CHAPTER V.
HOW TO DRESS INFANTS.
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FASHION has far too long been permitted to hold absolute sway over the layette, and it is more than time that some radical change should be made in this respect. If the problem to be solved in clothing infants were how best to keep them cold, fetter their movements, check their excretions, and render them generally uncomfortable, no better plan could be adopted than that at present in fashion. But the reverse of all this is what is required in accordance with the laws of health and growth.
Clothing should be warm, but not heavy; it should allow free transpiration, so that the breathing action of the skin may not be impaired, and it should be absorbent of moisture. All these conditions are fulfilled by wool; but the exactly opposite characteristics are possessed by those cotton and linen materials of which infants' clothing is, on the present system, chiefly constructed. Further, clothing must not hinder any of the natural or acquired movements of the body. Before going into details as to what I consider the most healthy mode of clothing children, I wish to urge the total abolition of what Prof. Humphry calls "a sort of baptism to the numerous evils of fashion in dress," to which the vast majority of infants are subjected, viz. the binder, or swather. I cannot do better than quote Prof. Humphry's words on the subject from his address at the Congress of the Sanitary Institute of Great Britain:1[1]— "Those mischievous two yards of calico . . . con-constrict and hinder the expansion of that very region of the body where heart and lungs, stomach and liver . . . are struggling for room to grow and do their work." It hampers the breathing, and may even occasion rupture by preventing due expansion of the chest when the child coughs. It interferes with digestion, and when the stomach is distended with food, causes pain by its unyielding pressure. Dr. Humphry continues :—" A more pernicious device can hardly be conceived than this relic of ancient nursedom, and it is impossible to estimate the number of deformed or pigeon-chests, of hampered stomachs, livers, lungs, and hearts, with their varied attendant life-enduring infirmities and curtailment of life that must result from the use of these 'swathers,' as they are called, for which there is not the slightest necessity."
Binders are a relic of the ancient custom of swaddling infants, which arose from a sort of superstition that infants required to be artificially pressed into a proper shape, like bear-cubs, which, according to a similar myth, "want licking." The swaddled baby is as incapable of moving a limb as if it were in reality the mummy it resembles in appearance, and the only apparent advantage of the practice is that a mother, when going out, could conveniently hang up her swaddled baby to a nail out of harm's way, in the comfortable assurance that by no possibility could it wriggle itself into mischief during her absence. The custom of swaddling arose from a belief that Nature was unable to perform her duties towards the growing child without aid from Art.
An author, writing in 1658, remarked in evident regret and surprise, when speaking of the Caribs, "They do not swaddle their infants, but leave them to tumble about at liberty in their little hammocks, or on beds of leaves spread on the earth in a corner of their tents; and nevertheless (mark the naiveness of this expression) their limbs do not become crooked, and their whole body is perfectly well made." In France, it was Voltaire who first raised a voice against the practice of swaddling, and he maintained that it was the cause of most of the deformities so common in civilized countries. Yet so firmly rooted was this custom in the country of Voltaire, that I have heard my lamented friend, the late Prof. Cassal, say that he was swaddled when an infant.
The treatment ordinarily received by infants in civilized London at the present time is not altogether undictated by the same barbarous idea of the incapacity of Nature, although the origin of the customs practised is obscured by their revered antiquity; and in outcry against the opinions of such heterodox people as myself, mothers and nurses will doubtless maintain that whatever they do is right, since it was always done by their mothers and grandmothers for centuries past.
The following instructions, although contrary to custom, will, however, be found in accordance with reason, physiology, and Nature.
At birth the navel cord, instead of being bound tightly to the body and pointing towards the chest, according to a common but very bad practice, which is apt to cause premature separation, sore navel, and even rupture at the part, should be wrapped in a piece of clean, soft rag, and left as free as possible. Its tendency will be to incline towards the feet.
The navel string generally dries up and separates from the body about the fifth day, and the following very excellent advice on this subject is given by the Ladies' Sanitary Association in its pamphlet on "How to manage a Baby :"—"If the navel is sore, a piece of very soft linen rag should be put upon it. If the navel seems likely to push outwards, twelve little round pieces of linen rag should be put on it. The first piece should be the size of a threepenny-piece, and the second a little larger, and the third a little larger than that, and so on up to the twelfth, which should be as large as a penny-piece. These pieces should be laid one upon the other with the largest at the bottom, the next largest next, and so on to the smallest; the whole should then be put on with the smallest piece nearest to the navel, so as just to fit into it. A long strip of rag should then be rolled twice round the body to keep these little pieces from slipping off."
To avoid the evils so graphically described by Prof. Humphry, besides giving up the linen roller, the flannel one should be greatly reduced. Cut a strip of flannel long enough to go twice round the infant. Make one end of this narrower than the other, so that it can pass through a slit in the breadth of the other side. It will then sit quite smoothly round the baby, and should be tied to one side in front with ribbons. The edges of the flannel should be left raw, as, if they are bound, the skin of the little one may be chafed. The flannel should be broad enough to cover the abdomen, and long enough for the ribbon sewn on to the narrow end to tie quite close to the other ribbon, which must be sewn on behind the slit, for if the flannel does not meet in this way, the strings may cut the soft little body. A good plan is to crochet or knit a band of fine, soft, white wool, which can be made like woollen cuffs, and slipped up over the feet. It must be big enough to fit closely to the child, and different sizes should be kept to wear as the baby grows.
The best binder I have seen is that shown in Fig. 2. It is made of flannel, neatly bound with a soft ribbon, and has the front made of silk elastic, shaped to the abdomen, so that there is just 
Here, while counselling all mothers who use rollers for their infants to give up that most harmful practice, I warn them to be careful how they make the change. A piece of the roller should be cut off every day, so that its loss being gradual, it shall not be missed. Here, as elsewhere, it is of the greatest importance to remember that all sudden change is dangerous.
Too tight clothing may press upon and irritate the breasts of young infants and produce enlargement of the mammary glands, which may even go on to abscess. This is often caused by a binder which is too broad, or slips up, or by a string of the dress tied too tightly across the chest. In case of such enlargement occurring, the cause should be at once removed, and a pad of medicated wool placed over each breast to protect it.
The nervous system in infants is extremely unstable, and liable to be injured by disturbances which to us would appear slight. Thus fatal convulsions have been produced by cold, exposure to the night air, excessive heat, or even by a badly placed pin or painful constriction of the dress. Convulsions are so terribly fatal to infants that the utmost care should be taken to avoid anything which is likely to cause them. As an awful example, let me tell you that according to the Registrar-General's statistics for England and Wales during the year 1871, no less than 20,089 infants died of convulsions.
The necessity for avoiding a source of great danger, which is often incurred in dressing children carelessly, is well illustrated by the following cases : —Trousseau, the great French physician, was called with Dr. Blache to see a child who had for some hours been in convulsions, for which he had been put in a warm bath. Dr. Blache, on removing the child's cap, saw a piece of thread across his head, and on trying to take it away pulled out a long needle which had entered the brain; the convulsions ceased immediately, but the child died soon afterwards of water on the brain. A similar case is recounted by Underwood, where the cause of the convulsions was not discovered till after death, when, on the cap being removed, a small pin was found sticking into the anterior fontanel. Trousseau in his Clinical Lectures 2[2]relates another case, where a son of a French Professor of Medicine having died of convulsions, for which no cause could be assigned, a post-mortem examination was held, when a needle was found transfixing the liver. Such cases as these are, doubtless, very common; owing, however, to the unreasoning but widespread prejudice against post-mortem examinations, the true cause of the death is generally never discovered. As this prejudice raises unnecessary hindrances to the progress of the healing art, I take this opportunity to protest against it.
Babies' clothes as a rule are made according to a bad old fashion, and have four great faults, (1) They are not made high enough in the neck to keep the chest and shoulders warm; (2) they press on the arms, and so prevent them from being moved freely; (3) they are made so that they cannot be put on without the child's being turned over and over—some even having to be passed over its head; (4) they are too long, full, and heavy. The clothes ought, however, to be made: (1) to cover every part of the body alike; (2) to rest upon the collarbones so that the arms may be quite free; (3) they should be made so that they can be put on without turning the baby once; (4) they should be short and light, so that it can move its legs quite freely. Two or three kinds of infants' clothes have been invented to fulfil these conditions. Those invented by Mr. Day, assistant-surgeon to the Royal Hospital for Women and Children, consist of three articles. First a fine flannel vest reaching to about four inches below the feet, which should be protected by woollen socks, wrapped round the infant and tied in front with tapes; next a calico shirt with sleeves nearly to the wrist, to reach four inches below the vest; and, lastly, a robe made in the same way, that is, to fasten down the front. The robe and shirt may be fastened with small buttons, as the vest will protect the skin from their pressure, and the robe may be trimmed according to taste. With these garments dressing is a simple matter. All that has to be done is to lay the shirt on top of the robe, the vest on the shirt, and then slip the child's arms through the arm-holes of all of them together, fasten them up, and you have finished. Thus all risk is avoided of entangling the baby in its clothes or straining it by an unnatural position while being dressed, or making it sick by turning it over and over. In order to prevent any pressure round the waist, I venture to suggest that the belt round the middle of the vest in his pattern should be omitted, as it is quite unnecessary; but, if further fastening should be required, another pair of tapes can be sewn lower down.
The difficulty with garments made in this way, to fasten down the front, is that the infant's arms have to be bent backwards in order to insert them in the sleeves. Now the natural position of an infant's arms is forwards, and if they are carelessly bent back, there is danger of their being dislocated at the shoulder, for in infancy the cup-like surface with which the main-bone of the arm articulates is very shallow, and the process at the outer and upper extremity of the shoulder-blade, which serves to protect the joint, has not reached its firm and full development. Hence, if the clothes are made to fasten down the front, they must be cut very wide in the back, and great care must be taken in inserting the little arms into the sleeves. The clothes, however, may be made to fasten down the back, preferably rather to one side.
Mr. Day's infant's clothing is made only by Mr. Addley Bourne, of 174, Sloane Street, S.W., with whom I have arranged also to provide all the articles of children's clothing and ladies' underclothing, the use of which I recommend in the following pages. They will be made under my instructions.
The great object to attain is to have an equal warmth over every part of the body, and to obtain the necessary warmth with the least possible weight. We must, therefore, do away with the ordinary cotton or linen shirt, which only covers the middle part of the body, and substitute for it a garment with long sleeves, fitting closely round the throat and reaching to the feet, or a little below them. This should be made of fine flannel or merino, like that used for gentlemen's vests; calico, silk, and linen are all bad, as they are heavy, without being warm, and check perspiration, leaving the skin wet, instead of keeping it dry by absorbing the skin exhalations, as woollen materials do.
The great length and fulness of ordinary baby clothes is very injurious; as the child lies in the nurse's arms, the whole weight of this comes on the legs and feet, cramping their movements, and even deforming the feet by dragging on them. The clothes, therefore, should be made short from the very first, and the legs kept warm by knitted woollen stockings, made to fit loosely about the feet and legs, and long enough to fasten on the hips to buttons sewn on to the modified binder I have just now described. The buttons will pass through the meshes of the stocking. The diaper will protect the child underneath; it should be put on to pass over the binder and stockings at the sides, and fasten in front with a nursery-pin.
Drawers may, however, be worn even by very young children with great advantage, for if they are worn, the diaper can be folded thick and laid inside them, as they will keep it in place. The drawers should be of woollen material, and the diapers of either wool or cotton, as the ordinary linen diaper is neither so soft and comfortable nor so absorbent as these materials. Diapers are too often fastened so badly that they chafe the parts with which they come in contact, draw up the legs towards the abdomen, and prevent their free movement. I think this may be obviated by cutting the diapers to a triangular shape instead of making them square, cutting out semicircles for the legs, and fastening the three corners in front. A loop may be sewn to the front corner and strings to the side ones, which can be tied through the loop; or loops at the sides may be fastened to a button on the front. The diaper will then form a sort of drawers, and extra thickness may be given to it underneath by laying inside some absorbent material. This plan also removes the objection of overheat caused by the ordinary method of rolling a diaper round the child. With this sort of diaper, stockings should be worn, as above described, and these should always be well sloped out on the inner sides, so that they may not get wet.
Waterproof pilches, such as the "Baby's Napkin Protector," should on no account be used. They put a premium on dirt and neglect, and by preventing the escape of heat and moisture from the body keep it, as some one has graphically said, "in a state of perpetual poultice," a state which is decidedly injurious. Napkins should be removed as soon as they are soiled; and they should never be pinned with ordinary pins, for this may produce evil results. Doubtless the pin which proved fatal in Trousseau's case by entering the liver had been used to fasten the diaper. The new-fashioned safety-pin, with a solid guard to cover the point, is, however, unobjectionable.
The diaper can generally be left off at about six months, and then the stockings should be shortened and supplemented by little flannel drawers. Over the vest described just now, another, made in the same way, but without sleeves, should be worn in cold weather. The next thing is the robe, which for winter I should make of a pretty twilled flannel or other woollen material that will wash. It should have sleeves to the wrist; and, so that it may fit closely to the throat, it is best to make it fulled-in to a little shoulder-piece or yoke. Like the other garment, the robe should only reach the feet, or a couple of inches below them.
None of the clothes should be gathered at the waist, but what little weight there is should hang from the shoulders. When, from unusual tenderness of the skin, the woollen material of the vest irritates or induces too much perspiration, spun cotton may be used; but I do not recommend this except in rare instances. When woollen materials irritate, it is generally because they are too coarse or too new; therefore, the softest and finest obtainable should be used. To make baby's vests no material could possibly be better than that cut from vests which have been worn out by its father, for he will have taken the roughness off them.
I have seen very nice garments for children knitted of fine wool; these have the advantage of stretching with every movement; they can be made like slips and worn between the vest and the robe in cold weather. I strongly deprecate the habit of dressing a child in thin clothes in cold weather, and then wrapping it up in a shawl, which cramps its movements, or keeping it near the fire, which makes it very liable to take cold directly it is in a cooler atmosphere.
Much mischief may be done by the excessive relaxation induced by children being clothed too warmly in hot weather. If, on the one hand, the child is bathed in perspiration, or, on the other, if the skin feels hot and dry, without your being able to account for this in any other way, you may conclude it is too warmly dressed. Rashes such as those, the popular names of which are "prickly heat," "red gown," and "red gum" may be caused by the use of over-warm clothes in the summer.
Infants' heads are generally kept too warm, which, considering the natural tendency to nervous excitement and the rapid circulation of infancy, is a very bad practice. Nervous excitability is so increased by the head being kept very warm; that any accidental irritation is under these circumstances much more likely to be followed by spasmodic or convulsive fits than under any other conditions.
Infants do not require caps indoors, where the temperature is generally rather high; but when carried from room to room the square of flannel which forms part of every layette should be wrapped round them and over the head. Nervous excitability, and with it the liability to convulsions, is much increased if babies' heads are kept too hot; and the absence of hair from the little heads may be taken as an indication that Nature has provided for their being kept cool. The pillow on which they sleep should not be so soft that the part of the head in contact with it sinks into it and becomes overheated and perspires freely, while the rest of the head is comparatively cold. This is a frequent cause of colds.
Night-gowns should be made of flannel, and be worn over the vest. They also should have long sleeves, so that there need be no fear of the child's taking cold when it kicks off the bedclothes. Bedclothes should be as light as possible; and, on the principle that the movements of the body and limbs ought never to be impeded, they should not be tightly tucked in.
In cold weather a down quilt is very nice. Care should be taken as to the position in which baby lies. The best position for a child to lie in is on its back. If it lies on either side the ribs will be pressed inwards by the bed below and the weight of the arm above; and, moreover, if such a position is habitually assumed, the spine may become twisted, and lateral deformity result. If it is laid on its stomach, as is far too often the case, breathing is rendered difficult, the breast-bone is compressed, and the chest lessened in its dimensions, while the action of the diaphragm is hampered by pressure on the abdomen.
As I have already said, children lose heat very rapidly, and as the circulation is slower during sleep, they require then to be clothed even more warmly than during waking hours; but excessive heat must be as carefully avoided as debilitating cold. As, however, the little ones cannot tell you whether they are too warm or too cold, you must ascertain the state of affairs by passing your hand over their skins.
New-born infants as a rule sleep with the mother, in order to benefit from the warmth of her body. This plan, however, is a dangerous one. In the first place, children sleeping with adults are liable to breathe contaminated air; secondly, an accidental displacement of the bedclothes may easily suffocate them; thirdly, they may run the risk of being, as it is called, "overlain." At an inquest held in St. Pancras, on the 12th of March, 1884, upon the bodies of two children who were found suffocated in bed with their parents, the coroner, Dr. Danford Thomas, stated that he held every year between 120 and 150 inquests upon children who had met their deaths in this way. In Birmingham the borough coroner held four inquests on the 18th of October on infants who had been overlain in bed, and he remarked that, in order to avoid such large sacrifice of infant life, cots for children should be provided, as enforced by law on the Continent. The line between the accidental and intentional disposal of infants is allowed to be very indistinct. These facts I quote from the Lancet for October 27th, 1884. Mothers, when they take their children into bed, should put them back into their cots directly they have been fed.
After the first week or two, if an infant wants more warmth than can be got from clothing, a hot water-bottle, hot brick, or sand-bag wrapped in flannel may be put in the bottom of the cradle. Cradles or cots should be raised to a level with the mother's bed, and should never be made to rock. A bad practice is unfortunately very prevalent, of which the mildest form is rocking a baby, or walking up and down with it until it goes to sleep; while the most aggravated form is to jump it up and down when it cries, by way of pacifying it. No doubt the treatment is effective in that it makes the baby go to sleep, or stop crying; but it does so simply by a process of stupefaction. Indeed it might be made so effective that the child would never cry again at all, so thoroughly might the shaking disturb the brain as to stop the vital processes. Fathers especially are fond of tossing their children high up into the air, turning them head over heels, &c. Now, just imagine the nervous shock you would suffer if some great' giant were to treat you in this way, and then you will have some faint idea of the injury done by this practice to infants, whose nervous systems, remember, are much more easily disturbed than ours. I have little doubt that many an embryo poet or philosopher has literally had his brains addled in this way.
I read a very good illustration of the commonest form of this practice, as carried out by mothers, in a comic paper. Said a gentleman to his wife, who for the last hour had been shaking her baby up and down on her knee, "My dear, I don't think so much butter is good for the child." "Butter? I never give my Tootsy-Wootsy butter—what an idea!" "Well, you know, you gave him a good feed of milk, and now you've been over an hour churning it!"
If parents could only be made to understand the mischief done, not only to the nervous, but also to the digestive and circulatory systems of their children by this idiotic custom of jolting and tossing them about, as if they were mere inanimate toys, I am sure they would speedily abandon so harmful and irrational a practice. Children should not be rocked or patted off to sleep; but simply laid in their cots, and if for the first night or two they cry a little, this will not hurt them, but will rather be good mental discipline for the future; they will soon gain the habit of sleeping without external help. By rocking a baby, sleep is obtained through a process of stupefaction, and the practice is as bad as, and very similar to, that of giving chloral or morphia to an adult to procure the same end.