After these general propositions, which include the whole subject of hygiene, it is perhaps best to consider the subject of prophylaxis as it is practiced dining the various periods of childhood. The subsequent treatment of the subject is made with a view to the various phases of development at different periods of life. Depending upon the age, there occurs an occasional asymmetry or other defect, which will inter fere with the healthy progress of the individual. This is sometimes produced by internal causes (as backwardness or sensitiveness of indi vidual organs), and sometimes by external causes (as great bodily or mental strain).
The most important hygienic measure pertaining to the "epoch of the newborn." by which we understand the period from the moment of birth until the falling off of the cord and the healing of the umbili cus, is strict and thorough asepsis. Careful consideration of the process of involution of the vessels and the healing of the umbilical cord will make it apparent how, in the first weeks following the birth of the child, there are rich opportunities for infection of the umbilical wound with production of localized disease, or how the severest general infections may ensue through the entrance into the blood current of malignant organisms. It should also be borne in mind that. not only is the umbil icus a possible point of entrance for infection during the early days of life, but that the delicate skin and easily injured, or previously injured, mucous membranes arc a sensitive and receptive ground for the growth of pathogenic bacteria, and that the germs, which are normally present upon them may become active and multiply. Painstaking care of the navel, therefore, until after the cord has fallen, is one of the most impor tant prophylactic measures for the newborn. Bearing this in mind, the tying off of the cord should be performed under the most careful aseptic precautions, as soon as the pulsations in the umbilical vessels have ceased. After sterilizing the hands, the cord is to be tied with sterile tape about two fingers' breadth from the umbilicus, and again at about the same distance toward the placenta, and divided between the two. Then, after the infant is bathed, the first knot is to he tightened and a second final knot is to be made. The ends of the tape are then properly arranged upon the abdominal wall, covered with dry sterile gauze, and fixed in place by the abdominal binder. This dressing-, is to be renewed
in the same manner each day after the bath. In place of the usually unsatisfactory abdominal binder, one can. with advantage, use the Hick apron-bandage by which soiling through the urine and feces is largely avoided.
All other measures taken for the protection of the newborn are directed chiefly toward the prevention of the growth of infections or ganisms upon the skin and mucous membranes. The success of these efforts depends upon two factors: first, absolute cleanliness in all pro cedures carried Out upon the child: and, second, the maintenance of a normal, healthy condition of the skin and mucous membranes, partic ular care being taken to prevent traumatisms, however small.
As to the first, the bath is of paramount importance and should certainly be given daily from the time of birth, both for cleanliness and for the hygiene of the skin. The temperature of the bath should be pre scribed by the physician at 35° C. (95° F.). to be ascertained by a bath thermometer. The temperature should be neither higher nor lower than this. After the first six months the temperature may be ordered at 33°-34° C. (91°-93° F.). Careful drying of the skin after the bath is of great benefit in keeping it in good condition. In the middle or at the end of the second year the temperature of the bath may be gradu ally lowered to 31°-32° C. (SS°-90° F.), and after that may be slowly reduced a few degrees from year to year. Baths in flowing water should not be permitted until the seventh year. In addition to the bath. daily local washing with mild soap is desirable, particularly of those parts which are liable to become soiled or where free perspiration occurs (as between the fleshy folds of fat children, cleansing them if possible be fore irritation takes place). This is particularly necessary in the region of the neck, where milk is apt to trickle during nursing, and in the axilla, the bend of the elbow, knee, and groin, and the anogenital region. The child should also be cleaned after each change of napkin, which latter cannot be done too often or too carefully. The head should re ceive particular attention, as not infrequently an excessive dryness of the scalp causes it to become covered with a layer of epithelial debris and dirt particles, which may lead to a chronic eczema of the part, but which is easily prevented by the timely use of soap followed by an application of oil.