Part 202
Except in Glasgow, Sheffield, and London, the women are asserted to be totally ignorant and incompetent to meet any difficulty that might arise. In country districts the pernicious custom of giving an aperient to a newly born babe was very general, but less prevalent in London and the large towns. Amongst the married poor, suckling was found to be the rule; and it seemed to be pretty conclusively proved that it is often unreasonably prolonged for eighteen months or even two years, as a preventive to renewed pregnancy. It was found, however, that illegitimate children were rarely suckled, but almost always fed on artificial food. Amongst the married poor also it appears universal to give the children artificial food as well as the breast, and this from a very early and tender age. Further, it was found that the food was generally unsuited to the child both in quantity and quality. It consisted chiefly of bread soaked in water and milk, and sweetened, of arrow-root, sago and corn flour, and such like objectionable substances.
In one case the mother admitted to giving her infant (who was a few months old only) a diet similar to that she herself partook of, viz.--cheese, bread, meat, salt fish, heavy pastry, vegetables and beer. Amongst the upper classes it was ascertained that there is an increasing tendency amongst mothers to discontinue lactation, and to employ instead the services of a wet nurse; and where this was not done, it was found that the food partaken of by the babe was much more judiciously chosen than is the case amongst the poorer women. Mr Curquiven and others observed that a large number of women in London do not suckle their offspring, because of a deficient secretion of milk. It is satisfactory to find that both in the manufacturing and agricultural districts, the children of the poor are so constantly in the open air; but equally unsatisfactory to learn that at night they sleep in ill-ventilated and over crowded dormitories. The infant is encouraged to sleep to the utmost, and should it fail in securing renewed slumber (its waking being attributed to a desire for food), is very often dosed with gin, syrup of poppies, and paregoric. Another plan adopted for keeping infants quiet, consisted in letting them remain in the cradles and allowing them to suck the nipple attached to the empty feeding bottle, long after the food had been consumed; a practice that gives rise to infantile dyspepsia.
As regards cleanliness, it was learnt that poor people's children are tolerably well attended to in this respect, or rather that the baby generally comes in for a larger share of ablution than the elder ones, who are sometimes much neglected in the matter of soap and water. The clothing of the little ones was much too scanty, and this was the case no matter what the season of the year. A prevalent practice, except in the agricultural villages, was that of giving the children cordials, spirits, and medicines.
A still worse custom was found to be the systematic administration of opiates. At Long Sutton, in Lincolnshire, which has a population of 6000, one chemist alone sold 25-1/2 gallons yearly of Godfrey's cordial (a mixture principally consisting of treacle and opium), whilst 6-1/2 pints were got rid of weekly by another chemist in the same town. This administration of anodynes was mostly confined to illegitimate infants, and factory children placed out to nurse. A habit not unusual was that of an intentional deferring sending for a doctor when the child was first seized with illness, medical advice being only sought when in many cases it could be of no avail. Desertion by fathers and mothers of their children, especially of illegitimate ones, as well as concealment of birth and infanticide, were found to be much more general in London and the larger cities than in the country.
The causes of the high rate of infant mortality prevailing amongst the poor, seem very clearly indicated in the above abstract. For instance, the deaths of nearly half the children under one year of age are referable to diarrh[oe]a, convulsions, atrophy, mesenteric disease, and allied disorders; all of which maladies are caused by the grossly erroneous and unsuitable diet upon which the children are fed. In the article "Infants' Food," we have already pointed out that the proper and only safe aliment for an infant up to the age of eight or nine months is the maternal milk, and failing this, the pure and unadulterated milk of the cow; and we have furthermore shown that the admission into the dietary of infants even above nine months old, of farinaceous foods, should be regulated with great caution. Yet we learn from the above report, that in the early days of the infants' existence, amongst the poor the breast milk is in most cases supplemented by large quantities of these very farinaceous matters, which we have shown to be so prejudicial and dangerous. That the deaths from these causes are clearly preventable, in a large measure, if not wholly, is proved by the very much less extent in which they occur amongst the higher classes, who use much greater judgment in the selection of their children's food. Another important factor in the high infant death-rate is the extensive use of narcotics, a practice there is no doubt which yearly carries off a large number of infants, by poisoning, more or less prolonged. Inadequate clothing is likewise another source of mortality amongst the very young, whose tender frames easily succumb to inclement weather, and the sudden changes of temperature occurring in our variable climate. Hence we shall have no difficulty in understanding why pneumonia, bronchitis, &c., should be so prevalent among poor children. The habits of overcrowding and bad ventilation which prevail amongst the poor must also be fertile sources of disease amongst their offspring--the more immediate effect of such violations of sanitary principles resulting in bronchitis. That the extensive recourse by the poor to uneducated and unskilful midwives, also adds to infant mortality, seems indisputable.
In the report already alluded to, beyond reference to the fact that infanticide was rare, we find no mention made as to the number of violent deaths occurring amongst infants. It appears that about a sixteenth of the mortality amongst infants under one year old is due to violence, mostly accidental, the great majority of such deaths being caused by the mother lying upon and smothering her babe. These misadventures are said to occur mostly on Saturday nights, and raise the question as to whether a large proportion of such deaths are not due to the drunkenness of the mothers, who retire to rest in a state of alcoholic stupor.[358]
[Footnote 358: Blythe.]
The inference, we think, to be drawn from the above statements is, that the preponderating mortality prevailing amongst the children of the poor is due to ignorance and poverty, and not to intentional neglect or want of parental affection. Bearing in mind that poor women much more frequently suckle their babes than rich ones, it might perhaps be argued that this was evidence of greater maternal solicitude, and that, therefore, the poor mother exhibits more natural affection than the lady who consigns her offspring to the arms of the wet-nurse; but, possibly, were the circumstances of the two inverted, the lady might be found giving her infant the breast, whilst the humbler wife might call in the services of the wet-nurse; neither of them perhaps reflecting that, in choosing the latter alternative, they were depriving another little human unit of the maternal sustenance, and exposing it to the dangers of vicarious nurture and supervision. What these dangers are that beset the children of the poor when removed from their mother, the revelations of baby-farming and the appalling statistics of illegitimate infant mortality serve very forcibly to illustrate. For every 311 legitimate children of all classes 500 illegitimate out of every 1000 die each year under one month old, this large increase being due to cruel neglect and substitution of bad, insufficient, and improper food for the maternal milk. That in their own homes they are exposed to the serious hardships arising from errors in diet has already been shown, but in their own homes they die at little more than half this rate; hence the deduction is unavoidable that half of these poor little waifs perish because they are deprived of the care and solicitude of the mother.
Writing on this subject M. Hanon says that of 59,927 infants born in Paris, 20,049 are sent into the country to nurses. Of those children that remain in Paris, and that are so rarely suckled by their mothers, no less than 8250 die from 0-1 year, which gives a death-rate of 243 per 1000 births. As to the mortality of the unfortunate infants, 20,049 in number, sent off to nurse, this amounts to 500 or 700 per 1000 in the first year of life.
We extract the following from the 'Echo' of October 9th, 1878:
"ALLEGED BABY-FARMING.
"Dr Hardwicke, the coroner for Central Middlesex, held an inquest at the Islington Coroner's Court, Holloway Road, this morning, relative to the death of the female child of Emily Corley, a servant at 49, Gower Street, Euston Road. Mr Baby, the inspector under the Infants Life Protection Act, watched the case. The mother of the child had gone to service as a wet nurse after coming out of the workhouse, leaving it with one Ann Leach, who said it was a very delicate child. She added that she had for a time two children under one year of age with her, and had been told that this was contrary to the Act. The inspector under the Infant Life Protection Act pointed out that persons having more than one child to nurse under a year old had to obtain a licence. The coroner characterised the Act as a mere farce. It left children to take care of themselves after they were twelve months old--the most critical time of their existence. He also remarked on how prolific a source of prostitution such cases as the present were, where mothers had to forsake their own illegitimate offspring, depriving them of breast milk in order that they might sell it to the rich. The jury found that the child died from exhaustion following from diarrh[oe]a, accelerated by want of breast milk."
=INFANTS, Food for.= For the newly-born and very young of all mammiferous animals, no food is so expressly and admirably adapted as that drawn from the mother. In the nourishment of the babe from the maternal breast lies the soundest condition for its physical well-being and growth, subject to the qualification that the mother must be in good health, which, of course, implies that she must be well fed. This latter essential fulfilled, it is very wonderful to note how nature makes provision for the proper nourishment of the offspring by converting even a weakly and frequently ailing mother into a strong one during the period of suckling.
There may be, and doubtless are, many circumstances in which lactation cannot be practised with safety either to mother or child; but, where such circumstances do not exist, the practice of seeking the vicarious services of the wet-nurse, or of having recourse to other than the maternal milk, for many reasons, calls for remonstrance and reproof.
We may emphasise this by the following quotation from Dr West's admirable work, 'Diseases of Infancy and Childhood.' He says: "The infant whose mother refuses to perform towards it a mother's part, or who by accident, disease, or death is deprived of the food that nature destined for it, too often languishes and dies. Such children you may see with no fat to give plumpness to their limbs--no red particles in their blood to impart a healthy hue to the skin, their face wearing in infancy the lineaments of age; the voice a constant wail; their whole aspect an embodiment of woe. But give to such children the food that nature destined for them, and if the remedy do not come too late to save them, the mournful cry will cease, the face will assume a look of content, by degrees the features will disclose themselves, the limbs will grow round, the skin pure red and white."
But although the maternal aliment (or, failing this, that supplied from the breast of a young and healthy wet-nurse, who has been recently confined) is undoubtedly the best adapted for infantile nutrition, it fortunately happens that in circumstances where the infant is unable to be fed from either of these sources, we have a very valuable substitute in the milk of the cow, the similarity of which, in composition to woman's milk, will be seen at once by studying the following table arranged by Dr Letheby:
+---------------------------+-------- | Woman's Milk. | Cow's | | Milk. --------------+--------+--------+---------+-------- | Max. | Min. | Average.| Average. Casein | 4·36 | 2·97 | 3·52 | 3·64 Butter | 5·18 | 4·45 | 4·02 | 3·55 Sugar of Milk | 4·43 | 3·29 | 4·27 | 4·70 Various salts | 0·26 | 0·38 | 0·28 | 0·81 +--------+--------+---------+-------- Total solids | 14·20 | 11·09 | 12·09 | 12·70 Water | 85·80 | 88·91 | 87·91 | 87·30 +--------+--------+---------+-------- Total | 100·00 | 100·00 | 100·00 | 100·00 --------------+--------+--------+---------+--------
The milk of the cow being rather richer in solids than that of woman, it is considered desirable to somewhat dilute the former when it is used as food for the infant. Dr Letheby recommends the addition to it of a third of water, with a little sugar to sweeten it, and to render it more acceptable to the baby palate. It cannot be too forcibly insisted upon that immeasurably the best and safest food for an infant, next to human milk, is the milk of the cow, _and nothing else_, until it reaches the age of eight or nine months. It is perhaps needless to state that the milk must be perfectly pure and unadulterated, and that it will fail of being this if yielded by an unhealthy cow. The animal's food and habitat also exercise an important influence on the quality of the milk, that given by grass-fed cows roaming in open pastures undoubtedly being the best and richest.
Different cows yield different qualities of milk; hence, when milk from any particular cow suits an infant, it has been found desirable not to change it.
The newer and fresher the milk the better is it adapted for the child's use; that which has in the least become soured should be especially rejected.
Sometimes even fresh and good milk is found to disagree with a child. When this is the case it may be remedied by adding a little lime water to it previous to its being drunk. If it were practicable, and within the means of every family to keep their own cow, so that the infant could be fed with the milk directly it came from the animal, nature's example in giving it direct from the mother's breast might be followed. The writer remembers, some years ago, the Princess of Wales travelling with her baby on a voyage to and from Denmark, and being accompanied by her bovine purveyor in the shape of an Alderney.
In hot weather, more particularly, if milk be kept even for a short time it is liable to become acid, or "to turn," as it is called. It is, therefore, always desirable to keep it in a cool cellar till required for use, and in very hot weather it should be stood in ice.
The daily allowance of milk for a child during the first month of its life is two or three pints. M. Guillot says 2-1/2 lbs. avoirdupois is the least the babe can properly subsist on. He weighed several infants before and after they had taken the breast, and found that they had gained in weight, in quantities varying from 2 oz. to 5 oz.
Opinion is divided as to the value of condensed cows' milk as a food for infants. Its chief merit seems to be that it affords a substitute for the natural milk in cases where this latter is not obtainable, or where, in consequence of disease amongst the cows of a neighbourhood, it cannot with safety be consumed. Since the maternal fluid, without undergoing alteration or modification, forms so perfect and model a food for infants, it does not seem an unreasonable inference that the milk from the cow, which so nearly approaches it in composition and qualities, should prove most advantageous when partaken of under similar conditions. It has been asserted that condensed milk is inferior in strengthening qualities to the natural cows' milk. If this be the case it is certainly not due, according to Mr Wanklyn, to any removal of the constituents of the latter. In his useful little work on 'Milk Analysis' Mr Wanklyn says: "A year ago a report was spread that these preserved milks were preserved skim-milk, and not preserved new milk. I have myself examined the principal brands of preserved and condensed milk, which are in the London market, and find that the milk which has been condensed, or condensed and preserved, had been charged with its due proportion of fat."
The physiological facts that in an early stage of infancy the digestion is very feeble, and that until an infant has cut its first teeth there is but little, if any, secretion of saliva, which latter is essential for the conversion in the system of starch into sugar, point, therefore, to the imprudence of feeding very young infants upon so-called "infants' foods," where these consist of amylaceous substances. The starch of which these latter are composed not only fails to become assimilated, and therefore to produce no nutrient effect, but clogs up the lower parts of the bowels, and thus gives rise to a train of evils, amongst which may be included indigestion, diarrh[oe]a, vomiting, and not infrequently convulsions and death.
The difference in the mortality between infants under one year of age who annually die of convulsions in England and Scotland is attributed to the fact that whereas the English mother feeds her offspring on thick spoon-food, the Scotch woman nourishes hers from the breast. In 'The Fourteenth detailed Annual Report of the Registrar-General of Scotland' it is stated that "The English practice of stuffing their babes with spoon-meat occasioned the death by convulsions of 23,198 children under one year of age during the year 1868, out of 786,858 births; in other words, caused 1 death from convulsions in every 34 of the children born during the year in England. In Scotland, during the same year, only 312 infants under one year of age fell victims to convulsions out of 115,514 children born during the year; in other words, 1 death from convulsions in every 370 born during the year."
When a child has reached the age of eight or nine months the judicious use of farinaceous foods is not only unobjectionable but desirable; but even then it is most important to increase the quantity of the food very cautiously with the age, as well as to see that it has been well baked and afterwards boiled before being partaken of. In all cases it should be mixed with the milk.
When the child has reached the age of twenty months Dr Letheby advises the quantity of farinaceous food to be still further increased, and with a little egg given in the form of pudding until it attains its third year. At this period the child's diet may also include bread and butter, and at the end of it well-boiled potato with a little meat gravy.
From the third to the fifth year he prescribes a small quantity of meat, and at the end of the ninth year the usual food of the family. During all these periods the use of milk as an important article of the dietary is enforced.
The following table by the late Dr Edward Smith, exhibiting the proportions between the daily quantities of carbon and nitrogen required at different periods of human existence, illustrates the great preponderance of nitrogen demanded by the infant over those who succeed him in the scale of age:
Carbon. Nitrogen. In infancy 69 6·72 At ten years of age 48 2·81 At sixteen years of age 30 2·16 At adult life 23 1·04 In middle life 25 1·13
See MILK.
=IN'FANTS' PRESER'VATIVE.= (Atkinson's.) Carbonate of magnesia, 6 dr.; white sugar, 2-1/2 oz.; oil of aniseed, 20 drops; compound spirit of ammonia and rectified spirit, of each 2-1/2 fl. dr.; laudanum, 1 fl. dr.; syrup of saffron, 1 oz.; caraway water, q. s. to make the whole measure 1 pint. Antacid, anodyne, and hypnotic.
=INFEC'TION.= _Syn._ CONTAGION. The communication of disease, either by personal contact with the sick or by means of effluvia arising from their bodies. Attempts have been made to restrict the term contagion to the former, and infection to the latter, but this distinction is now discarded by the majority of writers. The following are the principal diseases which are commonly regarded as contagious:--Chicken-pox, cholera, cow-pox, dysentery, erysipelas, glanders, gonorrh[oe]a, hooping-cough, hydrophobia, itch, measles, mumps, ophthalmia (purulent), plague, scald-head, scarlet fever, smallpox, syphilis, yaws. See DISINFECTANT, &c.
=INFLAM'MABLE AIR.= See HYDROGEN.
=INFLAMMA'TION.= _Syn._ INFLAMMATIO, L. In _pathology_, a certain state of disease. The common symptoms of inflammation are pain, swelling, heat, and redness, attended with fever, and general constitutional derangement when severe.
The treatment of inflammations, whether trifling; or serious, is essentially the same in principle, and only differs in degree. This consists in the adoption of the usual means for lowering the force of the circulation and the frequency of the pulse; of which leeching, purging, a low diet, and the use of refrigerant drinks and lotions, form the most important part. The constitutional derangement or symptomatic inflammatory fever, and inflammatory condition of the blood always accompany local inflammation, and progress with its intensity. In inflammations of a more purely local character, cupping or leeching the part immediately affected, or the parts adjacent to it, is in general more appropriate and successful. In these cases the application of refrigerant or sedative lotions, baths, &c., generally proves of much advantage. In cases in which there is induration or dryness of the part, the use of warm embrocations is indicated.
Inflammation often arises from apparently very trifling causes, particularly in persons of a full or bad habit of body, or who indulge in the free use of malt liquors. In some persons a very trifling local injury, as a slight abrasion, cut, prick, or sprain, produces a considerable amount of tumefaction, attended with severe constitutional excitement. Punctured wounds, sprains, and dislocations commonly furnish the most serious cases of inflammation that depend on mere external injury.[359] See ABSCESS, FEVER, TUMOUR, &c.
[Footnote 359: In all inflammatory cases of a serious nature, the reader is strongly advised to commit himself to the care of a medical practitioner.]