2368. The operations of churning and butter-making over, the butter-milk is disposed of: usually, in England, it goes to the pigs; but it is a, very wholesome beverage when fresh, and some persons like it; the disposal, therefore, will rest with the mistress: the dairy-maid's duty is to get rid of it. She must then scald with boiling water and scrub out every utensil she has used; brush out the churn, clean out the cream-jars, which will probably require the use of a little common soda to purify; wipe all dry, and place them in a position where the sun can reach them for a short time, to sweeten them.
2369. In Devonshire, celebrated for its dairy system, the milk is always scalded. The milk-pans, which are of tin, and contain from 10 to 12 quarts, after standing 10 or 12 hours, are placed on a hot plate of iron, over a stove, until the cream has formed on the surface, which is indicated by the air-bubbles rising through the milk, and producing blisters on the surface-coating of cream. This indicates its approach to the boiling point: and the vessel is now removed to cool. When sufficiently, that is, quite cool, the cream is skimmed off with the slice: it is now the clouted cream for which Devonshire is so famous. It is now placed in the churn, and churned until the butter comes, which it generally does in a much shorter time than by the other process. The butter so made contains more caseine than butter made in the usual way, but does not keep so long.
2370. It is a question frequently discussed, how far it is economical for families to keep cows and make their own butter. It is calculated that a good cow costs from May 1 to October 1, when well but economically kept, £5. 16s. 6d; and from October 1 to April 30, £10. 2s. 6d. During that time she should produce 227 lbs. of butter, besides the skimmed milk. Of course, if new milk and cream are required, that will diminish the quantity of butter.
2371. Besides churning and keeping her dairy in order, the dairy-maid has charge of the whole produce, handing it over to the cook, butler, or housemaid as required; and she will do well to keep an exact account both of what she receives and how and when she disposes of it.
DUTIES OF THE LAUNDRY-MAID.
2372. The laundry-maid is charged with the duty of washing and getting-up the family linen,—a situation of great importance where the washing is all done at home; but in large towns, where there is little convenience for bleaching and drying, it is chiefly done by professional laundresses and companies, who apply mechanical and chemical processes to the purpose. These processes, however, are supposed to injure the fabric of the linen; and in many families the fine linen, cottons, and muslins, are washed and got-up at home, even where the bulk of the washing is given out. In country and suburban houses, where greater conveniences exist, washing at home is more common,—in country places universal.
2373. The laundry establishment consists of a washing-house, an ironing and drying-room, and sometimes a drying-closet heated by furnaces. The washing-house will probably be attached to the kitchen; but it is better that it should be completely detached from it, and of one story, with a funnel or shaft to carry off the steam. It will be of a size proportioned to the extent of the washing to be done. A range of tubs, either round or oblong, opposite to, and sloping towards, the light, narrower at the bottom than the top, for convenience in stooping over, and fixed at a height suited to the convenience of the women using them; each tub having a tap for hot and cold water, and another in the bottom, communicating with the drains, for drawing off foul water. A boiler and furnace, proportioned in size to the wants of the family, should also be fixed. The flooring should be York stone, laid on brick piers, with good drainage, or asphalte, sloping gently towards a gutter connected with the drain.
2374. Adjoining the bleaching-house, a second room, about the same size, is required for ironing, drying, and mangling. The contents of this room should comprise an ironing-board, opposite to the light; a strong white deal table, about twelve or fourteen feet long, and about three and a half feet broad, with drawers for ironing-blankets; a mangle in one corner, and clothes-horses for drying and airing; cupboards for holding the various irons, starch, and other articles used in ironing; a hot-plate built in the chimney, with furnace beneath it for heating the irons; sometimes arranged with a flue for carrying the hot air round the room for drying. Where this is the case, however, there should be a funnel in the ceiling for ventilation and carrying off steam; but a better arrangement is to have a hot-air closet adjoining, heated by hot-air pipes, and lined with iron, with proper arrangements for carrying off steam, and clothes-horses on castors running in grooves, to run into it for drying purposes. This leaves the laundry free from unwholesome vapour.
2375. The laundry-maid should commence her labours on Monday morning by a careful examination of the articles committed to her care, and enter them in the washing-book; separating the white linen and collars, sheets and body-linen, into one heap, fine muslins into another, coloured cotton and linen fabrics into a third, woollens into a fourth, and the coarser kitchen and other greasy cloths into a fifth. Every article should be examined for ink- or grease-spots, or for fruit- or wine-stains. Ink-spots are removed by dipping the part into hot water, and then spreading it smoothly on the hand or on the back of a spoon, pouring a few drops of oxalic acid or salts of sorel over the ink-spot, rubbing and rinsing it in cold water till removed; grease-spots, by rubbing over with yellow soap, and rinsing in hot water; fruit- and wine-spots, by dipping in a solution of sal ammonia or spirits of wine, and rinsing.
2376. Every article having been examined and assorted, the sheets and fine linen should be placed in one of the tubs and just covered with lukewarm water, in which a little soda has been dissolved and mixed, and left there to soak till the morning. The greasy cloths and dirtier things should be laid to soak in another tub, in a liquor composed of 1/2 lb. of unslaked lime to every 6 quarts of water which has been boiled for two hours, then left to settle, and strained off when clear. Each article should be rinsed in this liquor to wet it thoroughly, and left to soak till the morning, just covered by it when the things are pressed together. Coppers and boilers should now be filled, and the fires laid ready to light.
2377. Early on the following morning the fires should be lighted, and as soon as hot water can be procured, washing commenced; the sheets and body-linen being wanted to whiten in the morning, should be taken first; each article being removed in succession from the lye in which it has been soaking, rinsed, rubbed, and wrung, and laid aside until the tub is empty, when the foul water is drawn off. The tub should be again filled with luke-warm water, about 80°, in which the articles should again be plunged, and each gone over carefully with soap, and rubbed. Novices in the art sometimes rub the linen against the skin; more experienced washerwomen rub one linen surface against the other, which saves their hands, and enables them to continue their labour much longer, besides economizing time, two parts being thus cleaned at once.
2378. After this first washing, the linen should be put into a second water as hot as the hand can bear, and again rubbed over in every part, examining every part for spots not yet moved, which require to be again soaped over and rubbed till thoroughly clean; then rinsed and wrung, the larger and stronger articles by two of the women; the smaller and more delicate articles requiring gentler treatment.
2379. In order to remove every particle of soap, and produce a good colour, they should now be placed, and boiled for about an hour and a half in the copper, in which soda, in the proportion of a teaspoonful to every two gallons of water, has been dissolved. Some very careful laundresses put the linen into a canvas bag to protect it from the scum and the sides of the copper. When taken out, it should again be rinsed, first in clean hot water, and then in abundance of cold water slightly tinged with fig-blue, and again wrung dry. It should now be removed from the washing-house and hung up to dry or spread out to bleach, if there are conveniences for it; and the earlier in the day this is done, the clearer and whiter will be the linen.
2380. Coloured muslins, cottons, and linens, require a milder treatment; any application of soda will discharge the colour, and soaking all night, even in pure water, deteriorates the more delicate tints. When ready for washing, if not too dirty, they should be put into cold water and washed very speedily, using the common yellow soap, which should be rinsed off immediately. One article should be washed at a time, and rinsed out immediately before any others are wetted. When washed thoroughly, they should be rinsed in succession in soft water, in which common salt has been dissolved, in the proportion of a handful to three or four gallons, and afterwards wrung gently, as soon as rinsed, with as little twisting as possible, and then hung out to dry. Delicate-coloured articles should not be exposed to the sun, but dried in the shade, using clean lines and wooden pegs.
2381. Woollen articles are liable to shrink, unless the flannel has been well shrunk before making up. This liability is increased where very hot water is used: cold water would thus be the best to wash woollens in; but, as this would not remove the dirt, lukewarm water, about 85°, and yellow soap, are recommended. When thoroughly washed in this, they require a good deal of rinsing in cold water, to remove the soap.
2382. Greasy cloths, which have soaked all night in the liquid described, should be now washed out with soap-and-water as hot as the hands can bear, first in one water, and rinsed out in a second; and afterwards boiled for two hours in water in which a little soda is dissolved. When taken out, they should be rinsed in cold water, and laid out or hung up to dry.
2383. Silk handkerchiefs require to be washed alone. When they contain snuff, they should be soaked by themselves in lukewarm water two or three hours; they should be rinsed out and put to soak with the others in cold water for an hour or two; then washed in lukewarm water, being soaped as they are washed. If this does not remove all stains, they should be washed a second time in similar water, and, when finished, rinsed in soft water in which a handful of common salt has been dissolved. In washing stuff or woollen dresses, the band at the waist and the lining at the bottom should be removed, and wherever it is gathered into folds; and, in furniture, the hems and gatherings. A black silk dress, if very dirty, must be washed; but, if only soiled, soaking for four-and-twenty hours will do; if old and rusty, a pint of common spirits should be mixed with each gallon of water, which is an improvement under any circumstances. Whether soaked or washed, it should be hung up to drain, and dried without wringing.
2384. Satin and silk ribbons, both white and coloured, may be cleaned in the same manner.
2385. Silks, when washed, should be dried in the shade, on a linen-horse, taking care that they are kept smooth and unwrinkled. If black or blue, they will be improved if laid again on the table, when dry, and sponged with gin, or whiskey, or other white spirit.
2386. The operations should be concluded by rinsing the tubs, cleaning the coppers, scrubbing the floors of the washing-house, and restoring everything to order and cleanliness.
2387. Thursday and Friday, in a laundry in full employ, are usually devoted to mangling, starching, and ironing.
2388. Linen, cotton, and other fabrics, after being washed and dried, are made smooth and glossy by mangling and by ironing. The mangling process, which is simply passing them between rollers subjected to a very considerable pressure, produced by weight, is confined to sheets, towels, table-linen, and similar articles, which are without folds or plaits. Ironing is necessary to smooth body-linen, and made-up articles of delicate texture or gathered into folds. The mangle is too well known to need description.
2389. Ironing.—The irons consist of the common flat-iron, which is of different sizes, varying from 4 to 10 inches in length, triangular in form, and from 2-1/2 to 4-1/2 inches in width at the broad end; the oval iron, which is used for more delicate articles; and the box-iron, which is hollow, and heated by a red-hot iron inserted into the box. The Italian iron is a hollow tube, smooth on the outside, and raised on a slender pedestal with a footstalk. Into the hollow cylinder a red-hot iron is pushed, which heats it; and the smooth outside of the latter is used, on which articles such as frills, and plaited articles, are drawn. Crimping- and gauffering-machines are used for a kind of plaiting where much regularity is required, the articles being passed through two iron rollers fluted so as to represent the kind of plait or fold required.
2390. Starching is a process by which stiffness is communicated to certain parts of linen, as the collar and front of shirts, by dipping them in a paste made of starch boiled in water, mixed with a little gum Arabic, where extra stiffness is required.
TO MAKE STARCH.
2391. INGREDIENTS.—Allow 1/2 pint of cold water and 1 quart of boiling water to every 2 tablespoonfuls of starch.
Mode.—Put the starch into a tolerably large basin; pour over it the cold water, and stir the mixture well with a wooden spoon until it is perfectly free from lumps, and quite smooth. Then take the basin to the fire, and whilst the water is actually boiling in the kettle or boiler, pour it over the starch, stirring it the whole time. If made properly in this manner, the starch will require no further boiling; but should the water not be boiling when added to the starch, it will not thicken, and must be put into a clean saucepan, and stirred over the fire until it boils. Take it off the fire, strain it into a clean basin, cover it up to prevent a skin forming on the top, and, when sufficiently cool that the hand may be borne in it, starch the things. Many persons, to give a shiny and smooth appearance to the linen when ironed, stir round two or three times in the starch a piece of wax candle, which also prevents the iron from sticking.
2392. When the "things to be starched" are washed, dried, and taken off the lines, they should be dipped into the hot starch made as directed, squeezed out of it, and then just dipped into cold water, and immediately squeezed dry. If fine things be wrung, or roughly used, they are very liable to tear; so too much care cannot be exercised in this respect. If the article is lace, clap it between the hands a few times, which will assist to clear it; then have ready laid out on the table a large clean towel or cloth; shake out the starched things, lay them on the cloth, and roll it up tightly, and let it remain for three or fours, when the things will be ready to iron.
2393. To be able to iron properly requires much practice and experience. Strict cleanliness with all the ironing utensils must be observed, as, if this is not the case, not the most expert ironer will be able to make her things look clear and free from smears, &c. After wiping down her ironing table, the laundry-maid should place a coarse cloth on it, and over that the ironing-blanket, with her stand and iron-rubber; and having ascertained that her irons are quite clean and of the right heat, she proceeds with her work.
2394. It is a good plan to try the heat of the iron on a coarse cloth or apron before ironing anything fine: there is then no danger of scorching. For ironing fine things, such as collars, cuffs, muslins, and laces, there is nothing so clean and nice to use as the box-iron; the bottom being bright, and never placed near the fire, it is always perfectly clean; it should, however, be kept in a dry place, for fear of its rusting. Gauffering-tongs or irons must be placed in a clear fire for a minute, then withdrawn, wiped with a coarse rubber, and the heat of them tried on a piece of paper, as, unless great care is taken, these will very soon scorch.
2395. The skirts of muslin dresses should be ironed on a skirt-board covered with flannel, and the fronts of shirts on a smaller board, also covered with flannel; this board being placed between the back and front.
2396. After things are mangled, they should also be ironed in the folds and gathers; dinner-napkins smoothed over, as also table-cloths, pillow-cases, and sometimes sheets. The bands of flannel petticoats, and shoulder-straps to flannel waistcoats, must also undergo the same process.
UPPER AND UNDER NURSEMAIDS.
2397. The nursery is of great importance in every family, and in families of distinction, where there are several young children, it is an establishment kept apart from the rest of the family, under the charge of an upper nurse, assisted by under nursery-maids proportioned to the work to be done. The responsible duties of upper nursemaid commence with the weaning of the child: it must now be separated from the mother or wet-nurse, at least for a time, and the cares of the nursemaid, which have hitherto been only occasionally put in requisition, are now to be entirely devoted to the infant. She washes, dresses, and feeds it; walks out with it, and regulates all its little wants; and, even at this early age, many good qualities are required to do so in a satisfactory manner. Patience and good temper are indispensable qualities; truthfulness, purity of manners, minute cleanliness, and docility and obedience, almost equally so. She ought also to be acquainted with the art of ironing and trimming little caps, and be handy with her needle.
2398. There is a considerable art in carrying an infant comfortably for itself and for the nursemaid. If she carry it always seated upright on her arm, and presses it too closely against her chest, the stomach of the child is apt to get compressed, and the back fatigued. For her own comfort, a good nurse will frequently vary this position, by changing from one arm to the other, and sometimes by laying it across both, raising the head a little. When teaching it to walk, and guiding it by the hand, she should change the hand from time to time, so as to avoid raising one shoulder higher than the other. This is the only way in which a child should be taught to walk; leading-strings and other foolish inventions, which force an infant to make efforts, with its shoulders and head forward, before it knows how to use its limbs, will only render it feeble, and retard its progress.
2399. Most children have some bad habit, of which they must be broken; but this is never accomplished by harshness without developing worse evils: kindness, perseverance, and patience in the nurse, are here of the utmost importance. When finger-sucking is one of these habits, the fingers are sometimes rubbed with bitter aloes, or some equally disagreeable substance. Others have dirty habits, which are only to be changed by patience, perseverance, and, above all, by regularity in the nurse. She should never be permitted to inflict punishment on these occasions, or, indeed, on any occasion. But, if punishment is to be avoided, it is still more necessary that all kinds of indulgences and flattery be equally forbidden. Yielding to all the whims of a child,—picking up its toys when thrown away in mere wantonness, would be intolerable. A child should never be led to think others inferior to it, to beat a dog, or even the stone against which it falls, as some children are taught to do by silly nurses. Neither should the nurse affect or show alarm at any of the little accidents which must inevitably happen: if it falls, treat it as a trifle; otherwise she encourages a spirit of cowardice and timidity. But she will take care that such accidents are not of frequent occurrence, or the result of neglect.
2400. The nurse should keep the child as clean as possible, and particularly she should train it to habits of cleanliness, so that it should feel uncomfortable when otherwise; watching especially that it does not soil itself in eating. At the same time, vanity in its personal appearance is not to be encouraged by over-care in this respect, or by too tight lacing or buttoning of dresses, nor a small foot cultivated by the use of tight shoes.
2401. Nursemaids would do well to repeat to the parents faithfully and truly the defects they observe in the dispositions of very young children. If properly checked in time, evil propensities may be eradicated; but this should not extend to anything but serious defects; otherwise, the intuitive perceptions which all children possess will construe the act into "spying" and "informing," which should never be resorted to in the case of children, nor, indeed, in any case.
2402. Such are the cares which devolve upon the nursemaid, and it is her duty to fulfil them personally. In large establishments she will have assistants proportioned to the number of children of which she has the care. The under nursemaid lights the fires, sweeps, scours, and dusts the rooms, and makes the beds; empties slops, and carries up water; brings up and removes the nursery meals; washes and dresses all the children, except the infant, and assists in mending. Where there is a nursery girl to assist, she does the rougher part of the cleaning; and all take their meals in the nursery together, after the children of the family have done.
2403. In smaller families, where there is only one nursemaid kept, she is assisted by the housemaid, or servant-of-all-work, who will do the rougher part of the work, and carry up the nursery meals. In such circumstances she will be more immediately under the eye of her mistress, who will probably relieve her from some of the cares of the infant. In higher families, the upper nurse is usually permitted to sup or dine occasionally at the housekeeper's table by way of relaxation, when the children are all well, and her subordinates trustworthy.
2404. Where the nurse has the entire charge of the nursery, and the mother is too much occupied to do more than pay a daily visit to it, it is desirable that she be a person of observation, and possess some acquaintance with the diseases incident to childhood, as also with such simple remedies as may be useful before a medical attendant can be procured, or where such attendance is not considered necessary. All these little ailments are preceded by symptoms so minute as to be only perceptible to close observation; such as twitching of the brows, restless sleep, grinding the gums, and, in some inflammatory diseases, even to the child abstaining from crying, from fear of the increased pain produced by the movement. Dentition, or cutting the teeth, is attended with many of these symptoms. Measles, thrush, scarlatina, croup, hooping-cough, and other childish complaints, are all preceded by well-known symptoms, which may be alleviated and rendered less virulent by simple remedies instantaneously applied.
2405. Dentition is usually the first serious trouble, bringing many other disorders in its train. The symptoms are most perceptible to the mother: the child sucks feebly, and with gums hot, inflamed, and swollen. In this case, relief is yielded by rubbing them from time to time with a little of Mrs. Johnson's soothing syrup, a valuable and perfectly safe medicine. Selfish and thoughtless nurses, and mothers too, sometimes give cordials and sleeping-draughts, whose effects are too well known.
2406. Convulsion Fits sometimes follow the feverish restlessness produced by these causes; in which case a hot bath should be administered without delay, and the lower parts of the body rubbed, the bath being as hot as it can be without scalding the tender skin; at the same time, the doctor should be sent for immediately, for no nurse should administer medicine in this case, unless the fits have been repeated and the doctor has left directions with her how to act.
2407. Croup is one of the most alarming diseases of childhood; it is accompanied with a hoarse, croaking, ringing cough, and comes on very suddenly, and most so in strong, robust children. A very hot bath should be instantly administered, followed by an emetic, either in the form of tartar-emetic, croup-powder, or a teaspoonful of ipecacuanha, wrapping the body warmly up in flannel after the bath. The slightest delay in administering the bath, or the emetic, may be fatal; hence, the importance of nurses about very young children being acquainted with the symptoms.
2408. Hooping-Cough is generally preceded by the moaning noise during sleep, which even adults threatened with the disorder cannot avoid: it is followed by violent fits of coughing, which little can be done to relieve. A child attacked by this disorder should be kept as much as possible in the fresh, pure air, but out of draughts, and kept warm, and supplied with plenty of nourishing food. Many fatal diseases flow from this scourge of childhood, and a change to purer air, if possible, should follow convalescence.
2409. Worms are the torment of some children: the symptoms are, an unnatural craving for food, even after a full meal; costiveness, suddenly followed by the reverse; fetid breath, a livid circle under the eyes, enlarged abdomen, and picking the nose; for which the remedies must be prescribed by the doctor.
2410. Measles and Scarlatina much resemble each other in their early stages: headache, restlessness, and fretfulness are the symptoms of both. Shivering fits, succeeded by a hot skin; pains in the back and limbs, accompanied by sickness, and, in severe cases, sore throat; pain about the jaws, difficulty in swallowing, running at the eyes, which become red and inflamed, while the face is hot and flushed, often distinguish scarlatina and scarlet fever, of which it is only a mild form.
2411. While the case is doubtful, a dessert-spoonful of spirit of nitre diluted in water, given at bedtime, will throw the child into a gentle perspiration, and will bring out the rash in either case. In measles, this appears first on the face; in scarlatina, on the chest; and in both cases a doctor should be called in. In scarlatina, tartar-emetic powder or ipecacuanha may be administered in the mean time.
2412. In all cases, cleanliness, fresh air, clean utensils, and frequent washing of the person, both of nurse and children, are even more necessary in the nursery than in either drawing-room or sick-room, inasmuch as the delicate organs of childhood are more susceptible of injury from smells and vapours than adults.
2413. It may not be out of place if we conclude this brief notice of the duties of a nursemaid, by an extract from Florence Nightingale's admirable "Notes on Nursing." Referring to children, she says:—
2414. "They are much more susceptible than grown people to all noxious influences. They are affected by the same things, but much more quickly and seriously; by want of fresh air, of proper warmth; want of cleanliness in house, clothes, bedding, or body; by improper food, want of punctuality, by dulness, by want of light, by too much or too little covering in bed or when up." And all this in health; and then she quotes a passage from a lecture on sudden deaths in infancy, to show the importance of careful nursing of children:—"In the great majority of instances, when death suddenly befalls the infant or young child, it is an accident; it is not a necessary, inevitable result of any disease. That which is known to injure children most seriously is foul air; keeping the rooms where they sleep closely shut up is destruction to them; and, if the child's breathing be disordered by disease, a few hours only of such foul air may endanger its life, even where no inconvenience is felt by grown-up persons in the room."
2415. Persons moving in the beat society will see, after perusing Miss Nightingale's book, that this "foul air," "want of light," "too much or too little clothing," and improper food, is not confined to Crown Street or St. Giles's; that Belgravia and the squares have their north room, where the rays of the sun never reach. "A wooden bedstead, two or three mattresses piled up to above the height of the table, a vallance attached to the frame,—nothing but a miracle could ever thoroughly dry or air such a bed and bedding,"—is the ordinary bed of a private house, than which nothing can be more unwholesome. "Don't treat your children like sick," she sums up; "don't dose them with tea. Let them eat meat and drink milk, or half a glass of light beer. Give them fresh, light, sunny, and open rooms, cool bedrooms, plenty of outdoor exercise, facing even the cold, and wind, and weather, in sufficiently warm clothes, and with sufficient exercise, plenty of amusements and play; more liberty, and less schooling, and cramming, and training; more attention to food and less to physic."
DUTIES OF THE SICK-NURSE.
2416. All women are likely, at some period of their lives, to be called on to perform the duties of a sick-nurse, and should prepare themselves as much as possible, by observation and reading, for the occasion when they may be required to perform the office. The main requirements are good temper, compassion for suffering, sympathy with sufferers, which most women worthy of the name possess, neat-handedness, quiet manners, love of order, and cleanliness. With these qualifications there will be very little to be wished for; the desire to relieve suffering will inspire a thousand little attentions, and surmount the disgusts which some of the offices attending the sick-room are apt to create. Where serious illness visits a household, and protracted nursing is likely to become necessary, a professional nurse will probably be engaged, who has been trained to its duties; but in some families, and those not a few let us hope, the ladies of the family would oppose such an arrangement as a failure of duty on their part. There is, besides, even when a professional nurse is ultimately called in, a period of doubt and hesitation, while disease has not yet developed itself, when the patient must be attended to; and, in these cases, some of the female servants of the establishment must give their attendance in the sick-room. There are, also, slight attacks of cold, influenza, and accidents in a thousand forms, to which all are subject, where domestic nursing becomes a necessity; where disease, though unattended with danger, is nevertheless accompanied by the nervous irritation incident to illness, and when all the attention of the domestic nurse becomes necessary.
2417. In the first stage of sickness, while doubt and a little perplexity hang over the household as to the nature of the sickness, there are some things about which no doubt can exist: the patient's room must be kept in a perfectly pure state, and arrangements made for proper attendance; for the first canon of nursing, according to Florence Nightingale, its apostle, is to "keep the air the patient breathes as pure as the external air, without chilling him." This can be done without any preparation which might alarm the patient; with proper windows, open fireplaces, and a supply of fuel, the room may be as fresh as it is outside, and kept at a temperature suitable for the patient's state.
2418. Windows, however, must be opened from above, and not from below, and draughts avoided; cool air admitted beneath the patient's head chills the lower strata and the floor. The careful nurse will keep the door shut when the window is open; she will also take care that the patient is not placed between the door and the open window, nor between the open fireplace and the window. If confined to bed, she will see that the bed is placed in a thoroughly ventilated part of the room, but out of the current of air which is produced by the momentary opening of doors, as well as out of the line of draught between the window and the open chimney, and that the temperature of the room is kept about 64°. Where it is necessary to admit air by the door, the windows should be closed; but there are few circumstances in which good air can be obtained through the chamber-door; through it, on the contrary, the gases generated in the lower parts of the house are likely to be drawn into the invalid chamber.
2419. These precautions taken, and plain nourishing diet, such as the patient desires, furnished, probably little more can be done, unless more serious symptoms present themselves; in which case medical advice will be sought.
2420. Under no circumstances is ventilation of the sick-room so essential as in cases of febrile diseases, usually considered infectious; such as typhus and puerperal fevers, influenza, hooping-cough, small- and chicken-pox, scarlet fever, measles, and erysipelas: all these are considered communicable through the air; but there is little danger of infection being thus communicated, provided the room is kept thoroughly ventilated. On the contrary, if this essential be neglected, the power of infection is greatly increased and concentrated in the confined and impure air; it settles upon the clothes of the attendants and visitors, especially where they are of wool, and is frequently communicated to other families in this manner.
2421. Under all circumstances, therefore, the sick-room should be kept as fresh and sweet as the open air, while the temperature is kept up by artificial heat, taking care that the fire burns clear, and gives out no smoke into the room; that the room is perfectly clean, wiped over with a damp cloth every day, if boarded; and swept, after sprinkling with damp tea-leaves, or other aromatic leaves, if carpeted; that all utensils are emptied and cleaned as soon as used, and not once in four-and-twenty hours, as is sometimes done. "A slop-pail," Miss Nightingale says, "should never enter a sick-room; everything should be carried direct to the water-closet, emptied there, and brought up clean; in the best hospitals the slop-pail is unknown." "I do not approve," says Miss Nightingale, "of making housemaids of nurses,—that would be waste of means; but I have seen surgical sisters, women whose hands were worth to them two or three guineas a week, down on their knees, scouring a room or hut, because they thought it was not fit for their patients: these women had the true nurse spirit."
2422. Bad smells are sometimes met by sprinkling a little liquid chloride of lime on the floor; fumigation by burning pastiles is also a common expedient for the purification of the sick-room. They are useful, but only in the sense hinted at by the medical lecturer, who commenced his lecture thus:—"Fumigations, gentlemen, are of essential importance; they make so abominable a smell, that they compel you to open the windows and admit fresh air." In this sense they are useful, but ineffectual unless the cause be removed, and fresh air admitted.
2423. The sick-room should be quiet; no talking, no gossiping, and, above all, no whispering,—this is absolute cruelty to the patient; he thinks his complaint the subject, and strains his ear painfully to catch the sound. No rustling of dresses, nor creaking shoes either; where the carpets are taken up, the nurse should wear list shoes, or some other noiseless material, and her dress should be of soft material that does not rustle. Miss Nightingale denounces crinoline, and quotes Lord Melbourne on the subject of women in the sick-room, who said, "I would rather have men about me, when ill, than women; it requires very strong health to put up with women." Ungrateful man! but absolute quiet is necessary in the sick-room.
2424. Never let the patient be waked out of his first sleep by noise, never roused by anything like a surprise. Always sit in the apartment, so that the patient has you in view, and that it is not necessary for him to turn in speaking to you. Never keep a patient standing; never speak to one while moving. Never lean on the sick-bed. Above all, be calm and decisive with the patient, and prevent all noises over-head.
2425. A careful nurse, when a patient leaves his bed, will open the sheets wide, and throw the clothes back so as thoroughly to air the bed; She will avoid drying or airing anything damp in the sick-room.
2426. "It is another fallacy," says Florence Nightingale, "to suppose that night air is injurious; a great authority told me that, in London, the air is never so good as after ten o'clock, when smoke has diminished; but then it must be air from without, not within, and not air vitiated by gaseous airs." "A great fallacy prevails also," she says, in another section, "about flowers poisoning the air of the sick-room: no one ever saw them over-crowding the sick-room; but, if they did, they actually absorb carbonic acid and give off oxygen." Cut flowers also decompose water, and produce oxygen gas. Lilies, and some other very odorous plants, may perhaps give out smells unsuited to a close room, while the atmosphere of the sick-room should always be fresh and natural.
2427. "Patients," says Miss Nightingale, "are sometimes starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food. A spoonful of beef-tea, or arrowroot and wine, or some other light nourishing diet, should be given every hour, for the patient's stomach will reject large supplies. In very weak patients there is often a nervous difficulty in swallowing, which is much increased if food is not ready and presented at the moment when it is wanted: the nurse should be able to discriminate, and know when this moment is approaching."
2428. Diet suitable for patients will depend, in some degree, on their natural likes and dislikes, which the nurse will do well to acquaint herself with. Beef-tea is useful and relishing, but possesses little nourishment; when evaporated, it presents a teaspoonful of solid meat to a pint of water. Eggs are not equivalent to the same weight of meat. Arrowroot is less nourishing than flour. Butter is the lightest and most digestible kind of fat. Cream, in some diseases, cannot be replaced. But, to sum up with some of Miss Nightingale's useful maxims:—Observation is the nurse's best guide, and the patient's appetite the rule. Half a pint of milk is equal to a quarter of a pound of meat. Beef-tea is the least nourishing food administered to the sick; and tea and coffee, she thinks, are both too much excluded from the sick-room.
THE MONTHLY NURSE.
2429. The choice of a monthly nurse is of the utmost importance; and in the case of a young mother with her first child, it would be well for her to seek advice and counsel from her more experienced relatives in this matter. In the first place, the engaging a monthly nurse in good time is of the utmost importance, as, if she be competent and clever, her services will be sought months beforehand; a good nurse having seldom much of her time disengaged. There are some qualifications which it is evident the nurse should possess: she should be scrupulously clean and tidy in her person; honest, sober, and noiseless in her movements; should possess a natural love for children, and have a strong nerve in case of emergencies. Snuff-taking and spirit-drinking must not be included in her habits; but these are happily much less frequent than they were in former days.
2430. Receiving, as she often will, instructions from the doctor, she should bear these in mind, and carefully carry them out. In those instances where she does not feel herself sufficiently informed, she should ask advice from the medical man, and not take upon herself to administer medicines, &c., without his knowledge.
2431. A monthly nurse should be between 30 and 50 years of age, sufficiently old to have had a little experience, and yet not too old or infirm to be able to perform various duties requiring strength and bodily vigour. She should be able to wake the moment she is called,—at any hour of the night, that the mother or child may have their wants immediately attended to. Good temper, united to a kind and gentle disposition, is indispensable; and, although the nurse will frequently have much to endure from the whims and caprices of the invalid, she should make allowances for these, and command her temper, at the same time exerting her authority when it is necessary.
2432. What the nurse has to do in the way of cleaning and dusting her lady's room, depends entirely on the establishment that is kept. Where there are plenty of servants, the nurse, of course, has nothing whatever to do but attend on her patient, and ring the bell for anything she may require. Where the number of domestics is limited, she should not mind keeping her room in order; that is to say, sweeping and dusting it every morning. If fires be necessary, the housemaid should always clean the grate, and do all that is wanted in that way, as this, being rather dirty work, would soil the nurse's dress, and unfit her to approach the bed, or take the infant without soiling its clothes. In small establishments, too, the nurse should herself fetch things she may require, and not ring every time she wants anything; and she must, of course, not leave her invalid unless she sees everything is comfortable; and then only for a few minutes. When down stairs, and in company with the other servants, the nurse should not repeat what she may have heard in her lady's room, as much mischief may be done by a gossiping nurse. As in most houses the monthly nurse is usually sent for a few days before her services may be required, she should see that all is in readiness; that there be no bustle and hurry at the time the confinement takes place. She should keep two pairs of sheets thoroughly aired, as well as night-dresses, flannels, &c. &c. All the things which will be required to dress the baby the first time should be laid in the basket in readiness, in the order in which they are to be put on; as well as scissors, thread, a few pieces of soft linen rag, and two or three flannel squares. If a berceaunette is to be used immediately, the nurse should ascertain that the mattresses, pillow, &c. are all well aired; and if not already done before she arrives, she should assist in covering and trimming it, ready for the little occupant. A monthly nurse should be handy at her needle, as, if she is in the house some time before the baby is born, she will require some work of this sort; to occupy her time. She should also understand the making-up of little caps, although we can scarcely say this is one of the nurse's duties. As most children wear no caps, except out of doors, her powers in this way will not be much taxed.
2433. A nurse should endeavour to make her room as cheerful as possible, and always keep it clean and tidy. She should empty the chamber utensils as soon as used, and on no account put things under the bed. Soiled baby's napkins should be rolled up and put into a pan, when they should be washed out every morning, and hung out to dry: they are then in a fit state to send to the laundress; and should, on no account, be left dirty, but done every morning in this way. The bedroom should be kept rather dark, particularly for the first week or ten days; of a regular temperature, and as free as possible from draughts, at the same time well ventilated and free from unpleasant smells.
2434. The infant during the month must not be exposed to strong light, or much air; and in carrying it about the passages, stairs, &c., the nurse should always have its head-flannel on, to protect the eyes and ears from the currents of air. For the management of children, we must refer our readers to the following chapters; and we need only say, in conclusion, that a good nurse should understand the symptoms of various ills incident to this period, as, in all cases, prevention is better than cure. As young mothers with their first baby are very often much troubled at first with their breasts, the nurse should understand the art of emptying them by suction, or some other contrivance. If the breasts are kept well drawn, there will be but little danger of inflammation; and as the infant at first cannot take all that is necessary, something must be done to keep the inflammation down. This is one of the greatest difficulties a nurse has to contend with, and we can only advise her to be very persevering, to rub the breasts well, and to let the infant suck as soon and as often as possible, until they get in proper order.
THE WET-NURSE.
2435. We are aware that, according to the opinion of some ladies, there is no domestic theme, during a certain period of their married lives, more fraught with vexation and disquietude than that ever-fruitful source of annoyance, "the Nurse;" but, as we believe, there are thousands of excellent wives and mothers who pass through life without even a temporary embroglio in the kitchen, or suffering a state of moral hectic the whole time of a nurse's empire in the nursery or bedroom. Our own experience goes to prove, that although many unqualified persons palm themselves off on ladies as fully competent for the duties they so rashly and dishonestly undertake to perform, and thus expose themselves to ill-will and merited censure, there are still very many fully equal to the legitimate exercise of what they undertake; and if they do not in every case give entire satisfaction, some of the fault,—and sometimes a great deal of it,—may be honestly placed to the account of the ladies themselves, who, in many instances, are so impressed with the propriety of their own method of performing everything, as to insist upon the adoption of their system in preference to that of the nurse, whose plan is probably based on a comprehensive forethought, and rendered perfect in all its details by an ample experience.
2436. In all our remarks on this subject, we should remember with gentleness the order of society from which our nurses are drawn; and that those who make their duty a study, and are termed professional nurses, have much to endure from the caprice and egotism of their employers; while others are driven to the occupation from the laudable motive of feeding their own children, and who, in fulfilling that object, are too often both selfish and sensual, performing, without further interest than is consistent with their own advantage, the routine of customary duties.
2437. Properly speaking, there are two nurses,—the nurse for the mother and the nurse for the child, or, the monthly and the wet nurse. Of the former we have already spoken, and will now proceed to describe the duties of the latter, and add some suggestions as to her age, physical health, and moral conduct, subjects of the utmost importance as far as the charge intrusted to her is concerned, and therefore demanding some special remarks.
2438. When from illness, suppression of the milk, accident, or some natural process, the mother is deprived of the pleasure of rearing her infant, it becomes necessary at once to look around for a fitting substitute, so that the child may not suffer, by any needless delay, a physical loss by the deprivation of its natural food. The first consideration should be as regards age, state of health, and temper.
2439. The age, if possible, should not be less than twenty nor exceed thirty years, with the health sound in every respect, and the body free from all eruptive disease or local blemish. The best evidence of a sound state of health will be found in the woman's clear open countenance, the ruddy tone of the skin, the full, round, and elastic state of the breasts, and especially in the erectile, firm condition of the nipple, which, in all unhealthy states of the body, is pendulous, flabby, and relaxed; in which case, the milk is sure to be imperfect in its organization, and, consequently, deficient in its nutrient qualities. Appetite is another indication of health in the suckling nurse or mother; for it is impossible a woman can feed her child without having a corresponding appetite; and though inordinate craving for food is neither desirable nor necessary, a natural vigour should be experienced at meal-times, and the food taken should be anticipated and enjoyed.
2440. Besides her health, the moral state of the nurse is to be taken into account, or that mental discipline or principle of conduct which would deter the nurse from at any time gratifying her own pleasures and appetites at the cost or suffering of her infant charge.
2441. The conscientiousness and good faith that would prevent a nurse so acting are, unfortunately, very rare; and many nurses, rather than forego the enjoyment of a favourite dish, though morally certain of the effect it will have on the child, will, on the first opportunity, feed with avidity on fried meats, cabbage, cucumbers, pickles, or other crude and injurious aliments, in defiance of all orders given, or confidence reposed in their word, good sense, and humanity. And when the infant is afterwards racked with pain, and a night of disquiet alarms the mother, the doctor is sent for, and the nurse, covering her dereliction by a falsehood, the consequence of her gluttony is treated as a disease, and the poor infant is dosed for some days with medicines, that can do it but little if any good, and, in all probability, materially retard its physical development. The selfish nurse, in her ignorance, believes, too, that as long as she experiences no admonitory symptoms herself, the child cannot suffer; and satisfied that, whatever is the cause of its screams and plunges, neither she, nor what she had eaten, had anything to do with it, with this flattering assurance at her heart, she watches her opportunity, and has another luxurious feast off the proscribed dainties, till the increasing disturbance in the child's health, or treachery from the kitchen, opens the eyes of mother and doctor to the nurse's unprincipled conduct. In all such cases the infant should be spared the infliction of medicine, and, as a wholesome corrective to herself, and relief to her charge, a good sound dose administered to the nurse.
2442. Respecting the diet of the wet-nurse, the first point of importance is to fix early and definite hours for every meal; and the mother should see that no cause is ever allowed to interfere with their punctuality. The food itself should be light, easy of digestion, and simple. Boiled or roast meat, with bread and potatoes, with occasionally a piece of sago, rice, or tapioca pudding, should constitute the dinner, the only meal that requires special comment; broths, green vegetables, and all acid or salt foods, must be avoided. Fresh fish, once or twice a week, may be taken; but it is hardly sufficiently nutritious to be often used as a meal. If the dinner is taken early,—at one o'clock,—there will be no occasion for luncheon, which too often, to the injury of the child, is made the cover for a first dinner. Half a pint of stout, with a Reading biscuit, at eleven o'clock, will be abundantly sufficient between breakfast at eight and a good dinner, with a pint of porter at one o'clock. About eight o'clock in the evening, half a pint of stout, with another biscuit, may be taken; and for supper, at ten or half-past, a pint of porter, with a slice of toast or a small amount of bread and cheese, may conclude the feeding for the day.
2443. Animal food once in twenty-four hours is quite sufficient. All spirits, unless in extreme cases, should be avoided; and wine is still more seldom needed. With a due quantity of plain digestible food, and the proportion of stout and porter ordered, with early hours and regularity, the nurse will not only be strong and healthy herself, but fully capable of rearing a child in health and strength. There are two points all mothers, who are obliged to employ wet-nurses, should remember, and be on their guard against. The first is, never to allow a nurse to give medicine to the infant on her own authority: many have such an infatuated idea of the healing excellence of castor-oil, that they would administer a dose of this disgusting grease twice a week, and think they had done a meritorious service to the child. The next point is, to watch carefully, lest, to insure a night's sleep for herself, she does not dose the infant with Godfrey's cordial, syrup of poppies, or some narcotic potion, to insure tranquillity to the one and give the opportunity of sleep to the other. The fact that scores of nurses keep secret bottles of these deadly syrups, for the purpose of stilling their charges, is notorious; and that many use them to a fearful extent, is sufficiently patent to all.
2444. It therefore behoves the mother, while obliged to trust to a nurse, to use her best discretion to guard her child from the unprincipled treatment of the person she must, to a certain extent, depend upon and trust; and to remember, in all cases, rather than resort to castor-oil or sedatives, to consult a medical man for her infant in preference to following the counsel of her nurse.
THE REARING, MANAGEMENT, AND DISEASES OF INFANCY AND CHILDHOOD.
CHAPTER XLII.
Physiology of Life, as illustrated by Respiration, Circulation, and
Digestion.
2445. The infantine management of children, like the mother's love for her offspring, seems to be born with the child, and to be a direct intelligence of Nature. It may thus, at first sight, appear as inconsistent and presumptuous to tell a woman how to rear her infant as to instruct her in the manner of loving it. Yet, though Nature is unquestionably the best nurse, Art makes so admirable a foster-mother, that no sensible woman, in her novitiate of parent, would refuse the admonitions of art, or the teachings of experience, to consummate her duties of nurse. It is true that, in a civilized state of society, few young wives reach the epoch that makes them mothers without some insight, traditional or practical, into the management of infants: consequently, the cases wherein a woman is left to her own unaided intelligence, or what, in such a case, may be called instinct, and obliged to trust to the promptings of nature alone for the well-being of her child, are very rare indeed. Again, every woman is not gifted with the same physical ability for the harassing duties of a mother; and though Nature, as a general rule, has endowed all female creation with the attributes necessary to that most beautiful and, at the same time, holiest function,—the healthy rearing of their offspring,—the cases are sufficiently numerous to establish the exception, where the mother is either physically or socially incapacitated from undertaking these most pleasing duties herself, and where, consequently, she is compelled to trust to adventitious aid for those natural benefits which are at once the mother's pride and delight to render to her child.
2446. In these cases, when obliged to call in the services of hired assistance, she must trust the dearest obligation of her life to one who, from her social sphere, has probably notions of rearing children diametrically opposed to the preconceived ideas of the mother, and at enmity with all her sentiments of right and prejudices of position.
2447. It has justly been said—we think by Hood—that the children of the poor are not brought up, but dragged up. However facetious this remark may seem, there is much truth in it; and that children, reared in the reeking dens of squalor and poverty, live at all, is an apparent anomaly in the course of things, that, at first sight, would seem to set the laws of sanitary provision at defiance, and make it appear a perfect waste of time to insist on pure air and exercise as indispensable necessaries of life, and especially so as regards infantine existence.
2448. We see elaborate care bestowed on a family of children, everything studied that can tend to their personal comfort,—pure air, pure water, regular ablution, a dietary prescribed by art, and every precaution adopted that medical judgment and maternal love can dictate, for the well-being of the parents' hope; and find, in despite of all this care and vigilance, disease and death invading the guarded treasure. We turn to the foetor and darkness that, in some obscure court, attend the robust brood who, coated in dirt, and with mud and refuse for playthings, live and thrive, and grow into manhood, and, in contrast to the pale face and flabby flesh of the aristocratic child, exhibit strength, vigour, and well-developed frames, and our belief in the potency of the life-giving elements of air, light, and cleanliness receives a shock that, at first sight, would appear fatal to the implied benefits of these, in reality, all-sufficient attributes of health and life.
2449. But as we must enter more largely on this subject hereafter, we shall leave its consideration for the present, and return to what we were about to say respecting trusting to others' aid in the rearing of children. Here it is that the young and probably inexperienced mother may find our remarks not only an assistance but a comfort to her, in as far as, knowing the simplest and best system to adopt, she may be able to instruct another, and see that her directions are fully carried out.
2450. The human body, materially considered, is a beautiful piece of mechanism, consisting of many parts, each one being the centre of a system, and performing its own vital function irrespectively of the others, and yet dependent for its vitality upon the harmony and health of the whole. It is, in fact, to a certain extent, like a watch, which, when once wound up and set in motion, will continue its function of recording true time only so long as every wheel, spring, and lever performs its allotted duty, and at its allotted time; or till the limit that man's ingenuity has placed to its existence as a moving automaton has been reached, or, in other words, till it has run down.
2451. What the key is to the mechanical watch, air is to the physical man. Once admit air into the mouth and nostrils, and the lungs expand, the heart beats, the blood rushes to the remotest part of the body, the mouth secretes saliva, to soften and macerate the food; the liver forms its bile, to separate the nutriment from the digested aliment; the kidneys perform their office; the eye elaborates its tears, to facilitate motion and impart that glistening to the orb on which depends so much of its beauty; and a dewy moisture exudes from the skin, protecting the body from the extremes of heat and cold, and sharpening the perception of touch and feeling. At the same instant, and in every part, the arteries, like innumerable bees, are everywhere laying down layers of muscle, bones, teeth, and, in fact, like the coral zoophyte, building up a continent of life and matter; while the veins, equally busy, are carrying away the débris and refuse collected from where the zoophyte arteries are building,—this refuse, in its turn, being conveyed to the liver, there to be converted into bile.
2452. All these—and they are but a few of the vital actions constantly taking place—are the instant result of one gasp of life-giving air. No subject can be fraught with greater interest than watching the first spark of life, as it courses with electric speed "through all the gates and alleys" of the soft, insensate body of the infant. The effect of air on the new-born child is as remarkable in its results as it is wonderful in its consequence; but to understand this more intelligibly, it must first be remembered that life consists of the performance of three vital functions—RESPIRATION, CIRCULATION, and DIGESTION. The lungs digest the air, taking from it its most nutritious element, the oxygen, to give to the impoverished blood that circulates through them. The stomach digests the food, and separates the nutriment—chyle—from the aliment, which it gives to the blood for the development of the frame; and the blood, which is understood by the term circulation, digests in its passage through the lungs the nutriment—chyle—to give it quantity and quality, and the oxygen from the air to give it vitality. Hence it will be seen, that, speaking generally, the three vital functions resolve themselves into one,—DIGESTION; and that the lungs are the primary and the most important of the vital organs; and respiration, the first in fact, as we all know it is the last in deed, of all the functions performed by the living body.
THE LUNGS.—RESPIRATION.
2453. The first effect of air on the infant is a slight tremor about the lips and angles of the mouth, increasing to twitchings, and finally to a convulsive contraction of the lips and cheeks, the consequence of sudden cold to the nerves of the face. This spasmodic action produces a gasp, causing the air to rush through the mouth and nostrils, and enter the windpipe and upper portion of the flat and contracted lungs, which, like a sponge partly immersed in water, immediately expand. This is succeeded by a few faint sobs or pants, by which larger volumes of air are drawn into the chest, till, after a few seconds, and when a greater bulk of the lungs has become inflated, the breast-bone and ribs rise, the chest expands, and, with a sudden start, the infant gives utterance to a succession of loud, sharp cries, which have the effect of filling every cell of the entire organ with air and life. To the anxious mother, the first voice of her child is, doubtless, the sweetest music she ever heard; and the more loudly it peals, the greater should be her joy, as it is an indication of health and strength, and not only shows the perfect expansion of the lungs, but that the process of life has set in with vigour. Having welcomed in its own existence, like the morning bird, with a shrill note of gladness, the infant ceases its cry, and, after a few short sobs, usually subsides into sleep or quietude.
2454. At the same instant that the air rushes into the lungs, the valve, or door between the two sides of the heart-and through which the blood had previously passed-is closed and hermetically sealed, and the blood taking a new course, bounds into the lungs, now expanded with air, and which we have likened to a wetted sponge, to which they bear a not unapt affinity, air being substituted for water. It here receives the oxygen from the atmosphere, and the chyle, or white blood, from the digested food, and becomes, in an instant, arterial blood, a vital principle, from which every solid and fluid of the body is constructed. Besides the lungs, Nature has provided another respiratory organ, a sort of supplemental lung, that, as well as being a covering to the body, _in_spires air and _ex_pires moisture;—this is the cuticle, or skin; and so intimate is the connection between the skin and lungs, that whatever injures the first, is certain to affect the latter.
2455. Hence the difficulty of breathing experienced after scalds or burns on the cuticle, the cough that follows the absorption of cold or damp by the skin, the oppressed and laborious breathing experienced by children in all eruptive diseases, while the rash is coming to the surface, and the hot, dry skin that always attends congestion of the lungs, and fever.
2456. The great practical advantage derivable from this fact is, the knowledge that whatever relieves the one benefits the other. Hence, too, the great utility of hot baths in all affections of the lungs or diseases of the skin; and the reason why exposure to cold or wet is, in nearly all cases, followed by tightness of the chest, sore throat, difficulty of breathing, and cough. These symptoms are the consequence of a larger quantity of blood than is natural remaining in the lungs, and the cough is a mere effort of Nature to throw off the obstruction caused by the presence of too much blood in the organ of respiration. The hot bath, by causing a larger amount of blood to rush suddenly to the skin, has the effect of relieving the lungs of their excess of blood, and by equalizing the circulation, and promoting perspiration from the cuticle, affords immediate and direct benefit, both to the lungs and the system at large.
THE STOMACH—DIGESTION.
2457. The organs that either directly or indirectly contribute to the process of digestion are, the mouth, teeth, tongue, and gullet, the stomach, small intestines, the pancreas, the salivary glands, and the liver. Next to respiration, digestion is the chief function in the economy of life, as, without the nutritious fluid digested from the aliment, there would be nothing to supply the immense and constantly recurring waste of the system, caused by the activity with which the arteries at all periods, but especially during infancy and youth, are building up the frame and developing the body. In infancy (the period of which our present subject treats), the series of parts engaged in the process of digestion may be reduced simply to the stomach and liver, or rather its secretion,—the bile. The stomach is a thick muscular bag, connected above with the gullet, and, at its lower extremity, with the commencement of the small intestines. The duty or function of the stomach is to secrete from the arteries spread over its inner surface, a sharp acid liquid called the gastric juice; this, with a due mixture of saliva, softens, dissolves, and gradually digests the food or contents of the stomach, reducing the whole into a soft pulpy mass, which then passes into the first part of the small intestines, where it comes in contact with the bile from the gall-bladder, which immediately separates the digested food into two parts, one is a white creamy fluid called chyle, and the absolute concentration of all nourishment, which is taken up by proper vessels, and, as we have before said, carried directly to the heart, to be made blood of, and vitalized in the lungs, and thus provide for the wear and tear of the system. It must be here observed that the stomach can only digest solids, for fluids, being incapable of that process, can only be absorbed; and without the result of digestion, animal, at least human life, could not exist. Now, as Nature has ordained that infantine life shall be supported on liquid aliment, and as, without a digestion the body would perish, some provision was necessary to meet this difficulty, and that provision was found in the nature of the liquid itself, or in other words, THE MILK. The process of making cheese, or fresh curds and whey, is familiar to most persons; but as it is necessary to the elucidation of our subject, we will briefly repeat it. The internal membrane, or the lining coat of a calf's stomach, having been removed from the organ, is hung up, like a bladder, to dry; when required, a piece is cut off, put in a jug, a little warm water poured upon it, and after a few hours it is fit for use; the liquid so made being called rennet. A little of this rennet, poured into a basin of warm milk, at once coagulates the greater part, and separates from it a quantity of thin liquor, called whey. This is precisely the action that takes place in the infant's stomach after every supply from the breast. The cause is the same in both cases, the acid of the gastric juice in the infant's stomach immediately converting the milk into a soft cheese. It is gastric juice, adhering to the calf's stomach, and drawn out by the water, forming rennet, that makes the curds in the basin. The cheesy substance being a solid, at once undergoes the process of digestion, is separated into chyle by the bile, and, in a few hours, finds its way to the infant's heart, to become blood, and commence the architecture of its little frame. This is the simple process of a baby's digestion:-milk converted into cheese, cheese into chyle, chyle into blood, and blood into flesh, bone, and tegument-how simple is the cause, but how sublime and wonderful are the effects!
2458. We have described the most important of the three functions that take place in the infant's body-respiration and digestion; the third, namely, circulation, we hardly think it necessary to enter on, not being called for by the requirements of the nurse and mother; so we shall omit its notice, and proceed from theoretical to more practical considerations. Children of weakly constitutions are just as likely to be born of robust parents, and those who earn their bread by toil, as the offspring of luxury and affluence; and, indeed, it is against the ordinary providence of Nature to suppose the children of the hardworking and necessitous to be hardier and more vigorous than those of parents blessed with ease and competence.
2459. All children come into the world in the same imploring helplessness, with the same general organization and wants, and demanding either from the newly-awakened mother's love, or from the memory of motherly feeling in the nurse, or the common appeals of humanity in those who undertake the earliest duties of an infant, the same assistance and protection, and the same fostering care.
THE INFANT.
2460. We have already described the phenomena produced on the new-born child by the contact of air, which, after a succession of muscular twitchings, becomes endowed with voice, and heralds its advent by a loud but brief succession of cries. But though this is the general rule, it sometimes happens (from causes it is unnecessary here to explain) that the infant does not cry, or give utterance to any audible sounds, or if it does, they are so faint as scarcely to be distinguished as human accents, plainly indicating that life, as yet, to the new visitor, is neither a boon nor a blessing; the infant being, in fact, in a state of suspended or imperfect vitality,—a state of quasi existence, closely approximating the condition of a still-birth.
2461. As soon as this state of things is discovered, the child should be turned on its right side, and the whole length of the spine, from the head downwards, rubbed with all the fingers of the right hand, sharply and quickly, without intermission, till the quick action has not only evoked heat, but electricity in the part, and till the loud and sharp cries of the child have thoroughly expanded the lungs, and satisfactorily established its life. The operation will seldom require above a minute to effect, and less frequently demands a repetition. If there is brandy at hand, the fingers before rubbing may be dipped into that, or any other spirit.
2462. There-is another condition of what we may call "mute births," where the child only makes short ineffectual gasps, and those at intervals of a minute or two apart, when the lips, eyelids, and fingers become of a deep purple or slate colour, sometimes half the body remaining white, while the other half, which was at first swarthy, deepens to a livid hue. This condition of the infant is owing to the valve between the two sides of the heart remaining open, and allowing the unvitalized venous blood to enter the arteries and get into the circulation.
2463. The object in this case, as in the previous one, is to dilate the lungs as quickly as possible, so that, by the sudden effect of a vigorous inspiration, the valve may be firmly closed, and the impure blood, losing this means of egress, be sent directly to the lungs. The same treatment is therefore necessary as in the previous case, with the addition, if the friction along the spine has failed, of a warm bath at a temperature of about 80°, in which the child is to be plunged up to the neck, first cleansing the mouth and nostrils of the mucus that might interfere with the free passage of air.
2464. While in the bath, the friction along the spine is to be continued, and if the lungs still remain unexpended, while one person retains the child in an inclined position in the water, another should insert the pipe of a small pair of bellows into one nostril, and while the month is closed and the other nostril compressed on the pipe with the hand of the assistant, the lungs are to be slowly inflated by steady puffs of air from the bellows, the hand being removed from the mouth and nose after each inflation, and placed on the pit of the stomach, and by a steady pressure expelling it out again by the mouth. This process is to be continued, steadily inflating and expelling the air from the lungs, till, with a sort of tremulous leap, Nature takes up the process, and the infant begins to gasp, and finally to cry, at first low and faint, but with every gulp of air increasing in length and strength of volume, when it is to be removed from the water, and instantly wrapped (all but the face and mouth) in a flannel. Sometimes, however, all these means will fail in effecting an utterance from the child, which will lie, with livid lips and a flaccid body, every few minutes opening its mouth with a short gasping pant, and then subsiding into a state of pulseless inaction, lingering probably some hours, till the spasmodic pantings growing further apart, it ceases to exist.
2465. The time that this state of negative vitality will linger in the frame of an infant is remarkable; and even when all the previous operations, though long-continued, have proved ineffectual, the child will often rally from the simplest of means—the application of dry heat. When removed from the bath, place three or four hot bricks or tiles on the hearth, and lay the child, loosely folded in a flannel, on its back along them, taking care that there is but one fold of flannel between the spine and heated bricks or tiles. When neither of these articles can be procured, put a few clear pieces of red cinder in a warming-pan, and extend the child in the same manner along the closed lid. As the heat gradually diffuses itself over the spinal marrow, the child that was dying, or seemingly dead, will frequently give a sudden and energetic cry, succeeded in another minute by a long and vigorous peal, making up, in volume and force, for the previous delay, and instantly confirming its existence by every effort in its nature.