Health in the Nursery.
by Frank Godfrey, Esq., M.B.
Volume 11, 1900, pgs. 19-27
"A healthy infant requires nothing more than a proper amount of healthy milk from its mother, and on this it will grow and thrive, and all the vital processes will be properly carried out. It is, I consider, the bounden duty of every healthy mother to nurse her baby if she can, and nothing but physical incapacity or the sheer exigencies of life should prevent her from fulfilling that duty."
Lecture delivered before the Leeds Branch of P.N.E.U., Feb. 16th, 1898.
Upon the proper care and nurture of the young plant and animal depend its future health and strength. The tender plant, protected from withering cold, warmed and gladdened by sunshine, and duly watered, will grow into the vigorous shrub or noble tree; but if it be deprived of sunshine, if it be nipped by chilling wind or biting frost, it receives a check from which it may never recover, and which leaves it for life stunted, dwarfed, and ill-developed.
Similarly the young animal which, under favourable conditions of health, thrives and grows into the robust adult, will, under adverse circumstances, be rendered puny and weak, unfit to fight its way among its more study fellows, and it will early fall a prey to enemy, disease, and death. And so with the young of the highest animal: man. His after life, and health, and strength depend very largely upon the care bestowed on him during infancy and childhood; ignorance or neglect of the laws of health on the part of his parents; administration by them of insufficient or improper food; the practical application to his small body of fads, as regards clothing and exposure, which they espouse, may set a seal upon him, which he has to carry with weak and faltering steps through a life of suffering to an early grave. But, on the other hand, the child on whom his parents bestow proper care, and for whom they exercise prudence and common sense, will reward them by growing up to manhood physically and mentally robust and healthy, fit and able to take his place in the battle of life, and to rise, maybe, to greatness and renown.
Think for a moment what this means to those of us who are privileged to be parents, how great is our responsibility, how solemn the charge with which we are entrusted, how sinful would be our betrayal of that trust, and how great may be our reward. We are guardians to our children for their health, we are responsible to them that they be safely piloted through the period of life when they are unable to do for themselves, and launched on the ocean of life in a fit state to face its storms. More than that, we have a national duty entrusted to us as well, for is not the national life and vigour but a compound of its individuals? Let us see, then, very simply and shortly, how we may best endeavour to fulfil these great obligations.
Now, the proper growth and development of the young animal organism depend upon four main external factors--Food, Air, Warmth, and Sunlight, and I propose to sketch for you how these important conditions may be best secured for children.
Firstly, Food. This is, in itself, of sufficient magnitude to form the subject of an entire lecture, and I cannot attempt to deal with it anything like fully to-day. We must clearly realize what food is, and for what purpose food is required. In the human organism, as in all living structures, certain processes are being constantly carried on--growth, development, decay, and repair. Growth, development, and repair are, so to speak, gains from without, and the purpose of food is to supply these gains. In children, not only have the tissues to be kept in repair, but growth and development are also going on apace in the formation and building up of new tissues and organs. It is on the proper building up of these new tissues and organs that the after-life and health of the child depends, and the material which is chiefly concerned in their structure is food. Now, food consists of five great essential elements:--
(1.) The Nitrogenous Elements, so called because their chief constituent is Nitrogen, and these are found chiefly in animal foods, such as albumen, or white of egg, caseine and curd of milk, and the flesh and juice of meat. They are of first importance, for from them are formed muscle, brain, nerve, and most of the other vital tissues.
(2.) The Hydrocarbons or Fats, which take their share in the development on many important structures. These are largely concerned, and please to note this very carefully, in the formation of bones and teeth; they also provide, to a large extent, the fuel from which the body heat is generated and maintained, and in children more especially the maintenance of heat is vital. Indeed the importance of fat in the young animal organisms cannot be over-estimated.
(3.) The Carbo-hydrates, starch and sugar, are fat producers, they aid in the development of the various tissues, and are also consumed as fuel for the generation of heat.
(4.) The Mineral Constituents, such as salts of lime, potash, and iron, help in the formation of the hard tissues of the body, the bones, and teeth; and lastly--
(5.) Water, which is required for the liquefying of the blood, for the conveyance of nutriment to the different parts of the body, for the carrying off of waste products from the system, and for the restoration of tissue.
These then are the essential elements of food, for infants as well as for adults, and for the former, they are all contained in their proper relative proportions in human milk, which must be taken as the type of infants' food.
The composition of human milk is as follows:--
Nitrogenous Elements . . . 3924
Hydrocarbons or Fats . . . 2666
Carbo-hydrates . . . 4364
Mineral Matters . . . 138
Water . . . . 88908
100000
The Nitrogenous Elements are represented by the caseine or curd; the hydrocarbons by the cream; the Carbo-hydrates by the sugar of milk; the Mineral Matters by salts of lime, potash and iron; and, lastly, there is a large amount of water. A healthy infant requires nothing more than a proper amount of healthy milk from its mother, and on this it will grow and thrive, and all the vital processes will be properly carried out. It is, I consider, the bounden duty of every healthy mother to nurse her baby if she can, and nothing but physical incapacity or the sheer exigencies of life should prevent her from fulfilling that duty. I have no sympathy with the lady of fashion who allows the claims of society, or the attentions of pleasure-seeking, to interfere with her duty to her offspring, and one would fain hope that the recent noble action of a young royal mother, who sturdily took her stand upon her motherhood and set custom at defiance, might awaken a similar instinct in some of the mothers among our better classes. If an infant be not naturally fed, it becomes dependent on artificial substitutes for its natural food, and the moment you begin with these, you open the door to numberless opportunities for evil. I do not for one moment say that a perfectly efficient artificial food is not obtainable; most certainly it is, but that food must resemble human milk in composition, and it must be kept free from decomposition and infectious germs. And how are we to attain this? By giving raw cow's milk diluted largely with water or barley water or other fluid, as is so often done? Most certainly not, unless that dilution be of proper strength and unless elements, reduced by the dilution below their proper standard, be added. Cows' milk diluted with two parts of water, as is usually done in early infancy, is not an efficient food, as you will at once see by a glance at this table.
Cows' milk, diluted with two parts of water:--
Nitrogenous Elements . . . 1'801
Hydrocarbons . . . 1'435
Carbohydrates . . . 1'345
Salts . . . '182
Water . . . 95'237
It is sadly deficient in that very vital element fat, it is also deficient in sugar, and in curd or caseine, the flesh-forming element. It is a food far below the proper standard. Its curd, too, is more dense and hard that that of human milk, and all these defects must be remedied. And how can this be done? We can supply the deficient fat by adding cream, one or two teaspoonfuls to the feed; we can make up the proper amount of sugar by the addition of white sugar, or better still sugar of milk; we can bring the Nitrogenous element up to its proper standard by adding a little raw meat juice. We can further render the curd lighter and more digestible by boiling or sterilizing the milk.
For those of us who can afford it a most excellent and perfect substitute can be obtained from the Aylesbury Dairy Company, or some of the better known dairy companies,--the Humanized Milk.
The vast majority of the patented infants' foods, excellent though they may be in some respects, are deficient in that very vital element fat; and that favourite food with many, condensed milk, is, from a food point of view, a hollow sham; it should never be given, save to tide over a temporary difficulty.
In selecting an artificial food for our babies, we should proceed on proper lines; we should ascertain from some one who knows, or from some written authority, what form of food will best represent the natural one; and even if we have to apply to a doctor for information, it will cost us less than having to call him in to remedy the results of improper feeding.
The great dangers of artificial foods prepared with milk are those of souring, of decomposition, and of the conveyance of disease germs. Souring, as you know, sets in very rapidly, especially in hot or thundery weather, indeed it may be said to commence almost as soon as the milk is drawn from the cow. The germs of some infectious diseases are not at all uncommonly introduced in milk to which they have gained access, germs of typhoid and scarlet fevers, of diphtheria, of cholera, and most deadly of all, of turbercle. This last disease is very common in cattle, often existing before any active evidence of its presence be noticed; and the milk drawn from a turberculous cow may readily produce consumption or other form of tubercle in the child who drinks it.
These dangers which, mark you, are very real ones, may, to a very large extent, be counteracted by boiling or by sterilization, and milk used in the nursery should always be subjected to one or other of these processes directly the milkman leaves it at the house. It matters not very much which process be adopted, boiling is quite efficient, sterilization is more recent and more fashionable, and it has the advantage that milk so treated does not acquire the taste, objectionable to many children, of boiled milk.
There are many forms of Sterilizer now before the public, which can be bought at the cost of a few shillings, and of these, that known as "Aymond's" is, from its simplicity, probably the best.
An infant under four months old has no power of digesting starch, and to give it starch-containing foods such as arrowroot, sopped bread, or gruel is to give it that which it cannot digest and which may do grave harm. I wish this fact were more generally known, specially by self-opinionated old nurses.
Perfect cleanliness in all vessels and bottles in which children's food is kept and given is absolutely essential, and cannot be too carefully supervised; and all glass and rubber tubes, mouth-pieces, etc., which cannot be thoroughly cleansed, must be carefully avoided. Many a grave illness has its origin in a dirty bottle or foul rubber tube. And foul these tubes will get in spite of all one's care; they are the cause of a vast amount of infant illness, and cannot be too strongly condemned.
Children's meals should be regular, simple and ample. Too frequent feeding, stuffing with cake, sweets, or fruit, between meals, the giving of unwholesome food, of jams in excess, curries, or savouries, and the like, will tend to intestinal disorder and ill-health. If a child be plainly, sufficiently, and regularly fed, it will not require food between times. The stomach, like every other organ, requires its periods of rest, and it should have them. Every child should be allowed to eat as much as it wants at meal-times; if the food be wholesome and not hurried over, the child may safely be left to satisfy its appetite without fear of repletion, and to deny a second helping to a hungry child is a cruel mistake.
We are sometimes apt to forget too that children, specially infants, are liable to be thirsty, and to think that milk will satisfy thirst. Milk is a food, not a drink, and water is what they want, pure wholesome water. It is an essential, and it serves an important purpose in the economy. In summer-time a little lime or other fruit juice added to the water is agreeable and advantageous.
It cannot be too strongly insisted upon that children do not require alcohol in health. It is in no sense a food, and it is a powerful drug which is capable of doing irreparable harm. Occasionally it is of great service as a medicine, but only occasionally, and it should never be given except under medical advice.
The public are far too apt to give, and to advise their friends to give, wine and other forms of alcohol to themselves and to their children, in the vain belief that they are feeding and strength-giving, and capable of "building you up," as it is called; and one is apt to be led away by the specious advertisements of the various forms of medicated wines, which their manufacturers would have you believe contain the elixir of life, or something very nearly allied to it. It has become the custom with many people to give these medicated wines to themselves and to their children as a tonic. Even some total abstainers have been known to use them, under the delusion that they are non-alcoholic. There never was a greater mistake. These medicated wines, the demand for which is shewn by the large amount of space they occupy in the advertisement columns of the daily papers, and by the prominence given them in the windows of many grocers and chemists are, I consider, the curse of the age. They are potent intoxicants under the cloak of medicine, and many of them contain strong narcotic poisons in addition to bad alcohol. Of them all, coca wine [akin to cola?] is the chief sinner. Some of the forms of coca wine are made from the coca leaves themselves; others, and I fear the majority, from the drug cocaine, a narcotic quite as insidious and quite as deadly in its effects as morphine. The dangers of such a wine are obvious, more especially if taken when the system is weakened by recent illness, for not only does the patient acquire a liking for alcohol, which is presented in a seductive form, but he soon falls a victim to what has aptly been termed the third scourge of humanity the cocaine habit. It is high time that stringent steps were taken by our legislature to put a restriction on the manufacture and sale of all medicated wines. And may I digress a little further, to condemn the most cruel and wicked practice of supplying alcoholic drinks at children's parties: claret cup, port wine negus and the like. It is done, and it cannot be too strongly denounced. Who knows what poor child may not inherit an inebriate crave, and what dire evil may not result. I do not stand here as a teetotaller to denounce alcohol all around, but I do think strong speaking is necessary in this regard.
Many children are allowed too long a fast during the night time, and suffer in consequence. It is too long for a young child to go from tea at, say, six until breakfast at eight on the following morning. Infants, of course, are fed in the night. Older children, if awake, are all the better for a little milk at eight or nine at night, and as all children are like the birds, early astir, it is a wise plan to let them have some bread and butter or milk by their bed-side to eat on first waking in the morning.
I have already spoken about the need for fat in infancy and childhood, and I would like again to enforce it. Its importance cannot be over-estimated, and is shewn by the very large proportion of fat contained in human milk. On the fat depends, as I have said, two very important conditions, the maintenance of animal heat and the development of the bones and teeth. Without fat, the body heat falls below its proper standard; without fat, the bones and teeth are ill-developed, and rickets and dental decay ensue. Some years ago a series of very interesting experiments were conducted at the Zoo on the feeding of young carnivorous animals, the result of which was to prove that those from whose food fat was excluded rapidly developed rickets. In infancy, fat may be supplied in the form of cream, in childhood as cream, as butter, as meat fat and as bacon drip. Many children naturally dislike fat, and if so it is cruel to force them to eat it. By carefully mixing it with mashed potato, or by giving it in the form of light suet pudding, it will generally be taken without demur.
Next as to Air. Children require air in abundance, and, deprived of plenty of fresh air, they soon flag and become pale and listless. Witness the children in our crowded centers of population. I am often astonished at the marvelous change in the child from some large inland town, whose home is in a confined neighbourhood, after a week on our Scarborough sands. The pale face, the want of appetite, the lack of "go," the frequent complaint "I am so tired," give place to rosy cheeks, to bright eyes, to a voracious appetite, and to an energy almost untiring. We have all felt the same thing, have we not, when wearied by work and much confinement to the house, we have sought the moors and stretched away over them, rejoicing in our new-found strength and reveling in what poor Lindsay Gordon described as "God's glorious oxygen."
Let your children have as much fresh air as possible, both inside and outside the house. Let your nurseries be large and airy, and airiness should be obtained without draught. In summer, keep the top windows freely open. In winter, suitable methods of ventilation may be arranged; or, where such do not exist, the desired result may be obtained by the well-known plan of putting a board under the raised lower sash of the window, and allowing air to enter the room through the space between the top and bottom sash. The air thus enters high above the occupants' heads and is diffused over the room insensibly. Draughts may be met by putting draught protectors under the door, and by setting suitable screens to, as it were, break them up. This question of ventilation applies to the night nursery probably with even greater force than to the day, for our children spend more time there. After the children leave the night nursery in the morning, the windows should be widely opened, the bed clothes all turned up, and its contents thoroughly flushed with fresh air.
The more children are out of doors, the better; nothing but bad weather should prevent them from getting out for as much of the daytime as lessons and other circumstances will allow. And talking of lessons, do not allow lessons to occupy the best hours of the day. The morning air is best because fresher and purer than any other, and we should get our children out during the morning if possible. Lessons are much better mixed up with periods of recreation than carried on continuously for several hours. In one large public school, justly celebrated for the physical and mental health of its pupils, the boys are turned out for fifteen minutes between each class, and the bulk of the work is done before eleven and after three o'clock. The young brain must not be overstrained by too much study. It is a delicate organ, the brain, though hidden away and intangible; but it is the dominant organ of the whole system, and anything that impairs its health reacts throughout the system. We are, some of us, apt to forget that our hidden and unfelt organs are subject to the same fatigue as those we know more about. We realize muscular fatigue quickly enough, and we rest the tired muscles; we know when the eyes tire with much reading, and we put the book away for a period; when the heart is beating too quickly from over-exertion, we cease the violent exercise. But do we in the same way seek to avoid over-fatigue of the brain, do we give it always the rest and relaxation it so urgently needs? The headache produced by long study; the general feeling of weariness for which we cannot account; are not these evidences of brain fatigue, and should we not so regard them? They should above all be most carefully watched for in childhood, and most carefully guarded against.
(To be continued.)
Proofread by LNL, Jul. 2011