Massachusetts Medical Society: A Dissertation on the Prophylactic Management of Infancy and Early Childhood

A Dissertation on the Prophylactic Management of Infancy and Early Childhood

Annual Oration 1826

By Joseph H. Flint, M.D.

It has been computed that “one fourth of those who are born die before the age of five years.” This disproportioned mortality is usually ascribed to the peculiar “irritability and sensibility” of infancy and early childhood, predisposing it to the ravages of acute diseases.

However plausible, and at first view satisfactory, may be this explanation, it is a fact that the young of all other animals, in a natural state, are comparatively vigorous and healthy. And making every allowance for diseases incident to the human family alone, still it will be found, I apprehend, that most of the disorders of early life, and many of those which occur at a later period, derive their origin from mismanagement. And just in proportion as the laws of Nature are violated, and her plain and salutary requisitions neglected or disregarded, is this peculiar “irritability and sensibility” fatally developed. It has been justly remarked “that when mismanagement in infancy does not actually destroy life, it often very essentially impairs the health,—the foundation of a future good or bad constitution being frequently laid at this period.”

The prophylactic management of infancy and early childhood, consists in a proper regulation of the dress, diet, and exercise.

The skin from its continuous and relative sympathies, may be considered a vital organ. Reflected, it constitutes the mucous membranes; which accounts for its important connexion with the respiratory and digestive functions. And through the medium of the nerves with which it is so largely endowed, it sympathizes relatively with all the other vital organs. As we advance in age the skin becomes more and more firm—but it is not until about the thirtieth year that it acquires its greatest power of resistance to the impression of external stimuli. During this whole period, but more especially in infancy when the cutaneous susceptibility is the strongest, in so far as the functions of the skin exert an influence on other organs important in the economy of health, an equable excitement should be preserved by a careful adaptation of the dress to the natural succession of seasons, and other causes of injurious excitement which the customs of society have so greatly multiplied.

“If during the greatest part of life the skin be so fruitful a source of disease, and the various alterations it experiences produce so frequent disorders in the internal organs, it is only owing to the varied causes of excitement to which it is every instant subjected.” Here allow me to remark that the fashionable attire of the present day gives to the children of opulence no advantage over the “shreds and patches” of poverty. It affords but a scanty protection in their frequent transitions from more than tropical heat to hyperborean cold. It is neither a security against the diseases consequent upon exposure to alternations of heat and cold; nor the still more fatal ones which are the effect in a great measure, of the enervating heats of summer upon the functions of the skin. Unguarded exposure to cold when the body is heated—or to heat when it is chilled—induce diseases with which we all are familiar, and so speedily as to leave no room to doubt their cause. The cholera of India, on the other hand, to which our infantile diseases of the summer months, usually attributed to irregularities and indiscretions in diet, are somewhat analogous, affords the strongest exemplification of the effect of continued heat on the functions of the skin and internal organs sympathizing with it. The European who retreats from the scorching rays of a tropical sun to seek repose under his net in the shade, falls a victim to disease; while the native Hindoo who toils all the day, owes his comparative immunity, not so much to a constitution framed to the climate, as to his frequent ablutions and daily inunctions of rancid oil. And though the one be a religious rite, and the other an expedient to protect him from swarms of insects, they both combine to preserve an equable excitement in the vessels of the skin. And were it not that his ingenuity has supplied this latter substitute, mosquitoes and cock-roaches would be as well entitled to his homage as the consecrated waters of the Ganges.

The sustenance of the infant for nearly the first year of its life should be drawn exclusively from its mother. This is nature's provision; and ordinarily the supply is commensurate to the demand; and for this no artificial combination is an adequate substitute. Nature, too, has wisely placed this secretion beyond the influence of ordinary indisposition; and though there are instances of real, constitutional inability, a mother, generally speaking, is competent to perform the kindly offices of nurse. Happily our country women, with but few exceptions, have not arrived at that maximum of refinement which prompts them to alienate their children. And if there be living a female who can unnecessarily and most unnaturally resolve to relinquish the important duties, and to forego the endearing pleasures of a mother, and to abandon her helpless offspring to the carelessness and cupidity of an hireling,

“Hear, nature, hear! Suspend thy purpose, if
Thou did'st intend to make this creature fruitful.
Into her womb convey sterility!
Dry up in her the organs of increase,
And from her derogate body never spring
A babe to honor her.”

At the period of ablactation it is only necessary to avoid great and sudden changes in diet. The digestion of the child is rapid, and its calls for food consequently frequent; and so it be but plain and bland, indulgence may be safely allowed.—Nature unhackneyed seldom errs in her demands; and if the appetite is not pampered, no limits need be set to time or quantity in its gratification.—Contrast, now, these plain and obviously natural rules with the practices which too generally prevail in the management of infancy. ‘Sanis omnia Sana,’ would seem to be an adopted axiom; and a most pernicious one it is. From the moment of birth up to the period we are considering, the wailings of infancy are quieted with diffusibles—its clamors are hushed by epicurean indulgencies—and its very smiles are purchased by an enormous tax to the confectioner. Hence follows a long train of functional disorders of the digestive organs, by which, if life is not destroyed, the growth is checked; the constitution is impaired; and very frequently structural disease is superinduced which no art afterwards can remedy; and hence, too, by reverse sympathy, springs a tribe of eruptive diseases so loathsome and so common to early life.

Nor do the evils of early mismanagement in relation to diet stop here. The moralist would follow up consequences to a later period, and tell you that tastes and appetites, vitiated and depraved in the cradle, go on step by step, from year to year, until they terminate, at length, in that most odious, degrading and disgusting of all vices,—in our country “the pestilence that walketh by noonday”—beastly inebriety.

The health of the infant depends on the equable evolution and perfect integrity of its several organs—to which exercise of body, both passive and active, greatly conduces. In the first months of existence it must necessarily be passive; but when locomotion is acquired it may well be left to the buoyancy of infant feeling. The gambols of childhood should be rarely repressed—and when properly clothed and properly fed, it will brave with comparative impunity the most inclement seasons. When situation or circumstances forbid the indulgence of active exercises abroad, the shower-bath, the bathing-tub, and the fleshbrush at home will almost compensate for the deprivation.

“Certain physical and moral differences that present themselves in man, and which depend on the diversity of the proportions and connexion between the parts forming their organization, as well as the different degrees of energy relative to certain organs,” have been fancifully named by Physiologists—Temperaments. A knowledge of the differences or “peculiar dispositions of the body with which we are born, is of little practical value; as by education, manner of living, climate, or acquired habits, they become altered or totally changed.” “Man never remains in a state of nature, being acted on by every surrounding body; his physical qualities, therefore, if observed at distant periods of life, present as many differences as his moral or intellectual character.”

By another physiological subtlety, this generic name, which is made to imply a constitutional liability to a certain cast of diseases, has under gone a subdivision, and hereditary predisposition to disease from peculiar individual organization is called Idiosyncracy. The opinion I am aware very generally obtains that diseases are propagated from parents to their offspring: and to a certain extent it cannot, perhaps, be denied. But reasons enough do exist to justify a suspicion at least that idiosyncracy is often but another name for habit.

The arthritic entails the gout upon his heir—but it may be by bequeathing with his wealth the very errors of physical education that engendered the disease in his own person. There is a concurrence, too, of all authority in the remark, that, now and then, a generation springs up among the most predisposed that enjoys a perfect immunity from disease; and which might be traced, possibly, either to the wisdom that devised or the necessity which enforced an improvement in physical education.

The fearful increase of pulmonary consumption, a disease which Pathologists have identified with scrophula, gives to this subject additional interest. I speak not of diseases often confounded with consumption, whose cure has inspired the ignorant with confidence and given to a thousand nostrums an ephemeral celebrity;—but whoever has watched the insidious approach of tubercular phthisis to its developement upon the lungs—and who of you has not?—and has experienced, too, the utter hopelessness and insufficiency of all means afterwards—I will not say to a cure, but to arrest or even retard its downward progress—will unite in the opinion that if a remedy is yet to be found it must be sought in prevention.

A history of this disease with the various and opposite modes of treatment which have at different times been adopted, is foreign to my purpose. It is enough that all have resulted in disappointment and discomfiture; and in the strong language of a frank and fearless writer, “let us no longer deceive mankind—let us candidly acknowledge that there are diseases which cannot be cured. Were this generous confession universally made, the world would more earnestly adopt preventive measures. So long as we promulgate opposite doctrines we are no better than empirics; we are destitute of honor—of humanity.”

In latitudes of equable temperature, whether of heat or cold, consumption is almost unknown. It is equally a stranger to the mild skies of Italy, and to the perpetual snows and frosts of the Arctic regions; but in our variable climate it is a monster, whose terrific strides are yet unchecked, and who riots unrestrained in our best blood.

Independently of hereditary predisposition, the same causes which at one period of life produce scrophula, are the proximate ones of consumption at another. Among the most prominent of these is unguarded exposure to the vicissitudes of the seasons; to which may be added dietetic mismanagement. The first effects are—in infancy, functional disorders of the digestive organs—at a later period, enlargement of the glands—and at a still later, when one train of sympathies have become blunted and new ones excited, turbercular phthisis, which is indeed but the sequel of scrophula—its last fatal stage—the assurance that the foundations of life are irremediably sapped.

Eruptions, suddenly repelled, are not an infrequent cause of consumption; and of the vast multitude and variety of remedial means which have, at different times, engaged the attention of the medical world, all are buried with the Capulets, except they be such only as tend to procure and perpetuate an equable excitement of the vessels of the skin, and a healthy performance of the functions of the digestive organs.

Taking into view then, the latitudes in which alone this disease so fatally prevails—its causes—the inadequacy to a cure of all means yet employed—its connexion with scrophula, and its almost certain incurability—instead of searching farther the face of the earth and exploring its very bowels, for remedies which will probably never be found, or instituting anew experiments which will but too surely end in bitter disappointment—is it not time, and does not humanity require it, that the attention be given earnestly to preventive measures? And these, permit me to suggest, consist in an early adoption of the prophylactic management to which I have taken the liberty to invite your attention.

“Mens sana in corpore sano,” is not an unmeaning apothegm. It is not my intention to agitate the question of the “mysterious incomprehensible union of mind and matter,” nor whether the quantum of intellectual power depends on the length of the facial angle, or a protuberance, more or less, of the skull. I leave the discussion of these questions to Theologists and Craniologists. It is sufficient for my purpose that the physical and intellectual man are intimately united; that they mutually act and react on one another. From its first dawnings in infancy the mind is gradually unfolded as the physical organs are developed. “It grows with our growth, and strengthens with our strength.” A disturbance of the functions of the body deranges the faculties of the mind; and so far as we know, the decay and death of the one, is the extinction of the other. Do not misunderstand me—I speak with reference to human life; and I would not shake the hopes which spring from a conviction of the soul's immortality. On the contrary, by physical culture and discipline, I would give to the mind augmented power and a wider range; and thereby not only fit it the better for the great and varied demands of this life, but prepare it, perhaps, for higher and nobler enjoyment in another.

Every departure from health is marked by a proportionate affection of mind. Acute diseases suddenly paralyze the most gigantic powers. It is recorded of one renowned for valor in the field, and wisdom in the senate, and eloquence in the forum—of one “who could employ, at the same time, his ears to listen, his eyes to read, his hands to write, and his mind to dictate”—who in the turmoil of a camp found time to compose his volume of commentaries, “which has always been admired for the elegance as well as correctness of its style,” that he

“Had a fever when he was in Spain,
And when the fit was on him,
That tongue of his that bade the Romans
Mark him and write his speeches in their books,
Alas! It cried, ‘Give me some drink Titinius,’
As a sick girl.”

Mental alienations of every shade, from lowness of spirits to despondency and madness, are but so many symptoms of physical disease, which has acquired, by a ready process of medical amalgamation, the indiscriminate appellation of chronic. Of this numerous class of diseases, by far the greater proportion derive their origin from some error in physical management; and our boasted improvements in this department of medicine, great as they really are, do not consist so much in researches and speculations which have led to the discovery and employment of new medicines, as to the adoption of more correct principles, and the rigid enforcement of a better physical and moral treatment.

It were a curious and interesting inquiry how far the stormy and corroding passions, which disturb domestic tranquility, disquiet neighborhoods, and sometimes convulse nations, might be traced to the operations of physical disease.

Peter the hermit, who incited the powers of Europe to the bootless attempt to plant the standard of the cross, through slaughter and blood, on the empire of the crescent, was “mad, at least, north, north-west;” and his fanaticism, I doubt not, would have yielded readily to hellebore and a straight-jacket.

Nor would it be difficult, I conceive, to account for the astonishing changes in individual character on the hypothesis of deranged physical organization. Who would recognise in the exiled driveller of St. Helena that master spirit, who but a few months before led the Imperial eagles of France, through every obstacle, into the very heart of the Russian empire? And may not his cowardly abandonment of the half-famished remnant of his troops—his indecision at Waterloo—and the subsequent surrender of his person to his most implacable foe, be attributed to a spirit broken down by that cruel disease which ultimately terminated his life?

Examples are not wanting to shew that if the mind is not the offspring of physical organization it often derives from it the bias and direction of its powers. The history of the illiterate, demisavage of Sweden, whose vast projects were equaled only by the extraordinary ability with which he executed them—one whom no labors could tire and no dangers appal—whose whole soul was engrossed by a single passion—and who in the prosecution of his mad schemes of conquest regarded with equal indifference the robe of the grand Vizier, and the thunder of his master's cannon—affords a strong illustration of the influence which an ‘iron body’ exerts over the energies of the mind.

But military prowess and audacious courage are not the only fruits of the rigid fibre of health. Imagination has soared to its highest flights; and the richest inspirations of poetry and song have been caught in the school where Cincinnatus learned the art of war. And for the most important discoveries in science, and most valuable improvements in the arts, we are indebted, not to the starts of a sickly or precocious intellect, but to the steady, persevering industry of hardy, plodding genius. In our own profession, the unparalleled labors of one man are a proud proof of how much may be accomplished with few advantages but native vigor and untiring zeal; and how justly have his discoveries and improvements in the medical art, immortalized the name of John Hunter.

There was much of wisdom and forecast in the decision of that monarch who made the possession of good health an indispensable prerequisite to a participation in his councils.

You will not understand me to intimate that debility of body necessarily implies hebetude of mind; on the contrary, by strong voluntary effort, the spirit of the invalid will, now and then, “burst its cerements” with overwhelming power; but the exertion is certain to be succeeded by a most painful collapse, and the “crazy tenement” invariably demands repose to rally for every succeeding mental effort—and if, through the clouds of disease which perpetually overhang it, the mind can occasionally emit a brilliant spark, what think you would have been its steady blaze, sustained and invigorated in its exertions by sturdy health?

Unhappily, for want of physical energy, the mind is too often goaded into exercise by unnatural and deadly substitutes. “Drink gin,” said one who has been called the first poet of his age, “it is the source of all my inspiration.” And I ask you—do not his productions, sometimes, smack strongly of the spirit that inspired them?

Physical culture is to the body what moral culture is to the mind. At no very distant period—and perhaps within the recollection of some of you—the elements of an early education were derived from the study of the Bible and the Assembly's Catechism. The philosophy of the human mind is now better understood; and instead of putting into the hands of lisping infancy a volume which the most mature minds have failed to reconcile—or another which sets explanation at defiance altogether—the gradually unfolding powers of the mind are fed, from time to time, with the kind of aliment best adapted to their capacity for intellectual assimilation. The mind's dependence, too, on a healthy physical organization, is beginning to be more justly appreciated; and it is not uncommon at this time to find a Gymnasium attached to our best modern literary institutions.

To complete the reform it is necessary to carry back these principles to the nursery and the cradle, and rescue the tender period of infancy and childhood,—when body and mind may be moulded almost to the will, from the trammels of fashion and caprice—from the vulgar traditions and cabalistic charms of the ancient Sibyls. Nor does the accomplishment of this object present any insuperable difficulty. The world needs but to know the value and importance of these principles to adopt them earnestly and zealously. And information and instruction of this kind, coming from the medical man to his patrons, will not be the most likely to be disregarded or contemned.

It is, I am persuaded, from prophylactic medicine generally,—and its application to early life particularly,—“we must expect the future improvement of our profession—not from the addition of new medicines to a catalogue already too long—not from fresh accessions to that mass of clinical observations which lie unread on the shelves of our medical libraries.” And though with Paracelsus, we may not hope to train our children to triumph over death; by assiduous care and well directed efforts in physical and moral culture—by blending in their education the physical vigor of Sparta, with the intellectual refinement of Athens, we can fit them to discharge with ability the high duties, and to endure with dignity the inevitable ills, of life.

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