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Hygiene of the Nursery.

Chapter VII.

Bathing.

 

A well-known English writer states, that "water to the body -- to the whole body -- is a necessity of life, of health, and of happiness; it wards off disease, it braces the nerves, it hardens the frame, it is the finest tonic in the world."

On the word "tonic" the whole subject hinges. Every one know that food, even in such a simple form as milk, may be given to excess, with the production of illness, and that medicines are yet more easily abused. Why, then, if the bath be a tonic agent, may it not be often used injudiciously and to the detriment of the child?

Intelligent nurses who have grown gray in service, often say that they have seen babies "washed into heaven." This act has never been actually accomplished in my experience, but it has been often enough approached to justify introducing this chapter with the caution that, should the infant be ailing, the bath had better be discontinued until the physician can be consulted. This, of course, does not preclude ordinary cleanliness, for every part of child's body liable to become soiled can be readily cleaned by the use of a moist sponge, with or without soap, and without bringing into play any of the medicinal or, in other words, tonic effects of the bath.

The initial bath is to be given as soon after birth as the nurse, having made the mother comfortable, can turn her attention to the child. This bath differs somewhat from those that succeed it during infancy, in the fact that it involves a special procedure, namely, the removal of the tenacious, pastelike material which usually adheres to the skin of the newly born.

This substance, the vernix caseosa, is a fatty varnish or deposit secreted by the glands of the skin. While the foetus is in the womb, it probably acts as a protecting agent, but if allowed to remain long after delivery, it becomes dry and hard, and, in addition to impeding the healthy activity of the skin, leads to excoriations or various eruptions.

To remove it, first rub the whole surface gently, though thoroughly, with a bit of flannel covered with fresh lard or olive oil; next, wash off the softened and greasy coating with a sponge saturated with warm water and soap, and finally, complete the bath by immersing the body in warm water for one or two minutes.

After this preliminary cleansing, one bath a day should be the rule until the completion of the third year of life.

The monthly nurse must bathe the child while she remains in attendance; afterward the mother is the proper person, unless the nurse-maid be exceptionally careful and experienced; and even in this event the mother should superintend the process.

A tub with a supply of water, a piece of soft flannel for a wash rag, a fine sponge, a bit of good soap and several soft towels are the necessary articles. A long apron made of soft flannel is also useful, and it is well to provide a low chair and a bit of oilcloth to place on the floor underneath the tub. The former enables the bather to get more on a level with her work and make a deeper lap for the child to rest in, and the latter receives any water that may be splashed about. A stand is now made to hold the baby's bath tub, Fig. 15, and is so contrived that it can be folded up and laid away when not in use. It is convenient, inasmuch as it obviates the necessity of stooping over, by bringing the child more on a level with the bather. It has straps and hooks attached to the sides to hold the tub firmly in place while in use.

An ordinary, oblong tin tub, painted white inside and large enough to give plenty of room is preferred to either a porcelain basin or a wooden tub. When in use, the tub should be placed on the floor, for the sake of firm support, or on the bath table, and afterward must be well cleaned, dried and aired.

Water for the bath ought to be pure and soft, and should it be muddy or otherwise foul, the nurse must take the trouble to filter it. The character of softness is an important one, and when it is impossible to obtain anything but hard water from the ordinary sources of supply, a special provision ought to be made for the collection of rain water. The quantity used at a time should be sufficient to cover the child up to the neck when placed in the tub in a semi-reclining position.

A matter of great importance is the temperature of the water. Some -- fortunately very few -- people use cold water from the first, under the impression that it is strengthening. So far from this being the case, cold water, instead of "hardening," depresses the vital forces and frequently produces inflammation of the eyes, nasal catarrh and inflammation of the lungs and bowels.

While cold baths are not to be recommended, one must not go to the other extreme, and use too hot water; for this also weakens the frame and renders it more susceptible to the attack of disease.

Ninety-five degrees Fahrenheit in winter, and from eighty-five to ninety-two degrees in summer are the proper temperatures. As the heat of water cannot be estimated by the hand with any degree of accuracy, it is essential to use a bath thermometer. See Fig. 16.

Place this instrument in the water and allow it to remain a few moments, so as to get a full effect upon the mercury. Should the water be too hot, it may be readily cooled by the addition of cold water, or, if too low in temperature, as easily raised to the proper degree by pouring in hot water.

It is impossible to insist too strongly upon the necessity of uniformly using the bath thermometer. Several times in my experience a tin bath tub has been filled with water so hot that its sides burned the delicate skin of the little hand placed upon it; fortunately, in such instances, the consequent screams led to careful investigation, and no serious damage resulted. On the other hand, I have felt the water cold enough to pain the fingers. Don't neglect the thermometer, then!

A piece of flannel is very useful for the first part of the bathing. It readily takes soap, and, being soft, can be thoroughly rubbed over the skin without danger of injury. A large, soft sponge, however, is best suited to the finishing of the bath, for it holds more water than a flannel wash rag, and enables the bather to stream the water over the child's body, and thus get the stimulating effect of a miniature shower bath at the same time that the dirt and superfluous soap are washed away from the surface. The wash rag and sponge must, by the way, be the child's exclusive property, and are not to be used twice in succession without being thoroughly cleaned and dried in the open air.

Unscented Castile or glycerine soaps are the best to use. Common soaps are irritating to the skin, and even the purest and most bland articles must be employed with care; that is, neither too frequently nor too profusely, lest they lead to eczema or other cutaneous disorders. When any skin disease is present, the physician's advice must be had not only as to the use of soap, but also in reference to the propriety of the bath itself.

Two towels are required for each bath. These should be large and composed of fine, soft material. They must be dry and warm, and perfectly clean before they are applied to the surface of the child.

The bath apron should be made of two pieces of soft, white flannel; one long enough to extend from the waist almost to the feet of the bather, and broad enough to completely cover the front of her gown; the other quite as broad but about four inches shorter. Both pieces are sewed to a waist belt, forming, in reality, two aprons; the upper of which is thrown over the shoulder when the infant is being lifted from the tub, and then used as a dry and warm covering when he reaches the lap. After the bath, the apron, being more or less wet, must be taken off and thoroughly dried. Several such articles should be provided, as they must be frequently washed to keep them clean and free from odors.

Any low chair will do to use in bathing, though, as those usually sold in the shops have not a sufficiently broad seat to give a comfortable support, it is better to make one by sawing off the legs of an ordinary wooden kitchen chair.

The bath must be given at a regular time each day. The best hours are in the morning, midway between two feedings, at ten o'clock, for instance; and in the evening, just before the infant gets his last bottle and goes to bed. The first is perhaps the better hour, but regularity is the more important point.

At the time selected, place the tub containing the water, heated to a proper temperature, in a warm and sheltered part of the room, and around it arrange, within convenient reach of the hand, the various requisites of the bath.

Upon undressing the child, wet his head first; then let the head and shoulders rest on the left forearm and lower the child gently into the water, that his body may be covered as far as his neck. Take a wetted and sponged flannel wash cloth in the right hand, and pass it rapidly but thoroughly over the body, avoiding the eyes. Pay particular attention to the arm-pits, to the region between the folds of the buttocks and to the groins. This done, take a large, well-filled sponge in the right hand and squeeze the contents over the body. The chief force of this miniature douche must fall upon the back and loins, and the child, during the operation, must be lifted clear of the bath-water by the left arm and hand.

The sponge is used simply to clear off the dirt loosened by the wash rag, and to remove all superfluous soap; therefore, so soon as this is accomplished, the child should be lifted from the tub to the lap and enveloped in a towel, or better still in the loose folds of the bathing apron. The drying process now begins and consists in absorbing the moisture from the skin. This is done by a series of very gentle patting movements with a towel folded over the palm of the hand. In drying a baby, especial attention must be given to those portions of the body where the natural folds form crevices in which water may lodge. Unless these parts be thoroughly dried, serious consequences may ensue. If it be retained in a normal crevice -- the fold of the buttocks or behind the ears -- it causes in a short time troublesome excoriation.

"Never allow anything smaller than the elbow to enter the ear," is excellent advice; though, during the bath should water get in and be allowed to remain, it may lead to ear-ache and abscesses, and in extreme, though not rare, cases, to deafness. In the event of this a blunt cone formed out of a soft handkerchief will quickly absorb the moisture, and will do no harm if inserted but a very short distance within the orifice.

The nose can be readily cleaned by the soft cone-shaped handkerchief, especially if a little vaseline be added to facilitate the process.

After the infant is patted perfectly dry -- not rudely rubbed with a towel -- the whole surface, but especially the region on each side of the spine, should be rubbed with the naked palm until the skin becomes slightly red. This modified massage ends the bath, and the child must then be dressed as quickly as possible.

Several important points yet remain to be mentioned. Never give a bath immediately after a meal nor when the child is either cold or overheated. Never suddenly nor rudely plunge the body into the water, and never allow the time of actual immersion to exceed five minutes. Under no circumstances should the head and face be allowed to dip beneath the surface. Should this happen, the child will become so frightened that it will be difficult to get him to enter the water again; and here, by the way, it may be well to state that if there be repugnance to the bath, the tub may be covered over with a blanket, and the child being placed upon it, may be slowly lowered into the water without seeing anything to excite his fears.

The question of the propriety of using powder after a bath is often asked by mothers. Powdering has always seemed to me to be a lazy way of absorbing moisture that should be taken up with a dry towel, and unless there be some excoriation or other indication for its use, the skin can be kept cleaner and healthier without it. In cases, too, in which some disorder of the skin would seem to warrant its employment, better and quicker results are ordinarily obtained by the application of cold cream, oxide of zinc ointment or vaseline.

The rule of one bath a day may be exceeded in very hot weather, when, in addition to the morning full bath, the body may be sponged twice daily with water at a temperature of 90° F. This, contrary to what might be expected, has a greater and more permanently cooling effect than bathing with cold water.

From what has been written, one might suppose that the details of an infant's bath are endless; so they must seem when given in full. A skillful bather, however, ought to fulfill every requisite and complete the bath in a period of time not exceeding twenty minutes at the very outside, and this must include not only the actual five minutes' immersion, but the preparation of the bath and the drying process.

After the third year three full baths a week are quite sufficient. An evening hour is now to be preferred, but the water must still be heated to 90° F. in winter, though it may be cooler in the heat of the summer. While, at this age, the child has his three full baths weekly, for the purpose of securing absolute cleanliness, he must be sponged every day with water, cool or warmed according to the season.

The sponge bath is best given in the morning, soon after the child has roused himself from sleep and before any food is given. The nurse, for this, must provide herself with a large basis containing water at a temperature of 75° in summer and 85° in winter, a large, fine sponge and several towels. The bath-apron being donned and the child's nightclothes removed, the sponge filled with water is passed rapidly over the whole surface of the body; then the child must be wrapped up in the apron and the skin first dried gently with a soft towel and then rubbed into redness with the open hand. When this process is completed -- and it should be done in at least ten minutes -- the clothing is put on rapidly, and the child is ready and usually hungry for his morning meal. No soap need be used in these baths.

In the tri-weekly cleansing bath the process of washing is much the same as in infancy. That is, the bath tub being filled with water at a temperature of about 90°, the child is put into it up to his neck and thoroughly soaped with a wash rag, and next douched clean with a large sponge. Here, also, the head must be wet first; the body immersion must not last longer than five minutes, and the drying must be done quickly and with a patting rather than a rubbing movement. Ample reaction of the skin must be secured by gently rubbing with the palm of the hand, especially over the spine.

The washing of the head is a most important matter, as it cleanses the scalp and prevents the formation of scurf, and adds beauty to the hair. At the same time the nurse must be careful how she dries the hair. To rub it gently with a soft towel and then brush it out with a fine hair brush is the proper plan. Combing, in so far as it means dressing the hair and cleansing the scalp, must never be allowed, as it not only thins the hair by pulling it out by the roots, but also irritates the scalp and produces eruptions upon it.

As the child approaches puberty he must gradually be taught to wash himself, and should be encouraged to form the habit of bathing every day. The bath at this age should be a sponging rather than a soaking process, it is best taken in the morning directly after rising, and the temperature of the water may range from 65° to 75°, though delicate children may require it warmer, especially during winter weather.

When childhood merges into youth, while the sponge is still preferable to the plunge, water may be used, all the year round, just as it flows from the faucet. The temperature will be, of course, quite low at times, but so long as the bath is taken in a warm room, completed quickly, and followed by a sense of stimulation and warmth, nothing but good results.

Whatever room be used for the purpose of the toilet, the child, if he be old enough to bathe himself, should occupy it alone, so that the whole body may be stripped naked; otherwise washing cannot be thoroughly or effectually accomplished. The paraphernalia required are: a large basin, a tin chamber tub or the ordinary fixed bath tub; a piece of coarse flannel, one yard long and half a yard wide; a large sponge; a tablet of soap; a soft towel and a Turkish bath towel.

Having drawn a sufficient quantity of water -- two thirds of the basinful, or two or three inches in either of the tubs -- the successive steps of the bath are as follows: Wash the hands with soap; dip the head and face into the water; resoap the hands and rub and wash the head, face, neck, chest, and arm-pits; take the wetted sponge and go all over the parts previously covered by the soaped hands; fold the flannel into a long band, dip it into the water, and, holding an end in either hand, throw it over the shoulders, and move it several times from side to side, then up and down, and then across the back and loins; dip the sponge into water again, and holding the head and shoulders over the tub, stream the water once or twice over the head, neck, and face; step into the bath, resoap the hands and pass them quickly up and down the legs and over the feet. Fill the sponge and squeeze its contents over each leg; finally; sit down and with soaped hands wash the region between the buttocks, removing the suds by a few splashes of water. Next, step from the bath and dry the body quickly, taking care to remove all the moisture from the ears, from between the toes and from the different folds of the body. The drying is to be accomplished by brisk rubbing, first with the soft towel and then with the Turkish towel. The back and loins are the most difficult to reach, but if the towel be thrown over the shoulders, as one would a skipping rope, and moved from side to side several times, the drying of these parts is accomplished without trouble.

A boy should wash his head as above described each morning; a girl, who has long hair, at least once a week.

Any loitering over the bath is attended with the danger of chilling. Never occupy more time than fifteen minutes in the whole process.

These daily sponge baths are ordinarily quite sufficient to keep the person perfectly clean; sometimes, however, it is necessary to take, in addition, a full, warm bath at intervals of a week. These baths are relaxing if too prolonged; ten minutes is the maximum time for remaining in the water. After leaving the bath there must be no exposure to draughts. The best hour for such a bath is in the evening; some time after the last meal and just before going to bed.

Sea-water baths are useful for a child of any age, although ordinary sea bathing is not to be recommended until the child is old enough and strong enough to hold his own in a moderate surf -- after the eighth year, for instance. A younger subject may, when at the seaside, be dressed daily in a bathing suit and allowed to splash for a time at the edge of the surf. The process of carrying a child against his will into the waves and immersing his head, as is often done, is cruel and productive of so much terror that more harm than good results.

In our climate, the proper season for sea bathing is from the middle of June until the middle of September.

On arriving at the cost, it is always well to prepare for the plunge into the sea by giving, on the first day, a warm salt-water bath. On the day following, about three hours after breakfast, the child may don his bathing dress. Immediately on entering the water, the head must be thoroughly wetted. After this, the bath may be protracted for fifteen, or at most twenty, minutes. To get the invigorating effects of a surf bath, it should never be repeated oftener than once a day, and in some cases it is better to allow a day to intervene, or even to enter the water only twice a week. Drying and dressing should be rapidly performed, and a half-hour's brisk walk is very useful in promoting reaction and causing free circulation of the blood. Should the bather feel faint after coming out of the water, he must be wrapped in towels and given half a tumblerful of milk containing one or more teaspoonfuls of brandy or whisky.

When the child is either cold or perspiring freely, the bath must not be undertaken.

The bathing suit should be of light flannel, made in one piece like a pair of moderately loose night drawers, but with short arms and legs; it should open only over the shoulders, where, when put on, it is fastened by buttons. This arrangement permits of easy removal after the bath when the flannel is saturated with sea water, and is, in consequence, heavy and sticky.

The question of sea bathing suggests that of swimming. Boys, and girls also, should learn to swim early. The art is not only a safeguard, but a means of most pleasant and invigorating exercise. It develops the muscles, expands the chest, aids digestion, strengthens the whole frame, and promotes energy, courage and self-reliance.

Swimming, like every other exercise, must be taken in moderation. Even with this care it is not always beneficial. The bather should leave the water experiencing a pleasant glow over the whole surface of the body; the spirits and appetite should be increased, and there ought to be a sensation of augmented strength. If, on the contrary, it should disagree, there is a sense of chilliness, with lassitude and depression of spirits; the face is pinched and pale, and the lips and finger nails are apt to look blue.

Swimming in salt water is more invigorating than in fresh. Apart from the different quality of the two waters, the battling with the waves in the former case is more exhilarating, and the sea breezes, blowing upon the body, carry with them health and strength. Every one must have noticed the increased softness and beauty of the skin and the greater lustre of the hair after a sojourn at the seaside.

It may be serviceable next briefly to detail the different baths in common use as well as those most often directed by physicians, with some reference to their effects upon the system.

Concerning temperature, the bath may be:--

1.

Cold, temperature

50° to 65° F.

2.

Cool, "

65° to 75° F.

3.

Temperate, "

75° to 85° F.

4.

Tepid, "

85° to 92° F.

5.

Warm, "

92° to 98° F.

6.

Hot, "

98° to 112° F.

When giving a cold bath, strip the child in a warm room, and rub him thoroughly with the palm of the hand until the whole body, especially the spinal region, is warm. Let him then stand in a tub containing enough hot water to cover the feet, and sponge him rapidly with the cold water. The temperature of the latter must never be below 60° F., and the addition of half an ounce of rock salt or a tablespoon of concentrated sea water to the gallon, renders it more stimulating and insures a complete reaction. After sponging, the surface must be thoroughly and quickly dried with a soft towel and shampooed with the open hand until aglow.

This bath, provided the degree of cold does not exceed the resisting powers of the child, is a powerful tonic, producing rapid tissue changes and increasing nutrition. Should the water be too cold, or the sponging continued too long, reaction does not follow the primary shock, and the result is fatigue, exhaustion, or even dangerous prostration. This bath, therefore, must be used with caution and only under a physician's advice. The cases in which it is of most service are those in which there is a sluggish circulation with poor appetite and feeble digestion; in which the nutrition is impaired, as in rickets, and in certain spasmodic nervous disorders.

A cooled bath is sometimes prescribed, and may be employed with advantage in conditions attended with very high fever. The child is first immersed in water at 95°, and this is gradually lowered to 70° by the addition of cold water, the process occupying from fifteen to thirty minutes.

Analogous to this bath is the cold pack. Fold a sheet in such a way as to be long enough to extend from the child's arm-pits to his feet, and wide enough to encircle completely his body; dip it in water at 80° and lay it smoothly upon a cot, the mattress of which must be protected by a rubber Mackintosh. When all is in readiness, place the child upon the sheet, and wrap it around his body and legs. A blanket must then be thrown over the sheet and the pack left undisturbed for ten minutes. Then lift the child out quickly and envelop him in a warm blanket and allow him to remain at rest for some little time.

In the absence of a physician, sponging with water, at a temperature of 70° or 80°, is the only safe bath to employ to reduce temperature. In giving this bath, strip the child and place him in bed between blankets, while the nurse, inserting her hand between, must pass a damp sponge slowly over the surface. Five to ten minutes may be consumed in this operation, though, if the child complain of chilliness, discontinue the sponging at once; a sensation of cold, too, indicates the use of warmer water. The operation may be repeated several times daily, or as often as every two hours in urgent cases, and when the heat reduction is of short duration.

The hot bath, 95° to 100°, is employed for various purposes -- to relieve nervous irritability, to promote sleep, to produce sweating, and to draw the blood to the surface in the event of congestion of some internal organ. Whether a full bath or merely a foot bath be required, five minutes is sufficient time for immersion; then, with or without drying, according to the degree of sweating desired, the whole body, or only the feet and legs in case of a foot bath, must be enveloped in a blanket, and the child put to bed. To render these baths more stimulating, a teaspoonful to a tablespoonful of mustard flour may be added, and the child held in the water until the arms of the nurse begin to tingle. The hot bath is purely stimulating, and it is important not to continue it too long, lest the primary and only desirable effect be followed by depression.

The blanket bath is useful in producing perspiration. Wring a blanket out of hot water and wrap it around the child; then throw three or four dry blankets over him and leave him for half an hour; rub the body then with a soft towel, to absorb the moisture thoroughly, and keep the child in bed.

There are several medicated baths in frequent domestic use, which it may be useful to describe.

Mustard Bath. -- Take from two teaspoonfuls to two tablespoonfuls of mustard flour; hot water, two to four gallons.

In form of foot bath it produces sweating and determines the blood to the surface. A a general bath it acts as a powerful stimulant.

Salt-water Bath. -- Take four tablespoonfuls of rock salt, or Ditman's sea salt, or concentrated sea water; water, hot or cool, according to season, four gallons.

To be used as a general bath every morning in chronic tuberculosis, scrofula, rickets, and general debility. Bath to be followed by thorough rubbing of the surface, especially over the spine.

Bran Bath. -- Take one pint of bran; tie up in a muslin bag, place in a quart of water, boil for an hour, squeeze bag thoroughly into the water, and add to four gallons of warm water.

Useful in eczema and other skin diseases.

Soda Bath. -- Take one tablespoonful of bicarbonate of sodium; warm water, four gallons.

Used in skin affections.

Compresses are often useful. The wet compress consists simply of a roll of flannel or soft linen dipped in cold water and wrung out, and then applied to the part indicated. Cover this with a piece of oiled silk rather larger than the compress.

There are several matters that bear a more or less close relation to the subject of bathing. These are the care of the teeth, nails, and hair.

The teeth must be cleaned morning and evening, and the cleansing process must be begun with the appearance of the first tooth. Ordinarily, a soft wash rag folded over the forefinger, dipped in cool water and thoroughly rubbed over the teeth, is sufficient to keep the early teeth clean, and does not injure the tender gums. Should a dark-colored scum form at the junction of the tooth and gum, a little prepared chalk or other bland tooth-powder may be used in addition. If it be impossible to get at the point of discoloration in this way, shape with a penknife a moderately hard bit of wood into the form shown in Fig. 17, then either bite or but the woody fibres at the extreme end into a sort of bunch, wet this, dip it in the tooth powder, and gently rub at the discoloration until it disappears, taking care not to make the gum bleed. Over a piece of wood so shaped one may also wrap a bit of soft cambric and use water and powder as before.

Take good care of the milk teeth, for if they become decayed and broken off or lost, their permanent substitutes are apt to come in irregularly and produce a lasting deformity.

The tooth brush can be used after a number of the milk teeth have been cut. The bristles should be very soft and fine, and it must be employed with gentleness. Unless there should be some discoloration, no powder need be used.

The child should early learn to clean his own teeth.

The importance of taking care of the toe nails has already been referred to in the chapter on clothing. The finger nails should not be allowed to grow too long; at the same time it is a bad plan to cut them close to the quick. In trimming them, use a moderately dull pair of scissors, and do not round them too much. When hang nails appear, they must be cut close with sharp scissors. The fingers and toes should be inspected carefully after each bath, to see if they require attention.

Directions have already been given in regard to washing the hair. All that remains to be said now is to repeat the caution against the use of a fine comb, and to protest against the employment of hair-oil and hair-washes. The best scent for the hair is an occasional dressing of soap and water; the best beautifier, a thoroughly good brushing with good brushes, and the latter should be employed every morning and evening.

Besides keeping the long hair of a girl free from scent and grease, do not dress it over the ears or tie it up tight and make it "like a cap of iron over the skull."

If the hair be well brushed and the scalp thus sufficiently stimulated, there will be enough natural oil secreted to keep it tidy; artificial oily applications only act temporarily, and by blocking up the pores of the skin tend to make the hair drier and harder to keep in order.

Should there be a tendency for the hair to fall out, wash the scalp thoroughly and frequently with soap and water, and stimulate it by firm brushing and the use of a wash such as the following:--

Take of--

Aromatic spirits of ammonia, one fluidounce.

Tincture of cantharides, one and a half fluidrachms.

Glycerine, half a fluidounce.

Rose water, seven fluidounces.

Mix.

A tablespoonful of this may be rubbed into the scalp once every day, the rubbing to be followed by washing with a sponge and vigorous brushing.

In such cases, however, it is best to seek the advice of a physician, for falling out of the hair may be due to a variety of causes.

 


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