Devoted exclusively to the care of infants and young children, and the general VOL. VI. WE interests of the nursery. FEBRUARY, 1890. E are much gratified to be able to state that a substantial beginning has at last been made in the direction of training schools for nursery maids, in which subject so great an interest has been shown by our subscribers. Most readers will remember the article by Dr. Samuel S. Adams, of the Children's Hospital at Washington, D. C., which appeared in BABYHOOD for October, 1887, urging the great importance of such a school, and the number of communications which followed it. BABYHOOD remarked at that time that "it is often discouraging to see how long it takes for any such project, however meritorious, to develop ;" and we had hardly hoped that a school would so soon be established. It is exceedingly fortunate that the start now made is under most excellent auspices-no better could be desired or expected-and its progress will be watched with the keenest interest. The institution is known as the "Training School for Infants' Nurses," and has been founded by Mrs. Robert W. Chapin, of New York, in connection with the Babies' Hospital at 657 Lexing ton avenue. The Hospital has accommodations for the care of thirty-five infants. Among these some are convalescent and able to be taken out for a daily airing; others are delicate and suffering from chronic disorders of the stomach and bowels, requiring the most careful attention to feeding; while the greater number are admitted suffering from various other diseases of infancy, acute and chronic. Opportunity is thus afforded in the Hospital for nurses to gain an experience among comparatively well children as well as among those seriously sick. The course of training has been fixed at six months, and it covers the No. 63. range of subjects apparent in the following list: 1. Feeding.-Including the care of milk, sterilizing milk, the preparation of all the commonly-used infant foods; together with instruction with reference to quantity of food and frequency of feeding, regularity, etc. 2. Bathing.-The daily bath; salt and bran baths, hot baths, mustard baths and others which may be required in cases of illness. 3. Nursery Hygiene.-The proper temperature of a nursery, day and night; ventilation, clothing, cleanliness and fresh air. 4. Perambulators.-How to dress children for an airing, with instructions as to the proper protection of the eyes and ears. 5. General Regimen.-Simple matters required in cases of slight illness; such as the use of the thermometer, the use of enemata, the making of poultices or oil silk jackets. Much additional instruction will be incidentally given, as the nurses will be required to give a portion of their time to the care of children who are acutely ill. It is not the design of the training to make these girls "trained nurses" in the usual sense of the term, but to give them systematic, routine instruction in the subjects required in the care of any infant, and in addition to give them some idea of sick-nursing. The chief part of the instruction will be given by trained head nurses of the different wards under whose direction and supervision the infants' nurses will do their work. The infants' nurses are to be paid $7 a month during their term of service; they will be registered at the hospital for situations when out of employment, as is now the custom in the training schools. Our readers who may desire further information, may obtain it by addressing Mrs. R. W. Chapin, 32 West 38th street, to whom, also, applications for admission to the school may be sent. Let us hope that other cities will now take up this subject in earnest, so that we shall soon see a practical solution of one of the greatest-perhaps the greatest-of difficulti that beset busy mothers. There is certainly no lack of public sentiment to appreciate the efforts that may be put forward in the matter, and all that was said two-and-a-half years ago of the need of such institutions may be said now with greater emphasis, since every year shows an increase in popular knowledge of rational nursery hygiene, and the demand for enlightened nursery assistants. Among the various valuable papers read at the recent Convention of Charities and Corrections, held in San Francisco, that on State Care for Destitute Infants," by H. F. Shurtleff, of Boston, Superintendent of Outdoor Poor, contains many wise suggestions. The system which he describes is to be especially commended from the fact that it makes the children inmates of homes, rather than herding them together in institutions, where, though made as good as circumstances will allow, there can never be a satisfactory substitute for home surroundings. As there is always a chance of the homes proving unsuitable, not only are they subject to a thorough investigation before any baby is placed in them, but all the conditions of the child and his surroundings are carefully inspected and recorded from time to time by officials, medical and otherwise, appointed by the Board. In the words of the writer: "No pains are spared to give these charges of the State the best possible start in their physical life; and closer medical oversight is unquestionably received by these children than by those of average families in the Commonwealth. The success of this work is distinctly the result of growth of experience, of daily observation and scrutiny into the needs of each individual child. The children are watched over by medical officers who have children of their own, and who have made the study of children's requirements a part of the work of their life. One of these physicians, and one on whom most of this care has devolved in recent years, is a woman; and it is to her enthusiasm and devotion that the gratifying results in the saving of infant lives are so largely due." A minute record is kept of every child, its condition at the time of its reception, and also at each inspection; and for those children eligible for adoption a photograph is added to the record. The character and circumstances of any family wishing to adopt a child are thoroughly inquired into, and the Board continues to exercise a superintending care over adopted children as long as it may be necessary or desirable. In an Edinburgh professional journal a simple and ingenious contrivance is mentioned, to admit of the continuous inhalation of steam fumes by patients suffering from diphtheria. This is nothing more than the fixing of an open umbrella to the bed, or suspending it from the ceiling, and throwing over this a large sheet, which, falling in a tent about the patient, will surround him with the atmosphere of steam. The steam is supplied by a pipe connection with a kettle or other boiling contrivance that passes beneath the tent. The suggestion is so admirable and feasible that we are sure it will be welcomed by many physicians, who are sometimes at a loss, in the absence of especially devised contrivances, to know how to effect with simple means the end desired in such cases. The importance of early re-vaccination of children is the subject of an article in the London Medical Recorder, in a review of a pamphlet by Dr. Gerstäcker. In 1874 this was practiced throughout the schools of Germany by imperial edict, with the result of the almost total extinction of small-pox. The beneficial results of this act are apparent today in the German army, in which there has never been such immunity from the disease. There is no better ascertained fact than that systematic re-vaccination is necessary at an early age in children, both to test the thoroughness of a previous operation and effect present protection. The duration of individual susceptibility is somewhat variable, in some few cases extending throughout life, but in most instances being from seven to ten years. Instructor in Orthopedic Surgery, University of Pennsylvania, and Attending Surgeon, Orthopedic Department, University Hospital, Philadelphia. E Causes and Symptoms. VERY intelligent person has observed | anguish depicted by Scott in his "Black upon the crowded thoroughfares of Dwarf." These represent severe cases in which, large cities, at summer watering resorts, and as we see them now, the leg, hip, chest and in similar places where people congregate, head bones, are also misshapen and distorted. how very many people have deformed limbs. The bow legs and knock knee in which we Not limbs that have been broken and badly are interested result from the milder grades set, but legs that bow out or in at the knee, of the affection, and are therefore more liable in which the center of gravitation does not to be overlooked. fall as it should; in which the knee does not move with that freedom which nature intended, but describes a circle outward or inward-bow legs and knock knee-limbs that might have been perfect in symmetry and movement had intelligent mothers had their attention directed to the cause, and taken proper precaution to prevent the trouble or remedy it after it had begun. These deformities are in the majority of cases the result of an affection called rickets, or rachitis as it is scientifically known, occurring in children from birth to the fifth year, at a time when the bones are growing rapidly. There is also another form occurring particularly from 12 to 18 years in boys who are obliged to stand most of the time, but this may be overlooked for the present. It may not be appropriate to describe this affection scientifically here, but a proper understanding of its nature, cause, symptoms and prevention may be interesting and instructive and lead to good results. Though described by the early fathers of medicine, Hippocrates and Galen, it remained for an Englishman, Whistler, to give the first scientific description of the disease, from which fact, and from the large number of sufferers in Great Britain, it has of late years received in all countries the title of the "English disease." Literature contains numerous types, as Æsop and Thersites, and every one is familiar with the physical suffering and mental Rickets, although common among the poor, is by no means rare among the better class of society. Congenital cases occur, but inheritance is a small factor in its causation. Bad hygienic surroundings, such as foul air, want of sunlight, warmth and proper clothing accentuate the affection, but could not develop it per se. It is emphatically a diet disease, the result of improper food; and being particularly common in the so-called "hand-fed" children, or those who have suffered from prolonged nursing. In fact, among the lower animals, particularly carnivora, it has been produced experimentally. In the Zoological Gardens in London, the lioness could not be trusted to suckle her cubs, and the young lions, fed by hand upon food deficient in bonemaking elements-earthy phosphates and fat rapidly developed rickets. Nine months after the substitution of proper food all symptoms disappeared, and they were still healthy eighteen months after. The affection, then, is primarily constitutional. The blood is watery and impoverished, its circulation retarded through dilated arteries, compressed lungs, and enlarged liver, the stomach and intestines are distended, and there is everywhere a tendency to increased vascularity. The local manifestations are most marked in the long bones of the extremities, although the joint surfaces and surrounding structures (ligaments, muscles, etc.) participate and were at one time considered the starting point. These long bones are formed in cartilage, and at this time are rapidly undergoing growth and transformation into bone by the deposit of lime salts. This increased congestion throughout the bone retards the deposit, and the soft bones readily yield to the weight when the child attempts to stand or walk. The affection generally shows itself about dentition or later, when the child attempts to walk, with more or less disturbance of digestion, vomiting and diarrhoea. The child sweats easily and freely, particularly about the head and neck, lies quiet and drowsy, preferring not to be disturbed. Many children appear well nourished, but usually even in these the abdomen is prominent, the skin pale and puffy, and the muscles soft, flabby and weak. As the disease progresses, the body and head may grow while the limbs remain small and weak; attempts to use them result in bending the bones in different directions as the direction of the weight variesas the child walks, crawls, sits or shuffles across the floor. Sometimes the disease seems to expend itself in one locality, and we have a one-sided bow leg or knock knee. As the affection advances, the bones harden and become permanently fixed in their crooked positions. Three marked stages, then, are recognized-stage of vascularity; a stage of softening, and a stage of hardening; and a recent writer has placed the period between the second and third stages at three years. Later, from a change of diet or otherwise, all the symptoms gradually subside or disappear entirely, and nothing remains but the deformed limbs. Treatment. From what has been said regarding the cause and nature of this affliction, it follows that mothers should be particularly careful with children to whom a proper human milk diet cannot be administered, lest they be compelled later to allow them to grow up with unsightly limbs, or submit them to operations which we, as surgeons, are compelled to perform for their correction. In a hand-fed" child the selection of an appropriate diet is most essential. For this purpose the suggestion of Dr. Meigs, of a mixture of equal parts of cream, milk, and barley gruel, seasoned with salt, answers admirably and fulfils its purpose. These articles should be supplemented later by prepared foods of the Liebig class, of which Mellin's food is the type. The child should be taken regularly into the open air; proper bathing should be instituted to keep the skin in good condition; the limbs should be rubbed with bathing whiskey, and all approved hygienic methods should be systematically and persistently employed, Such children should be kept off their feet longer than those properly fed, and not be allowed to stand or walk until they show a strong inclination to do so. In the case of the young lions, cod-liver oil, milk, and powdered bones brought about the cure, and so with children it is a specific, and to it we add compound syrup of hypophosphites, and milk as above prepared. It has been my habit to omit the oil during the three summer months and depend entirely upon the other remedies. Other medicines, if required, should be prescribed by a physician. There is a popular fallacy, which is shared by some medical men, that these deformities will be in time "outgrown "—an idea as pernicious in practice as it is unsound in principle. A few children may have grown out of them, but the proportion is too small to allow any child to go uncared for, as every observant person who looks about him can see. While in the soft stage crooked limbs may be restrained from growing worse by proper mechanical supports, and may be bent into better position; but, after hardening has commenced, nothing offers any relief but correct surgical interference. Therefore are we impressed with the importance of early care and prompt recognition of this affection. COLOR-BLINDNESS IN CHILDREN. BY CHARLES H. MAY, M.D. Visiting Oculist and Aurist to the Randall's Island Hospitals: Instructor in Diseases of the Eye, Vanderbilt Clinic, College of Physicians and Surgeons, N. Y., etc. OF F late years, considerable attention has been attracted to the subject of colorblindness, on account of the occurrence of accidents on land and water the causes of which have been traced to the existence of this defect in pilots at sea and engineers of railroads. The importance of the subject will be appreciated when we consider how often the safety of many hundreds of human beings depends upon the correct observance of a green or a red light; it being a strange coincidence, that the very colors which most often cannot be seen by those who are colorblind, have been selected as signals for marine navigation and land transportation. What is Color? Color-blindness is a defect of vision which prevents the afflicted person from being able to distinguish certain colors. It is exceedingly interesting to stop to consider what is. color; and it might seem absurd to state that the color of any object is anything but what it seems to be; but such is really the case. In order to understand this, it must be remembered that ordinary light seems white, because it is a mixture of all the various hues; and that when we separate this light into its component parts, we produce the different colors. This is what we do when the light passes through prisms of glass; this effect is probably familiar to all, and explains the beautiful rainbow tints resulting when the sunlight falls, for instance, upon a crystal chandelier. In this example we have produced all the colors, and the reason we see them is because they are all reflected back into the eye. Suppose, however, that all the color rays were absorbed by the body upon which they fall, excepting the red ones, and that these red ones only were reflected back into the eye-the body would then appear red; if all the color rays were absorbed excepting the green ones which were reflected back into the eye, the body would, for like reason, be green; and so with all the other colors. From this it will be seen, that the statement made above, that the color of any object is not really due to any color of its own, but is simply dependent upon the variety of color rays which it sends back into the eye, is a correct one. This explanation is necessary for the proper understanding of the nature of the affection of which we are speaking. Degrees of Color-Blindness. Color-blindness has been most frequently investigated in adults, but recent examinations have shown that it is equally prevalent in children; in fact, the great majority of cases are born with color-blindness. It can undoubtedly be produced in certain of the diseases of the eye; but we leave these out of consideration because those diseases of the eye producing this defect are rare in children, and even in adults the congenital variety is probably the more frequent. It it rare for children to be born without any color sense at all, though there are cases in which this does occur-in which to the child everything appears of a varying shade of gray. In by far the greater number of cases, however, there is only absence of the power of distinguishing a certain one color. We speak of red, green, and blue or purple, as the fundamental colors, because we can produce all the other colors by mixing two or all of these in varying proportions. These complementary colors-red, green and blue—are the ones in which the color-blind is defective. By far the largest number of children having this defect are " red-blind," that is, |