The eyes of the newborn infant also demand certain preventive measures. As infection of the eyes may occur during the passage of the child through the genital canal, it is well to make this region as surgically clean as possible by means of vaginal douches before labor. After birth the eves should be washed with clean absorbent cotton and water set aside for that purpose, followed by that best of prophylactic measures, a few drops of 2 per cent. silver nitrate solution instilled into the conjunctival sac, as advised by Crede. In case one eye becomes diseased, the other should be protected by a cover or bandage, and the strictest aseptic measures should be observed, in order that other mem bers of the family may not become infected through the use of wash bowls, towels, etc. As in the case of the eyes, so may the nose, mouth, digestive tract, and genital apparatus become in a similar manner the point of entrance for the invasion of micro-organisms, making it neces sary to cure, as soon as possible, a local lesion wherever existing.
Thus it is readily seen that in nearly all the orifices of the body, careful cleansing is the best prophylaxis. There is but one exception to this general rule, and that is the mouth of the newborn and of the infant, for the reasons given in the previous pages. As it is well-nigh impossible to wipe out the baby's mouth without producing slight superficial lesions, the washing out of the baby's mouth before and often after each feeding, formerly a common practice, has been entirely abandoned. Upon these lesions the bacteria may settle most readily, whether normally present in the mouth, or introduced upon the cotton or linen used for wiping. The presence of Bednar's aphthre may occa sionally be the starting point of a general infection, or the cause of serious constitutional trouble. These facts present such unanswerable arguments against washing the mouth, that the benefit to be derived from the mechanical removal of the milk coagula and the schizomycetes to which they lead, need not be considered.
While the maintenance of a healthy skin and mucous membrane is of prime importance in the first days of life, in order to prevent the entrance and possible spread through the blood current of pathogenic organisms, which may endanger life; it is still more important in the succeeding period of the infant's career to prevent digestive disturbances by rational methods of feeding, so that no retardation or cessation of development may occur, nor any of the conditions may ensue which if not checked frequently proVe fatal. The general care of the infant
in this respect is naturally most important, cleanliness and taking a leading part therein. This care comprises not only the bath, the handling of the linen, the furnishing and arrangement of the baby's bed, the nursery and attendants, but also the preparation of the food and all the procedures which I have already briefly sketched regarding the prophylaxis of the newborn.
The results of this care of the infant \•ill stand or fall according to the intelligence and training of the nurse. The training of good infants' nurses who know exactly what is required for the proper care and correct feeding of the baby raises a protecting wall against the foolish advice of ignorant midwives; and the direct teaching of those mothers who cannot or do not have nurses is the most effectual means of prevent ing the diseases of infancy. The nurse, as well as the physician, must understand the care and management of the infant. She must know how easily most cases of intestinal catarrh, simple cough, and coryza can be conveyed from one infant to another by contact; that persons and utensils are sometimes instrumental in carrying the infection; and how dangerous to the infant many of-these mild conditions may be come. In modern infants' hospitals isolating walls (Grancher's boxes) are used between the beds of the patients, in order to prevent, the spread of infectious germs which may exist upon inmates or surroundings. In regard to further precautionary measures and the carrying out of asepsis to diminish the danger of infection by contact in hospitals, I refer you to Ileubner's fundamental work upon "Infant Feeding and Infants' In the family, also, prompt isolation of the sick should be practiced for the protection of the well. Beside infection through contact, sensi tive infants may become infected through the air. Inasmuch as the finest dust may contain bacilli-laden 'particles, carried from the sick, this forms a very common source of infection for healthy individuals. In this manner a child may infect another, or the nurse, mother, brothers, and sisters, when suffering from an affection of the upper respiratory tract (e.g., rhinitis, pharyngitis, bronchitis), are likely to carry the dis ease to the infant. Whenever, for any reason, it is impossible to remove from the vicinity of the child a parent or nurse suffering from catarrhal infection, it is well for her to wear the well-known Mikulicz's face mask.