The handicapped baby. A plea for adequate prophylaxis.
HARRY V. BROWN, M.D., LOS ANGELES, CAL.
When importuned by the chairman of this section to present a paper for the NATIONAL, I fully intended to refresh my memory on some important disease and hand it out to you in the time-honored way. Many times has my desk been strewn with books, as testimonials of my good intentions, yet always the result was the same—unable to convince myself that there was any one disease in childhood of vastly greater importance than another, nor could I believe that those of this assembly were lacking in any material point of information concerning the classical diseases of childhood. The overwhelming thought possessed me that we could well afford to abandon the diseases for the moment and turn our attention to the underlying cause of the weakling. I, therefore, adopted a shotgun policy, hoping thereby to hit a few high points of general interest to the infantry.
One who becomes interested or absorbed in the seed time, spring time, and blossoming period of child life, as we find it to-day in this country, must needs be impressed with the generally unfair environment which prevails for the little ones, from the standpoint of physical growth and development. My attention was recently called to a nursing bottle advertisement which read like this: "When the baby is done drinking it must be unscrewed and laid in a cool place under a tap. If the baby does not thrive on fresh milk it should be boiled." Many babies look as though they had been through the boiling process when they arrive, and it is not to be wondered at in the light of the hurly-burly, tango existence which their mothers enjoy from childhood to maternity. This fox-trot pace which has been set for the women of to-day, taken with the fact that they are constantly having more superinduced abortions than babies, are in themselves sufficient explanation for the disparity existing between them and their silver-crowned mothers when tried out in the endurance tests of life. An average mother of the earlier generation produced eight to ten babies and fed them at the fountain of youth, as against one, or possibly a grudging two for the modern woman, and in most instances she either can not or will not nurse the child. The former caused an overproduction at the expense of vitality, and the latter a decided under-production at the very same cost; we have had both extremes and may now hope for a balanced condition in the future.
It has been said that civilization and syphilization are the prime factors in the deterioration of the human species. This statement, doubtless true, is a serious indictment of ourselves and our progenitors. Of the many things credited to civilization, there are many which had their origin in hell and for which the devil alone is responsible. Among those for which we must accept responsibility are: The commercialization of every product of nature which has any known value (What a visionary!—MM) (the actual necessities of life being completely cornered), thus demanding more and more of the individual who hopes to exist, and encroaching more and more upon the time which should be allowed for the recuperation of wasted energy. This state of affairs has been brought about so gradually and stealthily, and we are so accustomed to the grind, that it is accepted by most of us as a visitation of Providence. Take a look backward and convince yourself, by comparison, what we are each day requiring of ourselves.
Second, there is the increasing tendency to flock to the great commercial centers, the large cities, where right living and hygienic surroundings are next to impossible. As a consequence, each city becomes a veritable hive of parasites, feeding one upon the other.
Third.—The social requirement of the age which turn night into day and day into night is not the least significant of these civilizing influences. The profession has not yet discovered any successful substitute for nature's sweet restorer. Society has endeavored in many ways to antedate sleep with such articles as high-balls, cocktails, etc., but I am informed that these attempts have proven to be only a very temporary kick with a sudden drop by crisis at the close.
Fourth, the growing lack of the mother instinct in those who are so situated that they could abundantly provide for the needs of child development.
Fifth, the decrease in number of those who nurse their infants, either from inability, from lack of desire, or because of inconvenience.
Sixth, the alarming percentage of children who have recognized or unrecognized tubercular invasion.
These and many other conditions which might be named are sapping the vitality of our people and reflect seriously upon the well-being of the child.
The term "syphilization" means that somewhere down the line some of our ancestors (remote) fell off the gospel wagon and unthought fully implanted the ineradicable virus which is now blamed for four-fifths of human ills. What does this array of somber truths mean? It can only mean that every child is born with a handicap, varying only in degree. Fortunately, these handicaps are partially compensated for in an artificial way by the small army of self-sacrificing, philanthropic persons who are devoting their energies to social settlement work, housing for the poor, free employment bureaus, pure milk depots, the advocacy of open air sleeping apartments. State and private sanitoriums for tuberculosis, etc. The one thing which to my mind promises the only permanent results along this line is the "back to the farms" propaganda. It is to be regretted that no definite plan has yet been devised, governmental or otherwise, making it feasible and attractive for the man of small means and a family to till the soil and make a livelihood without the danger of burning out the bearings of the human machine. Speaking on the subject of manual training in the public schools. Superintendent J. H. Francis, of the Los Angeles schools, recently said: "We are trying to put back into the lives of our boys and girls what civilization has taken out of it." All power to this work which has developed from a fad into a practical means of assisting the boy and girl to find himself or herself, physically, mentally and vocationally.
In some States the restriction of marriage to those who can pass a rigid physical examination is being tried out, but there are many reasons why it is impracticable. It may be, however, that these objections can be overcome by experience and this will become the partial solution of the problem of healthy children, after all. We hear much about the pedigreed dog from those who are too selfish to raise babies. Nevertheless, the work with dogs, if of no other benefit to the world, has demonstrated that blood will tell. Why not devote some attention to the subject of pedigreed babies? A father might well say with becoming dignity, "My boy is eligible to be registered."
At all events, whatever the solution of this question, it must be of a prophylactic nature, and that is the message I wish to bring to you to-day. If one wishes perfect rosebuds, the proper soil and environment must be selected for the parent plant. All clouds and rain with no sunshine will fail to produce the best type either in the animal or vegetable kingdom. In the meanwhile, it is our duty and privilege to endeavor to correct such deviations from the normal in our little friends as may be brought to our attention. There are certain well-defined principles in child therapeutics, which, if well understood, will make the treatment of each case a mere matter of filling in the details. I recommend the appended formula for your consideration.
- Correct the errors in diet.
- Correct all errors in hygiene.
- Base all medication on specific indications.
- If you have any with you, give the mother a full dose of common sense, intracranially, at the outset.
DR. H. T. WEBSTER: I think a great deal of this paper is very good, but the doctor mentioned in the beginning the advertisement that said the child should be unscrewed and placed under a tap, and that suggests something that is practical, and that is the unfortunate habit that some people have of bathing babies too much. I have found that puny babies are bathed too much; they are bathed in too much warm water; their treatment would kill an adult. They are bathed in warm water every day, and where I have not warned the mother or nurse against this I have found that the babies become puny. To give a baby a bath every two weeks, excepting some parts that need it often, is enough.
DR. SAXTON: I fully agree with the doctor that has just spoken. I saw a young lady, twenty-three years of age, that had never had a bath until after she was fifteen, and she was a healthy girl. She was an Esquimeaux, and she had lived on whale oil and never saw the ground until after she was fifteen. I have had some experience with mothers bathing their babies too much. I have seen babies bathed into the grave. An ordinary amount of bathing is all a baby should have.
DR. HUBBARD: Those who have had very much country practice know that country women especially use pretty harsh means with little infants. It is not uncommon to see women take some laundry soap and give a child a good scrubbing, and they will even take a scrubbing brush. I have seen cases of eczema in little infants caused by using harsh soap.
DR. CARYL: I was quite interested in what Dr. Brown said about getting back to the land, getting out where they could have fresh air and sunshine and plenty of wholesome food—and the very important point of putting common sense into the mother's head.
DR. MUNDY: There is a good deal in this paper put into a very small space, and to discuss it a person needs more than three minutes. I do not agree with some of the speakers as to the bathing of the baby. My small babies are bathed daily. Water never hurt anybody, inside or out. (Applause.) The first thing in the raising of a baby is its food, and the second is sunshine, and the third is bathing. I find more problems in the feeding of the baby than any other thing, and many a time all the child needs is the regulation of the mother's life and the regulation of the child's life, and no medicine. I find as I grow older that I have very many less cases of gastro-enteritis, and I believe it is because the mothers are becoming wiser in regard to the care and nature of the food they give to their children. Many a pale, sick child is benefited solely by plenty of fresh air and sunshine. It is not alone growth. The proper functions of digestion and assimilation must develop. They must develop in function as well as growth, and that is what the food primarily must do. The child is undeveloped, and, by proper supply of food, sunshine, fresh air and bathing, it is developed and made to grow.
I never saw anyone use laundry soap, but one of the worst cases of dermatitis I ever saw came from using a highly scented soap, and one that is most extensively advertised. I use olive oil for the first bath, wipe that off with a soft cloth, and it will cleanse as well as water. I do not use soap unless it is some plain, unscented soap.
DR. BROWN (closing): This discussion demonstrates the fact that you never can tell what you are going to hit when you shoot off a gun. I did not say anything in my paper about bathing the child, but it started something, anyway. As Dr. Munday has said, you can not cover the ground of this paper in three minutes. I simply tried to give a general survey of the situation as I see it in regard to the developing child. I did not say all I had in mind. The question of bathing, however, is very interesting, and my bathing of babies is based on specific indications. If the baby needs cold water, he gets it; if he needs hot water, he gets it, or a bran bath, or whatever kind, he gets it. I think the idea of bathing a baby every day as a regular routine should be based on the condition of the particular baby, and that is why common sense must be the particular element injected into the care of babies. The oil rubs are one of my hobbies, and I find that all weak, puny babies are benefited by oil rubs, and it is as cleansing as water. So far as soaps are concerned, I agree that the less soap you use the better the condition of the baby's skin.
National Eclectic Medical Association Quarterly, Vol. 7, 1915-16, was edited by William Nelson Mundy, M.D.