Chapter XVI: Part VII: The Change of Life (8)

From what we have previously said of the influence of the nervous system over the quantity and quality of the milk, and the instances we have adduced of the danger to the infant of all violent passions--such as anger, terror, anxiety, and grief--on the part of the mother, it will be apparent that it is of the greatest moment, during the whole course of nursing, to maintain a tranquil state of mind. Pleasing and peaceful emotions favor the normal secretion of milk, and go far towards securing the health of the child. When strongly affected by any powerful feelings, mothers should not give the breast, but should wait until they have calmed down to their usual tenor of temper. A case is related of a woman who was always excited by a highly electrical state of the atmosphere, and particularly during stormy weather. If when thus influenced she nursed her child he was sure to fall into convulsions; while, if she delayed doing so until this nervous excitement had passed, no unpleasant symptoms occurred. But we have already dwelt at length upon this subject in speaking of the influence of the mind of the mother over the child at her breast, and need not therefore recur to it. The _food_ while nursing must be nutritious and varied, though simple and unstimulating; and should consist both of meat and vegetables, soups, fish, flesh, and fowl, either in combination or succession. When the digestion requires stimulation and aid, a glass of mild ale twice a day will be useful. Wines, brandy, and whisky should not be taken without the advice of a physician. Moderate exercise in the open air and regular habits are necessary. A defective or excessive diet, fatigue, loss of rest at night, and irregularities and excesses of all kinds are unfavorable to mother and child. The proper methods of combating a tendency to over-abundance or to scantiness of milk have been alluded to. Medicines, unless prescribed by the medical attendant, should rarely or never be taken during this period, as many of them enter the milk and may thus affect the child.

RELATIONS OF HUSBAND AND WIFE DURING NURSING.

After a natural and healthful confinement, the nurse usually remains with the mother for a period of four weeks. During the whole of this time the husband should occupy a separate apartment, and, according to some physicians, this separation should be protracted during the entire period of nursing. But this is unusual, and in most cases unnecessary. Only those women who are warned by the recurrence of their monthly illness that they are liable to another pregnancy immediately, should insist on such an ascetic rule as this.

Unquestionably the quality of the milk is much deteriorated by a conception; and therefore, both in the interest of the mother and child, the husband should renounce his usual privileges at such times.

Most women do not have their periodical illness, and consequently are not liable to a second pregnancy, before seven months have elapsed after childbirth. There are, however, numerous exceptions to this rule, and it is impossible to foretell who will and who will not be the exception.

Moreover, as any excitement of the passions alters to some extent the secretion of the breasts, often to the injury of the child, it is every way advisable that great temperance be exercised in all cases in the marital relations at these epochs.

SIGNS OF OVER-NURSING.

The symptoms of over-nursing may be enumerated as follows:--Aching pain in the back; often, pain across the shoulders, and on the top of the head or forehead; marked paleness of the face; inability to sleep; frightful dreams when sleep does come; great debility; extreme depression of the spirits; disorders of the sight, and mental disturbances, which take on the form of melancholia, the delusions relating mostly to subjects of a religious character, to the effect that the unpardonable sin has been committed, and the like. The headache is situated on the top of the head, and this spot may be noticed to be perceptibly hotter to the touch than other parts of the head. These symptoms indicate that the process of nursing is making too great a drain upon the system.

A woman in ordinary health will generally be able to suckle her child for twelve months without experiencing any bad effects. When the child is kept at the breast much beyond this time, most mothers render themselves liable to the injurious consequences we have mentioned. Some, indeed, cannot furnish the child all the nourishment it needs longer than three or four months, without detriment to themselves. In such cases, by feeding the child two or three times a day, the mother may be relieved of the burden of its entire support, and may thus be enabled to continue nursing. The proper food for infants, under these circumstances, will be shortly mentioned. The prostrating effects of nursing upon the body and mind of the mother are in some, though comparatively rare, instances so marked, as to render it altogether improper from the commencement.

The treatment of the condition of system described as resulting from over-nursing is, if it cannot be remedied by partially feeding the infant and the use of tonics, to remove the child from the breast altogether, and either procure a wet-nurse for it, or wean it. The wet-nurse is greatly to be preferred; and the preference is the stronger, the younger the child. We have already alluded to the great difficulty of rearing children from birth by the hand. But after the infant has attained the age of several months, the danger of artificial feeding is much lessened, provided that the weaning does not take place during hot weather. This brings us to the consideration of the regimen of the mother who cannot nurse her own child, of the rules for the selection of a wet-nurse, of the directions for bringing up by hand, and of the proper method of weaning. These subjects we will now take up in the order mentioned.

DIRECTIONS FOR MOTHERS WHO CANNOT NURSE THEIR OWN CHILDREN.

There are many reasons why a mother should, if possible, nurse her own child. 'One of the principal is,' says the distinguished Dr. Tilt, 'that as nursing, generally speaking, prevents conception up to the tenth month, so it prevents the ruin of the mother's constitution by the too rapid bringing forth of children, and, we might even add, prevents a deterioration of the race, by the imperfect bringing up of this too-fast-got family.'

The same author appropriately adds: 'But while advocating maternal nursing, we must not forget that woman is not now the Eve of a primeval world; that human nature, wherever it is now met, in barbarous tribes or in civilised communities, is frequently so deteriorated, so diseased or prone to disease, that, by nursing, a mother may sometimes undermine her own frail constitution for the sake of giving an imperfect sustenance, and perhaps a poisonous heritage, to her babe.'

Some mothers, however anxiously they may wish to do so, cannot nurse their children. They are shut out from this charming and tender experience in the life of a woman. The milk that comes is not sufficient, and quickly disappears. Because of the influence of the mind of the mother over the child at her breast, to which we have before called attention, women who are very hysterical and nervous, subject to violent perturbations of the mind, should not, particularly if there be any family tendency to insanity, expose the child to the mischievous effects latent in their milk. So, also, the presence of certain diseases forbids wet-nursing. Thus it is ordinarily prohibited by consumption, scrofula, skin affections of long standing, and cancer. In consumption, all efforts to suckle are frequently equally fatal to the mother and child. Even a strong hereditary predisposition to this disease may render it advisable, in the opinion of the family physician,--who should always be consulted in such a case,--to counteract the family taint by giving the milk of the healthiest nurse that can be procured. The condition of the nipples and of the breast may not permit of nursing. We have pointed out how best to guard against such an occurrence, in treating of the care of the nipples during pregnancy.

She who is to be debarred from nursing her own child should take care that it is not allowed to approach her breasts, as sometimes the mental and physical excitement caused by such an approach is of an injurious and lasting character.

Ordinarily, if this direction be followed out, the mother will have little trouble in regard to herself. Under such circumstances, the chief danger is to the child. Hence the importance of knowing

HOW TO SELECT A WET-NURSE.

The choosing of a wet-nurse is a matter of great moment and responsibility. She should not be over thirty years of age, and should, if possible, be one who has previously suckled and had charge of children. Her own infant should be under the age of six months, for when above that age the milk sometimes disagrees with her new-born charge. One who has had several children should be preferred, because her milk is richer than after the first confinement.

The doctor should always examine carefully into the condition of the nurse's health, and into the quality and quantity of her milk. Various diseases and taints of the system are so hidden, while yet communicable to the child, that the knowledge and skill of a professional expert are required for their detection, and the protection of the nursling. In testing the quality of the milk, the experienced physician allows a little to rest on his finger nail, and by its examination readily decides as to its richness and fitness to nourish the little applicant for food. It is not necessary that the breasts should be large, as those of moderate size often furnish a sufficient amount of milk. But it is important that the nipples should be well developed. Those wet-nurses should be preferred in whom large blood-vessels are seen prominently passing in blue lines over the surface of the breasts. The possession of a vigorous, healthful infant is a good recommendation for a nurse, but care should be taken to ascertain that it is her _own_, as nurses have been known to borrow for such an occasion and so obtain credit not justly their due.

The moral and mental as well as physical characteristics should be considered. Temperance and cleanliness are indispensable in a wet-nurse, and the want of either should be an imperative reason for rejection. Equanimity of temper, cheerfulness, and an open, frank, affectionate disposition, are of course greatly to be desired.

If the nurse becomes 'unwell,' shall the child be taken from her? Should the monthly sickness reappear early, and both nurse and child be in good health, suckling may be continued. But when the return happens about the ninth or tenth month, the child should be weaned or the nurse changed. There is no physiological reason for preventing the nurse from living matrimonially; but if pregnancy occurs, the child should be taken from her.

The same rules that we have laid down for the mother for the care of her health while nursing, are of course applicable to the hired wet-nurse, and should be insisted upon and enforced.

_Changing a nurse._--When it becomes necessary to change a nurse, for any of the reasons above mentioned, it may be done without injury to the child. For fear of the effect of the unwelcome tidings upon the mind of the nurse, and the possible influence upon the milk, she should not be informed of the projected change until a successor has been secured to take her place at once. In choosing the second nurse, the same precautions should be had as in the selection of the first.

THE CHILD.

_THE CARE OF INFANCY._

By infancy we mean that portion of the life of the child between birth and the completion of the teething--about two and a half years. The care of this period of human life is entrusted to the mother. It forms an important era in the physical life of woman. Its discussion is therefore germane to our subject. In order that the young mother may fully appreciate the responsibilities of her position, she should know something of the liability of infants to sickness and death.

Out of one thousand children born, one hundred and fifty die within the first year, and one hundred and thirteen during the next four years. Thus two hundred and sixty-three, or _more than one-fourth, die within five years after birth_. Between the ages of five and ten, thirty-five die. During the next five years eighteen more are recorded on the death-list. Hence, at fifteen years of age only six hundred and eighty-five remain out of the one thousand born. When these figures are considered, and the additional fact that out of those who survive very many bear permanent marks of imperfect nourishment or of actual disease, the consequence of maladies contracted in early life, the importance of our present inquiry--the care of infancy--will be apparent to all mothers.

The younger the infant, the greater the danger of death. _One-tenth of all children born die within the first month after birth_, and four times as many as during the second month.

The mortality is much larger in cities than in the country. In Dublin, during 1867, very nearly one-third of all the persons who died were under five years of age. In the same year forty-three per cent. of those who died in the eight principal towns of Scotland were children below the age of five. In Philadelphia, during the same year, forty-five per cent. of all the deaths were of children under five years of age. In New York fifty-three per cent. of the total number of deaths occur under the age of five years, and twenty-six per cent. under the age of one year.

The danger of death lessens as the period of puberty approaches. Yet, even in the last years of childhood there is a greater liability to disease and a larger proportionate loss of life than during youth or middle age.

CAUSES OF INFANT MORTALITY.

What are the causes of this startling mortality of infant life? Why does one child out of ten die in the first month, and only three out of four live to be five years old? And what are the means of prevention?

Some of the causes which are active in producing this mortality among the little ones cannot be successfully opposed after birth. Such, for instance, are imperfect and vicious developments of internal organs existing when born. These malformations often result from inflammation while in the womb, excited by some taint of the mother's blood, or by some agitation of her nervous system. Means of prevention in those cases are therefore to be directed to the mother, in the manner indicated in treating of pregnancy. But other causes of death begin to act only after birth, and are to a greater or less extent avoidable. These are largely traceable to ignorance, negligence, and vice.

One cause of death to which infants are peculiarly liable, and which alone is said to have destroyed forty thousand children in England between the years 1686 and 1799, is being _overlain_ by the parents. For this reason, some physicians caution the mother against having the infant in bed with her while she sleeps.

The frightful waste of life caused by bringing children up by hand has been mentioned, and the importance of avoiding it when possible.

The natural feebleness of the system of infants is the reason why they succumb so easily to any malady. Deaths from any given disease are more numerous among infants than children, and among children than adults. Hence the importance of timely corrective measures in infantile affections; hence, also, the need that mothers should know and practise the means best adapted to preserve the health of their frail charges.

These means we shall proceed to give in detail, commencing with directions for

BRINGING UP BY HAND.

We have already alluded to the great danger to the child, particularly in a city, that is artificially fed from birth. But as there are many mothers who are unable, on account of the expense, to have a wet-nurse for the child they cannot suckle themselves, we will give such directions in regard to the diet as are best calculated to lessen the risk invariably incurred under such circumstances.

The child's food should be of the best quality, and prepared with the most scrupulous attention to cleanliness. The milk of the cow is preferable to that of the ass or of the goat, the former of which it is difficult to procure, and the latter having a disagreeable odour. For a child under three months of age, cow's milk should be used as the only food. It should be fresh, and if possible from one cow. When of the ordinary richness, it is to be diluted with an equal quantity of water or thin barley-water. If, however, the first milking can be obtained, which is more watery, and bears a closer resemblance in its chemical composition to human milk, but little dilution will be required. If green and acrid stools make their appearance, accompanied by emaciation and vomiting, the milk must be more diluted, and given less frequently. If the symptoms of indigestion do not yield, milk containing an excess of cream should be used. To procure it, allow fresh milk to stand for two or three hours, and remove the upper third, to which add two or three parts of warm water or barley-water, after having dissolved in it a little sugar of milk. Should this food also disagree, any of the preparations we are about to mention may be prepared and tried.

Professor Falkland recommends the following method of preparing milk for infants, as affording a product more nearly like the natural secretion:--'One third of a pint of pure milk is allowed to stand until the cream has risen. The latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk-vessel placed in warm water. In about five minutes the curd will have separated, and the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling, to prevent it becoming sour. A further quantity of curd separates, and must be removed by straining through calico. In one-quarter of a pint of this hot whey three-eighths of an ounce of milk sugar are to be dissolved; and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. This will constitute the food for an infant from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quantity required for twenty-four hours. It is absolutely necessary that a fresh quantity should be prepared every twelve hours; and it is scarcely necessary to add, that the strictest cleanliness in all the vessels used is indispensable.'

Dr. J. Forsyth Meigs directs the following article of diet as one which he has found to agree better with the digestive system of the infant than any other kind of food:--'A scruple of gelatine (or a piece two inches square of the flat cake in which it is sold) is soaked for a short time in cold water, and then boiled in half a pint of water, until it dissolves--about ten or fifteen minutes. To this is added, with constant stirring, and just at the termination of the boiling, the milk and arrowroot, the latter being previously mixed into a paste with a little cold water. After the addition of the milk and arrowroot, and just before the removal from the fire, the cream is poured in, and a moderate quantity of loaf sugar added. The proportions of milk, cream, and arrowroot must depend on the age and digestive powers of the child. For a healthy infant, within the month, I usually direct from three to four ounces of milk, half an ounce to an ounce of cream, and a tea-spoonful of arrowroot to half a pint of water. For older children, the quantity of milk and cream should be gradually increased to a half or two-thirds milk, and from one to two ounces of cream. I seldom increase the quantity of gelatine or arrowroot.'

The egg is a valuable article of food for infants and young children, especially in conditions of debility. It should be given nearly raw, and is best prepared by placing it in boiling water for two minutes. It is then easily digested.

Beef-tea, prepared in the manner described on page 234, is highly nutritious and useful as a food for infants: if it produce a laxative effect, it should be discontinued. When the child shows signs of weakness or of a scrofulous condition its nutrition will be improved by mingling with its food a small piece of butter or mutton suet.

During the first four or five months the food should be thin, and taken through a teat, thus preventing the stuffing of the infant.

On attaining the age of twelve or fifteen months, infants are usually able to digest ordinary wholesome solid food, neatly and well cooked, when mashed or cut into fine pieces.

An article of food employed for the diarrhoea of infants is prepared as follows:--'A pound of dry wheat flour of the best quality is packed snugly in a bag and boiled three or four hours. When it is taken from the bag it is hard, resembling a piece of chalk, with the exception of the exterior, which is wet, and should be removed. The flour grated from the mass should be used the same as arrowroot or rice.'

Infants nourished by prepared food thrive well enough during cool weather, but during the warm months of the year they are exceedingly liable to bowel complaint, of which large numbers of the spoon-fed infants of cities die each summer season. Hence the importance of taking them into the country; and keeping them there until the return of cool weather lessens the danger of city life.

WEANING.

This should take place when the child is about twelve months of age--sometimes a few months earlier, often a few later. If the mother's health be good, and her milk abundant, it may be deferred until the canine teeth appear--between the fifteenth and twentieth month. The child will then have sixteen teeth with which it can properly masticate soft solid food.

_Time of the year for._--The infant should not be taken from the breast during or immediately preceding warm weather. If the mother, either on account of sickness or failure in her breast-milk, is obliged during the summer to give up nursing, she should at once procure a wet-nurse. If she cannot, the child must be sent into the country. To wean an infant in the city in hot weather, is to expose it to almost certain death.

_Proper method._--The process of weaning should be a very slow one. No definite day should be fixed for it. Little by little, from week to week, the amount of spoon-food is to be increased and the nursing lessened--being first given up at night. The breast should never be suddenly denied to a child unaccustomed to artificial food, but be displaced by degrees, by the bottle and the spoon. This gradual change will neither fret the child nor annoy the mother, as sudden weaning always does.

The infant may begin to be accustomed to artificial food at the age of four months. At first, only diluted cow's milk should be given it occasionally between the times of nursing. In a tumbler one-third full of water dissolve a tea-spoonful of sugar of milk; add to the sweetened water an equal quantity of fresh cow's milk; then, if the child's stools are at all green, mix with this two tea-spoonfuls of lime water. Instead of pure water, barley-water made in the usual way, and boiled to the consistency of milk, may be employed in this preparation--being added, while still warm, to an equal amount of milk. Or, toast-water may be substituted as a diluter of the milk. Cow's milk should not be boiled, if it can be preserved in any other way. As the infant advances in months, some solid food may be allowed. After six months, pap, made with stale bread and tops and bottoms, is proper once or twice a day. Beef-tea, made according to the recipe we have given, and chicken, lamb, or mutton broth, may now also be occasionally taken. As the quantity of milk diminishes towards the close of the first year, the spoon-food should be resorted to more frequently to supply the want. Solid food ought not to be given before the child is a year old.

The breasts usually cause little trouble when the weaning is performed in the gradual manner which has been recommended. The mother should during this time drink as little as possible, refrain from stimulating food, and take occasionally a little cream of tartar, citrate of magnesia, or a seidlitz powder. If the breasts continue to fill with milk, _they should not be drawn_. The 'drying up of the milk' may be facilitated by gently rubbing the breasts several times a day with camphorated oil, made by dissolving over the fire, in a saucer of sweet oil, as much camphor as it will take up. Tea made from the marshmallow has also been recommended for this purpose.

TEETHING.

The period at which the teeth first make their appearance is not a fixed one. It varies considerably even within the limits of perfect health. It may be said, as a rule, that the babe begins to cut its teeth at the age of six or seven months. Quite frequently, however, the first teeth appear as early as the fourth month, or are delayed until the eighth. In some instances children come into the world with their teeth already cut. This is said to have been the case with Louis XIV. and with Mirabeau. King Richard the Third is another example. Shakspeare makes the Duke of York refer to this circumstance in these words:

'Marry, they say my uncle grew so fast,
That he could gnaw a crust at two hours old:
'Twas two full years ere I could get a tooth.'

It does not follow that children whose teeth show themselves early, will have, therefore, a quicker general development. Such cases are merely instances of irregularity in the time of dentition, and carry with them no particular significance. Irregularities in regard to the order in which the teeth are cut are also of frequent occurrence.

While, therefore, it cannot be maintained that all healthy children cut their teeth in a certain regular order and time, yet it is certain that those children who follow the general rule which prevails in this respect, suffer least from the difficulties and effects of dentition. As all mothers desire to know at what time they may expect the teeth, we will state the rule of their development in the great majority of cases.

The lower teeth generally precede those of the upper jaw by two to three months.

The twenty milk-teeth usually appear in the five following groups:--

_First_, Between the fourth and eighth months of life the two lower front middle teeth appear almost simultaneously; then a pause of from three to nine weeks ensues.

_Second_, Between the eighth and tenth months of life the five upper front teeth appear, following shortly upon each other, the two central preceding the two on each side of them. Another pause of from six to twelve weeks succeeds.

_Third_, Between the twelfth and sixteenth months of life six teeth appear nearly at once. They are first the two front grinding teeth in the upper jaw, leaving a space between them and the front teeth which before appeared; next the two lower front teeth, situated one on each side of the central ones, which were the first to appear; and, lastly, the two front grinders of the lower jaw. A pause until the eighteenth month now ensues.

_Fourth_, Between the eighteenth and twenty-fourth months of life the canine teeth cut through (the upper ones are called eye-teeth). Again a pause until the thirtieth month.

_Fifth_, Between the thirtieth and thirty-sixth months the second four grinders finally make their appearance.

This concludes the first teething. The child has now twenty milk-teeth.

We have mentioned that children are sometimes born with teeth. It is also true that sometimes they never acquire any. Instances are on record of adults who have never cut any teeth. Dentition has been known to take place very late in life. A case is related, on excellent authority, of an old lady aged eighty-five, who cut several teeth after attaining that age.

APPEARANCE OF THE PERMANENT TEETH.

Between the fifth and sixth years of life the second dentition begins. The front grinders are the ones first cut through. Between the sixth and tenth years all the front teeth appear, followed by the canines before the twelfth year. At this time the second grinders show themselves; and finally, between the sixteenth and twenty-fourth year, the wisdom-teeth complete the dental furniture of the mouth.

VACCINATION.

This operation, to which every infant should be subjected, is one of great practical importance. The attempt has been made of late to shake the public faith in its efficacy, and to revive the old fabulous stories and foolish notions as to the production of serious affections of the blood and skin in this manner. At the same time, the increasing frequency and virulence of small-pox are becoming only too evident. We therefore consider it our duty, in treating of the maternal management of infancy, to lay some stress upon the necessity for vaccination as a preservative of life and health. If observation and experience ever taught anything, they have taught the protective power of this operation against the most loathsome and one of the most fatal diseases that ever afflicted the human race. And that mother who is careless and indifferent in this matter neglects for her children a means of preventing disfigurement and saving life, compared with which all other means are scarcely worthy of mention.

In order to appreciate the value of vaccination, it is only necessary to consider what small-pox was before its discovery,--to look at that disease through the eyes of our fathers and grandfathers. Until the close of the last century it was the most terrible of all the ministers of death. It filled the churchyards with corpses. When Jenner published his great discovery, about seventy years ago, the annual death-rate from small-pox in England was estimated at three thousand in the million of population. In other countries of Europe the rate reached as high as four thousand in the million. And these fatal cases must be multiplied by five or six, to give the entire number of persons annually attacked by the disease. It spared neither high nor low. Macaulay informs us that Queen Mary, the wife of William III., fell a victim to it. Those in whom the disease did not prove fatal, carried about with them the hideous traces of its malignity; for it 'turned the babe into a changeling at which the mother shuddered,' and made 'the eyes and cheeks of the betrothed maiden objects of horror to the lover.' Few escaped being attacked by this fell disease. Nearly one-tenth of all the persons who died in London during the last century died of this one cause. Children were peculiarly its victims. In some of the great cities of England more than one-third of all the deaths among children under ten years of age arose from small-pox. Two-thirds of all the applicants for relief at the Hospital for the Indigent Blind had lost their sight by small-pox. The number of hopeless deafened ears, crippled joints, and broken-down constitutions from the same cause cannot be accurately computed, but was certainly very large. Vaccination is all that now stands between us and all these horrors of the last century.

Is the strength of this barrier doubted?--Its efficacy is readily proved. In England, during the twelve years (1854-1865) in which vaccination has been to a certain extent compulsory, the average annual rate of deaths by small-pox has been two hundred and two in the million of population. Contrast this with the annual death-rate of three thousand to the million, which was the average of thirty years previous to the introduction of vaccination. Mr. John Simon, medical officer of Her Majesty's Privy Council, one of the best statisticians in England, has collected a formidable array of figures, 'to doubt which would be to fly in the face of the multiplication-table.' From his mountain-height of statistics Mr. Simon says: 'Wheresoever vaccination falls into neglect, small-pox tends to become again the same frightful pestilence it was in the days before Jenner's discovery; and wherever it is universally and properly performed, small-pox tends to be of as little effect as any extinct epidemic of the Middle Ages.'

Are other diseases ever produced by vaccination?--The popular belief would answer this question in the affirmative. All affections of the skin and swelling's of the glands noticed in children soon after vaccination, are attributed by parents in many cases to this operation. They forget that such diseases are met with constantly in infancy and childhood, as often among the unvaccinated as the vaccinated. Observation does not show that they occur with greater frequency among the vaccinated. An English physician has been at the trouble to examine and record a thousand cases of skin disease in children: he found no evidence whatever that vaccination disposes the constitution to such affections. It has been stated with apparent justness, that parental complaints of this kind frequently arise from their unwillingness to believe there is anything wrong in their offspring. Hence, when other diseases follow, vaccination gets blamed for what is really and truly due to other causes. So far from doing any harm to the system, it has been observed in those countries where vaccination has been most thoroughly practised, that, leaving small-pox out of the question, there have been fewer deaths from other maladies. This is especially true of two of the most important classes of diseases, namely, scrofulous affections and low fever. For this reason, some medical statisticians have attributed to vaccination an indirect protective influence against these disorders.

At what _age_ should the child be vaccinated?--If the health permit, the operation should always be performed in very early infancy. The chief sufferers from small-pox are young children. One-fourth of all who die from this fatal disease in England are children under the age of one year. In Scotland, where until recently vaccination has been much more neglected than in England, the proportion even amounted to nearly one-third; and of these, one-fourth were under the age of three months. The great risk, particularly in large towns, where small-pox is seldom absent, of delaying vaccination is obvious. City children, if hearty, should be vaccinated when a month or six weeks old. Rarely or never ought it to be delayed beyond two or three months. This early period of life is also particularly suitable to vaccination, because the accompanying fever will then be over before the disturbing influence of teething begins.

RE-VACCINATION.

If the first vaccination be found imperfect in character, that is, if it has not properly 'taken,' the operation should be repeated at the earliest opportunity. It has been recommended, in all cases, to perform a second vaccination not later than the sixth or eighth year. If small-pox be prevailing, it is proper to vaccinate all who have not been vaccinated within three or four years. In any event, re-vaccination at or after the period of puberty is of extreme importance. It will give additional security even to those whose original vaccination was perfect. In some cases, the susceptibility to small-pox is not wholly exhausted by one vaccination. Inasmuch as it is desirable for every one to escape this disease, even in its most modified form, re-vaccination should always be performed, as it affords a very sure and trustworthy means of such escape. After successful re-vaccination, small-pox, even in its mildest shape, is rarely met with. In girls especially, in whom the changes which occur at puberty are most marked, re-vaccination should be performed about the age of fourteen.

GROWTH AND DEVELOPMENT.

During infancy the body grows with great rapidity. About the end of the third year one-half of the adult height of the body is attained. After this period growth is more gradual; for in order to reach the remaining half, about eighteen years more are required. At twenty years of age the height is somewhat more than three and a half times that at birth, and the weight about twenty times. Development does not go on at an equal rate in all parts of the body. The lower limbs, small at birth, increase proportionally more rapidly, while the head, relatively large at birth, developes more slowly. The muscular system is gradually strengthened. At the end of the third month the infant is able, if in good health, readily to support its head; at the fourth month it can be held upright; at the ninth month it crawls about the floor; by the end of the year it is able with assistance to step; and between one and two years, at different times, according to its vigor and activity, it acquires the power of standing and walking alone. The periods of greatest and least growth of the child are, on the one hand, spring and summer; on the other, autumn and winter. It has long been known that animals grow more rapidly in the spring than at any other season of the year. This has been attributed to the abundance of herbage they are then able to obtain. It has been ascertained by actual measurement, that children grow chiefly in the spring.

At six months of age the child begins to lisp, and at twelve months it is usually able to utter distinct and intelligible sounds of one or two syllables. The development of the senses and of the mind proceeds gradually. The sense of hearing is more active and further advanced than that of sight. Sounds are appreciated sooner than light or bright colored objects. The next sense which is developed is perhaps that of taste; then follow smell and touch.

THE FOOD OF INFANTS AND CHILDREN.

The diet of children is frequently improper either in regard to quantity, quality, or variety. In 1867, a committee, of which Professor Austin Flint, Jr., was chairman, was appointed in New York city to revise the 'Dietary Table of the Children's Nurseries on Randall's Island.' In the report rendered, attention was forcibly called to the fact that in childhood 'the demands of the system for nourishment are in excess of the waste, the extra quantity being required for growth and development. If the proper quantity and variety of food be not provided, full development cannot take place, and the children grow up, if they survive, into young men and women, incapable of the ordinary amount of labor, and liable to diseases of various kinds. This is frequently illustrated in the higher walks of life, particularly in females; for many suffer through life from improper diet in boarding schools, due to false and artificial notions of delicacy or refinement. After a certain period of improper and deficient diet in children, the appetite becomes permanently impaired, and the system is rendered incapable of appropriating the amount of matter necessary to proper development and growth.'

Charlotte Bronté has drawn, in _Jane Eyre_, a graphic and physiologically true picture of the effects upon young girls of long-continued insufficiency of food. Let mothers bear in mind that proper food cannot be too abundantly eaten by children, and that the greatest danger to which they are exposed arises from defective nutrition. We would again urge the value of a large amount of _milk_ in the dietary of young people. The disorders of the bowels, which are not uncommon in infancy and childhood, are due to errors in diet by which improper food is supplied, and not to an excess of simple and proper nourishment.

We have already given some directions for the preparation of infants' food in treating of 'bringing-up by hand.' In addition to the various substitutes for the mother's milk there mentioned, we wish to note that known as _Liebig's soup_. This great chemist thus describes the method of making it:

'Half an ounce of wheat flour, half an ounce of malt meal, and seven and a half grains of bicarbonate of potass, are weighed off. They are first mixed by themselves, then with the addition of one ounce of water, and lastly, of five ounces of milk. This mixture is then heated upon a slow fire, being constantly stirred until it begins to get thick. At this period the vessel is removed from the fire, and the mixture is stirred for five minutes, is again heated and again removed when it gets thick, and, lastly, it is heated till it boils. This soup is purified from bran by passing it through a fine sieve (a piece of fine muslin), and now it is ready for use.'

Barley-malt can be obtained at any brewery. First, it is separated from the impurities, and then ground in an ordinary coffee-mill to a coarse meal. Care should be taken to get the common fresh wheat-flour, _not the finest_, because the former is richest in starch.

In practice, the troublesome weighing of the materials may be dispensed with, as a heaped table-spoonful of wheat-flour weighs pretty nearly half an ounce, and a like table-spoonful of malt-meal, not quite as heaped, weighs also half an ounce. The bicarbonate of potass can be obtained from the druggist put up in powders of seven and a half grains, each ready for use. The amount of water and of milk prescribed can be attained with sufficient accuracy by means of the table-spoon; two table-spoonfuls will give the quantity of water (one ounce), and ten table-spoonfuls the quantity of milk (five ounces). These directions will enable any sensible mother to make the preparation without difficulty. The soup tastes tolerably sweet, and, when diluted with water, may be given to very young infants.

Although the method of preparing Liebig's soup is a somewhat tedious one, yet, as it is a combination which has long been so highly recommended by physicians of the largest experience for having visibly saved the lives of many wasting children, it deserves a trial in all cases in which the ordinary kinds of food disagree.

On page 276 are recorded the directions given by Dr. J. Forsyth Meigs for an article of diet, consisting of gelatine and arrowroot, which he prefers to all other kinds of artificial infant food. Another method of preparing a useful arrowroot mixture is as follows:--

Place a tea-spoonful of arrowroot in a porcelain vessel, with as much cold water as will make it into a fine dough; then add a cupful of boiling milk or of beef-tea; stir the mixture a little, and allow it to boil for a few minutes until the whole acquires the consistency of a fine light jelly.

The _manner_ in which nutriment is administered to infants is not immaterial. The custom of feeding them from a small spoon, or from a cup with a snout, is objectionable. The use of a sucking-bottle most nearly imitates the way in which nature designed the nursling to obtain its nourishment. By the act of sucking, the muscles of the face are exercised in an equal manner, and the saliva is mixed with the food to an extent which is not possible if any other mode of feeding be resorted to. Children drink very readily out of the perforated rubber nipples, which are now so popular for this purpose: they are made to fit over the mouth of the bottle, and are especially to be recommended on account of their cleanliness. The bottle should never be refilled until both it and the rubber cap have been thoroughly cleansed in warm water. A white glass bottle only should be employed in order that any want of cleanliness may readily be detected. It should be recollected that milk very quickly sours when kept in this way in a warm room; it is therefore better always to empty the bottle and fill it afresh each time it is given to the child, rather than to wait until its contents are exhausted before replenishing it.

We have hitherto been treating mainly of the diet proper for the first year of life. In the second year children may be permitted to have soft, finely-cut meat. Fresh ripe fruit in season ordinarily agrees excellently well. But boiled green vegetables and husk fruits are very apt to cause indigestion and diarrhoea. Fruit for children should be freed from the stones and skins; which latter are indigestible, and often do harm.

As an example of a diet suitable for a child two years of age we append the following:--In the mornings, between six and seven o'clock in summer, or between seven and eight in winter, milk-gruel; between nine and ten o'clock, a piece of wheat bread with a little butter on it; at twelve o'clock, well-prepared beef-tea, or chicken, lamb, mutton broth, or meat with a little gravy; or in place of the meat, a meal-broth prepared with eggs, but with very little fat; green vegetables to be allowed very rarely, and in very small quantities. At this noon meal a mealy well-mashed potato is unobjectionable; so also is rice pudding for a change. In the afternoon, between three and four, bread and milk, with the addition in summer of fresh ripe fruit; in the evening, at seven, bread and milk.

It will be observed that this dietetic table calls for five meals a day. Should the child eat so frequently? We answer yes. But the meals should be at regular intervals. A child, in order to replace the waste of the system, and to furnish over and above sufficient material to build up the growing body, requires a much larger proportionate amount of food than an adult. It also requires its food at shorter intervals. By observing the hours for meals stated above, _regularity_, which is of so much importance to the health of the digestive organs, will be secured. If a young child be allowed only the three ordinary meals of the family, it will crave for something between times, and too often have its craving met with a piece of cake or other improper food. Its appetite for dinner or supper will in this manner be destroyed, and the stomach and the general health suffer.

After the third or fourth year children are able to eat all kinds of vegetables. They may then very appropriately be allowed to eat at the table with the family. It is only necessary to refuse them very salt, sour, and highly-spiced victuals. Of all others they may partake in moderation. Neither wine nor any malt liquor should be given them. Tea and coffee are also, to say the least, unnecessary. They should have a regular luncheon between the meals which are furthest apart. This must be at a regular hour, and consist of bread and butter, with milk or water.

Pains should be taken to see that children do not fall into the habit of eating rapidly. Too often this pernicious habit, so destructive to healthy digestion, is formed in early life, and becomes the source of that dyspepsia which is the bane of so many lives. Food that is gulped down enters the stomach unmasticated, and unmixed with the secretions of the mouth. A dog may bolt his food without injury, but a human being cannot.

A child should be taught to eat everything that is wholesome, and not be permitted to become finical or fastidious in its appetite. It ought not, however, to be forced to eat any particular article for which it is found that there is an invincible dislike. Variety of diet is good for a child, after the second or third year.

THE POSITION OF THE CHILD WHEN FED.

An infant, no matter how young, should not receive its meals when lying. Its head should always be raised in the nurse's arm, if it be too young to support it itself. The practice of _jolting_ and _dandling_ the infant after eating is a wrong one. Rest of the body should be secured by placing the child on a bed, or holding it on the mother's knee, for a half hour or so. Observe the inclination which all animals show for repose and sleep after a full repast, and respect the same inclination in the infant.

In our remarks upon bathing we pointed out the importance of the mother herself performing for her child this office. So again, in connection with children's food, we must notice the necessity of the mother being always present at their meals, in order that they may be taught to take them quietly, with cleanliness and without hurry. Such advice is not needed by the poor nor by women of moderate fortune, who ordinarily have their children constantly under their eyes. But affluence brings with it many occupations which are frequently deemed of more moment than presiding over a child's dinner.

CONCERNING SLEEP IN EARLY LIFE.

There is a natural desire for much sleep during infancy, childhood, and youth; and there is reason for its free indulgence. Infants pass the greater portion of both day and night in sleep. Children up to the age of six years require, as a rule, twelve hours of repose at night, besides an hour or more in the middle of the day. About the sixth year the noon nap may be discontinued, but the night sleep ought not to be abridged before the tenth year, and then only to a moderate extent until the age of puberty. From this time the period of slumber may be gradually reduced to nine or ten hours. No further diminution should be attempted until the completion of growth, when another hour or two may be taken away, leaving about eight hours of daily sleep as the proper amount during middle life.

It is wrong, therefore, to wake a young child in the morning. It should be allowed to sleep as long as it will, which will be until the wants of the system are satisfied, if it be not aroused by noise or light.

When after a few months the infant is awake a considerable portion of the day, it should be brought into the habit of taking its second sleep near the middle of the day, say from eleven to one o'clock, and again, from half an hour to an hour, about three o'clock. It should not be permitted a nap later than this in the afternoon, as it would be very apt to cause a disturbed night. Although some physicians recommend that the sleep during the day be discontinued after the infant has attained the age of fifteen months, the wisdom of such advice may well be doubted. As soon as the child begins to walk, not only are its movements very constant and active, but its mind is busily employed and its nervous system excited. It therefore thrives better if its day be divided into two by sleep for an hour or two.

_Should the infant sleep alone?_--We have mentioned the danger of being overlain to which it is exposed when in bed with its mother or nurse. On the other hand, it must be remembered that an infant keeps warm with difficulty even when well covered, and that contact with the mother's body is the best way of securing its own warmth. Hence, during the first months the child had better be allowed to sleep with its mother. How, then, can the risk of being suffocated, which is no imaginary one, be lessened? The following rules are those given by a physician of reputation, to prevent an infant from being accidentally overlain.