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The Parents' Review

A Monthly Magazine of Home-Training and Culture

Edited by Charlotte Mason.

"Education is an atmosphere, a discipline, a life."
Nursery Hygiene *

by George B. Batten, M.D.
Volume 7, 1896, pgs. 592-602

*A Lecture given to the Dulwich Branch of the Parents' National Educational Union, in February, 1896

Mr. Chairman, Ladies and Gentlemen, you must please forgive me for not reading you a very erudite paper. Some months ago I intended to read the subject up; like many other good intentions I have not carried this one out, and, in fact, I have had no time to read about it at all. I venture, however, to think that perhaps there will be an advantage in putting before you my own opinions on this occasion, as it will probably cause some of you to differ from me, and so lead to more discussion than if I laid before you the opinions of some great recognised authority or authorities on the subject.

By Nursery Hygiene, or Hygiene of the Nursery, I understand and mean those conditions of the environment of children which tend to keep them in that blessed state of physical well-being which we call health. I wish to consider these conditions under five main headings, which, in my opinion, are the five most important factors in a child's health.

1. Fresh Air.
2. Suitable Food.
3. Freedom of movement.
4. Cleanliness.
5. Regularity in all things.

As you will see by this table, I subdivide these headings thus:--

Fresh Air. {Situation of House. Aspect of Nursery. Air Space. Ventilation. Warming.}

Suitable Food. {Infant Feeding. Artificial Mother's Milk. Fat very necessary. Drinks.}

Freedom of Movement. {Baby Clothing. Children's Clothing. Exercise.}

Cleanliness. {Cleaning Rooms. Washing Children. Washing Clothes. Infection.}

Regularity in all things. {Food. Sleep. Natural Functions. Exercise of Body and Mind. Nerves. Being Consistent.}

Now taking up these matters in detail:--Fresh Air. We all believe in fresh air in the abstract, but how many of us do our best to ensure as plentiful a supply of it as possible for our children? First, as to the house we live in; as our children are to most of us our most precious possession, let us choose a house in as healthy, airy, dry situation as possible; a house, though it may be sheltered perhaps from the east wind, yet where the fresh breezes, the blessed air of heaven-"God's air," as it has been classed-can blow freely round it and cleanse it; a house, if possible, in the country; a house, at any rate, with a fair-sized garden, not a garden all beds and flowers, but a garden with plenty of open grass space whereon the children may play freely; a house with a good aspect; a house into which the sunshine can freely enter-i.e., with windows of children's rooms towards the south, south-east, or south-west; a house chosen not for the grandeur of its reception rooms so much as for the large size and good aspect of its nurseries, wherein our most blessed possessions, our children, may grow up healthy and strong; a house-last but not least-a house really well and efficiently drained.

As to Air Space: A healthy adult requires some 3,000 cubic feet per hour for breathing, and a child not much less. To ensure this without draughts one should have 1,000 cubic feet of space per person, and for rooms constantly occupied day and night, we should see that this is obtained; but we seldom can get so much space, and in rooms not constantly occupied as much as this is hardly necessary, but it should be over 500 cubic feet per person. For instance, for four children or three children and a nurse, a room of 14 ft. by 15 ft. by 10 ft.-2,100 cubic feet is smallest that should be used. There should be a separate nursery for day and night; and don't fall into error of supposing that any room will do for the children to sleep in. The night nursery should be one of the best and most easily ventilated rooms in the house, and we should open all the windows wide and pull up all the blinds, and expose all the bed-clothes to fresh air and sunshine nearly all the day when the children are not in it, and at night keep one at least of the windows open a little at the top.

The day nursery, also, should be an easily ventilated large room; and this brings me to Ventilation. How to ventilate thoroughly without creating any draught in medium-sized rooms is, I fear, still one of the problems of the future. We can aim in this direction, however, first, by having some sort of cross ventilation possible in our nurseries, able to be used, at any rate, when children are not in them; secondly, having well-arranged fire-places; thirdly, placing a screen, or screens to break up currents of air near the inlets of fresh and cold air, and by employing some form or modification of Tobin's tubes, which direct currents of cold air upwards to mix with hot air towards top of room, as by the well-known and useful device of putting and fitting a piece of wood under bottom sash of a window so as to raise it some inches, letting air in between the sashes.

As to Warming Nurseries: Personally I prefer our English methods of open fire-places, or open gas stoves, which heat by radiation, rather than the German and Continental method of heating by closed stoves, which heat the air of the room by convection. There always seems to me a fresher, cleaner feel in a room warmed by radiation, than in one in which the air is warmed by closed stoves. One reason is that open fire-places create more currents of air, and so cause better ventilation. They also, thereby, are more apt to cause draughts, and so screens and other means should be used, as already mentioned, to break up these currents of air. Also, children should not be encouraged to sit close to fire-places, or they will be very apt to catch cold, by having the front half of their bodies warm, and their backs and sensitive spines cold. Also, I believe, that unless children are actually ill, it is better in this changeable climate of ours to accustom our children to these changes by not keeping the whole house at one temperature-i.e., not to try to keep passages as warm as the rooms. If we had the steady cold climate of Canada, and some parts of the Continent, I think equable warmth all through the house would be better, but we have not. If we use the cleanly and convenient gas stoves, or gas fire-places, we should have them arranged so as to evaporate some water into the rooms, as they otherwise make the air too dry.

We now come to Suitable Food: First as to infant feeding. There have been volumes written on this subject alone, and no doubt it is a most important one. But there is no doubt that the most suitable food for an infant mammal is its healthy mother's milk, and the mammal Human infant is no exception to this rule. But if from any cause, as illness of its mother, deficient milk supply, or any other such reasonable cause, we cannot obtain its own mother's milk for it, then we must fall back on another's healthy mother, or fall back upon one of the many artificial forms of feeding. Now which of all the so-called best foods is the best? Well, I venture to say, that which approaches most nearly to human mother's milk is the best. How are we get this desideratum? Asses' milk comes nearest to it among natural milks, but asses' milk is not easy to get. Cows' milk differs from mother's milk chiefly in that it contains comparatively more curd and less sugar; and that by the time we get it, it is slightly acid instead of slightly alkaline. To obviate this, some add water or barley water to dilute the curd or caseine, and add sugar to make up, and this will often do well, but it dilutes the all-important fat or cream too; and, I think, it is a much better way to take away the surplus curd from fresh cow's milk, add sugar of milk to make up deficiency of sugar, and neutralize the acidity by adding lime-water or a little bicarbonate of soda. I will show you how easily this is done. Demonstration:

Artificial Human Milk.-Add to 2/3 pint of new milk, the cream removed from another 1/3 pint after standing 12 hours. Curdle this 1/3 pint of skimmed milk, after heating to blood heat, with a square inch of rennet, or a teaspoonful of essence of rennet. Break up the curd frequently, and separate the whey, which heat to boiling point, removing the curd which is thus separated. Dissolve 2 teaspoonfuls of sugar of milk in the hot whey and mix it with the 2/3 pint milk containing the cream of the other 1/3 pint. Should this be the least acid, add 2 to 4 oz. of lime-water, or from 5 to 20 grs. of bicarbonate of soda. Or another way, which comes to the same thing almost, is a mixture of following: new milk 30 parts, cream 1 3/4 parts, milk sugar 1 1/8 parts, water 18 parts.

If we are sure the milk is from healthy cows, I believe a mixture of milks is more likely to suit for a lengthened period than the milk of one cow; and if we are sure that the milk has not got sour or contaminated by disease germs during its travellings from cow to child, then we had better not boil the milk, as it is, I believe, more digestible not boiled; but this is still a debated question. But if we are not sure, it is safer to boil the milk, or to sterilize it in some way. We can buy this all ready done in the humanized sterilized milk sold by the Aylesbury Dairy Company, but somehow this does not always agree with all children, and is comparatively expensive. How can we do this ourselves? The most complete way is with such an apparatus as the Soxhlet Apparatus-which I have here-it looks complicated, but it is really quite easy and convenient to use. One takes the artificial humanized milk, prepared as already described, in sufficient quantity for twenty-four hours, and fills these bottles, or as many of them as the baby will want meals in the twenty-four hours, up to the shoulder-three different sized bottles are supplied for different ages. Each bottle is covered with one of these rubber discs, which are kept in place with these metal caps. The bottles are, as you see, in a metal frame, which is placed in this saucepan, which is filled with cold water up to the level of milk in the bottles; the lid is put tightly on, and water is brought to boil, and allowed to boil for three-quarters of an hour-as a matter of fact, the milk need not boil, as if it is kept at a temperature of over 170 degrees Fahrenheit for two hours it will sterilize it quite as well, and it will be more digestible, and of nicer taste, but in practice the milk usually does boil.

The frame, bottles and all, are then taken out and put in a cool conventient place; as the bottles cool the rubber discs are partly sucked down into the necks, becoming concave on the top, and securely prevent any air from getting into the bottles. Now, when we want to feed baby, we simply take one of these bottles, take metal cap off, and place bottle, rubber stopper and all into this little saucepan, which has a false bottom to it, and which is fitted with cool or warm water-quite hot will crack a cold bottle-and warmed over fire or spirit lamp. Then after ascertaining that milk is hot enough-blood heat-by applying bottle to one's forehead, the rubber stopper is taken off, and this large rubber teat is put on, and given at once to the baby. In this way one avoids all risk of contamination, and these teats can be turned inside out and easily kept clean, and there are no nasty indiarubber tubes, &c., to get foul.

Another simpler method of sterilizing is simply to put the artificial mother's milk into one large clean bottle with a loose rubber or a clean cotton-wool stopper in it; put this into a tall saucepan or jug with warm water in it, and boil this water for some time, and then place bottle in a cool spot. Then, when we want to feed baby, take stopper out, and without laying this down, pour required amount of milk into a "Soxhlet" bottle, or some sort of boat bottle with large rubber teat fixing directly on to it. Then replace stopper in large bottle, and warm baby's bottle as already directed. This is not quite so ideal as Soxhlet's Apparatus, as milk may be contaminated by air each time we take out stopper, but with care this is not practically likely to occur. Of course we must keep everything very clean inside and outside.

As to Patent Foods and Condensed Milks: They all err, I believe, in not having enough cream or fat in them, it being very difficult to condense fat or cream in any way without altering its nature. Milk, good milk, ladies and gentlemen, milk suitably prepared, should be the almost exclusive diet of infants until they get some teeth, then you may give them a little oatmeal, wheaten flour, or some form of biscuit meal or such like, but still with milk, not instead of it. When children have most of their teeth, give them food that requires biting, but not till then. Nearly all the advertised baby foods consist chiefly of starch, which a baby, if under three months old, cannot digest properly. Why even the strictly vegetarian cow does not offer starch to its infants, the calves, nor does the cowman try to do so, but how often do human omnivorous mothers unscientifically offer useless starch to their babies? As well ask us adults to flourish on a hay diet as to give a young baby starch. As babies grow older give them a more mixed diet, but still with plenty of milk in it, and I repeat again, give all children enough fat, which does not mean too much fat, and does not include insisting on a child with its appetite satisfied being made to eat remnants of fat on its plate. Of fats, probably butter and cream are the best, especially butter, which if good hardly ever disagrees with anybody. Bacon fat is also good.

Now as to Drinks: Unless they are ill, and your doctor order otherwise-remember I am speaking of healthy children and how to keep them healthy-unless ordered otherwise, make your children avoid alcohol altogether. Remember also that milk is a food chiefly and not a drink, and even young babies require cold water to drink to satisfy their thirsts. Older children may have fresh lemon juice, lemonade quite weak, and best made with thin fresh barley water, also barley water alone, apple water, toast water, &c. Don't, however, let them get into the habit of always being thirsty, and drinking at all times even of water, as when they grow older they may continue the habit of often drinking, not of water, but of stronger drinks. Lead them not into temptation.

Freedom of Movement. To grow or keep strong a baby or child must be able to move. If a child who is awake keeps quite still, it is probably because it is ill, or because it is so swaddled and tied up that it cannot move. 'Then it cries; then many mothers feed it to stop its crying, this means overfeeding it; then it gets the wind; then it gets indigestion, and then the doctor is sent for to regulate its diet. Therefore don't swaddle up your babies, unless you wish to give us doctors work Let the babies expand their chests, their abdomens, and move their limbs freely. Avoid all stiff binders, wrapping-vests, stays, &c., and let the babies breath freely, suck freely, and kick freely. Why do many mothers and nurses put binders around babies' chests? I don't know, unless it is because their great-great-grandmothers did-and they do. The chief reason they give is "to support their dear little backs"; to which I answer their backs do not want any support, unless you handle them and sit them up carelessly, or your nurse or elder child does; to strengthen their backs, forsooth! If I tied your back or arm up in a splint or tight bandage for a month, would it be weaker or stronger at the end of that time? It would be so weak you could hardly use it, and so is a baby's back weaker if you prevent, or partly prevent it, using its important spinal and back muscles. As to another reason given. It gives you something to catch hold of. I answer, then you prefer a bundle to a baby! We must keep our babies and children warm. How are we to do this and give them freedom of movement also? Keep your babies equally warm all over-that is to say, equally covered up all over except their heads and hands. Not eleven layers around their chests and middles, and nothing practically over their abdomens and legs. I will show you my method of dressing babies; it is slightly modified from a common Australian method. It consists chiefly of two to four garments, which are open all the way down the back, and which can all be put on and taken off at once. As to details: for the first month or so after birth, it is better for obvious reasons to support babies' abdomens in front to prevent rupture of the navel when crying or otherwise straining. If the chest is allowed to expand freely there is less chance of this-nevertheless, how are we to support the constantly moving abdominal wall which moves in and out thirty to forty times a minute as the baby breathes? Surely not by an inelastic flannel or stiff binder, but by something elastic, which moves in and out with baby's body. I devised some years ago a binder, the back of which is made of inelastic flannel or swansdown, and the front of very close carefully-done elastic knitting, and I have known this used for many babies with excellent results; but recently I have got hold of a new material which does as well, it is Ickringill's elastic cloth. This material is warm, elastic, and will wash in cold or warm water. One can put it all round the child as a binder, or better only in front as in my original binder instead of the knitting. I have one here made of this material, it can be made up into such a binder in an hour or less, my wife, who made this, tells me. This material and binders may be obtained fron the Ickringill Elastic Cloth Company, Keighley, Yorkshire.

Now for my clothes. Here with the binder we have four or five garments; (1st) the binder; then (2nd) the little lawn shirt; (3rd) a flannel petticoat or shirt; (4th) a linen petticoat; and (5th) a gown. These all open all the way down the back. The flannel shirt is made with a yoke like a man's shirt, and comes right up to the neck and well down over the feet, and has sleeves to the wrists, and is the essential garment. The outside petticoat or chemise has only armlets, not sleeves, and is not an essential garment at all; and the gown is made like the flannel shirt up to the neck, and with sleeves to wrists. This may be made of any material, and as plain or as ornate as desired, but no scratchy frills, please, at neck or wrists. We dress baby in the following way: Demonstration-This takes less than a minute to put on and half-a-minute to take off. When baby is shortened, we use exactly the same sort of clothes, only shorter, and abdominal binder is left off altogether. No stays, no binders, no swaddling at all, but equable warmth all over. Knitted wool socks should also be used, but nothing tight round feet.

For older children who can run about, and even school girls and boys, the simplest and best underclothing consist of a knitted or some woollen vest; a woollen combination with high neck and long sleeves; a rational petticoat-i.e., a garment which is a bodice and knickerbockers in one, the same shape as a combination in fact, but looser; and then the outside dress of whatever kind is preferred. All these garments may be varied in material and thickness to suit various seasons and climates. Of course, stockings and shoes or boots are to be worn, but take care they fit the foot, not the beautiful feet of children distorted and squeezed to fit the boots or shoes.

As to Exercise: Let all healthy children, from the earliest crawling stage to the running schoolboy stage, have plenty of exercise every day, and out of doors whenever possible. Accustom your children gradually to go out in all weathers if they are well, and not shield them from every cold blast, and so bring them up as delicate hot-house plants, but as study Englishmen and Englishwomen, who can stand our changeable English climate, and any other climate in the world.

The rest of these headings I will condense greatly, as most of details are self-evident.

Cleanliness. Clean and ventilate nurseries, of course, every day.

Washing and Bathing Children: The morning is the best time to wash babies and children, in warm water at first, in cooler water as they grow older. The evening is the best time to bathe children in warm or tepid water, it cools and refreshes them after a day's exercise, and before a night's sleep. If we wash and bathe children daily, it is not necessary to use much soap, except perhaps for their hands. Soap removes natural fat of the skin, and makes children more likely to catch cold, especially after a hot bath.

Washing Clothes: See that clothes are well washed and changed often enough, and let no soda be used in washing garments that come in contact with children's skin, or, at any rate, see that no soda is left in these garments.

As to Infection: I should just like to say that, in my opinion, it is unscientific and bad policy to shield our children from every chance of infection. Nearly all infectious diseases confer immunity after an attack, and not only that, but it is now a well-demonstrated fact that we can get immunised or infection-proof, at any rate to a large extent, by our bodies becoming accustomed to resist certain infections, by being often exposed to small doses, so to speak, of these infections. It is in the physical as in the moral world. Who can resist temptations best; those who have never previously been tempted, or those who have been often tempted and have learnt, or been taught, to resist temptations? The latter, of course. So the child shielded from all infection is more likely-ceteris paribus-to get an infectious complaint when accidentally exposed, then is the child who has often been exposed to infection. Do we medical men, who are exposed to all sorts of infection daily, get infectious complaints more than others? Surely not, if anything it is rather the other way. There are several diseases, however, which do not confer immunity, and which we must guard our children from, the chief of which are erysipelas and tubercle. An attack of erysipelas predisposes to future attacks, and tubercle or consumption in its many forms does the same, or kills the person it attacks. Consumption may be hereditary, but there is now no possible doubt that it can easily be acquired, chiefly by inhaling the tubercle bacillus from the dried sputa of consumptive persons, and also by drinking milk from tubercular cows. Never let your children sleep in the same room or kiss a consumptive person. Take care not to have tubercular nurses and nursemaids.

Observe Regularity in all things. Get your babies and children to live by rule as far as time is concerned, but don't carry this principle too far so as to make it a hardship.

Be Regular in Feeding: Don't feed too often.

Regular in Sleep: Let children have plenty of sleep.

Be Regular in Exercise of Body and Mind .

Above all be consistent and honest and straightforward with your children; if you are not, they will lose their grand faith in you, which loss is often the beginning of the end, as far as a good up-bringing, and often as far as health is concerned. Don't sacrifice the good of the future to the pleasure of the moment.

Don't encourage your children to be nervous, nor too dainty. If you suffer from nerves yourself, do your best to counteract the effect of your heredity in them; don't bring them up nervous too. Counteract a nervous tendency as much or more than you would counteract a gouty or consumptive tendency. In conclusion of this very scrappy lecture, let me read some rather scrappy remarks on Nursery Hygiene from a recent number of a Medical Journal (Medical Times and Hospital Gazette, December 21st, p. 821):--

"Nursery Hygiene. The Atlanta Medical and Surgical Journal contains some very valuable remarks upon this subject, from which we extract the following:-1. Regular habits, proper food, and long hours of sleep are necessary conditions to a healthy infant. 2. The three prime essentials in the nursery are fresh air, good food, and pure water. 3. Never put a bottle nipple into your mouth and then into the baby's; this will often prove dangerous. 4. Always hold a baby in your arms before feeding it, in about the same position as when nursing it. 5. Feeding at night, after the third month, is both inconvenient and unnecessary; sleep at night is better than food. 6. Do not feed a baby because it cries; this may be due to pain, and it is hurtful to fill an infant's stomach at such a time. 7. Have a rule for feeding a baby, and do not vary from it; without regularity the mother becomes a slave. 8. More infants' lives are taken by overfeeding than by starvation. Never liken an infant's digestion or diet to your own. 9. An infant's thirst is not quenched by milk; it needs clean water to drink with regularity. 10. Plain boiled water, given between feedings, will often aid the digestion and satisfy the child when restless. 11. Vomiting and diarrhea are indications that the child is either sick or approaching sickness, and probably needs a doctor. 12. Cholera infantum would be of rare occurrence if proper attention was always given to the quantity and quality of the food. 13. A nursing mother who worries, or who is exhausted, or who indulges in excitement, may become a source of danger to her infant. 14. An infant is a creature of habit, and usually responds to the wish of the mother if the mother has order in her will. 15. Rubber tubes, complicated nipples, and nursing bottles are dangerous, and should never be used. 16. Light and loose clothing, frequent bathing, or cool sponging, are necessities for infants in hot weather. 17. Cleanliness, as applied to the body, the mouth, the food, the vessels, the clothing, the furniture, the floor, the carpets, the beds, and the atmosphere, should be strictly observed.