Mercedes Neto^I; Pedro Ruiz Nassar^II; Thalita Martins Freitas^III; Fernando Porto^IV
INurse, PhD Student Graduate Studies in Nursing and Biosciences, at Alfredo Pinto Nursing School, State of Rio de Janeiro, Federal University,  Member of the Laboratory Research Groups of Nursing History Research and Laboratory of Scientific approaches in the History of Nursing, Professor, Department of Public Health Nursing, State University of Rio de Janeiro, Responsible for the Epidemiological Surveillance Service and Healthcare Indicators of  the Maternity Maria Amélia Buarque de Hollanda - Municipal Health Secretary of Rio de Janeiro, Rio de Janeiro, Brazil, Email: mercedesneto@yahoo.com.br
^IINurse, Master's Degree Student in the Graduate Program - Master's degree in Nursing, the Alfredo Pinto School of Nursing, State of Rio de Janeiro.Federal University, Member of the Laboratory Research Groups of Nursing History Research and Laboratory of Scientific approaches in the History of Nursing, Grant holder of the Coordination for Improvement of Higher Education Personnel, Rio de Janeiro, Brazil, Email: pedrornassar@gmail.com
^IIINurse, Master's Degree Student in the Graduate Program - Master's degree in Nursing, the Alfredo Pinto School of Nursing, State of Rio de Janeiro.Federal University, Member of the Laboratory Research Groups of Nursing History Research and Laboratory of Scientific approaches in the History of Nursing, Rio de Janeiro, Brazil, Email: thalitamartins@hotmail.com
^IVPhD in Nursing with Post Doctorates Degree, School of Nursing, University of São Paulo, Assistant Professor, Alfredo Pinto School of Nursing, and Graduate Program - Master in Nursing and a PhD in Nursing and Biosciences, Federal University of the State of Rio de Janeiro. Rio de Janeiro, Brazil, E-mail: ramosporto@openlink.com.br

ABSTRACT: This study aims to examine newborn body care and clothing, in the nineteenth century. The documents used for analysis were the theses of the Faculty of Medicine of Rio de Janeiro that addressed the issue. The proposed analysis followed the approach of microanalysis. The result of the medical documents showed towards internalize the practice of care change in the culture of hygiene practices by gossips, grandparents, wet-nurses and others aimed to institutionalize its own rules and guidelines for disciplining mothers about care for reference.

Keywords: Nursing; infant care; newborn; historiography.

INTRODUCTION

The nineteenth century was marked by the discovery of humanistic needs and specificities of childhood, seen until then as a transitional period, without meaning to human development¹.

For the eighteenth century mindset childhood was delimited by the absence of speech or imperfect speech , involving the period that goes from birth to three years of age, and would be closely related to the physical attributes, speech, teething, secondary characters; male and female gender, size, among other¹.

The family and the child begin to be seen as political agents, such as promises of the future of the nation and the mother is considered the most important and vital agent for the protective measures were effective because they were directly responsible for the good and bad of the children².

In Brazil, during the colonial period a certain devaluation of the child was reflected, especially those of origin of black mothers, by being treated as a commodity and if an orphan, they were delivered to a Doorstep and led to early and exploitative labor. In short, the colonial family ignored and underestimating of the children, being the latest fragile image of childhood³.

With the arrival and establishment of the Royal Family in Rio de Janeiro, there was the emergence of devices that were aimed at adapting the city to European standards. The primary device was the work of doctor hygienists in the direction approaching the city from the way of civilized European life adjusting the hygiene behaviors to be adopted by the population³.

In this context, doctors relied on their scientific studies and gradually drew the precepts of hygiene for the society, despite the predominance of traditional family knowledge, which allowed reduction of child mortality, given the recommendations on hygiene.

The tropical climate in Brazil, at a time when it didn't have global warming, fans or air conditioning, but heat by means of the sun also shining and warming the imperial lands, in Rio de Janeiro. In this climate, the newborns perspired and required bathing and clothing for everyday use.

Stated another way, the hygiene was necessary, but; What is the temperature of the water more suitable for the newborn? What is the best type of fabric to make the clothes for the newborn?

Given the above, the objective of this research was to analyze bodily hygiene care and clothing, for the newborn in the nineteenth century. The justification for undertaking the study is meant that the intended contribution of another study⁴, for the construction of the history of nursing. , for the construction of the history of healthcare. This care deserves attention in being revisited by traces left in the past, which many times, still, founded the nursing practice in the twenty-first century, being, however, care of the nineteenth century.

METHODOLOGICAL THEORETIC REFERENTIAL

From the theoretical referential of history and the methodological proposal of this research is the approach of the microanalysis. This is understood in the sense of seeing the historical phenomenon through a magnifying glass, and is considered one of the basic tasks of micro-history⁵.

Therefore, the search of documents in microanalysis occurred in the Library of the National Academy of Medicine, located in Rio de Janeiro, concerning the theses of students of the Medical School from the nineteenth century.

The criteria used for selection of analysis of this study were the theses on the topic of caring for newborns, defined in the bodily hygiene and newborn clothing.

The result of this search totaled four dissertations produced by medical students in the nineteenth century. The documentation found was reproduced by camera, considering the state of fresh documents to be read on the screen of the computer monitor, in zoom up to 100%, or printed.

As criteria temporal delimitation of the period from 1840 to 1882 was established , justified in its own documentary selection, that the approach of the microanalysis, not if it is to delimit the scope of the research within which we must lead the analysis separately, because it is a possibility, if necessary, to generalize the conclusions to which it must reach the study⁶.

RESULTS AND DISCUSSION

Bath for the Newborn Infant

In 1840, Leitão affirms that bathing was essential for the preservation of health in all ages of life being the childhood that most needed it, therefore guarantee the integrity and the functionalism of the skin surface and the action focus and soothing on the body, by means of the temperature, which years later - 1882 - it would be better exploited⁷.

Florence Nightingale, in 1860, remembered the British nurses and indirectly those women who cared for children's bodily hygiene. The child's body should be clean, i.e. , "never leaving a single pore of their delicate skin blocked by dirt or by perspiration is the only way to make them happy and healthy"^8:174.

In France in the nineteenth century, the family doctor became a new ally of the mother of newborns in calming the maternal anxieties on some recommendations, among them, bodily hygiene. Thus, the daily bathing of newborns was daily practice subject to the temperature of the bath water. It was recommended to start the bath with cold water, gradually, until the child was clean, in the summer and winter. This would establish the hygiene habit for the possibility of a strong and healthy adult, despite the differences of temperatures for bathing, the bath was consensus in the literature⁹.

The newborn hygiene was, probably, one of the ways to combat other inappropriate hygiene habits based on popular beliefs in the religious sense of protection to ward off diseases. An example of this was the smoking and the baths of protection of newborns with the purpose of blessing and protecting them.

The explanation for this fact is due to the religious conditions of each locality as fads to take care of newborns¹⁰.

To combat these practices, hygiene was recommended in the theses of the medicine. The care of the ears should be made thoroughly to remove excess cerumen accumulated inside the ear, because it could produce inflammation, resulting in serious consequences, being done through injections of warm water or ether in the ear¹¹.

For the removal of the vernix , called verniz caseoso, blood and other secretions from the delivery, the body would be covered with oil, fresh butter and without salt or egg yolk, diluted in a little water, to remove the greasy substances of the skin¹¹.

After removal of the vernix, the skin should be cleaned with a sponge and then the child, would be immersed in water at room temperature around 28 0 C to 30 0 C, because it corresponded to the temperature of intrauterine life¹¹.

Another important precaution regarding the first intestinal elimination, known as meconium, which after being eliminated, it was the mother or who was responsible for taking care of the newborn promoting their hygiene.

In this perspective, bathing the newborn, the care should be to avoid the cooling of the body, with the recommendation that at the end, it should be wrapped in dry and heated towel. The bath as one of hygiene care in childhood in the course of the nineteenth century should be administered without leaving the newborn dizzy. This is due to the argument put forward in two works entitled Beliefs: hygiene and maternal care, for the first age by Ernance Dufaux of lla Jonclere and the book Treaty of physical education for boys, for use by
Portuguese Parents authored by Francisco de Melo Franco, in 1790¹².

The medical literature indicates that the bath in particular was a separate chapter on the practice of body hygiene, for example, the cold bath was recommended since the child's first year of life¹².

Temperature of the newborn bath water

The cold baths increased the power of the organs, by consolidating the tissues and preventing the losses caused by perspiration, being that Locke one of the first physicians to adopt the use of cold baths as a fortified formula for children, followed by Floyer and Rousseau, but the exaggerated use led to disadvantages, namely:
When Lycurgo barbarously dunked a newborn in a river the , and by this means intended to educate citizens strong, able men, by their physical development, to sustain the Republic; for those who do not steal life? How many unfortunate were not victims of such a cruel test? Only those escaped,

whose constitution presented strong resistance, and if opposed a cruel blow. Barbaric Practice, and unfaithful!!!^7:7.

In addition, the thesis says that if it were necessary a cold bath should be done, but quickly, i.e. if you start with water in hot temperatures, passing the warm and, gradually, reaching the cold, which would be confirmed the indication in 1882, in another thesis.

In 1864, it was possible to find reports of experiences of Milne Edward, that prove the low resistance of the newborn the low temperatures and the comparative statistics of mortality of children in cold climates and hot in the winter and summer seasons¹³.
Years later, 1882, it was reported that, in spite of baths being given at a low temperature, during early childhood in England, they should be avoided in the first two months of life. This was due, because they produced some depression of heart rate and respiratory movements that seldom return to the normal physiological state.
It is noteworthy that the classification of the water temperatures of the baths of the newborn, was as follows: cold (0-25°), indifferent (25-30°) and warm (30-40°)¹¹ .
Moreover, it was discussed that the hot baths should not be performed on newborns, since they stimulate the nervous system by promoting abundant sweating, causing weakness, being even fatal. Thus, they used the argument that the children had disadvantages the high temperatures of the water for the baths, because it was suddenly the skin temperature, having as a consequence increase of pulmonary and cutaneous exhalation, and when extended, elicited by: onset of congestive phenomena for various organs and; increase
of the nervous excitability, exercising at the same time debilitating actions¹¹.

The indication of the ideal temperature of water for the baths of newborns was lukewarm water, because it softened the skin, softening the irritability, to produce good general condition and by promoting sleep and keep the health¹¹, in spite of a previous study, in 1864, recommend for newborns hot baths or warm, the temperature between 25 to 35 Celsius, and should be bathed at least once in every 24 hours and, still, perform whenever necessary, especially after the umbilical cord section¹³.
It is clear from the discussion that the baths indifferent to be lukewarm or tepid, were convenient children during the first days of life, mainly with the purpose of calming the nervous system.

Clothing for the newborn

The concern with the dowry for the newborn was not only on the part of the pregnant women, the nineteenth-century medicine also presented evidence of this concern, in order to meet the best way the needs of the garment of the newborn.

• Two shirts, on of them being light, withoutstarch, preferably used, and open the front; the other made of ( flannel or felt), open later, felted ties on the shores of this opening, and shorter than the first; both with sleeves that can cover the whole arm and forearm of the child.
• A blanket also made of wool more or lighter, depending on the season.
• A baby belt.
• Two caps, one light and another of flannel or felt, if the season is winter.
• In this same season, a pair of booties or baby stocking
• A scarf for the neck and
• Triangular cloths bearing laces on the ends, commonly known as [diaper]. 1:2,5.

The recommended clothing, it cannot be confirmed that women to care for their newborns, but the amount could vary, for example, in fact used it: a shirt, wool or moleskin robe, a soft white silk hat without being bound with cords and straps especially while at least not walking, excusing the footwear^14:325.

In addition, the study recommended appropriate clothing according to the age of the children. The clothing should be appropriate and allow the free exercise of the child's body.

The use of a cap was one of the recommendations by medicine in order to compress the head, avoiding deformation accompanied by mental alienation, as shown in the study by doctor Fovilla. This part of the clothing should be lightweight, porous and made so that, it warms the head, not producing excessive heat for the organs contained in the skull and called attention that the neglect could lead to convulsions, meningitis and scalp disorders¹⁵.
As if that wasn't enough the presentation of the outfit, the theses showed how one should handle the newborn. The three-point diaper should be placed under the buttocks, by means of a triangular cloth, with the purpose of receiving the excrement and to protect the clothes of the newly born, described as follows:

• Place under the buttocks one of the triangular clothes (whose purpose is toreceive the excrement and assist the cleanliness of the child's clothing), securing loosely its three tips a little above the pubis, and cross the tabs of shirt on the chest and belly.
• Wrap them in the blanket to restrain their waist and the lower limbs, and then put the belt on them to hold the blanket in place
• cap over the head, so that covers the ears and the guards them from the cold and secure the straps that keeps it on their chest and not the neck or behind the chin, which could be a cause of poor circulation and respiration and;
• Finally, wrapping their the neck with the scarf^1:2 .

In addition, it is warned that the handling of the newborn should be done with tenderness, to avoid abrupt movements, which could compromise the susceptibility of their organs, and also that the items of clothing should be preheated in order to remove moisture not to be inconvenient to the little one¹⁵.

For doctors at the time, the newborn would be well dressed when using a cap and two ample and long garments, the lower fine and soft cloth, bottom is thin, soft cloth, the wool top more or less fine, according to the season, adding to this the booties known as the mothers, and cloth to receive the defecations. By following these recommendations, any child would be perfectly dressed and wrapped according to the climate, especially if the clothes were closed up to the neck and with sleeves¹⁵.

On the other hand, it is advised that the clothing should observe the weather conditions, i.e., when In cold temperatures wrap the newborn, but do not use wool in contact with the skin, directly, and change immediately any garment in the case you find it to be moist or wet, making them meticulously clean.

The children's clothing should be made with different materials, according to the weather and the seasons; unlike the wool, which is a bad thermal conductor, it was advised to be used in the winter, in order to prevent the rapid cooling of the body by irradiation, in particular, for the weak, sick and lymphatic temperament newborns¹⁵.

The cotton should be used in warmer climate stations, because it allows evaporation, Correcting the effects of high temperatures of the air¹⁵.

The linen, cotton top-level, it is a better heat conductor, by conserving greater amount of moisture in contact with the skin, disturbing the cutaneous respiration, favoring the manifestation of catarrhal diseases¹⁵.

In the logic of that, it was recommended that the newborn remain long with wet  or urine diapers even after using those urinated and dried in the Sol. This meant that the newborns clothes should be carefully washed, avoiding to leave waste materials accumulated excrements or soap in the washing¹⁵.

CONCLUSION

How one can identify the results of the study, there was concern about the medicine and hygiene in the newborn's garments, in the nineteenth century. It was not simply to call the attention of the mothers, but instead to institutionalize their own rules and guidelines to regulate the population in ways of performing newborn care.

Thinking, in this logic, in current times it is believed that it makes the young and more experienced nurses reflect in their practice on primary care focused on the mothers, in the nineteenth century, which are still current concerns after the birth and daily warnings explained in the guidelines to the mothers of the twenty-first century.

In this study, once again, it can be evidenced that, still, there is a long way to go in the construction of knowledge of the care provided by the nursing staff, in particular, as regards to the bath, best water temperature for bathing and clothes to be used by newborn infants. Finally, studying the trajectory of care for those who think a thing of the past ends up discovering as present concerns, which might even consider that they were written in contemporary history.

REFERENCES

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2. Martins APV. Vamos criar seu filho: os médicos puericultores e a pedagogia materna do século XX. História, Ciências, Saúde – Manguinhos. 2008; 15 (1): 135-54.

3. Costa JF. Ordem médica e norma familiar. Rio de Janeiro: Graal; 2004.

4. Porto F, Freitas TM. Cuidados com o cordão umbilical do recém-nascido, no século XIX. Rev enferm UERJ. 2011; 19: 524-9.

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7. Leitão AGA. Hygiene da infância [tese de doutorado]. Rio de Janeiro: Faculdade de medicina do Rio de Janeiro; 1840.

8. Nightingale F. Notas sobre enfermagem: o que é e o que não é (1860). Tradutora Amália Correa de Carvalho. São Paulo: Cortez; 1989.

9. Badinter E. Um amor conquistado: o mito do amor materno. Rio de Janeiro: Fronteira; 1985.

10.Del Priore M, Amantino M. História do corpo no Brasil. São Paulo: UNESP; 2011.

11. Vieira JCN. Hygiene da primeira infância [tese de doutorado]. Rio de Janeiro: Faculdade de medicina do Rio de Janeiro; 1882.

12. Mauad AM. A vida das crianças de elite durante o império. In: Del Priore M, organizadora. In: História das crianças no Brasil. São Paulo: Editora Contexto; 2010; p.137-76.

13. Duque FB. Hygiene da criança, do nascimento à queda do cordão umbilical. [tese de doutorado]. Rio de Janeiro: Faculdade de Medicina do Rio de Janeiro; 1864.

14. Del Priore M. Ao sul do corpo da mulher: condição feminina, maternidade e mentalidades no Brasil Colônia. Brasília (DF): EDUNB; 1993.