Mortality Of Infants


I was browsing the 1829 edition of The Ladies' Pocket Magazine, when I came across this article about the mortality of infants at the time and its causes. The article was republished from another magazine, "The Companion to the Almanack", which The Ladies' Pocket Magazine described as "one of the most useful publications of the day". Here it is:

MORTALITY OF INFANTS

Before the introduction of vaccine inoculation, more than a fourth of the children who were born in London, died, before they had attained their second year. The proportion for 1827 was between a fourth and fifth, the numbers christened being 29,925, and those dying thus prematurely 6,580. This, we regret to observe, is an increase upon the returns of seven years earlier, 1820, by which it appears that a fifth so perished. The numbers fluctuate; and the cause may, perhaps, be attributed to the prevalence of fevers and other contagious diseases at particular seasons. Upon an average of years, it would appear that about a fifth of the children, born in the metropolis, die before two years of age.

It is certainly not intended by nature, that so large a proportion of the young of the human race should be thus cut off from life. The infancy of man is, indeed, a tender and helpless period, and one which requires the exercise of the most watchful care on the part of the mother. But the evils which naturally belong to it are infinitely aggravated by injudicious management—by unnatural methods of feeding and clothing —by the neglect of a due attention to cleanliness and exercise. From the moment that a child is born, a system of mismanagement begins, which, fortunately, it is now the earnest endeavour of medical men to reprove; but which still exists in almost all cases where the mother is either herself weak and ignorant, or surrenders her judgment to weak and ignorant nurses. We shall point out the chief of these evils, and offer, as we go along, a few hints for the adoption of a more reasonable course.

The first process which nurses were accustomed to pursue with a new-born child, (and which many still continue,) was to wash it, even in winter, with cold water. Spirits have been sometimes mixed with the water, or rubbed over afterwards, by which the violently painful sensation of cold is increased, by the increase of evaporation; and strong soap has been used, by which the skin is inflamed, and is rendered exquisitely painful to the touch for several days. It is necessary to wash the infant, but that should be done with warm water and a soft cloth, and the gentlest friction only should be employed.

The operation of dressing was formerly conducted with the same disregard to the feelings of the infant, as that of washing. A long roller was bound several times round the chest, and was usually so tightly applied, as to press upon and confine the ribs, and prevent that fair play of the lungs so necessary to the newly-established function of respiration. This bandage, in the use of which many nurses and mothers still persist, is a great cause of the flat sides and contracted chests which we see in after life; for the bones of infants are so soft, that they yield and take a form from very slight pressure. To prevent a new-born infant suffering from cold, it requires to be clothed with all convenient speed; but its clothes should be made to fit on loosely, so as not to produce the smallest degree of pressure on any part of its limbs or body. The roller that is commonly applied to confine the clothes round the chest should on no account be used. The greater part of the infant's dress should consist of flannel, particularly the garment next the skin. A flannel cap is generally put upon the head; but this is an error, for the head should be kept as cool as possible, and the flannel cap, and perhaps all caps, should be discontinued.

The practice of giving new-born infants gruel, sugar and butter, or medicine, is in all respects absurd and injurious. Some mothers and nurses even give the infant gin, which is absolute poison. Nature has provided both food and medicine in the sustenance which the mother affords. Some mothers and nurses had a ridiculous notion that two or three days ought to elapse, before the infant should receive the food which nature has destined for it; and, till that time arrived, it was drenched with pap, which filled its bowels with acidity, and produced flatulency and pain. Even this absurdity is not altogether exploded. Disease is the certain consequence of every attempt to substitute any food whatever for the sustenance of the mother. It is very rarely that the mother has not sufficient for the support of her infant, even within a few hours of its birth; the substitution, therefore, is as unnecessary, as it is cruel.

But the great evil which the unhappy infant has to endure, in many cases, is when mothers, after they have perfectly recovered, persuade themselves, or are persuaded, that the child requires feeding;—that they have not adequate means for its support; and that it may be supported by any other food than that which nature has provided. Indolence, and a love of pleasure, sometimes suggest this fatal delusion to the rich; ignorance, and a wish to be freed from a constant interruption to labor, lead the poor to a similar course. The result for the infant is, almost invariably, death, or diseases through life, which are worse than death. From the moment that the pap-spoon is constantly, and even occasionally, in the mouth of a child, and he is obliged to swallow all sorts of indigestible messes, as substitutes for the thin, light, easily digestible fluid that nature destined for him, sickness must necessarily follow. There is no escaping it; and, one by one, the unhappy victims swell the list of burials in every parish. The stages which lead to the grave are these :—

The bowels, which were before regular, become confined or loose; flatulence, gripes, and acidities, are continually present; the child loses its rest, and is always crying; its belly enlarges; its skin becomes flabby, and wrinkled; and its limbs have more the appearance belonging to age than to infancy; a sure sign that it is not nourished by the large quantities of food that it is continually taking, and ever craving for. Its limbs grow weak, and, at the time it may be expected to walk, it is found unable to use its legs at all. The evil effects of an unnatural diet are generally increased by the injudicious attempts to remedy them by medicine. With the poor, 'Dalby's Carminative,' or 'Godfrey's Cordial,' are at hand to procure a little rest for the sufferer, or quiet for the nurse; if these are wanting, porter or gin is added to its victuals for the same purpose. Others undertake to cure his gripes by purging, and for that purpose he is poisoned with calomel, an active preparation of mercury, which is given as though it was as harmless as so much chalk. A deprivation of air and exercise is generally added to the evils enumerated. It greatly aggravates the injury inflicted on the health by ill-judged feeding, and neglect; and often causes, and always tends to confirm, the derangement of the functions of the stomach and bowels, from which most of the disorders proceed that originate in childhood, and which so often shorten and embitter life.

The great point to impress upon every mother is, that a child requires no other food than her milk, till it has four teeth. If, by a chance, which rarely happens, except amongst women who live luxuriously, the supply of the mother should not be adequate, or be deficient in quality of nourishment, assistance must be obtained. The milk of another woman, whose child is about the same age, should, if possible, be procured, as the best substitute for the mother's milk. If this cannot be obtained, asses' milk should be preferred to anything else; but, if neither of these are at hand, the food should consist of two parts of thin barley water or gruel, or arrow root made with water, and one part of cows' milk, sweetened with a little white sugar: this mixture, if properly made, is very thin. Whether asses' milk, or this food be used, the child should be made to suck it from a proper sucking bottle, the action of sucking being as necessary to the infant as chewing is to the adult. When the child has four teeth, it may be furnished with more substantial food than can be procured from the mother; and upon the appearance of the canine or eye teeth, it may be allowed animal food. But the stomach is best satisfied with the simplest viands; and any changes of diet, or provocatives to appetite, are perfectly unnecessary, and altogether injurious. Of salt, (which, in some respects, is a provocation to appetite,) children should be allowed to partake freely. It is almost universally the practice, with those who have the care of children, to deny them salt, under the mistaken idea that it makes them thirsty. To this mistake is to be attributed the prevalence of worms in the intestines of children. Salt is a preventive in this disease, and a grateful stimulant to the digestive organs.

Some children outlive the worst nursing; and others, who may have been nursed upon rational principles, have their constitutions ruined at a later stage, by the false indulgence of their parents, who allow them fermented liquors, of wine and beer, under the mistaken notion of supporting their strength. Others, again, are allowed to eat to excess, the moment they can eat at all. The only secure direction for feeding infants is, that they should be kept slightly craving. When children have all their teeth, the necessity for this restraint in a great measure ceases.

The directions given for dressing the infant, in the first instance, contain the principles that should be kept in view as it grows older. Its clothes should be so formed as to protect it from cold, and not to restrain the motion of its limbs, or to produce the effects of pressure on any part of the body. Great attention is necessary to be paid to keeping the body of an infant clean, which can only be done by regular washing, morning and evening. The napkins of infants, for an obvious reason, cannot be changed too frequently. We would lay great stress on the necessity of washing them twice a day. The great heat of their bodies, and the very tender and irritable state of their skin, render this absolutely necessary. When neglected, it is not surprising that the child should spend the night in crying; a complaint frequently made by those mothers and nurses who are careless on this subject.

Exercise is essential to well-being in every period of life; and in none more so than in the helpless state of infancy. No bounds can be assigned, to which the exercising infants should be carried. If it be but of a nature proportioned to their strength, there is greater fear of their having too little than too much. As soon as a child is able to crawl, the restless activity with which nature has endowed it, will secure its enjoyment of all the advantages exercise can give it. It may be necessary, however, to observe, that during the winter it is hazardous to carry infants, unable to walk, into the open air.

We sum up these remarks, by repeating their principal practical directions:—The food of the infant should be adapted to its age and growth; while it is without teeth, it should live upon its mother's milk ; when it has four teeth, it may be weaned, and fed on milk, with a little bread; as the number of its teeth increases, the solid part of its food should be increased; and when it has all its teeth, it may be allowed animal food, and not before; the quantity of its food should be attended to as much as the quality; children require no change of food to stimulate their appetites; air and exercise cannot be secured to them too liberally; cleanliness, and frequent washing, are essential to their comfort; they should be clothed in flannel; and their clothes should fit them so loosely as not to produce the slightest effect of pressure.

Further reading:
The Ladies' Pocket Magazine, 1829