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Hygiene of the Nursery.

Chapter IV.



In introducing this subject, it may be well to call attention to two important points that are often either unrecognized or overlooked.

1st. All children, but particularly infants, have little power to resist the depressing influences of continued cold, and on this account require warm clothing.

Too much cannot be said against the fashion which, for the sake of supposed beauty, demands that children should be dressed in a way to leave their legs and knees bare. Even in the house, and except in extreme tropical weather, this barbarous practice is injurious, as it exposes a considerable part of the body to constant chilling. The physician knows, and the intelligent layman should be readily convinced of, the bad effects of such protracted abstraction of body-heat. The explanation is simple: every child is supplied by nature with a certain definite quantity of nerve force destined to be expended each day in maintaining what physiologists term "the functions of the body," namely, breathing, circulation of the blood, digestion, heat-production, and so on. Now, if an undue proportion of this nerve force be consumed in producing body heat, as must be the case when so large a surface is left bare, the other functions will be robbed of force. From this robbery the digestion suffers most. With feeble digestion comes constipation or its opposite, diarrhoea. Again, if the surface be chilled, the blood which should circulate in the skin is driven to the interior of the body, and the vessels of the mucous membrane become surcharged. This surcharging, or congestion, causes the condition known as catarrh, which, affecting the lining membrane of the alimentary tract, causes vomiting and diarrhoea; and, in the case of the lungs, bronchitis.

Mothers who allow their children to have their legs and knees covered with the "hideous" long stocking or drawers, often come to me and complain that Mrs. So-So's children have bare legs, and are even healthier and more robust-looking that theirs. Some children are born hardier than others, but no one knows, in the long run, how much better in health, in after life, are those whose vital forces have been husbanded and strengthened in infancy and childhood. I cannot waver in my opinion. I have been too often called to the bedside of these poor little "robust" children whose health, and even life, had been spared had their clothing been better adapted to their tender years. One great argument advanced by the advocates of bare knees is that in olden time all children were clad with their arms and neck, as well as knees, bare. No one says how many died by the wayside. What mother would, on a winter's day, care to sit on the floor or walk through the halls with her own knees uncovered. The mother who protests the loudest I have always observed to be warmly dressed herself.

2d. Infants and children have soft tissues. This statement applies as well to the bones as to the muscles. Therefore, the clothing should fit loosely, that it may not interfere with the motion of the limbs, with the rise and fall of the chest in respiration, or with the necessary freedom of the muscles of the abdominal wall or intestinal canal, one of which is concerned in respiration, the other, in the no less important function of digestion.

Let the clothing, then, be warm and loose.

Thought for the infant's clothing must begin before its birth, with the filling of the "baby's basket." This should contain the following articles:--

A nainsook slip.

A flannel skirt.

A merino shirt, high neck and long sleeves.

A flannel band, twenty-two inches long and six inches wide.

A soft woolen shawl, to be used for a wrap in cold weather.

Worsted socks.

Two linen diapers.

Large and small safety-pins.

One pair blunt-pointed scissors.

Two soft towels.

Castile soap.

Small silk sponge.

Powder box and puff.

Soft hair-brush.

Cold-cream or vaseline.

Linen bobbin.

Fine old linen, for infant's mouth.

So soon as the child is born and the cutting of the cord frees it from maternal protection, it is the rule to wrap it in a piece of soft flannel and place it in a position of safety until, certain necessary attentions having been rendered to the mother, a convenient time arrives for washing. After this operation, which will be described on a future page, the child is dressed for the first time. Every infant requires knitted worsted shoes, or, as they are properly called, "socks," a napkin and an abdominal belt or "binder;" the rest of the dress -- the body clothing proper -- consists usually of three garments, which vary in pattern with individual ideas and tastes.

The "socks" are made of silk thread or soft worsted yarn fashioned by needles into the shape of shoes, and of such a size as to fit the foot loosely, while covering the leg two inches or more above the ankle. They are held in position by a loosely tied tape or a narrowed band of stitches -- the mechanism of which every knitter will understand -- near the top. Stockings are unnecessary, and are rarely used before the clothes are shortened.

The napkin or diaper may be made either of linen or muslin, the former material being preferred, as it is less heating and less liable to cause chafing of the skin when wet. It must be folded in such a way that it may not cause pain by undue pressure upon the back or abdomen.

A soiled napkin can never be used safely a second time, even though the soiling medium be simply urine and the subsequent drying be thorough. In consequence, an abundant supply is essential. The least dampness renders its use dangerous, and while insisting upon the washing of all soiled napkins, it is equally important that they be aired for at least twelve hours before being used again, that they may be surely dry. One must be most careful, too, to insist upon the laundress using only pure soap and avoiding soda in washing, for the constant contact of diapers impregnated with irritating substances is sure to produce troublesome excoriation of the buttocks and neighboring delicate skin.

The "binder" may be of fine, soft flannel or of knitted wool. In either case it should extend from the brim of the pelvis or hip bones to the lower ribs. I prefer a knitted band made narrower in the centre than at either extremity. Any woman who is apt with her knitting needles can make one, and the product has the advantages of being readily applied and of keeping its position without the aid of either strings or pins. [1] When a flannel band is preferred, it should be wide enough to cover the same area, and long enough to go a little more than around the abdomen. It is best fixed in position by two small safety-pins. Such a band is difficult to keep in place, collects more perspiration than the more net-like knitted binder, and the necessary pins may cause inconvenience.

Several bands are required to be on hand at the same time for the sake of proper cleanliness, and, as they should be worn up to the end of the second year, it is necessary to replace them, set by set, as the growth of the child demands.

The body-clothing is usually composed of three separate pieces: a shirt, a petticoat and an outside dress or "slip." The shirt should be long enough to extend from the neck to the lowest part of the trunk and have sleeves reaching to the wrists. It may be made of merino or of soft worsted yarn. In either case it should fit loosely and be fastened at the neck with tape or buttons. The petticoat must be long enough to extend from the waist to six or eight inches below the feet. The proper material for the skirt is light, white flannel. This is gathered at the top into a muslin band, which must be deep enough to reach from the hips to the arm pits, and wide enough to lap over considerably at the back; it is fastened by small safety-pins. The over-width is to allow for increase in size.

An equally good waist can be made with arm-holes and buttoned in the back.

The dress or slip is made of fine cambric, cut in one piece, opening well at the back that it may be readily slipped on and off.

Another, and I think a preferable outfit, consists, also, of three garments. The first or under garment, made of soft, white flannel, is long enough to extend from the neck to ten inches below the feet -- about twenty-five inches in total measurements -- with wide arm-holes. All the seams must be smooth, and the hem at the neck turned outward. The next garment, cut in the same way, but one-half inch larger, and five inches longer, is made of muslin. The slip is also cut "Princess," has long sleeves, a longer skirt than either of the other garments, and all are fastened behind by small buttons.

When dressing the infant these three coverings are put together, sleeve fitting to sleeve, and the whole passed over the little one's head, then buttoned behind, and the process is complete.

The advantages of the last method of dressing are:--

1st. Perfect freedom to the organs contained within the chest, abdomen and pelvis.

2d. Suspension of the clothing from the shoulders.

3d. Saving of time to the mother and fatigue to the infant in the process of dressing.

4th. A uniform covering of the whole body.

So much for the day clothing. At night the dress should consist of the flannel and the outer garment.

In the foregoing, my intention has been to lay especial stress upon the advantage of holding the garments in place by tape or buttons rather than by pins, and it should be noticed, that a baby may be completely dressed with but one pin in its clothing, namely, that fastening the napkin. This, which is allowed only for the sake of convenience, must be a safety-pin, the ordinary pointed pin being an abomination in the nursery.

It is hardly necessary to say that, for the sake of cleanliness, an abundant supply of body-clothing should be at hand; a mother, particularly, must recognize that "cleanliness is next to godliness," and provide accordingly. Let her remember, too, that fresh clothing must be thoroughly "aired" or dried before it is put upon the infant.

Sometimes, to keep the body-clothes dry, a piece of thin rubber cloth is placed over the napkin; this does nothing but harm, for it over-heats the parts, and when the diaper is wet with urine, makes a poultice of it, and thus macerates the skin and causes irritating and painful excoriation.

At the age of six months in summer and of eight months in winter, provided, in both cases, the health be good, the clothing may be "shortened." This change introduces several important questions, namely, the covering of the legs and knees, and the selection of shoes and stockings.

The shortening process makes no change in the body-clothing except that the skirts end a short distance below the knees, at about the point to which an ordinary shoe top comes; this, of course, practically leaves the legs, from the top of a short stocking to the lower edge of the napkin, exposed. As already hinted, it is necessary for the health of the infant to keep this comparatively large surface protected, except, perhaps, during a few extremely hot days in mid-summer. There are two ways of accomplishing this: either by drawers or by stockings long enough to extend from the feet to the napkin, to which they may be attached by safety-pins or ordinary "fasteners." The best drawers are those made in two pieces, one for each leg, as shown in Fig. 12.

These, as furnished in the shop, are made of merino, but any clever woman should be able to cut them out of Canton flannel and make them at home. They must fit the legs moderately closely, and have a buttonhole at the top, so that when passed over the napkin they may be buttoned to the waist of the skirt on its inner side, and so be held up. These drawers are not readily soiled, as they cover the legs only, and the napkin comes between. They must, of course, be made of material to suit the season -- heavy in winter, light in summer.

When stockings alone are used they must be long enough to come well above the knees, and should be held in position by "supporters" instead of garters, since the latter, being necessarily tight, bind the limbs, and often, by interfering with free circulation, cause cold feet. The supporter must be adjusted to make only the required amount of traction, and this always in a direction parallel with the axis of the body. The stocking foot ought to fit easily, but without wrinkling, and at the same time have a rounded rather than a conical-shaped toe. For although the silk, woolen, or cotton material of which the stocking is composed may be yielding, it is elastic, and consequently capable of exerting a certain amount of pressure upon the foot; and there is little doubt that the persistent compression made by a short, sharply conical point, cramps the toes, crowds them together, and sometimes, even, forces them to overlap one another.

Colored stockings are often preferred to white, but they are only permissible, provided the coloring matter be well fixed in the texture and not of such a nature as to cause irritation of the skin. Every stocking should be turned inside out, carefully examined, and all knots and ends removed, the smallest of which hurt the tender little feet. Were this matter oftener looked to, many an unexplained tear would be avoided.

As with the drawers, so with the hose; several weights should be provided to correspond with the varying demands of the seasons for greater or less warmth, and in both cases a sufficient supply must be kept to allow of frequent changing.

The shoes are prominent items of the clothing; their shape, size, and manner of fastening, and the make-up of the soles being the important matters for consideration.

An infant's feet are plumper than those of the adult, and all the tissues, but especially the bones, are software. They may be readily deformed by protracted pressure from badly constructed shoes, despite the assertions of unhandy shoemakers, who say that the feet are shapeless masses of fat, for which any leathern bag having the semblance of a shoe will serve as a covering.

Throwing out the element of fleshiness, the characteristics of the perfectly formed baby and adult foot do not materially differ. In the first place, the inner and outer margins are very different in contour. Secondly, the heel and middle third of the foot is firm and presents little mobility in its component bones, whereas the anterior third, including the toes, is very mobile. The toes again bear much the same relation to the rest of the foot as the fingers to the hand. This is particularly noticeable in the great toe, which, instead of inclining toward a line passing along the centre of the foot, points away from it, in the same manner as the thumb from the hand, although, of course, to a far less degree. An inclination of the great toe toward the mid-line of the foot is undoubtedly often seen in adults, but in them it is a deformity resulting from badly made shoes, and one that gives a conical contour to the toes, cripples the movements of the great toe, and greatly interferes with the ease of walking, just as a contraction and permanent drawing of the thumb toward the palm of the hand would materially lessen the usefulness of that member.

The normal position of the toes just described will be readily understood from the tracing of the sole of the right foot as shown in Fig. 13.

The most striking features of this diagram are, the expanded position of the toes; the width of the anterior part of the foot compared with the heel, and the straight outer and curved inner margins of the foot. The line, A B, represents the axis of walking, which, while nearly parallel to E F, the inner edge of the foot, forms quite an angle with C D, the centre line.

In the normal foot the great toe is directly in the axis of walking, a position in which, of course, it is of much greater service and if it were inclined inward toward the line C D.

Now, if a line be drawn closely around the margin of the above imprint, it will give the exact shape of a perfect shoe sole for the right foot; or taking the imprint of both feet, we get the outlines shown in Fig. 14.


On first sight, one would suppose that a shoe with a sole so shaped would look very awkward, but when made by a skillful shoemaker, it differs very little in appearance from those ordinarily sold in the shop, with the exception that it is broader in the toes.

Another important fact is clearly demonstrated by Fig. 14, namely, the absolute necessity of having the shoes made "right and left," and the fallacy of supposing that one or the other shoe may be used on either foot indiscriminately.

Besides having a correct shape, the shoes should be long enough not to cramp the toes and bend them down and backward upon themselves. At the same time it is a mistake to have them too long, allowing the foot to slide back and forth, as this leads to the formation of either blisters or corns. Let the shoe fit snugly about the heel and instep, and easily at the toes, and all is well. I say easily at the toes, because many an otherwise good shoe is ruined by having the uppers at the points too scanty, so that the toes are forced against the sole and subjected to painful pressure.

The best method of fastening is by a lace, since this admits of making one part of the upper tight and another part loose, according to circumstances.

Elastic fastenings, as in the so-called congress shoes, are not good for children; and when buttons are used, the nurse must not necessarily leave them in the position fixed by the shoemaker, but move one or more as the size of the ankle demands.

The thickness of the soles depends upon the age of the child. Before walking is attempted, they may be thin, flexible, and of uniform thickness from heel to toe; afterward they should be made heavier and more resisting, in order to protect the tender feet, and should be decidedly thicker at the heel, that this part of the foot may be elevated. A clear-cut heel, however, as in boots adapted for adults, is not to be recommended in children's shoes before the age of six or eight years.

Sometimes a careful mother may notice that, for a short time after stockings and shoes are put upon her baby, the feet are cooler than before. Undue pressure about the ankle, with consequent interference with the blood circulation in the feet, is the cause of this, and the remedy is to remove occasionally the coverings; chafe the feet into warmth, and see that the shoe-top is not so tightly laced or buttoned as to constrict the ankle.

So far, all that has been said of the clothing after "shortening" refers to the day and house garments. It remains now to consider the night dress and the extra wraps to be worn out of doors.

At bedtime, all the clothing worn during the day being removed, the baby is washed, and after the application of a fresh napkin and binder, is ready for the night dress. This consists of a shirt and an especial gown. The shirt should always be of flannel, a light gauze in summer and a heavier wool in winter; its pattern may be the same as that worn by day, though its texture ought to be a trifle lighter. The best pattern of a winter night-gown is a long, plain slip, with a drawing string at the bottom, to prevent exposure of the feet and limbs, should the child kick off the bed covering during sleep. It ought to be made of flannel, or the more easily washed Canton flannel. In summer, a loose muslin slip of the same design, but without the drawing string, may be worn. There is even more temptation by night than by day to use a rubber cloth over the napkin, to protect the body and bed clothing, but never do this.

It is a good plan to provide the child with a flannel garment corresponding to the dressing gown of the adult, and with a pair of bedroom shoes. The latter are composed of soft leather or felt soles and knitted uppers, and are fastened around the ankle by a soft elastic. Both of these will be found useful in the many occasions when the child has to be taken up at night.

When dressing a child for exercise in the open air in cold weather, do not put on the extra, outer clothing until immediately before leaving the house, and remove it directly on returning. A long cloak, with or without capes or fur, according to the degree of cold, and a pair of long, warm leggings, constitute the extra covering for the body. Protect the head, in winter, by a close-fitting, thick cap; the hands, by worsted gloves or mittens.

In summer the child may go out of doors in the same dress worn in the house, the head being protected from the direct rays of the sun by a broad-brimmed, light straw hat.

Every mother must decide for herself when her child is to doff the costume of babyhood and assume that of a boy or a girl. There are two points that must always be considered, however, namely, the time of dispensing with the napkin and with the abdominal belt. Abandon the napkin, and substitute ordinary drawers, as soon as the child can be trusted to make known the calls of nature -- a period that varies considerably with the care and skill in training. The binder should always be worn until the completion of the eruption of the milk teeth, or until about the end of the second year.

In clothing the boy or girl, be particular to secure warmth, freedom of movement and cleanliness. The first is accomplished by enveloping the whole body -- no matter what the season -- in woollen underclothing. This means high-necked and long-sleeved flannel shirts and flannel drawers extending down to the ankles. It is hardly necessary to mention that the thickness of these garments must vary with the seasons, but it is quite worth while insisting upon woollen under-garments, except during the very excessively hot days of midsummer. This provision being made, and the shape of the shoes and stockings [2] looked into, it matters little what may be the fancy of the mother in regard to outer clothing.

Freedom of movement refers not only to the limbs, but to the chest and abdomen, which should never be constricted, lest the important organs they contain be crippled in their action. Loose-fitting clothes accomplish this object; but it is to be understood that looseness or ease in fit does not necessarily imply that the dress must be awkward, ill-fitting and a source of mortification to the wearer. On the contrary, clothes may be easy and yet well cut and stylish.

To be clean, the child must have a plentiful supply of clothing, so that changes may be made as frequently as required. Clean, cheap clothes look much better than soiled finery.

The night dress of a child five or six years old consists, during winter, of a light, high-neck and long-sleeve merino shirt and night drawers of Canton flannel; in summer, of a gauze undershirt, with short sleeves and muslin night drawers.

Cold weather calls for a warm overcoat, hat, mittens, and leggings, or rubber boots in wet or snowing weather, when the child leaves the warmth of the house. Should the cold be so great as to necessitate ear tabs and a neck wrap for protection, a child under six years is better off in the nursery.

As for rain-proof clothing, and our climate calls often for both rubber boots and a long mackintosh, it must be remembered that such coverings, while impervious to moisture from without, are no more pervious to body moisture or, in other words, to perspiration, which secretion they encourage by their warmth. Of course, when perspiration is retained, the under clothing becomes moist, and there is a great risk of surface chilling and subsequent catarrh. Therefore, it is a good plan, when waterproof garments have been worn for any length of time, to take off the under clothing as soon as shelter is reached, to rub the surface into a glow with a coarse towel and then redress the child.

Before concluding this chapter, let me advise that the change from winter to spring or summer clothing be not made at any fixed date, under the supposition that it is the time to change, and the weather should be warm, whether it is or not. In our Eastern climate it is unusual to have settled, warm weather until June. May has a certain number of warm days, but they are quickly followed by cooler ones. Consequently the safe plan is to keep on the heavy winter flannels until hot weather surely sets in, changing, in the meanwhile, the outer clothing to suit each day.


[1] Formula for Crochetted Baby-band. -- Single zephyr in ridge stitch, that is, half stitch, in which, going back and forth, only the back half of the stitches in the lower row are picked up. Being on a chain of fifty and crochet forty-eight ridges, hence ninety-six rows. Join by a row of tight stitches or by sewing. Finish off at bottom by a row of plain stitches and at top by a picot-edging (five chains and a tight stitch back into the first). -- "Babyhood," Vol. III, p. 33.

[2] It is impossible for either a stocking or a shoe to fit accurately unless the toe nails be kept in good order. In cutting the toe nails there is, as in every other affair of life, a right and a wrong way. Cut the nail directly across, without rounding the corners. Should the latter be done, the nail is apt to grow into the flesh and give suffering to the child and work to the surgeon.

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Created 12/13/97 / Last modified 12/19/97
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