need- less indulgence in sickness has disturbed, produces more misery than any rational firmness to control the invalid can inflict. CHAPTER X. STAMMERING. The organs of speech are, with rare exceptions, perfect, and calculated, by proper nurture and example, to perform correctly their assigned office. In the first efforts to speak, the child is a mere creature of imitation, and will acquire a tone andhabitof utterance in conformity with those of his instructors. It is therefore of importance to avoid all improper modes of speak- ing before children, and in particular to keep them from acquir- ing the habit of stammering or stuttering. This defect in speech, besides being readily caught by imitation, sometimes arises from fear, eagerness, or violent passion. A child whose ideas succeed each other very rapidly, is often unable to express himself quickly enough, and utterance is impeded by his own energy. When the trick of stammering has once begun to take place in a few words, it will extend itself to others, and particularly to all the first words of sentences, because then the organs pass in an instant from inactivity to action. The propensity to starn- STAMMERING. 75 mer, from whatever cause it proceeds, should be checked on its earliest manifestation. The person addressed should refuse to attend until the child speaks slowly, and with care. The mo- ment he begins to hesitate, he should instantly be made to cease from speaking, and then to recommence with deliberation. If these precautions are not sufficient, let the child, for a few minutes at a time, and frequently in the course of the day, re- peat the vowels in a firm, strong voice, and afterwards the con- sonants, singly, and variously combined with the vowels, and occasionally a few sentences fitted to his intelligence. Above all things, patience is necessary. If, as is most proba- ble, the child is nervous and irritable, any treatment increasing these feelings will also increase the propensity to stammer. Stammering is often caught by imitation. The means recom- mended above will best put a stop to a habit so acquired: to reason with, or forbid the little mimic, is not likely to quell the active propensity. Stammering sometimes arises from any nervous disorder of the muscles of speech, particularly a spasmodic affection of the glottis, or narrow opening at the top of the windpipe, by which the air passes to and from the lungs. It is difficult to say how far young children may be affected by such disorders; but, however this may be, attention should be paid to strengthening the frame generally, while every means should be taken to ac- quire perfect articulation. It has been suggested by Dr. Arnott, that the glottis during common speech need never be closed, and if it be kept open, stuttering is avoided. In humming or droning any simple sound, like e in the word berry (to do which at once is no difficulty to an habitual stutterer,) the glottis is opened, and the pronunciation of any other sound rendered easy. If, in speaking or reading, the stammerer joins his words together, as if each phrase formed but one long word, or nearly as they are joined in singing, the voice never stops, the glottis never closes, and there is no stutter. Stutterers often sing well, without the slightest hesitation, for the glottis opens to emit the tone before the words of the song are pronounced, and does not again close. They also de- claim and read poetry well, the uninterrupted tone being al- most as great as in singing. Many persons speak in a drawl- ing tone, and often rest on the simple sound of e mentioned c2 76 TREATMENT OF INFANTS. above; saying, for instance, " e, I, e—, think, e- --, you may, e —;" the sound never ceasing until the end of the phrase. A stutterer adopting such a manner, would overcome his defect, and be no more remarkable than any other drawling speaker. If the simple means first recommended be not sufficient to check the early habit of hesitation, it may be supposed that there is some spasmodic affection of the glottis. With children the cure of stammering must be pretty much a matter of imita- tion ; they cannot understand the causes of their difficulty, nor the means of removing it; but if the mother assume the drawl- ing mode of speech recommended by Dr. Arnott to the adult stutterer, and the child can be brought to imitate and adopt her manner, it is fair to presume that the effects will be the same. The broken English of infancy is so engaging, that parents are generally unwilling to correct it. Mere infantine mispro- nunciation requires no such sacrifice. Indeed, it would be wrong to attempt to improve it, since the child's temper there- by would suffer; but there are errors which ought to be con- tended against at first, such as the hesitation already remark- ed, lisping, and the inability to sound the r. In order to overcome these defects, the mother should first ascertain by what actions of the lips, tongue, palate, and throat, she herself produces the various simple and compound sounds which constitute the elements of speech; then transferring her observation to the child, discover how the organs are misem- ployed. For instance, lisping is chiefly the substitution of th for sh; in which case, the tongue is thrust loosely forward against or between the teeth, thereby stopping the transmis- sion of breath through them, instead of being kept back rigidly in the mouth, and the breath forced over it, through the teeth. The pronunciation of the letter r requires the tongue to be first put forward, and then drawn curlingly back, by raising its tip to the palate. If the latter action be missed, the necessary vi- bration is omitted. R is sometimes pronounced like /; in which case the tongue goes at once to the palate, instead of being first thrust forward to produce the vibration. A small degree of care on the part of the mother or nurse will remedy these de- fects of utterance. It is hardly necessary to offer any comment upon the impor- STAMMERING. w tance of possessing a distinct articulation free from any defects. The following passage from an eloquent writer will best advo- cate the cause, if, indeed, advocate can be needed:—"Speech is one of our grand distinctions from the brute. A man was not made to shut up his mind in itself, but to give it voice, and to exchange it for other minds. Our power over others lies not so much in the amount of thought within us, as in the power of bringing it out. A man of more than ordinary intellectual vigour may, for want of expression, be a cipher, without significance, in society. And not only does a man influence others, but he greatly aids his own intellect, by giving distinct and forcible ut- terance to his thoughts. Our social rank, too, depends a good deal on our power of utterance. The principal distinction be- tween what are called gentlemen and the vulgar, lies in this; that the latter are awkward in manners, and are especially wanting in propriety, clearness, grace, and ease of utterance." It is therefore for mothers to lay the foundation of the bene- fits to be derived from this " power of utterance." Where the articulation is faulty, the expression of ideas, however admira- ble they may be, will be ineffective, if net ludicrous. 78 INFANT TREAT?MfiNf. CHAPTER XI. SQUINTING. The eyes of an infant are for some time very weak, and can scarcely be said to be obedient to its will or inclinations. The mind being as yet inert, the organs of vision roll about, as if by instinctive impulse. While in this unregulated condition, ihi two eyes may occasionally be observed to look different ways, or perhaps both inwards towards the nose. These afflictions, which arise frequently from the desire to look towards the light, or towards any object which captivates the infantile curiosity, should be in all cases checked, by simply holding the hand over the eyes, so as to cause them to shut, and assume, a proper di- rection on being opened. So extremely liable is the child to squint in its vision, that this will sometimes require to be per- formed several times in a day. As the strength of a child increases, so does its power of vis- ion; nevertheless, the mind being uninstructed, the eyes will Continue for some time liable to derangement. Light shining always from one side, or the placing of a knot of ribbon over one eye, will lead to a habit of looking obliquely, and therefore all such causes of derangement should as far as possible be avoided. The infant must be guided »in its efforts to look as well as to speak. It should be held fairly towards the light, or towards any bright object, and at such a distance as will ac- commodate the focus of its vision, and cause it to use both eyes alike. The habit of looking obliquely either with one eye or both, is that which has to be chiefly guarded against, and cor- rected when it occurs. Obliquity of vision may arise from nat- ural defects, but that is seldom the case; in almost every in- stance, squinting is a result of sheer carelessness of the mother or nurse. When the child's faculties are advanced, it may acquire a habit of looking with one eye, While the other is kept shut.— The effect of such a habit being to strengthen one eye unduly, SQtJiNTlNG. 79 and weaken the other in proportion, it should be promptly checked; which may be done by covering the strong eye, or that which is always employed, and confirming the use of the neglected eye. By this means the muscles of the latter gain strength, and acquire the^ower of directing and adjusting the eye. The time necessary for the cure depends upon the inve- teracy of the habit, the length of time that the muscles have been left to themselves, and their consequent weakness; for it is with difficulty that muscles acquire an increased degree of ac* Hon after having been habituated to a more limited employmenti Where the habit has been of short duration, a piece of gauze, stretched upon a circle of whalebone to cover the best eye in such a manner as to reduce the distinctness of vision to an equa- lity, and worn some hours every day, has effected a cure. In- stances are on record of a squint being removed by wearing be- tween the eyes a piece of thin metal, which, projecting from the nose, prevents the distorted eye from seeing an object ob* liquely. The following mode of curing squinting has been recommend- ed :—When the child is of an age to observe directions, place him directly before you, and let him close the undistorted eye, and look at you with the other. When you find the axis of the eye fixed directly upon you, bid him endeavour to keep it in that situation, and open his other eye; you will now see the distorted eye turn away from you towards his nose, and the axis of the other eye will be turned towards you. But, with patience and repeated trials, he will by degrees be able to keep his distorted eye fixed upon you, at least for some little time; and when you have brought him to keep the axes of both eyes fixed upon yon, as you stand directly before him, you may change his posture; setting him first a little on one side, and then on the other. When in all these situations he can per- fectly and readily turn the axes of both eyes towards you, the cure is effected. Squinting is sometimes the consequence of any severe illness which has affected the head. In such cases, it will probably disappear as the strength of the constitution is restored. It is also brought on by over-tasking the mind with study, or by any cause which exhausts the vital energy of the system. In such cases, no remedy can be effected unless the cause be removed. c4 - 80 INFANT TREATMENT. The following case is quite worthy the attention of parents} the facts have never before been printed, but their verity is un- doubted:— A healthy boy, when about four or five years of age, con- tracted a habit of squinting with one«ye, and so suddenly, that his parents at first supposed it was brought on by his haying imitated some person who laboured under the defect. This, however, could not be ascertained, and the habit continued to increase. Medical men were consulted, and various mechani- .cal contrivances applied, but with no effect, except, indeed, that the weak eye grew worse, and the other became affected, though in a less degree. One surgeon recommended a course of alterative medicine; but inasmuch as the general health of the child was undisturbed, the parents were unwilling to try such an experiment. The boy could read well for his age, and was generally intelligent, but books were now prohibited, and he was restricted from looking at small or near objects, as the squinting was always thereby increased. The father of the child, after repeated investigations, came to the conclusion that the antagonist muscles were not strong enough to keep the eye in its proper position, for the'sight of both, when used separate- ly, was quite sound. The cure, therefore, could only be effect- ed by strengthening these muscles, and he proposed to confirm the whole muscular system, as well as give power locally. To this end a regular course of gymnastics was adopted, superin- tended by the father himself, and proportioned to the age and power of the child ; he was well fed, kept a great deal in the air, restricted from study, but instructed orally in subjects suit- ed to his age and capacity. He was also made to shut the eyes alternately, and to look straight forward at an object, and out- wardly with the unclosed eye. Every morning on rising, win- ter as well as summer, a pint of the coldest water was dashed upon the temples, and in the warm season a shower-bath was added. He was also encouraged to catch a ball daily. For some time, little or no improvement was perceptible • the perseverance of the parents was unrelaxed; and at length a gradual amendment became apparent, but of no permanent kind, for at the end of two or three days, the eyes would re- lapse into the original state, and then rally again. The plan was not, however, given up or neglected, although if any acci- SQUINTING. 81 dental omission of any of the remedies (particularly the gym- nastics) occurred, a change for the worse was immediately visi- ble. If the child had cried, was reprimanded, alarmed, kept in the house in consequence of bad weather, or did not go to bed till after his usual hour, the squinting invariably and immedi- ately became worse. At the end of about eighteen months the boy was capable in some degree of controlling the action of the eyes; and as he became aware of this power, his own endea- vours to overcome the defect were added to the energetic atten- tion of his father. Four years elapsed before the defect could be considered cured, and even after this time, indisposition, men- tal excitement, particularly of a painful nature, want of strong exercise, or over-fatigue, occasioned a slight temporary waver- ing of the axis of the weaker eye. Parents will not fail to perceive, from the instance above cit- ed, that perseverance and even fortitude are required on their part, and unremitting personal attention, if they would over- come the physical defects of their children. Above all things, it is desirable they should be impressed with the possibility of a cure, and that the advice and attendance of a medical man, to be of any avail, must be seconded by themselves. Again, docility and intelligence on the part of the afflicted child will be needed, and these qualities mainly spring from the training it receives. There is an old notion, that, in order to effect any cure, the patient must have faith in the remedy. At first sight the observation appears to be founded in superstition; but on reflection it will be seen that faith not only implies be- lief, but also the desire to act in accordance with the dictates of belief. Thus, the patient seconds the efforts made by others in his behalf, and remedies are therefore more likely to take ef- fect. To this state of willingness the mother must bring the child, and nothing is so likely to operate advantageously as her own mild, patient, affectionate energy and attention. Example has its effect, while the influence which it is the peculiar privi- lege of a mother to establish over the affections and understand- ings of her children, strengthens the power of her example. c5 82 INFANT TREATMENT- CHAPTER XII. TEETHING. The milk teeth, or teeth which appear during infancy, are twenty in number; namely, four incisors or front teeth, two canine or eye teeth, and four molar or double teeth, in each jaw, The period at which they cut the gum differs considerably in different children; sometimes they begin to come forth at four months, sometimes not till near a twelvemonth: the double teeth have been in some instances delayed till near three years of age. In their cutting, they usually follow a certain order: first, the middle incisors of th*e lower jaw, and, after an interval of three or four weeks, the corresponding upper incisors; but not unfrequently the whole four first appear in the upper jaws, succeeded at intervals by the molars, those nearest the single teeth appearing first. There* is a popular notion that a depart- ure from this order, which often takes place, increases the diffi- culty of teething; but, as far as we have been able to judge, this opinion does not appear to rest on any proper foundation. The following is the process of teething: At the time of birth, the teeth are lodged in their separate sockets, each being surrounded by a delicate and vascular membrane, which, as the tooth increases in size, becomes stretched and pressed upon in all directions, occasioning pain and inflammation. This pressure stimulates the absorbents to take away the interposing mem- brane and gum, and thus a passage is made for the tooth. One of the first symptoms of teething is a heat in the mouth, perceptible while sucking. Other symptoms are a flowing of the saliva, eagerness in the child to convey every thin"- to the mouth, and biting and grinding the gums together. The flow of the saliva is very advantageous; it diminishes the inflamma- tion and irritability of the gums, allays thirst, assists digestion, and lowers the action of the system, which is generally'excited by the process of teething. After these symptoms have continu- ed for some time (the period is indefinite), the gum becomes redder, swelled and semi-transparent, just above the points TEETHING. 83 where the teeth appear. The saliva often flows abundantly, months before the teeth appear. This sympathetic affection probably denotes the hardening of the tooth, the surrounding membrane being irritated before the gums are affected. The flow of the saliva is not therefore to be regarded as certainly indicative of the immediate appearance of the teeth. The de- sire to press the gums seems instinctive, and intended to assist the absorption effected by the mechanical pressure of the grow- ing teeth, and to promote salivation. It has long been customary to give an infant a coral, an ivory ring, or a piece of orris root, to bite ; but hard substances tend to bruise and inflame the gums: the best material is a piece of flat India-rubber, about an inch thick, cut in the form of a cross, or thus, T, the edges being rounded. The elasticity of the material prevents injury to the gum, while the form here re- commended does not distend the mouth like the ring, nor incur the risk of choking, or wounding the roof of the mouth. A crust of bread is agreeable and serviceable, but requires care ; when it has been sucked for some time, it is apt to break, and lumps may be swallowed, or stick in the throat. Teething in some cases occasions fever, flushings of the cheeks, diarrhoea, disordered passing of the urine, impatience, disturbed sleep, sore eyes, eruptions, and convulsions. These symptoms are by no means frequent, and sometimes altogether absent. In many instances the teeth are cut so easily, that their first appearance is not discoverable from any symptomatic affec- tion. Feeble and excitable constitutions are most liable to dis- order. Where feebleness is the case, there must be strict at- tention to diet (the breast is almost essential), to warmth, cleanliness, ventilation, gentle exercise; in short, every regula- tion that promotes nourishment and precludes exhaustion.— When the nurse has to deal with excitability, every thing must be avoided that can promote excitement, whether of the stom- ach, the circulation, or the nerves. At such a time the gentle cheerfulness and patience of the nurse and mother will be largely called upon. The fretfulness of an infant when teeth- ing is often confirmed into a habit by the injudicious indulgence or impatience of the nurse. Previous habits have a great in- fluence at this time. If these have been regular from birth, the perfect health usually enables the system to sustain the ef- c6 84? INFANT TREATMENT. fects of teething with less pain and difficulty; the local symp- toms, such as swelling, redness, and irritation of the gums, may be considerable, but the system itself will be less disposed to irregular action. Where the mother has acquainted herself with the constitu- tion, she will be prepared to act in accordance with nature.— A moderately relaxed state of bowels is advantageous. If the bowels are confined, and will not yield to diet, a gentle purgative, such as castor-oil, manna, magnesia, or senna, must be given without delay. The warm-bath assists materially in soething pain and ex- citement, allaying fever, and regulating the circulation. A mother should continually examine the mouths of her children, nor discontinue the practice until the second set are cut; nei- ther should she forget that, even after three years of age, they may be disordered by teething. Sudden fretfulness or way- wardness of temper, cough, and even symptoms of croup, have been traced to the cutting of a delayed double tooth. Until all the teeth have appeared, the mouth should be continually in- spected, especially upon any sign of discomfort either in the temper or the health. Lancing the gums is an operation of great utility. It has been already said that the local irritation arises from the pres- sure of the teeth upon the membrane: when this is divided, the irritation is abated. The undefined fears of mothers often re- fuse the relief offered by lancing; but it does not appear that any mischievous consequence can arise, while it is certain that the operation produces benefit, even if the tooth does not ap- pear till some time afterwards: properly performed, it gives no pain, but, on the contrary, immediate relief. Delay is frequent- ly productive of serious conseqriences, and there are many in- stances where excessive fever has been almost immediately subdued by merely lancing the gums. EXERCISE. 85 CHAPTER XIII. EXERCISE. Repose is essential to the existence of a new-born babe: the functions of respiration, though regular, are not prepared for the excitement caused by motion, nor are any of the animal organs fitted for exercise. . Unless where there is unusual strength, the fatigue of washing and dressing is sufficient for the first three Aveeks, as is amply proved by the long sleep which (when all else goes on well) usually follows upon these operations. In the course of a few weeks, the senses begin to act. A brilliant object attracts the eye, or a sound the ear; and a slight movement is the consequence. This is the beginning of voluntary muscular motion. In time, muscular action becomes independent of mental impressions, for the activity of the body soon outstrips the progress of the mind, and leaves it behind. After this period, It may be said that an infant can create ex- ercise for itself in the acts of sucking and crying, and in slight movements of the head, hands, and feet. For some1 time, it is not fit for any other exertion of its muscular system; and, ac- cordingly, it should be subjected or exposed to no other. It should not be dandled, or in any way moved violently about.— It should lie quietly in the arms of the nurse, or hi its crib or bed, carefully supported in all parts of its body—head, back, loins, and limbs. The reason of this is, that the bones are at first cartilaginous, or gristly; soft, pliable, and elastic; and therefore totally unfit for enduring any strain, force, or weight.* Great evils may follow, from the infant being forced prema- turely into an upright position, or from that position, after the child is in some degree fitted for it, being continued too long.— Women entrusted with the charge of young infants out of doors, * The bones of all young animals are alike in texture. Let the mother remember how easily the bones of the sucking pig, the calf, lamb, or young fowl, may be bitten through, or even pres*ed and divided by (he finder and thumb, and she will have some notion of the condition of an in- font's bones; with this difference, that the latter are much softer, inas- much as animals and birds sooner reach maturity. 86 INFANT TREATMENT. are perpetually seen subjecting them to an upright posture, pre- maturely or too continuously, from a natural but most fatal wish to save fatigue to themselves. It should be distinctly under- stood, that when the upright posture is assumed, the weight of the upper part of the body, is thrown upon the lower part of the spine. If that part of the system be sufficiently strong, no harm ensues: but when it is otherwise, it gives way, and the chest is thrown forward and downward. The double conse- quence is a curvature of the spine, which too long neglect may confirm into a settled deformity, and a crushing of the organs, on which depend respiration, circulation and digestion. A slow rocking or swinging motion, as the infant reposes on the lap or in the arms, is the best possible commencement of exercise. Sudden jerking on the knee, or pats on the back, or anything which jolts and shakes, produce internal pain, and are more irritating than soothing. Gentle motion may proceed to something more active, as the strength of the limbs (and the neck especially) dictates. The power of holding the head up, and moving it steadily from side to side, forms a good index of the strength of the spine. In exercising a babe, nature must be followed and seconded, not directed and controlled. When it is desired for the first time to change the recumbent position, the Avhole person of the infant should be gently elevated as it lies along the arm or lap; and when the upright position is at length assumed, it should be only for a minute or two. Attention should be given to the effect produced upon the breathing by exercise. Some infants turn black in the face upon meeting the air quickly, and their breath will be stopped on being carried rapidly down stairs.— Where such symptoms exist, additional care is necessary. An infant should never remain very long in one position, because the pressure that takes place being confined to one part, free circulation is prevented, and numbness ensues. When carryin" a heavy child, the nurse herself experiences this, and the child must feel it in a greater degree. From six to fourteen months is the period which most taxes the strength and activity of a nurse. The child has muscular power enough to sit up, and to bear, and to need, a good deal of motion, yet is not sufficiently strong to depend upon itself__ It still requires to be so carried, that its weight chiefly falls up- EXERCISE. 87 on the nurse,,while its incessant desire for motion, makes nurs- ing really hard work. But when allowed and assisted to take judicious exercise, it sleeps more soundly, and for a longer time at once; it will be more easily diverted in its waking hours ; while its growing intelligence and affection, render it an object of deeper interest and amusement. Thus, the good nurse has her reward. The spontaneous efforts of a child will never injure it, if placed in a situation to make these efforts securely. Thus, when an infant is laid on a large soft cushion on the floor, the endeavour to rise is made as soon as the muscles of the neck have some power, and the head will be lifted a little, but the effort stops there. The head cannot be retained in its position, and it falls again. The cushion protects the part; there is no pain; and the attempt is made again and again, till the fatigue or disappointment causes a change in the action, or a cry for that assistance which experience has taught it to expect. Ac- customing a child thus early to be left on the floor, or in bed, is a means of moral discipline for the mother's convenience, and for the furtherance of freedom to the limbs. When a child can sit up firmly, tying it into a chair that will support the back, into a chair swing, or allowing it to sit on the stuffed cushion, with the means of amusement just within reach, promotes ex- ercise, and permits free spontaneous exertion. Such, and simi- lar resources for the advancement of physical good, ought never to be adopted as a means of punishment; when once this has happened, they are regarded with aversion; neither ought a child to be forced to submit to them, if at any time they are disagreeable or fatiguing. As with all the other functions, ex- ercise is a cause and a consequence of strength. The first in- dication of the desire to make the legs bear the weight of the body, is given by the child itself, by pressing its feet upon the lap ; the lower limbs are, however, still incapable of supporting weight. The pressure, with the setting of one foot before the other, are only salutary preparatory exercises, and should be en- couraged and aided by holding the infant so that it may just place the feet on a level surface, without bearing its own weight: from this, the progression must be very gradual. As the power of walking alone depends upon the strength 88 INFANT TREATMENT. of the bones and muscles, the period at which it may be ac- quired is not always the same; much, however, depends up- on nursing. An infant that is continually on the lap or in the arms, does not get the same amount of healthful exercise which lying on the floor and tossing about permits, and is there- fore not so well prepared to use its limbs ; it is not likely to run alone as early as one that has been thus reared, nor as soon as the infant who has been made to use its feet and legs by con- tinual forcing. The probability is, that a child too soon forced to walk has bent legs or weak ancles; or if it escapes these evils, it will probably be less strong upon its legs, and less ac- tive at two years of age, than the child whose exercise has been brought on by more gradual and judicious means. Chil- dren have been known to run alone at nine months; the aver- age age is between twelve and sixteen months. Very fat, heavy children, should be carefully managed, while a delicate child requires equal caution, although from a differ- ent cause. A notion prevails that it is desirable to get a child early to run alone, because it saves trouble and time ; yet as much attention, perhaps more, is required when the infant shows a disposition to walk early, as when it walks late. For many weeks, every attempt it makes to walk exposes it to the danger of falls or blows against furniture. It has to learn to balance, and guide itself, to acquire a knowledge of distances, all which can only be done by frequent repetition, during which the eye and the hand of the nurse are as needful as ever. These are better than her voice; the constant injunction to take care, and the exclamations of alarm which escape from the anxious guardian of a child learning to walk alone, are sel- dom beneficial; indeed, where the child is naturally timid and cautious, they deter him from making serviceable attempts and spontaneous efforts, and encourage a hesitation which ren- ders him incapable of accomplishing those efforts with the cer- tainty Which makes them pleasurable ; whereas, if he is heed- less, he learns to rely on the warning sounds which greet his ear, and is slow in acquiring those perceptions upon which safety depends. An irritable child is made impatient by them, and an obstinate one defies them. It is desirable not to hestow too much pity upon a child when suffering from a fall or blow; practical experience of the EXERCISE. 89 effects of incaution must be acquired by personal inconvenience; but while the effects are felt, there should be neither blame, ad- vice, nor indifference, but quiet assistance and moderate sym- pathy. A timid, sensitive child, requires to be encouraged to endure ; a bold one, perceiving his sufferings to be disregarded, learns also to disregard the pain of others, and, finally, to inflict it. Some children are very angry when hurt; with such it is useful to discover that you distinguish between the cry of anger and the cry of pain. None of the artificial means of teaching children to walk can be recommended; the leading-strings occasion all the weight to be thrown upon the chest, while the go-cart, though less objectionable, forces a child to continue on its feet too long at a time. It is a good plan to encourage walking, by placing the chairs and tables at convenient distances for the child to support itself by ; it then sits down on the floor when fatigued, and in raising itself again, acquires power in the right way. Leading by one hand ought not to be resorted to until there is enough of strength and firmness to walk upright, otherwise the child is dragged along, swinging upon one arm, with the weight of the whole body sustained by one side only. Lifting a child by both arms is dangerous, for it strains the ligaments, and occasions injury to the collar-bones; besides which, it gives pain. A child ought to be lifted by placing the hands round the waist. A child of a year old will raise itself by its arms, but it never prolongs or forces the effort to the production of pain; the only danger arises from a fall against the furniture. As soon as a child can walk safely and comfortably, it is on- ly necessary to provide against walking too much at a time when taking out-door exercise. While playing about the room, there is little occasion to guard against over-fatigue, be- cause the child, guided by its feelings, sits or lies down on the floor at the first sense of weariness; this source of rest it ought freely to enjoy, while its constant change of position calls the various bones and muscles successively into exercise, so that none are exhausted. When out of doors, this rest cannot be obtained, except in warm dry weather, and in fields or gar- dens : at other times, and in various situations, the nurse's arms must be the substitute ; and she must remember, that, although the child can walk, the power is newly acquired, the bones are still soft, and the muscles delicate. 90 INFANT TREATMENT. Most children are disinclined to proceed along the roadside with regularity, and prefer to sit down or to stand still .on this account they must be tempted along by a ball, a rolling stone, or anv toy that beguiles them on ; ingenuity must be set at work to devise variety, and apply that which is fitted for the purpose at the moment it is wanted. The exercise thus obtained will be more serviceable to the child, and less irksome to the nurse; for even at this early age, judicious employment of the senses promotes a healthy condition of the functions, and prevents the painful languor which follows upon the mere me- chanical motion of the limbs. There are always sufficient ob- jects of attraction, whether the exercise be taken on the high- road, in the fields, or in a garden ; but numerous and interest- ing as they are, the child soon ceases to observe and to enjoy, if the "notice of his nurse does not assure him of her attention and sympathy. Where two or three children are together, at- tention and sympathy are still to be given: these will only have to be addressed to many instead of one, and to be adapted to the nature and age of each child. Mothers ought, if possible, to superintend the out-door exer- cise of their children. The duty of doing so is almost univer- sally consigned to servants, who, even though well disposed, are not prepared by education to understand the nature of their duties. Children will learn much from the occasional exam- ple of a mother who is practically wise. It is not yet consid- ered a duty among women to take daily walking exercise; household occupations and sedentary employments are regard- ed as more important. Yet surely the preservation of health is a duty. Want of time is urged in some cases as the obstacle, want of strength in others. In most, it is to be feared, want of inclination is the real impediment. Unless compelled to remain within doors by the performance of some duty which could not be deputed to servants, mothers should make an exertion to go frequently o At into company with their children, both for the sake of watching over their personal safety, and calling their attention to objects calculated to amuse their fancy and instruct their infant understandings. The health of the mother will in this manner be as much bene- fited as that of her children. The prevailing excuse of indis- position or want of time is often deceptious. Much of the com- MORAL GOVERNMENT. 91 mon feeling of indisposition arises from neglect of exercise. It is necessary to repeat, that the muscles grow inefficient from want of use; exercise begun in moderation, and gradually in- creased, will restore them to the power nature intended them to possess. And what better motive for the undertaking than the benefit of the children ? What more delightful and saluta- ry occupation than to direct and aid that which is to produce so much moral and physical health and vigour ? Even these motives should stimulate the disinclined to shake off the le- thargy of idleness. Trees, flowers and animals, are works, great indeed, but so simple in their greatness, that they are peculiar- ly fitted to delight and advance the dawning faculties of child- ren. A mother's tenderness and intelligence draw from these sources an increase of happiness; she may sow the first seeds of religion, by fostering a love of nature, which shall gradually be led up to the Author of Nature; while she herself, derives the inestimable advantage of being associated in her children's minds with all that is beautiful, entertaining, good, and holy CHAPTER XIII. MORAL GOVERNMENT. During the first few weeks of life, happiness is solely deri- ved from the healthy operation of the bodily functions. Until the senses begin to act so as to convey impressions to the brain, there can be no pleasure drawn from external circumstances. The activity of the senses, and the enjoyment produced, will be in proportion to the state of the health. An infant who is continually in pain, who is either crying, moaning, or in a state of repletion or of exhaustion from the consequences of suffering, will be but little attracted by the light, sound, or motion, which first engage the senses of infan- cy. In no other instance, perhaps, are the influences of the physical condition so immediate and so evident. An infant, even 92 INFANT TREATMENT. of three weeks old, will exhibit a haggard grief-worn count* nance, sunken eyes and shrunken face, painful to those wnose experience tells them what these signs indicate. But tne lair, plump, contented look of the healthy babe, speaks a language of comfort, prophetic of the approaching dawn 01 intellect. How early does such an infant smile upon its nurse, fax its eyes upon her with a look of awakening intelligence when she speaks in accents never addressed but to infancy, and reply with the little dove-like sounds only uttered by the healthy babe ! The happiness or misery of this period of life is wholly derived from the physical condition, and the dawnings of the sentiments and the intelligence are in proportion to the health. The general irritability caused by disordered functions, ren- ders the impressions upon the senses even more painful than pleasurable; the disposition for enjoyment bestowed by the feeling of health is denied; the mother's voice, her smile, are associated with pain as much as with pleasure, and the affec- tions are imperfectly and tardily aroused. As weeks pass on, habits form, and instead of a habit of contentment, there is one of fretfulness. An infant so constituted is either reared with an indifference to its continual crying and fretfulness, or with the apprehension which causes its nurse to be continually seeking how she may quiet or prevent its cries. At the age when food alone appeases it, the babe is always eating or suck- mo- ; as it grows older, sugar, cake, &c, are superadded, with the addition of noises or rough exercise, and but too frequently some sedative or composing draught, which the mother believes herself obliged to adopt in order to procure the child needful repose, or the servant surreptitiously administers to relieve her- self from incessant fatigue. When ihe time arrives that re- straints and guidance should be adopted, the fear of farther ir- ritation by contradiction leads to a system of bribes, deceit, and coaxing ; all the lowest sentiments of human nature are appealed to ; and at two years old we have a selfish, wilful, ill-tempered child, with violence apportioned to its strength, and intelligence prompted by ill feelings. It is not to be sup- posed that these moral disorders belong exclusively to bad health. A healthy child may be selfish, wilful, and ill-tempered at two years of age, if injudicious treatment have cultivated the lower sentiments; but the healthy infant is predisposed to MORAL GOVERNMENT. 93 receive happy impressions, and enjoys the condition called good temper—a term which in infancy is synonymous with good health. The nurse has fewer temptations to mismanagement; and, the affections and intelligence being more healthful and active, moral mismanagement actually produces less permanent injury. There cannot, then, be too much value attached to the physical condition of an infant, to the condition of the parent while pregnant and while nursing, and to the regulation of every particular connected with the health of her offspring. This being the first object, both in point of time and impor- tance, the next consideration is the means of developing the moral and intellectual faculties. The brain, on which the mental functions depend, is in in- fancy the least perfect organ. Only a few of the simpler in- stincts, as the appetite for food, are at first in any degree active. After the child is a few weeks old, he begins to exercise his senses, and the first traces of intellect and feeling are exhibited. But still, and for long after, the brain is in a tender and delicate state, calling for the gentlest treatment. No loud or harsh sound should therefore ever reach the ears of young children ; no violent light should be allowed to come before their eyes ; they should always be addressed in the softest tones; and no- thing should ever be done in the least degree calculated to fright- en them. These are the chief particulars of treatment which we are called upon to attend to, with regard to the mental sys- tem of children, during the first few months. Opposite con- duct is apt to produce serious damage, and that of a very dura- ble nature. There are particular cases and circumstances, in which the value of kind and gentle treatment is greater than usual. Per- haps the infant may have derived from nature a constitutional irritability ; or he may be accidentally pained by some derange- ment of his system. In these cases, caresses, gentle changes of position, and lulling sounds and movements, are of great consequence ; while all loud singing, talking, and rough and sudden jerks, should be avoided. For further progress in the moral management of infants, it is in the first place necessary to bear in mind that the mental faculties, in their various degrees of natural strength, rest at 94 INFANT TREATMENT. first undeveloped, but ready to be brought into activity in accor- dance with the respective circumstances which are naturally calculated to stimulate them. All of these faculties are design- ed for useful purposes, under the guidance of reason and moral principle; but it may so happen that some of them are natu- rally in very strong activity, or are called into great force by the circumstances with which the individual is surrounded, so that the character may ultimately be of a very irregular and uncontrollable kind. In moral education, it ought to be the first object of a mother to put the more lively faculties of her infant under proper regulation, or restraint if necessary, and so to evoke and train the rest, that, in the result, she may have the best character which nature admits of in that case. Practically, the circumstances by which the infant is surround- ed are sufficient to serve the whole end in view, as far as very young infants are concerned; for it is clear, that if a child, for example, be brought up in a scene where angry words are never heard, and where nothing of an unduly irritating nature is allowed to visit him, his own angry feelings, though strong naturally, must be in a great measure kept out of exercise, and consequently weakened; just as the same circumstances, by their soothing and pleasing nature, are likely to have an active and positive effect in bringing out his own kindest and softest feelings. In like manner, supposing that a child may have a strong natural tendency to secretiveness, and that he never wit- nesses or hears from those near him any thing but the most perfect candour and directness, his tendency is just as liable to be kept below the point at which lying and deception take place, as his opposite feeling in behalf of truth is likely to be positive- ly encouraged. The first duty, then, is for the mother to be and to do on her own part, as she would wish her child to be and to do; and to accommodate all other circumstances, as far as possible, to the same end, particularly as regards the selection of attendants.— She must be on her guard against the delusive notion that an infant of a few months old is not capable of being affected by the conduct of those in whose arms he lives. Though unac- quainted with words, he is perfectly alive to what mav be call- ed the natural language of the feelings, as harsh looks, loud and sharp tones, or the reverse. At three months, the smile of MORAL GOVERNMENT. 95 his mother elicits from him an answering and sympathising smile; and at the same age, an angry gesture will frighten him. And not only is he sensible of language of either kind address- ed to himself, but also of what is addressed to others. An in- stance is on record of a child falling into fits in consequence of a violent altercation between his nurse and another person, which took place in his presence. An infant may possess such gentle dispositions, that he will contract no disposition to quar- relling from seeing his elders always doing so ; but this is a mere chance. The dispositions may naturally have a strong bent that way, and he will then be, as it were, in the very school calculated to make him a thorough quarreller. The more perfectly that the home of infancy is a home of peace and love, the chances are unquestionably the greater that the chil- dren will grow up creatures of gentleness and affection. The earliest intercourse between a mother and her child is carried on by means of the expression of the countenance and the tones of the voice. The first language of an infant is the language of signs ; these are at first involuntary, and indicate his wants and sufferings. After some time he begins to be sen- sible of the existence of external objects, and to distinguish his mother's face from that of all others. In this face he reads his first lesson. The child ascertains that there is one who takes constant care of him, to whom he can make known his wants and wishes; he looks, and she understands ; he cries, and she hastens to his relief; he improves daily in the use of a lan- guage which he finds is intelligible to her, and becomes at length a little master of pantomime. He sees, too, that she looks differently at him, at different times, and that the tones of her voice vary, indicating pleasure, pain, approbation, and re- proof. Thus, long before oral language is used, the mother and child have established a symbolical language of the coun- tenance and tones of the voice, to which, if the child is spright- ly, and the mother has a tact for it, gesticulation is added.— The mother has perhaps used this natural language uncon- sciously, but she may do much to improve and refine it, and to extend its use in the developement of the moral and intellectu- al powers of her child. Expression of countenance adds greatly to the force of speech ; and as it is subject to the will, it can be cultivated and improved. 96 INFANT TREATMENT. A mother should take care that every feature, look, and move- ment, corresponds with her feelings, and this without affecta- tion. Lei her feel as she ought, and then endeavour-to look as she feels. Let her, when the occasion calls forth the cones- ponding feeling, cast upon her child a look of pity, of sympathy, of consolation, of composure, of interest, or of playfulness, giv- ing to each a distinct character, while her habitual expression should bear the stamp of gentleness, patience, cheerfulness, and hope. When government and discipline are necessary, let the countenance exhibit authority, decision, firmness, disapproba- tion, and a determination to be obeyed, mingled, however, with entire composure and self-possession. In infancy and childhood, the muscles of the face which give it expression are exceedingly pliable, and yield an almost invol- untary obedience to the emotions and operations of the mind.— In addition to the care which mothers should take to preserve a command over their own features and tones of voice, it is im- portant that the same care should be exercised over the chil- dren themselves. By these means much may be done to mould the features into forms indicative of virtuous emotions. Habits of expression have a powerful influence upon the internal feel- ings. A smile, even if produced with effort, will assist in calm- ing angry emotions. There need be no hypocrisy in this. We adopt various methods of self-control, and effect that by indi- rect means, which we find by experience direct efforts of the will cannot accomplish. The effort to control our features aids us in subduing internal emotion. This principle may be per- verted, and applied to the worst purposes, for all that is good is subject to abuse. The child who is early habituated to avoid disagreeable, sullen, fretful, and unkind looks, and whose affec- tions are at the same time cultivated on sound principles, will have additional security given to the exercise of these affections, and a power of subduing contrary feelings, wanting to the child, over whose features and modes of expression no such discipline has been exercised. Great pains are often taken to cultivate the manners, and to give them an air of courtesy, respect, and kindness. The tones of the voice, articulation, pronunciation, and modes of speech, are made matter of early instruction. There is no doubt that all this has an influence in moulding the intellectual and moral MORAL GOVERNMENT. 97 character. The various expressions of countenance are as sus- ceptible of control and discipline, and react on the mind with as great a force. They should therefore be formed into habits, as well as the manners, or the voice, for there can be no greater danger of offending against nature and simplicity in the one case than in the other. The effect of these principles is fully seen in the change Which takes place in the countenance of an uneducated deaf mute, after he has enjoyed a few weeks' intercourse with his companions in misfortune in an asylum. His features, expres- sions of countenance, and general deportment, undergo a won- derful transformation, and seem to acquire a new power.— Catching by imitation the spirit of those around, they become instruments for the expanding mind to employ, and have no small degree of influence in forming habits of thinking and feeling. It is neither necessary nor desirable to school children into studying the expression of their features. As their violent emotions should be repressed, so every expression of that vio- lence, whether shown in voice, feature, or gesture, should be gradually checked; not thrown back to be indulged silently, and in concealment, but in infancy, by the mother's calm ex- pression of pity, regret, or condemnation, and in childhood by the same means, strengthened by rational appeals to the good feelings. A glance of the mother's eye is often sufficient to de- ter a child from error, a gesture to recall former advice, a word to overcome resistance, or soften rebellion. This power must have been established from the first. However much the gift of personal beauty may have been misused, and although it be confessedly secondary to moral and mental beauty, yet the charm of an agreeable and expres- sive face can neither be denied nor unfelt. Young children generally possess this charm ; and if it do not remain in after years, it may be because the indulgence of bad passions or bad habits have marred it. It is obviously the mother's duty to pre- serve the best gifts of nature, and to endeavour that the pure af- fections, lively intelligence, and gentle sympathies they seek to cultivate in their children, should speak in their countenances as well as in their actions. * For some time a child is content to enjoy the sight of objects, 98 INFANT TREATMENT. but growth and increasing strength, apparently inspire the de- sire to touch and to grasp. The efforts to do this are for months uncertain and imperfect; there is no knowledge of dis- tance or size; the infant reaches too far, or not far enough ; too much on one side or the other; and when the hand accom- plishes its intention, it has no power to hold or grasp the object of desire. Next comes the wish for possession. All who have observed the early manifestations of infancy, know that a child is not satisfied to touch and take hold : it wants to have. ^ No matter how unwieldy the object, possession alone will satisfy. The gestures accompanying these desires are animated in pro- portion to physical strength and energy; the infant leans for- ward, stretches out its arms, kicks its legs about, sometimes with a little straining scream, not, however, of anger, but of anxious expectation. The cry of anger comes when the object cannot be obtained, or when it is suddenly removed. Disappointment and vexation being expressed by the same means as bodily pain or hunger, it is not improbable that the attention which such manifestations have procured, leads the child to expect that crying will obtain all its desires. This im- pression should be removed, and a contrary lesson impressed. First, the infant should not be allowed to have what it cries for; and as the countenance and manner of the mother may have been the means of awakening happy emotion, so they should express concern at the evidences of impatience. If the child desires an object which it may touch, the wish should be granted before it grows into irritability, yet not in such haste as to preclude a small exercise of patience and forbearance. Instant and constant attention to the wants and wishes of children, renders them exacting, violent, or fretful, and will even engender a love of command, and impatience of control, quite inimical to obedience. Playful notice, while the child waits, will at first serve to restrain irritable feelings. It is too much to expect an infant to await its gratification with no oth- er occupation than expectation. This comes when time and habit have confirmed the certainty that the mother will attend to the wishes of the child; reliance upon her, and confidence in her love and truth, tending to confirm serenity of temper.— The influence of love fosters our best feelings. Love is our moral sunshine. An infant who is always surrounded by kind MORAL GOVERNMENT. 99 looks and gentle voices, not only imitates what he sees and hears, but all his emotions are of that happy character which inspires kindness. As months and days increase, his sources of happiness increase; he is prepared by his own physical com- fort, and the affection he experiences, to look upon every new object with confidence and cheerfulness; anticipating nothing but benevolence, he welcomes every body and every thing with gladness. Constitutional timidity is checked, and a habit of contentment formed. An infant, when once excited, often continues to cry after the exciting scene has ceased. To change the nature of the emo- tion should be the object; and where every thing is new and un- known, this is sufficiently easy. A pleasing sound, a bright object, will often suddenly put an end to a fit of anger. To prevent irritating circumstances is still more important. Un- easiness, however trifling the cause, disturbs peacefulness, and it is from peacefulness that cheerfulness and good temper spring. When the feelings are thus prepared, trifling annoy- ances are, after a while, more patiently endured; and as intelli- gence appears, there is a greater readiness to observe and to derive happiness from external objects. Differences of temper- ament are early manifested; excitable natures must be moder- ated by calmness and gentleness ; sluggish natures excited, yet never with violence. A fat, quiet, white-looking child, may give little trouble, and this condition is therefore called sweet temper ; but it is quite as nearly allied to insensibility, which must be shaken off by the activity of the parent; otherwise, selfishness, and a love of whatever contributes to selfish pleas- ures, may spring up. A young infant requires constant attention ; but as time goes on, enough of this may be given, although the child be left (or apparently left) to itself. Thus, at a tender age, he acquires a species of independence, namely—that of finding happiness in himself and for himself. A babe of six weeks old, awake in his bed, is preparing for this independence; at ten weeks, he will have fixed his eyes upon some attractive object, perhaps upon his own moving fingers, and he is happily occupied. At a later period, when he can sit in a chair, or on the floor amidst his playthings, he will require the watchful glance of the moth- er, and occasionally a word, or a little help, to assure him of 100 INFANT TREATMENT. her presence and sympathy. If the child be inactive and dull, then he will need to have his powers of observation frequently addressed and kept alive ; but an excitable child is best left to wear out the liveliness of his impressions upon a few objects, without interruption, or any other stimulus than that which is innate, or aroused by the objects themselves. An infant with lively feelings and quick perceptions, is more likely to be impa- tient and violent, than one of slow perceptions and deficient sensibility, and will need a counteracting rather than an exci- ting power. He should not be hurried from feeling to feeling, and from object to object, but encouraged to dwell upon one. Every office performed for a child should be done with gen- tleness and care. When carelessness pervades the general management, the child must be continually uneasy; he conse- quently gets the reputation of bad temper, and is deprived oi those kind influences which can alone foster goodness. The close connection between physical comfort and moral develope- ment ought never to be over-looked. Perhaps the most difficult period of infancy is that in which the want of speech is felt, but without the power of utterance. The intelligence is often great; the sentiments active; wishes and wants are intensely felt, but the means of expression are imperfect, and often unin- telligible. The more intelligent the child, the greater is the probability of violent emotion following the unsuccessful at- tempt to understand and be understood. This is the time when the mother's influence, and the experience she has gained of her child's character, will come into use. A. child who cannot make himself understood usually screams; it is in vain to at- tempt to silence him by giving him something that he does not cry for; neither will any good purpose be served by talking to him while crying: while violence is at its height, calmness and silence are the best reproofs. Besides, when a child is screaming, the voice of the mother must be elevated to loud or shrill tones in order to be heard; such sounds can only be associated with scolding, or with a noisy mirth, ill befitting the feeling with which she should wit- ness violence. The object is to show that screaming is of no avail, and that some better means must be adopted to express and'obfain its wishes ; there will be many bursts of anger be- fore this is effected, but no evil need be apprehended. While MORAL GOVERNMENT. 101 the mother is firm and calm, the child will not cease to love her, but, on the contrary, her aid wiil be felt upon this point quite as much as in matters of bodily suffering. It is not unusual for a child so treated to soften into tears of real grief, on finding that his mother's countenance looks sor- rowful, and so to forget the cause of his excitement. It is al- ways better for the parent and child to be alone together during such scenes. A child of a year old, when crying with anger, will often look round on his observers with an air of defiance or determined resistance, or, conscious that they have no sympa- thy, relapse into stubbornness. However erring, he should at no age feel that he has lost his mother's sympathy; and on the slightest evidence that grief has succeeded to anger, she must be ready to encourage and to aid. A shake of the head, a firm but gentle no, silence, or placing the child in solitude, will some- times calm the passions ; but this must be cautiously tried, lest it cause terror or greater violence. It is an error to induce children to cease crying by promising them what they want as soon as they leave off; for if they can understand the words, " when you have ceased crying, I will give it you,'''' they can quite as well comprehend, " you cannot have it, because you have cried;" but when anger has subsided, amusement must be provided, so that the child shall not re- lapse into fretfulness; the object being, not punishment, but to show the child that violence will not obtain its wishes. It is difficult to discover how children acquire the power of inter- preting language, but they do so long before they can use it: tone of voice, and expression of face, assist considerably; stran- gers, particularly when not accustomed to children, being rarely understood by them. It seems desirable to accustom a child to listen to a few words from the mother relating to familiar objects or persons, or to some of his own actions, that he may be habituated to comprehend, or at least to endeavour to do so; and he might be questioned by words and signs, so that he shall reply by ges- tures, and by such sounds as he is able to utter. As the vio- lence of this period of childhood arises so much from want of language, pains should«be taken by the mother to establish be- tween herself and her child some means of communication that will smooth the difficulty. 102 INFANT TREATMENT. Constant warnings, threats, or entreaties, have a most perni- cious effect, when the obedience they would obtain is not in- sisted on: the child, becoming accustomed to them, ceases to regard them, and imperceptibly discovers that words do not re- ally mean what they pretend to convey, and thus a disregard_ for truth is first taught. When a prohibition is given, it should be adhered to; it will be necessary to repeat it many times, be- cause the tender mind cannot be expected to retain ideas, which may immediately influence conduct; but the repetition must be made seriously and patiently, not by an angry ejaculation or re- proof, uttered in haste and irritation. The oft-repeated, " let that alone," " be quiet," " don't do so," " how naughty you are.'" only conveys that something is wrong ; no impression is made, except one, characterised by some annoyance felt equally by both parties; and no fixed and definite experience is obtained. A mother should always endeavour to ascertain what quali- ties or tendencies are most injuriously active, and, as far as pos- sible, suppress them by a gentle course of treatment. At the same time, she should observe what are the weakest points of character, and if these belong to the good qualities of the mind, let them be cultivated and exercised with all the diligence which she can command. For example, if the child incline to be destructive, by break- ing toys, killing flies or other small animals, abusing his com- panions, and so forth, it is of importance to check and suppress this dangerous propensity, and to rouse into activity benevolence and gentleness of manner in its stead. If the child show a de- ficiency in any useful quality, as memory, language, power of observation, and so on, these should be frequently exercised, De- cause exercise strengthens; and the longer that the exercise is continued, the power of performance becomes the more easy and agreeable. In a word, check bad propensities, encourage good ones, and in either case with gentleness and moderation, according to circumstances. It is important to recollect that the vicious or disagreeable tendencies of children are at first weak, and in most instances may with little trouble be remedied. But as the disease is su- perficial, the corrective should be light. It should be the ob- ject of the mother to prevent rather than to cure. If she keep her child from evil communications—that is, associating with MORAL GOVERNMENT. 103 persons, old or young, who are likely to sully the infant mind, and nothing is more easily done—she will be spared days, weeks, perhaps years, of toil, in eradicating the mischievous tendency which has been excited. But in the worst circumstances that may arise, do not on all occasions oppose and correct. The child should not be aware of your intentions to correct it sys- tematically, for he soon discovers he is to be thwarted, and is as ready for combat as his opponent. In this manner, injudicious correction has spoiled many children, who might otherwise have been the pride and solace of their parents in after years. Cleanliness, order, and general propriety of demeanour, are to be ranked amongst moral virtues, and their foundation is to be laid in childhood. Parental example will do much, whether manifested in the observance'of regular hours, of neatness, deli- cacy, genuine courtesy, and the ease which ahiiays accompa- nies true refinement. Children cannot be taught what is termed manners without rendering them affected and insincere, for these are usually artificial and conventional; but they may be prac-' tised in the true elements of politeness, namely, self-respect and a delicate regard to the rights and feelings of others, in contradistinction to the mere desire of admiration, or the self- ishness which has no regard for opinion, and which only prompts to individual gratification. It is desirable that children should observe a cleanly and delicate method of eating and drinking. While they are too young to feed themselves, their food should be given them with attention to neatness and comfort. As soon as they can assist themselves, continued care will be necessary to accustom them to the spoon, fork and knife, and also to arrange the food on the plate, so that it may be eaten with attention to the method usually observed; the meat, vegetable, and bread following each other in regular succession, with a proper proportion of salt. Drinking or speaking with the mouth full, putting the fingers into the plate and mingling the food, should be checked at first. Conduct at table is also worthy of attention. Children are often inclined to play with the different utensils, and so to break or overturn them : this habit, with that of reaching for what they require, putting their elbows on the table, sitting awkwardly, and other uncouth demeanour, often interrupt the 104 INFANT TREATMENT. comfort of the family meal. A love of order is so natural to some children, that any change from their customary routine, or in the usual place of the different objects around them, has been known to excite them to anger or tears. There are other minds, however, in which a love of order must be created. Mutual confidence should be a governing principle m the communion between parent and child. This cannot exist where the former acts only as a judge and lawgiver, who ac- knowledges no compassion, no sorrow, who cannot weep and hope With the offender. The few words, " lam sorry that you are angry," " try to be good and I will help you," " wipe away your tears, and let me hear what vexes you," are more likely to overcome error, or turn away wrath, than stern commands or cold disapprobation ; for this treatment does not conceal that there is error, or disguise its evils, while it differs totally from the compassion which fondles or coaxes, and bribes a child to soften its violence or withdraw its opposition. Are there not moments in the lives of all, when a confession of error to a friend whose sympathy, consolation, and encouragement, are certain, lessens the bitterness of self accusation and confirms good resolutions ? Are there not also moments, when the want of such a friend, or the reproaches and cold contempt of those who possess a right to condemn, hardens the heart, and con- verts a wavering repentance into dogged perversity ? If, then, at an age when experience and self dependence are so influ- enced by the denial of sympathy and the administering of stem reproach, how much more must the tender buds of infantine feelings be nipped and withered by the chilling frosts of sever- ity ! Nothing can be more beautiful than the conduct of a child reared under the influence of love. It enters among stran- gers unabashed and undismayed, ready to welcome, to be wel- comed, seeking happiness, and prepared to find it in every thing, and with every body; so willing to be pleased, that ev- ery gratification, however trifling, is prized and enjoyed; hab- ituated to cheerfulness, yet so full of the sympathy it has so largely enjoyed, that, however gay, it does not lose sight of the comfort or sorrows of others, however amused, there is no sel- fishness in its enjoyments; the mind is active and energetic, and the whole character beaming with intelligence and happi- ness. MORAL GOVERNMENT. 105 Reverse this picture, and see the child who has been govern- ed by fear—a suspicious timid glance, an endeavour to escape observation, no spontaneous prattle, no words or actions pour- ing out the unrestrained thoughts and feelings; nothing truly enjoyed, because there is an undefined fear of doing or saying something which may provoke rebuke; or if there be enjoy- ments, they are received in silence, and in that solitude, of heart which leads to selfishness. Candour is a quality to be encour- aged in children ; indeed it is natural to them; their helpless dependent nature leads them to seek and bestow confidence; they have no reason for concealment but such as fear induces. If it be needful, as assuredly it is, to learn the character of a child's disposition and feelings, to trace out the beginnings of error, to observe how impressions are made, and what are their effects, how can this be done when fear influences the child to conceal, to misrepresent, to affect, and to deceive ? To a young mother whose career of maternal duties has but just commenced, it may seem unnecessary to dwell upon the importance of an affection which she believes is already too full for increase; but she must look forward to the time when she will be surrounded with little ones, of different dispo- sitions, the novelty of her situation worn off, and youthful spirits less joyous and elastic. When pecuniary means are not so equal to the support and comfort of many as of one, when cares and anxieties of all kinds increase, then comes the time for the exercise of perfect love, when it is most powerfully taxed, and when it is most likely to give way. The active mind is more liable to irritability than the indolent; therefore the best in- formed, the most ardent, anxious, and well-meaning parents, are the most likely to forget their previous convictions, and in a moment of impatience to inspire their children with fear, and thus to shake the confidence which the child ought to re- pose in its parent. So true is it, that before we can govern children, we must be able to govern ourselves. Obedience from child to parent is justly insisted upon; but it is not sufficiently considered, that the means of establishing it depends more upon the conduct of the parent than upon that of the child. Obedience, to be of any use in forming goodness, must be based upon love, respect and confidence. It is by no means unusual for children to be told that what- 106 INFANT TREATMENT. ever their parents do or say is right, that they must be loved and looked up to as patterns, and obeyed without hesitation. Now, instead of telling them this, it would be wiser to make them/ee/it; and by the exercise of kindness and gentleness to all, industrious attention to duties, strict and universal ob- servance of truth, to earn the love and respect Ave would com- mand, and, by example and practice, accustom the young to witness and experience the effects of the virtues we recom- mend. The feelings of children may be subjected to habit as readily as their appetites, and they can only be habituated to goodness by continually feeling its effects. The serenity and happiness produced by" kind treatment nourishes love to oth- ers; example shows how that love may be made active. The child who sees that its mother's occupations have a reference to the advantage or welfare of others, that they contribute to the comfort of all, and that she finds pleasure in these occu- pations, has learned a practical lesson in benevolence; and if it seek to act upon what it has learned, its effort should be gratefully received: no matter whether they are serviceable or not, the intention is the thing to be valued. It exercises the benevolence to employ a child in little services, such as fetch- ing an article that is wanted, putting things in their places, picking up litter, &c.; when cheerfully executed, they should be acknowledged, and if unwillingly performed, thanks are still due ; but the child might be made to perceive that a wil- ling service is most prized. A mother gains nothing, and loses every thing, by making a child/ear her. Fear may compel obedience, but it will estab- lish no real goodness, no spontaneous wish to do right; on the contrary, commands will be evaded, whenever it may be done with impunity. There will be concealment of thoughts, feel- ings and actions; and cunning and deceit will take the place of truth and honesty, and the mother will never have any in- fluence, nothing but temporary power. The only fear a child should feel, is the fear to do wrong ; not, however, because it dreads punishment, for this is a low debasing motive but be- cause it would not pain those it loves. The fear of a mother's sorrowful countenance will be a more efficient check a more healthy influence to a young child, than the fear of her an"ry looks or her angry voice. - Confidence in a mother is very ne- MORAL GOVERNMENT. 107 cessary to obedience, and can only be obtained by such a prac- tice of truth and steadfastness on her part, that there is a per- fect reliance upon her. A child has little or no experience of the consequences of his actions, nor will he with the best gui- dance always consent to take warnings and prohibitions upon trust; but when he is never deceived, when promises are nev- er broken, threats never made in vain, there grows up a faith in the mother that leads a child to respect and to obey. To gain this faith, this perfect reliance, the mother must be con- sistent, equal in temper, the same to-day as yesterday, other- wise the child becomes confused, does not understand why the permission of yesterday is changed into a denial to-day, or why the smile of affection is now altered to the tone of irritable complaint. Falsehoods of a Very fearful kind are sometimes uttered to deter children from errors. Threats of old men and black men, and other like terrors, false and true, are resorted toj to frighten them into obedience. It is ascertained that death, fits, idiocy, or insanity, have been the consequences of such inhumanity.— But setting aside the probable chance of such calamities, there are other certain results: if the child discovers the falsehoods practised upon him, he becomes boldly indifferent to the threats, is more disobedient and wilful than ever ; disbelieves all that is said to him, and, finding no respect for truth in oth- ers, has no regard for it himself. What becomes of the timid child ? He lives in a state of fear of he knows not what; the sight of a strange face or a new object fills him with terror, for it may be one of the horrors with which he has been threatened; his faculties are all deceived, and diverted from their proper objects; he lives a life of fear and doubt, unable to distinguish between what is true or false, real or unreal, good or bad. He loves nothing; it is Avell if he does not hate. But he is not the more obedient. The exercise of any sort of cruelty towards children, renders them insensible to the sufferings of others. And this is the reason why they should not be subjected to personal chastise- ment. Imitation being one of the strongest faculties, the child who is beaten also uses blows to effect his purpose. There are many parents who, upon calm reflection, would shrink from in- flictino- a personal correction, or encouraging violence, yet are 108 INFANT TREATMENT. continually fostering a passion for fighting. For instance, a child falls down and hurts itself against the floor or the furni- ture, and is immediately urged to beat them. This is the first lesson, practically showing that revenge is to be indulged.— Above all things, let the mother beware how irritability betray her into a slight pat, a twitch, or a gentle shake: if indulged, they inevitably lead to something more, and personal correc- tion becomes a regular habit. When once recourse is had to blows, nothing else is left; the child is hardened to the sense of pain, indifferent to disgrace, and before committing a fault, does not consider whether he is about to do right or wrong, but weighs the chance of escape, and the proposed gratification against the pain of a beating. There is a quality in most minds which resents injustice and feels disgrace. It is a valuable sen- timent, and gives that self-respect which assists in elevating the character, and preserving the individual from every thing base and degrading. When this sentiment is poAverful, a re- sentful feeling is aroused by violent correction, not the humili- ty which is necessary to a sense of error and consequent amendment. Where it is not active, chastisement extinguish- es all feeling of self-respect, of honest and worthy ambition, of generous desires, and establishes in their stead a taste for all that is base, Ioav, and sensual. Every correction that is inflicted in anger bears the appear- ance of revenge, and seems intended to gratify the offended feelings of the parent, not to amend the child. If a parent is angry, she must wait before she speaks; this will give her time for reflection, and then she will seldom err. It is a habit that should be perseveringly practised by every irritable nature: many persons act wrong upon impulse, who are right upon re- flection; with such, reflection should always precede action. No man submits to a blow ; he considers it the heaviest in- dignity he can receive; while to strike a woman is deemed so great an act of cowardice, that few persons, hoAvever debased, are found guilty of the practice. Her Aveakness is her protec- tion. Hoav comes it, then, that children are subjected to a degradation Avhich a man revolts from enduring or inflicting ? The nature of a blow is not altered by the person on whom it is inflicted, except that the physical weakness of the one party reflects upon the individual who deals the blow: the in- MORAL GOVERNMENT. 109 fluence is, that the parent who inflicts personal chastisement is more degraded than the child who receives it; and though the child cannot reason thus, he feels thus, together Avitha sense of injury that must break up all filial respect and confidence.— These remarks apply to a later period than childhood; but the beginning is then, and the parent must beware of first steps.— She must guard her own habits as well as those of her chil- dren. Some children early evince a love of cruelty : they torture insects; they destroy wantonly, and pull in pieces, break, crush, and tear, every thing that comes in their way. To cul- tivate the opposite feeling, as has been already mentioned, is the mother's part; she must prevent every circumstance that can encourage the propensity, manifesting dislike at its exhibi- tion. No better check can be found than occupation, giving a child something to do that will employ its energies harmlessly. She ought to show it how animals should be treated, first mak- ing use of a toy, teaching the child to feed and caress and pro- tect the representation of the dog or horse, and taking it away on the first exhibition of unkindness. When the child can comprehend her, she should relate tales of mercy, never of cru- elty, even Avhen the imaginary delinquent is punished; for where there is a propensity to cruelty, the mind receives pleas- ure in listening to its details; indeed, it is seldom prudent to tell children any stories which illustrate misconduct; all their early ideas should be of goodness ; their curiosity is often so much excited, that they are impelled to do the things they hear of, in order to ascertain the facts. Neither is it wise to excite the feelings by tales of deep sor- row or suffering: indifference or unhealthy sensibility too of- ten succeeds such excitements, and compassion and tenderness are exhausted upon fiction, instead of being exercised upon re- alities. No child should be allowed to witness the death of trapped mice, rats, and droAvning of puppies and kittens, &c.; they cannot be made sensible of the reasons for their destruc- tion; they do not know the nature of suffering and death, but only derive amusement from the spectacle, and learn to look upon pain as matter for sport and pastime. Love, then, should be the impelling reason, the directing pow- er of educStion. Where love influences the parent, the chil- D 110 INFANT TREATMENT. dren of a family Avill be actuated by the same spirit—a spirit subversive of selfishness. Dissimilar as all characters are, dif- ferent as all intellects are, and different as all situations are, the great duty of life is the same—the promotion of the Avel- fare and happiness of our fellow-men. There are feAV errors, perhaps none, which do not affect the happiness of others as well as of ourselves; each individual who improves himself, improves society; and every mother avIio rears her child aright, aids the universal progress towards excellence. CHAPTER XV. EARLIEST INTELLECTUAL EDUCATION. The intellectual education of children, until two years of age, consists in preparing the senses for the reception of correct ideas of things. The rudiments of all learning are acquired by means of the sight, hearing, smell, touch, and taste; as these increase in strength and activity, new ideas are gained, and new impressions made. The operations of the senses are so closely connected, that correct notions cannot be at first acquired on any subject by the action of one sense only. Touch confirms or corrects ideas of form, texture, and substance; and Ave find that the blind em- ploy this sense to acquire the knowledge that cannot be obtain- ed by vision, while signs and gestures are addressed to the deaf, and employed by the dumb, to express Avhat speech usu- ally conveys. Infants must be permitted the free use of the senses, and be furnished Avith the best means for promoting their voluntary and healthful employment: direction is all that is needed from the parent, while imitation is the faculty she will chiefly appeal to, always keeping in mind the delicacy and excitability of the organs. She will find that at a very early age there are decided indications of a preference for cer- tain objects; and though she may contribute to happiness bv indulging a predilection, she ought gradually to endeavour to EARLIEST INTELLECTUAL EDUCATION. Ill direct the attention to objects which will generally employ the faculties. For example, if a child show most delight at seeing colours, she ought not to foster his use of the eye only, but direct it to discriminate form, dimension, arrangement, and numbers. It is natural to encourage that which is most easy and pleasura- ble, but the object of the first steps in education, is to prepare all the powers, not to perfect one. Next to bodily health, employment is the source of an in- fant's happiness, and one of the means of developing its moral nature. The love of employment is an inherent desire, or in- stinct ; and it remains to be considered, how this strong desire for occupation may best be satisfied and directed. First, objects must be found for its exercise which are harmless, of no value, or not easily injured, and which shall address the eye and the touch, or the ear and the touch. The inclination to carry ev- ery thing to the mouth, renders it difficult to provide proper means of amusement, but much may be done by a little inge- nuity. A coloured silk or cotton handkerchief, for instance, is to be met with in every house ; having variety of colour, and being capable of variety of form, the eye is delighted; its soft- ness gratifies its sense of touch, while its yielding nature per- mits it to be shaken, twisted, whisked about, offering endless excitement for the exercise of the hands and arms. As the power of observation groAvs, the mother may fold the handker- chief, when the child Avill watch, and next imitate. A piece of broad ribbon, will give a variety to the entertainment, and the crumpling and folding of paper changes its character again. A bag should be prepared in which to store every fragment that can delight without hurting an infant. There are articles in every house, which, if gathered up and applied, would spare money, time and temper—for example, feathers, shells, but- tons of every variety, cotton-winders, corks, cards, coloured beads, bits of silk, ribbon, and printed cotton, with many other nameless matters. One precaution is necessary—that every article that can be swallowed should be secured upon a string, so that it may be moved freely upon it. These things will at first only be turned over, tumbled about, shaken, rolled hith- er and thither, put in and out of the bag; as soon as this has become wearisome, and there is no more spontaneous applica- D2 112 INFANT TREATMENT. tion of them on the part of the child, the mother may arrange them in certain forms, or according to colour; in short, make any application of them likely to attract. Then she may place them by number—one here, two there, next three, &c, or she may raise cotton-winders, corks, or cubes of wood, one upon the other, or distribute them in squares, columns, &c. All she has to observe is, that she conveys only one idea at a» time—that she never insists upon the continuance of a pastime one instant after it has become irksome, nor worries a child from object to object, but leaves the child free to imitate, alter, or otherwise apply the idea, since something may have been suggested which it will benefit the child to work out, and so raise him above the mere imitator. She has only to give the direction: suggestion is her province equally with example. A book with cloth leaves, whereon to paste prints, is a source of unfailing pleasure ; it cannot be torn like paper, and gives the means of associating things with their names. Representa- tions of domestic animals, birds, insects, fruits, vegetables, uten- sils, and furniture, are the most desirable, because they are seen in their realities; while the power of cutting out with the scis- sors, is another admirable means of addressing the faculties, quite worth a mother's cultivation. A very rough resemblance satisfies a child; and the use of the pencil and scissors, or a reference to prints, assists in illustrating a story or a fact, which, without such aids, is often uninteresting and unintelligible.— Objects that fit one into another, exercise the hand and the eye, such as a box with a sliding lid, a piece of wood with holes, having corks corresponding in size, a basket to be filled with cubes of wood and carried steadily; these, and such as these, also act as trials of patience. A box with .compartments, in which shells, counters, beans, beads, cubes, and triangles &c. could be arranged»according to size, form, and colour, is a safe and desirable toy, when the child has ceased to put every thing to the mouth. It is almost unnecessary to recommend a box of bricks, nine-pins, a ball, a doll, a cradle, &c. As soon as a toy has ceased to amuse, it should be put away and, if it no longer excites attention, kept out of sight until time enough has elapsed to make its novelty again attractive. A slate and pencil, are usually welcome; children are delighted to imitate the occupations of older persons, and are happy in EARLIEST INTELLECTUAL EDUCATION. 113 believing themselves to be reading or writing. When children are beginning to articulate sounds, it would assist them if fa- miliar objects were pointed out, and, art the same time, the name of each distinctly pronounced. The ear Avould thus be instructed, and the imitation aroused. When listening earnest- ly, a child's lips and tongue may often be observed following involuntarily the movements of those of the speaker, and so ac- quiring the first principles of articulation. The deaf and dumb are taught to speak by directing their at- tention to the position of the,lips, tongue, teeth, and larynx of the speaker during utterance. The same means may be em- ployed to overcome the difficulty in pronouncing certain letters experienced by some children. Thus, the c and k are often sounded like t, as took for cook, tiss for kiss. If at four years of age, articulation is not perfect, a child ought to be systemati- cally taught to pronounce correctly. A child will not ahvays put a toy to the purpose for which it was intended; but provided he does not destroy it, this exercise of invention is advantageous, and it is for this reason that frag- ments are more agreeable than the most perfect toy which has but one action. Children are usually fond of destroying and of constructing; if they have not materials for the latter, they will make them out of any thing that first offers itself. Many are called mischievous, who are only impelled by their nature to construct, and Avho, having no employment found for their nat- ural activity, create it for themselves. The little articles above enumerated may be made at little cost; and in this de- partment of infant training, the father may give important aid. A child having no experience of its OAvn strength, does not knoAV what can and can not be broken, nor foresee the effect of its own actions; Avhile the constant injunction to take care, the directions not to do this, and to beware of that, so perplex, irri- tate, or alarm, that there is no enjoyment in the plaything, and the pastime ends in mechanically looking at, or moving it with- out benefit or pleasure. If allowed to destroy Avithout caution or care, the first step is taken towards reckless Avastefulness. The only care to be expected from a young child, is abstain- in* from direct violence, and the endeavour to gather his play- things together, and put them by in the box, drawer, or cup- board allotted to them; and even in this he must be assisted, d3 114> INFANT TREATMfiNf^ for when amusement is over, the interest in them is over also, and the child cannot be expected to understand the utility of or- der, till he has had experience of its advantages. We do not mean that children should be taught to play, or that their faculties should be systematically put to work; the object is to furnish the means of employing the activity with which they are so largely gifted, so that it may not be used in- juriously to themselves^»r others, but be turned to the deve- lopment of many of the mental qualities. Neglected children exhibit melancholy examples of the misapplication of their early powers. The Avell-worn adage—" Idleness is the root of all evil," applies to infants as well as to adults; with this dif- ference, that their idleness is not a matter of choice, and that, intellectually as well as physically, they are dependent beings. The playthings of children may be made serviceable in giv- ing them notions of property. Furniture, utensils, books, and the ornaments of a house, offer constant temptations to the cu- riosity and activity of children, and are often materially injured by them; they are continually infringing positive commands when they meddle with them; but if provided with proper ob- jects of amusement and observation, if they be repeatedly shown that these objects are their oi«n,- but not the furniture, the temp- tation to err will be less. Besides which, there ought to be as scrupulous a regard to the property of a child, as is required from him with regard to the possessions of others, while the understanding may be strengthened by reserving some feAV ar- ticles, which can be lent when asked for. These should be kept apart, and over his own toys there should be perfect pow- er, while they are not applied to injure other people. When there is a determination to destroy, no neAV toys should be be- stowed, but it is scarcely fair to take aAvay those already in pos- session; an article once given becomes property, which the owner cannot be justly made to resign. No moral law should be infringed, because a child is in the power of its parents: if so, the rule is admitted that authority—superior strength—in short, whatever constitutes power, may do wrong at its pleas- ure. Children shonld feel that their parents are their protec- tors, avIio will not only rescue them from the danger of the mo- ment, but also foresee and prevent evil. Havin°-felt this in all that regards comfort, health, the allaying of hunger and thirst, EARLIEST INTELLECTUAL EDUCATION. 115 alleviation of pain, &c, they will soon make an instinctive moral application of the protective poAver and inclination. Telling stories is an inexhaustible fund of amusement; and, fortunately, no one, hoAvever deficient in invention, need be at a loss, for the child is best satisfied Avith the simplest narrative, simply because he can understand and sympathise. He is de- lighted to hear that a little mouse came out of a hole, and car- ried some crumbs from the floor to his little hungry children at home. This may be related in more detail twenty times in the same words ; and " tell it again" will folloAV every repetition. Tales are better told than read. Indeed, there are very feW publications simple enough for very little children. Every mother should give attention to the accomplishment of telling a story ; it is a poAverful instrument for the production of good, when Avielded with discretion. She should not make too much use of the Avonderful, none of the terrible, the pathetic occa- sionally, the benevolent more frequently; but she must not al- Avays address the sentiments and affections. Simple facts illus- trative of the habits of animals, birds, insects, trifling details of common events, such as of the doings of the man while making a chair or painting a house, or of a little girl Avho gathered Avild straAvberries, and running home very fast, AVas quite out of breath—such are also very suitable materials for story-telling, to be embellished by descriptions, and lengthened out by Avords rather than by too many or dissimilar ideas. Verse and song should bring their charms also. Most children are caught by versification, and by the melody of rhyme, long before they un- derstand Avords; the effect of soft vocal music seems instinctively acknoAvledged in that maternal lullaby Avhich forms a part of all national music. It is scarcely necessary to remark upon the various sentiments and faculties Avhich may be thus healthily addressed, nor that the child may be kept from bodily fatigue during the recital of a tale, while the mother may ply her nee- dle, or pursue other domestic occupations. In telling stories, it is Avell to divide them into those that have happened, those that might happen, and those that never could happen. The last should be reserved till the understand- ing is advanced enough to make something like a distinction between the possible and the impossible. A love of truth ia d4 116 INFANT TREATMENT. imperceptibly but surely advanced by impressing its importance upon the intellect as well as upon the sentiments. Children indulge their imaginations by pretending to be other people, and performing a series of events which they have seen or heard of, or only supposed. They readily convert chairs into horses, houses, &c. and soon become so identified with the creations of their fancy, as to be greatly disturbed by any inter- ruption which recalls them to reality. When much given to this self-deception, they Avill sometimes defend themselves from the charge of having said or done Avrong, by asserting that they Avere then somebody else. A mother must never admit" this defence, however ingenious, nor allow the slightest approbation of the ingenuity to escape her. There can be no evil from this exercise of the imagination, provided there is no mischievous intention; on the contrary, the real character of the child Avili frequently be more perceptible. The prevailing sentiments Avill thus often manifest themselves ; the benevolent will enact deeds of kindness and generosity; the violent Avill perform deeds of arms, or of punishment, or of contention; the timid will dis- cover their fears, and the hopeful their desires. Dressing in a fancied character is a harmless adjunct to these sports of the fancy, and in this case taste and ingenuity may be cultivated; but Avhere the object of the child is to obtain admiration, and not to excite mirth, or to increase the reality of his personification he should find his failure in the indifference of the by-standers. Out-door sports in fields and gardens are dependent upon the Aveather. Gathering Avild-floAvers, forming them into nosegays and garlands, Avearing daisy chains, and stringing berries, the spade, the barroAV or cart, the ball, and the hoop, are univer- sally known. Here, as in the house, the mother must occa- sionally join the sport, suggest, and sympathise. Playing in and with the dirt for no object, should be discouraged; it leads to nothing useful, and gives a disregard to cleanliness. Digging and raking may soil the clothes, but, as the first step to the cul- tivation of the earth, the end justifies the occupation. In a garden, as in a house, there are means of imparling notions of property; and there should be an endeavour to give a clear un- derstanding of the floAvers which may and may not be gather- ed, and the spots Avhich may or may not be played in. EARLIEST INTELLECTUAL EDUCATION. 117 A fear of insects and reptiles is very prevalent amongst adults, and especially females, and may in most cases be traced to the impressions made in early childhood; it leads to much cruelty and needless destruction of life, while it deprives those who are under its influence of a large share of delightful and profitable information. The innocent pleasures to be derived from flowers, trees, and all else that adorns the country, are converted into fear and pain, by the dread of the insects and reptiles that dwell among them, and Avhich, in truth, contrib- ute to their interest. A child should be taught to avoid wasps and hornets, not to handle bees, and not to sit down on ants' nests. But, at the same time, let the ingenuity and industry of these insects be pointed out, so as to raise emotions of pleasure in the infant mind. A little attention in this respect would greatly improve the intelligence and taste of the child, and, at the least, prevent it from feeling disgust or aversion in looking upon some of na- ture's most interesting works. To bad training in infancy, we have to ascribe the loathing which is usually felt respecting toads, spiders, and many other creatures, whose uses and econ- omy ought to be the subject of delightful contemplation. We say to all mothers—lose no opportunity of cultivating in your children a perception of the useful and the beautiful, whether in nature or art, for on this may be founded the correct habits and tastes of after years. Telling children they must attend and observe, is of no use whatever ; they do not know why they should learn; they have no wish to learn, or rather they have no wish to study; but when they have continually derived pleasure from observation, they will observe from inclination. On first being put into a swing, the child has no notion Avhat it will feel; but when it has ascertained the motion to be pleasurable, the exercise of the swing is associated with pleasure. The use of the faculties undergoes the same process ; as soon as the child is conscious of the pleasure their exercise affords, he voluntarily applies them. By endeavouring in this manner to amuse or delight the ten- der perceptions of infants, mothers will have performed an im- portant part of their duty, and further than this, as respects in- struction, they must not at present go. D5 118 INFANT TREATMENT* Under two years of age—or even under three or four, accor- ding to circumstances—children should not be incited to ac- quire any species of knowledge Avhich requires a considerable exertion of the intellect. Attempts to teach very young child- ren to read, to repeat answers to catechisms, &c, are highly blameable. As repeatedly stated, all that is brought under the notice of the infant should excite joyous conceptions in his ten- der mind, and gently encourage the growth of those habits which are an ornament in youth as well as later years. Chil- dren being the creatures of imitation, should, by all means, be reared only by female attendants who possess an equable tem- per, and will study to cultivate correct sentiments and habits in their young charge. For the same reason, children should not be allowed to associate with servants who talk coarsely or indelicately. In those parts of the country where a vicious provincial dialect prevails, female attendants should, if possible, be procured from a district where the language is more correct; and if mothers are unable to incur the expense of doing so, they should endeavour, by personal attendance and care, to compen- sate the deficiency. Let mothers be assured that they cannot commit a greater error m the rearing of their children, than as- signing them to the charge of incompetent nurses and attend- ants ; for thus habits are ingrafted which no discipline or edu- cation in after years can altogether eradicate. It may be asked, whether there should be any difference be- tween the mode of rearing male and female infants. We an- swer, none at first. The mental faculties of both sexes are rad- ically alike. It may, however, be useful to mention, that boys are usually more difficult to rear than girls. It is allowed, for instance, that they are more liable to convulsion fits ; but this is a point which we leave to the discretion and advice of the physician. As infants approach two or three years of age, they will have a tendency to amuse themselves in a manner befit- ting their sex. A taste for nursing seems a strongly planted passion in females, and will readily demonstrate itself in the fondling and dressing of dolls. This is a sentiment which should be encouraged by the mother or .nurse, not only because it is natural and innocent, but because it leads to careful and taste- ful habits, Many women will acknowledge that their taste for neatness EARLIEST INTELLECTUAL EDUCATION. 119 in attire was first cultivated by the attentions which they lav- ished on their dolls. But this matter ought strictly lo be treat- ed of in an advanced work, and it is only necessary here to make it the object of a passing hint. Boys will, in the same manner, exhibit peculiar tastes and tendencies, Avhich will ad- mit of similar regulation. We now conclude the present treatise. At two, or, it may be, three, years of age, infants pass imperceptibly into a condi- tion of mind and body which calls for a more enlarged course of treatment than that to which they have been previously sub- jected. Now should commence that species of training which is always best carried out socially, or with respect to a number of children together, either at home or in the infant school, or both. 120 INFANT TREATMENT. SUPPLEMENTARY CHAPTER. BY THE AMERICAN EDITOR. INFANT MORTALITY IN THE UNITED STATES—INFANTILE DISEASES AND ADDITIONAL HINTS ON INFANT TREATMENT. The intelligent reader, who has perused the preceding pa- ges, need not be informed that the advice therein contained is in the highest degree valuable and judicious, and of universal application. And yet, when we consider the general ignorance of physiological science in our own country, the prevailing er- rors as respect infant management, and especially the ratio of infant mortality, when compared with that of Great Britain, we shall at once perceive that the considerations herein pre- sented, have claims upon the attention of American mothers and nurses, of a still more imperative and commanding nature. Rate of Infant Mortality.—A few facts gathered from offi- cial documents will serve to place this subject in a proper light, and to show that its importance can scarcely be exaggerated. Out of 7082 deaths, which occurred in the city of New York in the year 1835, 3614 (still births included) Avere under the age of five years—equivalent to 51 per cent, of the whole num- ber: in 1836, out of 8009 deaths, 4187, or 52 per cent, were under the age of five. Including the still born, the rate of mortality under five years for the last twenty years in the city of New York, is over fifty per cent, while between the ages of five and ten it is but four per cent, and between ten and twenty, 7 per cent. For example, out of 132,426 deaths, reported by the different City inspectors for the years *1835 to 1836, inclusive, including 6925 still born, about 51 per cent, were children un- der five years, and including the still born, about 40 per cent.; and of the Avhole number 73,714 were males, and 58,712 fe- males, there being an excess of males, of 15,000, or 11.32 per SUPPLEMENTARY CHAPTER. 121 cent. During the years 1832, 1833,1834, and 1835, there were 11,414 deaths under two years, out of 33,269, or 34 per cent. of the whole number, still-born included. The City In- spector, in his report for the year 1840, remarks, that " of the whole number of deaths, including still born infants,.3976, or more than 50 per cent, occurred among children under five years of age. The increasing mortality during infancy and childh ood forms a striking feature in the annual report for several years past, and appears to hold the same ratio with the increase of population in the city of New York. Thus in 1810, it aver- aged 32 per cent., in 1820 it amounted to 38 per cent., in 1830, to 44 per cent., and in 1840, to 50 per cent." During the same year the ratio of deaths to the population under five years, was of males, 1 in 11: of females, 1 in 13. In 1842 the same ratio existed, Avith a mortality of 2123 of males, and 1841 of fe- males. If Ave talfe the City of Philadelphia, the mortality among young children is nearly the same as in New York. For ex- ample: in the year 1839 the deaths of children under five years, were 2461, or 51 per cent.; and under one year, 1361 deaths, or 28.56 per cent, the entire mortality being 4765. In 1838, the total mortality was 5118, and of this number, 2552 were children under five years, or 49.S per cent., still born ex- cluded, and under one year, 1384, or 27 per cent. In the City of Boston, from the year 1811 to 1820 inclusive, there Avere 2207 deaths, out of 8132, or 27 per cent, under two years of age ; and 2698 deaths under five years, or 33.64 per cent. From the years 1821 to 1830 inclusive, there were 3182 deaths under two years, out of 11,470, or 27 per cent.; and un- der five years 3975, or 37.04 per cent, of the whole number. From 1831 to 1839 inclusive, there were 6240 deaths under five years, out of a total of 14,483, or 43.09 per cent.; between five and ten but 4.27 per cent., and betAveen ten and tAventy, 5.08 per cent. These results, which are obtained from the bills of mortality of that city, show, as we have seen to be the case in New York andj?hiladelphia,a gradual increase of mor- tality under five years;—an increase, betAveen the first and last given period, equal to 9.45 per cent., or a proportional increase of mortality of 28 per cent. ! The total result shows a mortality of 43 per cent., under five years, during the last nine years, or nearly one half of the 122 INFANT TREATMENT. whole number ; a ratio, however, considerably less than we have found to occur in the cities of New York and Philadel- phia. In our Southern cities, Charleston, Savannah, Mobile and New Orleans, infant mortality is still greater. We have no data, by which to calculate with exactness, the proportion of deaths among children, taking our own country, at large; al- though very great, it is doubtless considerably less than in our large cities. In the City of London, between the years 1730 and 1749, the rate of deaths under five years was 74.5 per cent; between 1750 and 1769, 63.0 per cent; between 1790 and 1809, 41.5 per cent.; and between 1810 and 1829, 31.0 per cent.; thus showing a gradual diminution of infant mortality; and the same is true of the other large European cities. It is then a curious fact, that while there is a constant diminution of in- fant mortality in Europe, there is a no less steady increase in our own country. In Europe the favourable change has been attributed to a more rational treatment of disease, and to the increased intelligence, and improved condition of the people. But are not the same causes also in operation in the United States ? In many of the economical influences, such as pure air, pure water, the general condition and habits of the people, all of which exert a greater or less control over the lives and health of our citizens, our cities as well as the country at large are admitted to be in advance, not only of London, but of most other populous cities in the world. Why then is it, that infant mortality should be greater amongst us than in Paris, where so many causes, which are unknown here, combine to destroy early life ? Why should it be eight per cent, above Glasgow; ten per cent, above Carlisle; thirteen per cent, greater than in London ? An answer to this question will, we trust, be made to appear in the sequel. Infantile Diseases.—In order to a full understanding of this subject, and especially as connected with the application of a remedy for the evil, it will be useful to examine to some ex- tent, into the nature of the causes, and especially, the diseases, which lead to such a sacrifice of human life. Dr. Bell has done this for the city of Philadelphia, and shown very conclu- sively, that the greater proportionate mortality of infants is chiefly manifested under the operation of climatic vicissitudes, or the extremes of heat and cold. For example, the deaths, of SUPPLEMENTARY CHAPTER. 123 all ages, from acute diseases of the air passages and lungs, ex- cluding consumption, viz., croup, bronchitis, and inflammation of the lungs, in Philadelphia, during the year 1838, were 349. Of these, the deaths of infants under a year, were 143, or a little more than 40 per cent.; and between the first and second years, 90, or more than 25 per cent. ; and between the second and fifth year, 98, or 28 per cent. In 1839, the whole number of deaths from the diseases specified above, were 459, of which those under a year, were 167, or upwards of 36 per cent.; be- tween one and two years, 80, or 17 per cent.; between two and five years, 89, or 19.3 per cent. The average for two years is, of the three periods mentioned, respectively, 38.21, and 23.65 per cent. If we turn to diseases of the digestive organs, we shall find them still more fatal than those of the Respiratory System. These are the product of the summer, as the other are of the winter months, and are usually classed under the heads of sum- mer complaint, (cholera infantum) diarrhoea, and dysentery. The cholera infantum, which is the general scourge of infan- tile existence in our large cities, is almost confined to children of the first and second year, and it is this, perhaps, more than all other diseases, which causes that great disparity between the rate of mortality under five, and between five and ten. For example, in Philadelphia, in 1838, of 382 deaths from this dis- ease, 247 were of children under one year; 116 betAveen one and two years, and 18 betAveen two and five years. In 1839, of 230 deaths from the same disease, the proportions were, in the three above mentioned periods, respectively, 142, 75 and 12. The average deaths in the years 1838 and 1839, for the diseases of the stomach and bowels, was, in children, from birth to five years, 550, and between the two first years, it was 494. The general result shows that the deaths of children in Philadel- phia produced by winter influences, or those of cold, betAveen birth and five years, Avere on an average, for 1838 and 1839, 329 ; from diseases of the summer or tropical climate, on an av- erage for the same years, 550; convulsions, 267; diseases of the brain, 77; debility, 123; dropsy of the head, 175—total 1521. The acknowledged summer and winter diseases thus amounted to a total of S79, or more than a third of all the deaths of children under five years. To these may be added many deaths which are ranged under other heads; so that Dr. 124 INFANT TREATMENT. Bell estimates that 1000 deaths occur annually in Philadelphia, of children under five years, which are caused by atmospheric extremes and vicissitudes, aided by errors in regimen. Of course, a large majority of these might be avoided, were pro- per measures taken to guard against those causes, to which they owe their fatality. In the city of New York, the same general results are wit- nessed. For example, in the year 1842, the deaths from dis- eases of the respiratory organs under five years, were 738, out of a total of 2242, of Avhich 388 were under one year; while those from disorders of the digestive organs were, under five> 1210; of which 684 were under one year. The deaths from cholera infantum alone, numbering 505 ; of which 290 were under one year. The mortality from diseases of the nervous system, were, during the same period, under five years, 1053, out of a total of 1611 of deaths of all ages, from the same class, of which 639 were under one year, and 874 under two years. During the year 1840, there were 552 deaths from con- vulsions, of which, all but six occurred under five years, and 410 under one year. During the year 1838 and 1839 the mor- tality from inflammation of the stomach and bowels, cholera infantum, diarrhoea, dysentery and marasmus, was, of all ages, 1383, of which, children under five years furnished 1025, and those under two years, 909. The greatest mortality from diseases of the digestive organs, occurs during the months of July, August and September, while that from affections of the respiratory system takes place during the colder months. The same general truths might be illustrated, by referring to the bills of mortality of our other cities ; but it is unnecessary.* We have seen that a majority of all the deaths occurs under the age of five years; and of these, a vast proportion during the first two years of life. The * Diseases depending upon congestion m the abdominal viscera, morbid irritability of the mucous surfaces, hepatic derangements and fevers, char- acterised by bilious symptoms, are much more frequent in the United States than in Great Britain. For example, in ten years, ending in 1829, there Avere reported by the City Inspector of New York, out of a population of about 200,000, J522 deaths from dysentery, 700 from diarrhoea, and 224 from cholera morbus, making in all 2,446. In London, with a population of between a million and a million and a half, for ten years ending in 1824, the bills of mortality contain less than 100 deaths from all three of the above diseases. SUPPLEMENTARY CHAPTER. 125 diseases which sweep away so large a number of the human race are chiefly disorders of the digestive organs, and of the respiratory and nervous systems; and these owe their fatality, in a great measure, to the extreme vicissitudes of our climate, aided by errors in regimen. Occasionally, it is true, epidemic diseases, such as measles, hooping cough, scarlet fever, and small-pox, prove extremely fatal to children; but even this fatality is oAving to predisposition, or that peculiar condition of the system, which not only invites disease, but gives malig* nancy to its attack. Prevention.—An examination of the causes of infant mortal- ity, must lead every intelligent mind to the full conviction, that it is in our poAver, if we will but use the means, to control it to that degree, as to strip disease of its poAver, as well as its terrors. Americans have been accused of undervaluing human life, and of manifesting great indifference to its preservation. If this accusation be just, and we are inclined to believe it is, we must seek for its proof,—not in the frequency of duels, of savage personal combats, Lynch laAV, the bursting of steam- boat boilers, or the destruction of rail-road cars, but rather in the general, and we fear, wilful ignorance of the laAvs of life— and of those conditions, on Avhich life and health depend. No one can for a moment believe, that the excessive and in- creasing infant mortality among us, is a part of the established order of nature, or of the systematic arrangements of Divine Providence; still less can he doubt that it is the result of secon- dary causes, which, to a very great extent, are under our con- trol, and which, if properly heeded, may be rendered nearly, if not altogether innocuous. If we are ignorant of the nature of the infant constitution—of those laws and conditions, under which its functions are intended to act; if we know not how it is affected by heat, by cold, by moisture, by those numerous agencies to which it is constantly liable to be exposed; hoAV shall Ave be able to protect it, when least capable of resistance, against those numerous influences to Avhich it is subjected, and which are, in no country, perhaps, more numerous and power- ful than in our own ? Our climate, as Ave have seen, is extremely unfavourable to human life, during its early periods. This arises, perhaps, not so much from the sudden variations, as from the great range of 126 INFANT TREATMENT. temperature. In fact, the Northern and Eastern States may truly be said to have two systems of climate, an arctic, and a tropical one; and the inhabitants ought, consequently, to adopt two systems of hygiene, adapted to these two climatic ex- tremes. More especially ought this rule to be observed in the case of young children, whose constitutions are not yet inured to hardship and exposure, and Avho Avould therefore succumb beneath the operation of causes, which would rarely be felt by those of a more advanced age. The inhabitant of a tropical clime, finds it conducive to health to live chiefly on fruits and other vegetables; Avhile the dweller in the arctic circle could not exist without his blubber and train oil, his pemmican and rein-deer. During those months, in which Ave are exposed to a tropical heat, who can doubt that a diet chiefly vegetable Avould be far more healthy, than one of rich animal food, especially in children, whose digestive organs are so liable to derangement and disease ? During the first and second year, Avhen the child is undergo- ing the process of teething, the stomach and bowels are highly irritable; slight errors in diet during the hot season bring on diarrhoea, or cholera infantum; and, if the infant has been weaned, small indeed will be the chance of its recovery. In these cases, Ave are persuaded, that in a large majority of them, the disease is often brought on by a too stimulating diet of ani- mal food,—by Avhich digestion becomes, at first impaired, and then destroyed. This leads us to offer a few remarks, in addi- tion to those contained in the preceding chapters, on the sub- ject of The Food of infants during the first two years. The health of mankind, in every stage and condition of life, depends on temperance and proper diet, on suitable clothing, on cleanliness, and protection against severities of Aveather. It is a just remark of Sir Anthony Carlisle, that " from infancy to old age life is continually supported by food, and health is mainly preserved by suitable diet; for although air, exercise, and clothing, are each of them, when properly ordered, condu- cive to health, they do not affect the living body so constantly as daily food." It is to errors in diet, that we attribute a very great share of the excessive mortality among children, in our country. In all states and conditions, the first sustenance of infants is SUPPLEMENTARY CHAPTER. 127 the mother's milk; and a similar provision is ordained for the whole creation. Milk contains the proper elements for the maintenance and growth of the helpless young, and it is the appointed food of infants, until their teeth are formed. Nature does not afford, nor can art supply any substitute. To this ali- ment should the infant be strictly confined, until teething has made considerable progress. Every person is aware of the fact, that it is extremely hazardous to attempt to rear an infant by hand, and if we consult the records of foundling hospitals, where such a mode is generally practised, Ave find the infant mortality ranging from 40 up to even 90 per cent. "lam con- vinced," says the celebrated Dr. Merriman, "that the attempt to bring up children by hand proves fatal, in London, to at least seven out of eight of these miserable sufferers ; and this hap- pens whether the child has never taken the breast, or having been suckled for three or four weeks, is then Aveaned. In the country, the mortality among dry-nursed children is not quite so great as in London, but it is abundantly greater than is gen- erally imagined." It is highly important, therefore, to provide a healthy wet-nurse, in all cases where the mother is unable to suckle her infant. This is generally understood by American mothers and nurses; but how do they carry it out in practice ? As soon as the little one is able to tottle alone, or sit erect in a chair, to which he is secured by a handkerchief or napkin, he is placed at the table, loaded with every variety of eatables, and there is - permitted to indulge the freedom of his infantile will, and the "liberty of choice," as the metaphysicians Avould say, in the selection of such food as seems most inviting,—whether it be sweetmeats, cake, pastry, or animal substances. No restriction is imposed, either as to quantity or quality,— jellies, puddings, fruit, pork, ham, smoked beef, coffee, tea, ci- der, each or all are freely allowed; and thus, in a short time, the digestive organs become deranged, and wholly unable to assimilate any kind of food: the child suffers from flatulence, griping pains, and irregularity of the bowels—becomes weak and emaciated—is dosed by the fond mother with Sherman's, or some other calomel worm lozenges, till at length convul- sions or cholera infantum, rescues the sufferer from all further misery. And this is a true history of a large proportion of the children that die under two years of age. 128 INFANT TREATMENT. Whether parents may be misled by their feelings or their ig- norance, the result is the same. If a child cries, he is prom- ised a cake, or sweetmeats, or that he shall be a little man and sit at the table; and if promises do not avail, he is put in immediate possession; and eating thus becomes the chief end and object of life, to the child, avIio has no other incentive to good behaviour held out to it. Who can wonder, that when premiums are thus set upon flattery, children should grow up (if by some miracle such should be their destiny) sensual, selfish, and devoted to gor- mandizing ? Parents avIio realize their responsibilities, will not forget the important principle so Avell illustrated by Dr. Combe, that in children every faculty is roused into action by the presence of its OAvn objects, without any intermediate oper- ation of either reason or judgment; and will, consequently, al- low no child the indulgence of an appetite, or propensity, other than that which is required by its instinctive wants, for its bod- ily support and health. A Aveak minded mother, or an igno- rant nurse, will, under the influence of Avhim and caprice, be as ready to satisfy the imaginary, as the real Avants of the child—forgetful of the important truth, that " every gratifica- tion of any one sense, Avhether of taste, sight, sound, or touch, is the beginning of a desire for its reneAval; and that every re- newal, gives a probability of the indulgence becoming a habit; and that a habit once formed, even in childhood, Avill often re- main during the Avhole of after life; acquiring strength every year, until it sets all laws, human and divine, at defiance." It is during the second year, that children suffer most from teething; and the second summer, especially in our large cities, is a critical one to the child, and proverbially hazardous: but an experience of tAventy years has taught us, that where the food of a child has been properly regulated, it generally passes through the period of dentition Avith little injury. Experience, as Avell as observation, sIioavs, that Avhere a mode of manage- ment is early adopted in accordance Avith the nature and wants of the infant constitution, not only Avill the dangers of teething be diminished, but those of all other diseases. It is, we repeat it, improper food, Avhich endangers infantile existence, and gives fatality to those maladies, Avhich are the great outlets of infant life. To particularize—we would allow no nourishment to the SUPPLEMENTARY CHAPTER. 129 child but the mother's milk-where that is sufficient in quanti- ty—durmg the first twelve or fourteen months, or while the in- cisor teeth are cutting; and where this rule is observed, the process of dentition will be found to occasion very slight, if any inconvenience. It is astonishing how soon an impropriety in the kind of food will excite serious disturbance during this peri- od, and often fatal convulsions: such is the highly irritable con- dition of the whole system. There are, however, some instan- ces, in which it is necessary to supply the child with addition- al nourishment ; in such cases, there is nothing better than a mixture of equal parts of good cow's milk and water, sweet- ened with loaf sugar. But here is a difficulty. A large pro- portion of the milk supplied to the inhabitants of our large ci- ties, is obtained from cows kept in close, filthy stables, and fed on acid distillery slops. The milk is consequently a rank poi- son to young children. By analysis, I find that six samples of the milk of country dairies give a specific gravity, varying from 1026 to 1030; from 7 to 10 per cent, of cream, and 9 to 12 per cent, of curd, with decidedly an alkaline reaction; while the same number of samples of milk from different distillery slop dairies, give a specific gravity of from 1013 to 1024; from 3 to 6 per cent, of cream, and from 4 to 8 per cent, of curd ; with strong acid properties: thus showing, conclusively, that slop milk contains less than half the nourishment of that produced from grass and other natural food. Slop milk, moreover, con- tains so little oil and albumen, that it is incapable of producing butter or cheese; and consequently must be essentially defi- cient in nutrient properties; and can not, therefore, afford the nourishment that is requisite for the growth and sustenance of a child. But in addition to this, in consequence of the close confinement of the cows in filthy, ill-ventilated stables, as well as their unnatural diet, the milk possesses actual deleterious properties, and according to the published testimony of fifty of the most respectable physicians of the city of New York, is one of the prolific causes of infantile disease and death. When an infant, or young child, is, therefore, supplied with milk from the cow, particular caution should be used, that the animal be healthy, and its food natural; that it should enjoy exercise, and breathe a pure air; and it is important, if practica. ble, that the milk should be always from the same animal, as dif- ferent cows feeding upon the same materials, often give differ- 130 INFANT TREATMENT. ent qualities of milk, and the stomach becomes reconciled more readily to any one certain quality, than to a mixture. We dif- fer in opinion from the writer of this volume, as to the proprie- ty of giving skimmed milk to infants, believing that milk, which contains its oily, as well as other ingredients, is far pre- ferable. We also have our doubts, as to the utility of those compounds of flour and milk, bread and water, oat-meal and water, &c, which, under the names of pap, panada, and water- gruel, are so generally given to young infants, under a mista- ken impression that they are indispensably necessary to pro- mote their strength and vigour. How often do we see chil- dren thus dieted, affected with colicky pains, disturbed sleep, fits of screaming, diarrhoea or dysentery, eruptions, or discoloTa- tions of the skin, and rapid emaciation ! And yet the simple good natured nurse cannot divine the cause, and plies her rhu- barb, magnesia, senna, oil, calomel and medicated lozenges, to drive out the secret enemy, disease, which, some how, has formed a lodgement within the digestive cavity of the little drug-swallower ! If these do not suffice, some cordial, or car- minative, of which opium forms the base, is freely administer- ed, and thus the mischief increases, until severe, or incurable disease is induced. The jaundice of new-born infants, is gen- erally the result of gastric and duodenal irritation, caused by gruel, panada, or some other substance, for the digestion of which the infant stomach is not adapted. Infants are fre- quently harassed with colic, manifested by fits of screaming, and this for weeks together, occasioned by improper nourish- ment, and yet the cause remains unsuspected. If the child have stamina enough to withstand such a state of gastric irritation, so long continued, it may at length become inured to its unnatural food, and appear to thrive; but more commonly it will fall a victim to jaundice, diarrhoea, cholera in- fantum, convulsions, scrofula, marasmus, or some other danger- ous malady. After a child has acquired several teeth, it will be proper to add barley or rice water to sweetened milk, for a portion of its food ; and if the irritation of teething is past, we may occasionally allow a little plain beef or mutton broth, though as a general rule, we believe that children thrive best during the first two years, on a purely vegetable diet. When dentition has made considerable progress, it will be proper also to allow the child a proportion of rice flour, arrow-root, or ta- SUPPLEMENTARY CHAPTER. 131 pioca with milk, and well sweetened,—or milk, in which gra- ted soda biscuit, or stale baker's bread, has been well stirred, or roasted kidney potatoes, reduced to a fine thin pulp with cream. They should, however, be given with moderation, and invariably prepared fresh, each time they are used. The great and universal error, in relation to infant diet in our country, is, that it is too stimulating, too abundant, and not sufficiently simple. More than twice the quantity of food is al- lowed, than is necessary to satisfy the wants of the system, and that, moreover, of a quality better adapted to the digestive powers of an adult, than of an infant. In cities, where children breathe a more unwholesome air, and take less exercise, than those of the country, such a diet clogs the system, deranges the functions of all the important organs, and predisposes to the whole catalogue of inflammatory and epidemic, infantile diseases. So far as our observation ex- tends, an abundance of animal food more frequently adds to the debility, than increases the strength of young children; and those avIio eat the least of it, are the most healthy. Under no circumstances, except as a medicine, and then very seldom, would Ave alloAV any table-beer to infants, as recommended in a previous chapter. We are aware that Dr. A. Combe has remarked, that "light, fresh table-beer would not be injurious to a child of four or five years old:" at the same time, however, he remarks, " it is unnecessary, and no advantage would in this instance result from the creation of a new want." But, if •' un- necessary," it Avould certainly be superfluous, and if superflu- ous, it must be hurtful. The day has gone by, when it was ne- cessary to caution parents against giving young children Avine, cider, or any other alcoholic liquor. One thing connected with the proper regulation of the diet of the nursing child should never be overlooked, and that is, the diet of the mother or the nurse. The quality of the milk, depends mainly on the kind of food which they are in the ha- bit of employing. In general, we may remark, that it should consist of such Avholesome aliment as is in ordinary use, simply cooked, and eaten in moderation. Made dishes, rich gravies, salted and smoked meats, as well as all high-seasoned viands, should Raise up a child after feeding—29. Give no stimulants, carraAvay seeds, carminatives, &c.; they are most pernicious—29. Give as little medicine to a child as possible, and al- ways by advice—29. Never overfeed, and never stop crying by feeding—29. Avoid rough jolting and patting on the back—30. Train an infant to regularity in all its wants—30. RULES FOR WEANING. Wean gradually, discontinuing suckling in the night. : the gradual change is beneficial to both mother and child. Avoid Aveaning in severe weather. Take for yourself a cooling purgative, and refrain from fluids and stimulating diet—32. 140 INFANT TREATMENT. In weaning, apply to the breasts three ounces com- pound soap liniment, three drachms laudanum, one drachm camphor liniment. If this is too irritating, foment with warm water, or poppy heads and camomile floAvers boiled in water. Avoid tightness or pressure from the dress, and all roughness for fear of abscess. Avoid drawing the breasts : avoid exposure to cold—32, 33. RULES FOR TREATMENT AFTER WEANING--FOOD. Study the child's constitution, digestive poAvers, teeth, strength, and proportion the kind and quantity of food—33. Animal food in small quantity once a day, if the teeth can masticate, is necessary when there is a rapid growth—33. Avoid too nourishing a diet with a violent tempered child—33. Give a nourishing diet to a white-looking lymphatic child—33. Both overfeeding and underfeeding produce scrofula and consumption—33. The spoiled and petted child is injured both in health and temper—34. Avoid seasoned dishes, fried and salted meats, pastry, uncooked vegetables, unripe fruits, wine and rich cake-34. Insist on thorough cheAving or mastication—34. Never tempt the appetite when disinclined—34. Vary the food from day to day, but avoid variety at one meal—35. Animal food should be tender, and eaten with a little salt, vegetables, and bread—35. Take care that the child's food is well cooked. Give no new bread—35. Sweetmeats and confections are only to be given to children in a very sparing manner, if given at all. Ne- ver pamper or reAvard Avith eatables—35, 36. RULES FOR SLEEP. Allow the child plenty of sleep without disturbance —37. Avoid accustoming the child to sleep on the lap; it will not sleep in bed if so accustomed—37. Establish times for regular sleeping—37. SUMMARY. 141 Keep the hands, feet, and face comfortably warm- blankets are better than sheets—37. Support every part of the body, raising by a slope the head and shoulders—37. Avoid laying the child in the same bed with an adult, unless for a short time to restore warmth if it fail—38. Never rouse the child by play when taken up during the night—38. S RULES FOR CLOTHING. In the first stage of infancy, warmth depends on cloth- ing alone, for there is no muscular movement—39. Avoid a degree of warmth Avhich produces sensible per- spiration—39. Flannel and calico are the best materials in all sea- sons—39. Dress the child loosely, and fasten with strings and not pins—39. The umbilical cord, navel, and belly-band, require much attention—42. Avoid keeping the child's head too warm or its feet cold—43, 45. Avoid chilling the child, or taking it abroad in cold weather—44. Attend to the form and size of the child's shoes, so that the feet shall not be cramped—45. The practice of plunging infants in cold water, to ren- der them hardy, is exceedingly dangerous—46. Let a child's washing be very completely and carefully performed. Keep the child ahvays perfectly clean and neat—47. Be very attentive to ventilate the apartment where a child lives, but-never expose it to draughts of air—43, 44. Begin early to form habits of personal cleanliness and delicacy—53. Regard should be had to the effect of light upon the infant—54. MEDICINE. Impropriety of administering purgative medicines to the new-born infant—54. If the child is well managed, medicine will rarely be required—56. 142 INFANT TREATMENT. Importance of physiological knowledge to mothers —56. When the family physician should be sent for—57. Proper regulation of the diet—57, 58. The physician should not be made a bugbear to the child—58. VACCINATION. Let the child be vaccinated from six weeks to tAVO months after birth, and that by a proper medical attend- ant. Vaccination should take place before teething—62 DEFORMITIES AND DISTORTIONS. Consult the surgeon on the first appearance of any de- formity j and do not allow fears for giving pain to the child to prevent the use of the necessary remedies—64. Be very vigilant Avith rickets or soft bones. Never allow the ricketty child to support its OAvn Aveight. It ought to be kept on its back for many months, and carri- ed about on a little mattrass on aboard or tray, and have nourishing diet, and the proper medicine to give solidity to the bones—66. Never jerk or SAving children by the arms; much mis- chief has been done by this practice—67. When a child falls or meets with any accident, it is highly culpable in a nurse to conceal it. If she do not immediately mention it, she may be the cause of the child's deformity and lameness for life—67. With proper attention, a tendency to be left-handed may be easily cured in a child—68, 69. Prevent all tricks and ill habits Avhich injure the fea- tures and organs ; such as stuffing the nostrils, ears, &c. distending the mouth with too large a spoon—69. Curvature of the spine is of very frequent occurrence from mismanaging children, by tight lacing, long sitting without support to the back—(all school seats and forms should have backs.) Take all deformities of the spine in time, before they get fixed—69, 70. PRECOCITY. When a child appears to be over-intelligent, or too clever, or wise, for its age, this is a symptom of an unna- tural development of the brain ; it is a kind of disease. SUMMARY. 143 Avoid, therefore, exercising the child's ability ; treat it, as an animal, with nutritious food, muscular out-door ex- ercise, and plenty of sleep ; and do this, and this only, for some years—72. No child should be kept engaged for more than a few minutes at a time in mental study—73. STAMBIERING AND DEFECTIVE ARTICULATION. This defect, with care, may be cured ; or rather, when it is first threatened, it may be prevented—75. Practise the child in letters or articulations where a pe- culiar defect appears—75. SQUINTING. Watch this very common Aveakness, check it in the infant by holding the hand over the eyes till they are shut; and when opened again, if they have not assumed a proper position, repeat the operation. It may have of- ten to be repeated. Careless nurses are very apt to pro- duce squinting in children—78. An ingenious and effectual mode of curing squinting has been discovered, and is now practised by surgeons —79. TEETHING. The first sign of teething is heat in the mouth of the ehild—felt by the mother during sucking—flow of saliva —biting and grinding the gums. A piece of India-rubber is better than coral, ivory, or any hard substance, for rub- bing the gums—82. When the child is much distressed, have recourse to medical aid—83. When the boAvels are confined, give Avithout delay a o-entle purgative, such as castor oil, manna, magnesia, or senna. The warm bath at 96 degrees soothes the child —84. A child's mouth should be often examined, even after three years of age—84. Wayward temper, cough, and even croup, have been traced to cutting a double tooth—84. Do not hesitate to allow the child's gums to be lanced —84. 144 INFANT TREATMENT. EXERCISE--WALKING ALONE. Very little motion, and that of the gentlest and most careful kind, is all the infant should have for a considera- ble time after birth—85. Avoid the upright posture as much as possible—85. Avoid all sudden and violent jerking, and long-contin- ued positions—86. Allow the child to move its limbs freely on the floor or in bed—88. Watch the first efforts of the child to walk alone, and interfere rather with eye and hand than by exclamations of caution and alarm: these last do much harm—88. Avoid sympathising too strongly Avith the child when hurt: assist quietly, and shoAv hoAv the the accident hap- pened—88, 89. Children who are angry when hurt, should see that you do not sympathise Avith their rage, although you do with their sufferings—89. Abjure all leading-strings aud go-carts, or other artifi- cial means of teaching the child to Avalk. Never drag the child by one hand, or lift it by either one or both arms—89. When the child \valks alone, it should not be permitted to over-fatigue itself—89. The mother should have her eye both on child and its attendant out-of-doors, and be as much as she can in her child's company—90. MORAL GOVERNMENT. Anticipate and prevent fretfulness and ill-temper by keeping the child in good health, ease, and comfort. Never quiet A\uth giving to eat, or by bribing in any Avay, still less by opiates—92. For the first fe\v months avoid loud arid harsh sounds in the hearing of children, or violent lights in their sight: address them in soft tones ; do nothing to frighten them ; and never jerk or roughly handle them—93. Avoid angry Avords and violence both to a child and in its presence ; by which means a naturally violent child will be trained to gentleness—94, 95. Moderate any propensity of a child, such as anger, vi- SUMMARY. 145 olence, greediness for food, cunning, &c, which appears too active—94. Show him no example of these—94. Let the mother be, and let her select servants such as she Avishes the child to be. The youngest child is affect- ed by the conduct of those in Avhose arms he lives—94. Cultivate and express benovolence and cheerfulness: in such an atmosphere, a child must become benevolent and cheerful—95. Let the mother feel as she ought, and she will look as she feels. Much of a child's earliest moral training is by looks and gestures—96. • When necessary, exhibit firmness and authority, al- ways Avith perfect temper, composure, and self-posses- sion—96. Never give the child that Avhich it cries for ; and avoid being too ready inansAvering children's demands, else they become impatient of refusal, and selfish—98. When the child is most violent, the mother should be most calm and silent—99. Out-screaming a screaming child is as useless as it is mischievous. Steady denial of the object screamed for, is the best cure for scream- ing—101, 102. In such contests, witnesses should withdraAV, and leave mother and child alone. A child is very ready to look round and attract the aid of foreign sympathy in its lit- tle rebellions—102. Never promise to give when the child leaves off crying. Let the crying be the reason for not giving—102. Constant Avarnings, reproofs, threats, and entreaties— as, let that alone—be quiet—how naughty you are, &c, all uttered in haste and irritation, are most pernicious. No fixed or definite moral improvement, but the reverse, re- sults from this too common practice—102. Watch destructiveness, manifested in fly and insect killing, and smashing and breaking, quarrelling, striking, &C.---102. Never encourage revenge—108. Never al- low a child to Avitness killing animals—109. CounterAvork secretiveness by exposing its manoeuvres. Regulate notions of propeity—one's own and another's —107. Never strike a child, and never teach it to strike again. Never tell a child to beat or threaten any animal or ob- E 146 INFANT TREATMENT. ject—108. Corporeal correction may be avoided by judi- cious substitutes—108. Set an example of cleanliness, order, punctuality, deli- cacy, politeness, and proper ease of manner. This is better than teaching manners, as it is called—103. Inculcate early, and manifest in yourself, a delicate re- gard for the rights of others and their feelings, in contrast Avith selfish vanity, arrogance, and exclusive attention to one's own ease, comfort, and gratification—103. Prevent all indelicacies and slovenly habits at table— touching the utensils, stretching for what is wanted, sit- ting awkwardly, &c—103. Study early to gain a child's confidence by judicious sympathy in its joys and sorrows. Have no conceal- ment Avith it—104. Govern by love, and not by fear: the contrast between children governed by the one and the other is truly in- structive. Never forget that kindness is power Avith man and beast. The Arab never strikes his horse—104. Cultivate truth, justice, and candour in the child, and manifest them in yourself—105. With a child whose firmness is apt to run into obstina- cy, never contend : in doing so, you aggravate the feel- ing by manifesting the same feeling in yourself; and by further shoAving your combativeness, exciting the child's opposition. Divert the child from the object, and put in activity its benevolence, justice,and reason—106. Never frighten to obtain a child's obedience : threats of hobgoblins, and all false terrors, are now universally ex- ploded, as atrocitiestOAvardsthe young; death, fits, idio- cy, insanity, have been the consequences. They are be- sides soon discovered to be falsehoods, and operate most immorally—107. EARLIEST INTELLECTUAL EDUCATION. Cultivate by exercise the five senses of seeing, hearing, touching, smelling, tasting—110. Teach the child to observe forms, sizes, weights, col- ours, arrangements, and numbers—111. Practise all a child's knowing faculties on objects— feathers, shells, ribbons, buttons, pictures of animals, &c— 111. SUMMARY. 147 Practise distinct articulation. If at four years of age a child has any defect, it ought to be systematically taught to pronounce correctly—113. Let a child put its toy to another than the intended use, if it does not destroy it. This exercises invention—113. Encourage construction, and furnish the materials, leav- ing ingenuity to Avork—113. Accustom the child to find its own amusement. It is the most unprofitable slavery to be constantly finding amusement for it—114. Remember that children love stories—the simpler the better ; and delight to have them told again and again. Ahvays give them a moral turn and character—115. Be sparing of the marvellous; exclude the terrible and horrible ; and utterly proscribe all ghost and Avitch sto- ries—115. Accustom children to reptiles, insects, &c.; and pre- vent the foolish fear of these creatures Avhich is often found in adults, and leads to the constant and most unne- cessary destruction of them—116, 117. Induce a child to give attention, by presenting objects, and giving narratives Avhich interest it. Do not tell it that it must give attention—117. Avoid employing female servants as nurses Avho possess coarse habits and sentiments, or Avhose mode of speaking is coarse and indelicate—118. No difference need at first be made betAveen the rearing and training of male and female infants. Allow female children as they groAV up to amuse themselves with dolls, and in a similar manner encourage and regulate the amuse- ments of boys—118. INFANTILE DISEASES AND TREATMENT IN THE UNITED STATES. The mortality among infants much greater in the IT. States than in Europe—121, 122. The cause to be found in the extreme vicissitudes of our climate, and certain errors of treatment—125. A stimulating diet of animal food often pernicious to infant constitutions in this country—126, 127, 128. Gluttony too much encouraged among infants—128. Teething—how its dangers may be diminished—128. 148 INFANT TREATMENT. During the first tAvelve or fourteen months, the moth- er's milk should constitute the sole nutriment of the child—127. The editor dissents from the author of this Avork in regard to using skimmed milk for infants; also in re- gard to administering any kind of table-beer—131. Cautions to the mother or nurse as to her diet. Pure water should form her only beverage—132. Autumn in this country is the most proper season for weaning a child—133. More attention should be paid to the clothing of in- fants—133. Fine Welsh flannel is the most suitable material for in- fant clothing, during the spring, Avinter, and autumnal months—134. Importance of pure air. Pernicious consequences of inhaling the gas from anthracite coal—f35,136. A variation suggested in the mode recommended by Mrs. Banvell for washing and bathing infants—137. Water, without the addition of soap, is recommend- ed—138. THE END. / a- ^ w^ A$*£j&*&* ^: wm&&&v&}^m;2#^£^i 1 1 riTH PRICE TWENTY-FIVE CEXTS. IIFANT T^ElffiftSx^ DIRECTIONS ^mrr^EftS^ vf j FOR SELF-MANAGEtaESaL__--~ Before, During, antr lifter JJregnancrj. Addressed to Mothers and Nurses, BY MRS. BARWELL. FIRST AMERICAN EDITION. REVISED, ENLARGED, AND ADAPTED TO HABITS AND CLIMATE IN THE UNITED STATES, BY A PHYSICIAN OF NEW-YORK, UNDER THE APPROVAL AND RECOMMENDATION OP VALENTINE MOTT, M.D. NEW YORK : PUBLISHED BY JAMES MOWATT & CO., No. 138 FULTON STREET ; BURGESS STRINGER, & CO., SUN OFFICE, AND GRAHAM le CHRISTIE, NEW YORK ; REDDING &. CO. BOSTON ; G.JONES, ALBANY; G. B. ZEIBER AND R. G. BERFOHD, PHILADEL- PHIA ; WM. TAYLOR, BALTIMORE ; ROBINSON & JONES, CIN- CINNATI ; BRAVO fe MORGAN, NEW ORLEANS. 1844. NEWARK, N. J. 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