[Illustration: _By courtesy of The New York Times_

NEW YORK'S BETTER BABY

Little Hiss Johanna Wiggers, who won the first prize in New York'sBetter Babies Contest by scoring 100 points, is the type of little girlthat will make the best mothers, and the better race tomorrow. Her scorecard showed; age, 28 months; weight, 33 lbs. 14 ozs. ; height, 35-1/2inches; circumference of head, 19-1/2 inches: circumference of chest, 20inches; lateral diameter of chest, 6 inches; diameter of chest fromfront to back, 4-1/2 inches; length of arm to tip of middle finger, 14-1/2 inches; length of leg to the sole of the foot, 16-1/2 inches;total, 100 points. ]

The Eugenic Marriage

A Personal Guide to the New Science of Better Living and Better Babies

By W. GRANT HAGUE, M. D. 

_College of Physicians and Surgeons (Columbia University), New York;Member of County Medical Society, and of the American MedicalAssociation_

In Four Volumes

VOLUME II

New York

THE REVIEW OF REVIEWS COMPANY

1914

 Copyright, 1913, by W. GRANT HAGUE

 Copyright, 1914, by W. GRANT HAGUE

TABLE OF CONTENTS

SEX HYGIENE FOR THE BOY

CHAPTER XII

BUILDING OUR BOYS

PAGE

A word to parents--Interest in sex hygiene--The "Social Evil"--Tenmillions suffering with venereal diseases in the UnitedStates--Immorality not confined to large cities--Venereal diseasescommon in country places--What are the consequences of venereal diseaseto the boy?--Gonorrhea, or clap--Symptoms of gonorrhea in themale--Complications of gonorrhea--Syphilis, or the "pox"--How syphilisis acquired--Syphilis attacks every organ in the body--Not possible totell when cured--The chancre--Systematic, or constitutionalsymptoms--Mucous patches and ulcers--Syphilis of the blood vessels andlymphatic glands--The interior organs--Brain and spinal cord--The nose, eye, ear, throat--Hair and nails--What the boy with venereal disease maycause in others--The infected wife--A girl's fate when shemarries--Young wife rendered sterile--Young wife made to miscarry--Isthe husband to blame--Building the man--Age of puberty--"InternalSecretion" . .. PAGE 139

CHAPTER XIII

THE PARENTS AND THE BOY

Abuse of the procreative function--The continent life--Provide theenvironment necessary to the clean life--The period of procreativepower--Self-abuse--Masturbation--Treatment of masturbation--Night lossesor wet dreams--Causes of night emissions--Sexual excesses--Treatment ofsexual excesses--What parents should know about the so-called "socialevil" before speaking with authority to the boy--The need ofenlightenment in sexual matters--"No one told me, I did not know"--Fakemedical treatment of venereal diseases--Sowing wild oats--Shouldcircumcision be advised . .. PAGE 153

SEX HYGIENE FOR THE GIRL

CHAPTER XIV

A MOTHER'S DUTY TO HER DAUGHTER

What a mother should tell her little girl--Where do babies comefrom--How baby birds and fish come from eggs--How other animals havelittle nests of their own--The duty of mothers to instruct anddirect--What a mother should tell her daughter--Every mother shouldregard this duty as sacred--Every female child is a possible futuremother--Motherhood the highest function of the sex--Health the onenecessary essential--Symptoms of the first, or beginningmenstruation--The period of puberty in the female--Changes in thereproductive organs at puberty--The female generative organs--Thefunction of the reproductive organs--The age of puberty in thefemale--The function of the ovary--The function of the womb--Whymenstruation occurs every twenty-eight days--The male or papa egg--Thefunction of the spermatozoa--"Tell the whole story"--"How do thesespermatozoa get there"--The union of the species--"How can a baby livein there for such a long time"--How the baby gets its nourishment in thewomb--Girls must not become mothers . .. PAGE 173

CHAPTER XV

PREPARING FOR MOTHERHOOD

Menstruation--Irregular menstruation--Changes in the quantityof the flow--How the womb is held in place--Symptoms ofmenstruation--Menstruation should not be accompanied with pain--Don'tgive your daughters patent medicines, or "Female Regulators"--Take yourdaughter to the doctor--Leucorrhea in girls--Bathing whenmenstruating--Constipation and displaced wombs--Dress andmenstruation--Absence of menstruation, or amenorrhea--Treatment ofamenorrhea--Painful menstruation, or dysmenorrhea--Causes ofdysmenorrhea--Treatment of dysmenorrhea--Sterility in thefemale--Conditions which affect the fertility of women--Climate, stationin life, season of the year, age, the tendency to miscarry--Causes ofsterility in the female--Displacement of womb--Diseases of womb, ovaries, or tubes--Malformations--Lacerations--Tumors--Leucorrhea--Physicaldebility--Obesity--Special poisons--"Knack of miscarrying"--Miscarriage--Causeof miscarriage--The course and symptoms of miscarriage--What to dowhen a miscarriage is threatened--Treatment of threatenedmiscarriage--Treatment of inevitable miscarriage--Aftertreatment of miscarriage--The tendency to miscarriage . .. PAGE 187

THE BABY

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to prepare for the coming baby--Care of the newly-born baby--Thefirst bath--Dressing the cord--Treatment after the cord falls off--Apouting navel--Bathing baby--Clothing the baby--Baby's nightclothes--Care of the eyes--Care of the mouth and first teeth--Care ofthe skin--Care of the genital organs--Amusing baby--Temperaturein children--The teeth--The permanent teeth--Care of theteeth--Dentition--Treatment of teething--How to weigh the baby--Averageweight of a male baby--Average weight of a female baby--Average heightof a male child--The rate of growth of a child--Pulse rate inchildren--Infant records, why they should be kept--"Growingpains" . .. PAGE 209

CHAPTER XVII

BABY'S FEEDING HABITS

Overfeeding baby--Intervals of feeding--How long should a baby stay atthe breast--Vomiting between feedings--Regularity of feeding--Why isregularity of feeding important--A baby never vomits--What is thesignificance of so-called vomiting after feedings--Mother's milk that isunfit for baby--Fresh air for baby--Air baths for baby . .. PAGE 223

CHAPTER XVIII

BABY'S GOOD AND BAD HABITS--FOOD FORMULAS

Baby's bed--The proper way to lay baby in bed--Baby should sleep byitself--How long should a baby sleep--Why a baby cries--The habitualcrier--The habit of feeding baby every time it cries--The habit ofwalking the floor with baby every time it cries--Jouncing, or hobblingbaby--Baby needs water to drink--The evil habit of kissingbaby--Establishing toilet habits--Baby's comforter--What can be done tolessen the evil effects of the comforter habit--Beef juice--Beef juiceby the cold process--Mutton broth--Mutton broth with cornstarch orarrowroot--Chicken, veal, and beef broths--Scraped beef or meatpulp--Junket or curds and whey--Whey--Barley water--Barley water gruelor barley jelly--Rice, wheat or oat water--Imperial Granum--Albumenwater--Dried bread--Coddled egg . .. PAGE 235

ARTIFICIAL FEEDING

CHAPTER XIX

ARTIFICIAL FEEDING

Elementary principles of milk modification--The secret of the efficiencyof mothers' milk--Two important factors in successful artificialfeeding--Every child is a problem in itself--Proprietary foods of littlevalue as infant foods--Their value is in the milk added to them--Thecredit belongs to the cow--Difference between human and cow's milk--What"top-milk" feeding means--Utensils necessary for home modification ofmilk--Artificial feeding from birth to the twelfth month--How tomeasure "top-milk"--Easy bottle-feeding method--Condensed milkfeeding--Objections to condensed milk feeding . .. PAGE 249

CHAPTER XX

ARTIFICIAL FEEDING (_continued_)

How to prepare milk mixtures--Sterilizing the food for the day'sfeeding--How to test the temperature of the food for baby--When toincrease the quality or quantity of food--Food allowable during thefirst year in addition to milk--Beef-juice--White of egg--Orangejuice--Peptonized milk--The hot or immediate process--The coldprocess--Partially peptonized milk--Completely peptonized milk--Uses ofpeptonized milk--Objections to peptonized milk--What a mother shouldknow about baby's feeding bottle and nipple--Should a mother put herbaby on artificial food if her supply of milk during the first two weeksis not quite enough to satisfy it--Certain conditions justify theadoption of artificial feeding from the beginning--Mothers' mistakes inthe preparation of artificial food--Feeding during the secondyear--Sample meals for a child three years of age--The diet of olderchildren--Meats, vegetables, cereals, bread, desserts, fruits . .. PAGE 259

WHAT MOTHERS SHOULD KNOW

CHAPTER XXI

THE EDUCATION OF THE MOTHER

What mothers should know about the care of children during illness--Asick child should be in bed--The diet of the sick child--A child is themost helpless living thing--The delicate child--How to feed the delicatechild--How to bathe the delicate child--Airing the delicatechild--Habits of the delicate child--Indiscriminate feeding--Poorappetite--Loss of appetite--Treatment of loss of appetite--Overeating ininfancy--What correct eating means--Bran as a food--Breakfast for achild at school--Lunch for a child at school--Bran muffins for schoolchildren--Bran muffins in constipation--Hysterical children--What amother should know about cathartics and how to give a dose of castoroil--Castor oil--Calomel--Citrate of Magnesium--When to use castoroil--When to use calomel--Vaccination--Time for vaccination--Methods ofvaccination--Symptoms of successful vaccination . .. PAGE 277

CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

Constipation--Regularity of bowel function--The function of thestomach--Fermentation--Incomplete constipation--Importance of a cleanbowel--A daily movement of the bowel necessary--Constipation inbreast-fed infants--Treatment of constipation in breast-fedinfants--Constipation in bottle-fed infants--Treatment of constipationin bottle-fed infants--Constipation in children over two years ofage--Diet list for constipation in children--Bran muffins inconstipation--Treatment of obstinate constipation--Oil injections inconstipation . .. PAGE 303

CHAPTER XXIII

CONSTIPATION IN WOMEN

Chief cause of constipation in women--Constipation a cause of domesticunhappiness--The requirements of good health--The cost ofconstipation--Constipation and social exigencies--One of the importantduties of mothers--Constipation and diseases of women--Constipation isalways harmful--Constipation and pregnancy--Explanation of incompleteconstipation--Causes of constipation--Negligence--Lack of exercise--Lackof water--Lack of bulk in the food taken--Abuse of cathartic drugs andaperient waters--Overeating--Treatment of constipation inwomen . .. PAGE 315

SEX HYGIENE FOR THE BOY

CHAPTER XII

 "The evil that men do lives after them. The good is often interred with them. "

 "The pleasure in living is to meet temptation and not yield to it. " Elmer Lee, M. D. 

BUILDING OUR BOYS

 A Word to Parents--Interest in Sex Hygiene--The "Social Evil"--Ten Millions Suffering with Venereal Diseases in the United States--Immorality not Confined to Large Cities--Venereal Diseases Common in Country Places--What Are the Consequences of Venereal Disease to the Boy?--Gonorrhea, or Clap--Symptoms of Gonorrhea in the Male--Complications of Gonorrhea--Syphilis, or the "Pox"--How Syphilis is Acquired--Syphilis Attacks Every Organ in the Body--Not Possible to Tell When Cured--The Chancre--Systematic or Constitutional Symptoms--Mucous Patches and Ulcers--Syphilis of the Blood Vessels and Lymphatic Glands--The Interior Organs--Brain and Spinal Cord--The Nose, Eye, Ear, Throat--Hair and Nails--What the Boy with Venereal Disease May Cause in Others--The Infected Wife--A Girl's Fate When She Marries--Young Wife Rendered Sterile--Young Wife Made to Miscarry--Is the Husband to Blame?--Building the Man--Age of Puberty--"Internal Secretion. "

A WORD TO PARENTS. --Within recent times the subject of sex hygiene hasbeen freely discussed by members of the medical profession and throughthem the general public has been made more or less acquainted with theproblem. It has therefore acquired a degree of genuine interest whichspeaks well for the future of the eugenic ideal. Eugenics is based to avery large extent upon the principles underlying sex hygiene. 

As a result of this widespread interest and investigation, we havediscovered that the only method that promises actual progress, is totalk plainly and to tell the actual truth. The day of the prude haspassed. To attempt to achieve results in the education of youth in sexproblems, without giving, facts, is wasted effort. To give facts we mustexplain each problem so that its principles may be clearly understoodand its meaning grasped. To point out the duty of youth is notsufficient. They must be shown why it is to their best interest to livethe clean life. In every department of education we are beginning toappreciate that to achieve results it must be based upon the individualequation. This is why we have found it necessary to assert that it isthe duty of parents to make sex hygiene a personal matter and toacquaint their children with the facts relating to this problem. It hasbeen discovered, however, that a very large percentage of parents areinadequately informed on these subjects, in fact they know practicallynothing about the actual facts which they are supposed to teach. I shalltry to tell the story in a way which every parent will understand. 

When a boy reaches the age of puberty he is susceptible to sexualdesire. If he has not been told the story of his growth from boyhood toman's estate he will either begin to abuse himself, or he will be laterenticed to commit himself to intercourse with some unclean female and hewill acquire a disease as a result. 

Inasmuch as it has been asserted that practically every boy has beenaddicted to self-abuse at some time, and that eighty per cent. Of allmales, between the ages of sixteen and thirty years, are victims ofvenereal disease, it would seem justifiable to assume that the boys whoare informed of the facts in time are the boys who constitute thepercentage who escape. This, of course, may not be literally true, butit is a reasonable assumption. 

While self-abuse is a pernicious habit and may be attended with seriousconsequences, it is not a disease and, as will be explained later, itcan be cured. It is therefore a menace to the individual, not to therace, and consequently need not concern us at the present time. On theother hand the venereal diseases are not to be considered as individualproblems since they affect the welfare of the race. The venerealdiseases which we will consider are gonorrhea and syphilis. 

THE SOCIAL EVIL. --It has been estimated that there are more than _tenmillions_ of people in this country to-day suffering from the effects ofvenereal diseases. In New York city alone, there are _two million_victims suffering from the direct or indirect consequences of thesediseases. It has been authoritatively asserted that, out of every tenmen between the ages of sixteen and thirty, eight have, or have had, oneor other of these diseases. When it is remembered that these diseasesare not merely temporary incidents, but that they may be regarded aspractically incurable in the vast majority, because of antagonisticsocial conditions and ignorance, and that they are highly infectious, wemay begin to realize how important they are from the standpoint of raceregeneration. 

Statistics of these conditions are never reliable because much of theevil is hidden and lied about. It is quite probable, --if the estimateswere based upon absolute knowledge--that the extent of the prevalency ofthese diseases would be greatly increased rather than reduced. It ishowever a fact, that the combined ravages of the Great White Plague, leprosy, yellow fever, and small-pox, are merely incidents compared tothe effects which the venereal diseases have had upon mankind. It isuseless to think that these diseases can be driven out of the land. Anyhope of this nature is the impression of the dreamer. By a propaganda ofeducation, by the spread of the eugenic idea and ideal, we may, however, reasonably hope to minimize the evil and, at least, to protect theinnocent. 

THE SOURCES OF IMMORALITY. --It is a fallacious idea to assume that thesources of immorality are confined to the large cities. This is far fromthe truth. In smaller towns and country places the diseases are quitecommon and conditions there tend to the spread of the contagion in amore intimate and a more harmful way. The individuals who are mostlikely to become affected are those most liable to succumb to temptationand whose home ties are of the best. There are many instances on recordwhere one or two loose women spread the infection all over the countrycommunities, infecting boys and men alike. No one can estimate what thefinal effect of such an epidemic may mean or how many innocentindividuals may have their lives wrecked as a direct consequence. It isbecause these consequences are the product of ignorance in a very largepercentage of the cases that there is such urgent need forenlightenment. It is at least our plain duty to tell the boy the actualfacts--to post him with reference to consequences. The more thoroughlywe instruct him in the elementary facts relative to the venerealdiseases, the safer he will be from temptation, and if he possesses thisknowledge and acquires disease, he will be more likely to immediatelyseek competent aid and advice. 

WHAT ARE THE CONSEQUENCES OF VENEREAL DISEASE TO THE BOY HIMSELF?

GONORRHEA OR "CLAP. "--This is the most frequent of the venerealdiseases. It is also the most serious. It is an unfortunate fact, thatin the past, --and even to-day--boys have been told that gonorrhea is noworse than "a bad cold. " This lie has been responsible for much evil anda great amount of unnecessary suffering and misery. 

Gonorrhea is caused by a germ, obtained, as a rule, during intercoursewith an infected person. This germ is called gonococcus. It thrives onany mucous membrane; it is not, therefore, limited to the sexual organs. For this reason it may attack any part of the body where mucous membraneis. It is particularly liable to damage, sometimes seriously andpermanently, the eye. It may be spread from one person to another, orfrom any infected article to a person in numerous ways. The innocent maythus suffer as a result of the carelessness of the vicious. 

THE SYMPTOMS OF GONORRHEA IN THE MALE are slight itching and burning ofthe mouth of the urethra. This is noticeable at any time from the thirdto the fourteenth day after exposure. These symptoms become morepronounced and a slight discharge appears. The patient is compelled tourinate frequently and it is painful and difficult. The dischargeincreases, it becomes thicker and looks like ordinary yellow pus. If thecase is a severe one, the discharge may be blood stained, and if thissymptom is present urination is more painful and more frequent. 

In about ten days the disease reaches its height; it remains stationaryfor a number of weeks and then slowly, seemingly, gets better. Thedischarge grows thinner, less in quantity and lighter in color. It mayrefuse, despite the most careful and efficient treatment, to stopaltogether; it is then known as "gleet. " If the discharge stopscompletely the patient is apparently cured, as far as any externalmanifestation of the disease is concerned. _In seventy-five per cent. Ofthe cases, however, this apparent cure is no cure at all, as will beseen later. _

Certain complications are likely to arise in the course of gonorrhea. The infection itself may be of such an acute or virulent type, that itinvades the deeper structures of its own accord and despite the mostcareful, competent treatment; or if the treatment is not adequate orskillful it may be forced backward; or through neglect in not beginningthe right kind of treatment in times, a simple infection may grow indegree into a serious disease, and invade the more important structures. In this way are produced disease of the bladder, prostate gland, seminalvesicles, testicles, and of the kidneys. Gonorrheal rheumatism mayfollow, and even disease of the lining membrane of the heart, and death. 

When disease of the deeper parts occur the patient is frequentlyincapacitated and compelled to go to bed. He may have chills, fever andsweats, intense pain and the passage of bloody urine. He may have to beoperated upon, and his general health may be permanently wrecked. Solong as the germs are present there is danger despite the mostscientific treatment. It is not the quality of the treatment that is atfault, it is the presence of the germs; and since it is impossible topursue any certain method of eradication, we must continue treatment--aslong as the germs are present--and hope for favorable results. Theinfection may last for many years. The germs having found entrance intothe small tubes in the interior organs they can only be dislodged withdifficulty, if at all. These pockets of germs may be excited to renewedactivity by sexual intercourse, or by injury to the parts, and mayreinfect the patient at any times. In a very considerable number ofthese cases where the deeper structures are involved, the patient mayrecover from the acute or painful period of the disease, only to findthat he is sterile. There are many such cases, and the most vindictiveindividual who may believe that every who sins should be punished willadmit that sterility, as the price of a moment's forgetfulness, is aterrible fee to pay. 

SYPHILIS, OR THE "POX, " is an infectious, germ blood disease. It is mostfrequently acquired through sexual intercourse. 

It may be acquired by direct contact with a diseased person. In order torender such contact effective, it is essential that the skin of thehealthy person be abraded, or the contact may be directly on a mucousmembrane, as the mouth in the act of kissing. 

It may be acquired by using any article which has been used by asyphilitic, as a drinking cup, or towel. 

It may be acquired through hereditary transmission. 

Surgeons frequently contract syphilis while operating on, or examiningpatients who have the disease. Dentists may convey it by means ofinstruments which have not been rendered aseptic, or thoroughly clean. Using a towel which has been used by a syphilitic has many timesconveyed the infection to an innocent party. For this reason the rollertowel has been done away with, and some states have legislated againstits use in hotels and other public places. To use dishes, spoons, tobacco pipe, beer glasses, etc. , which have been used by one having thedisease is an absolutely certain way of being infected. Cigars which mayhave been made by a syphilitic will infect whoever smokes them with thevirus of the disease. Syphilis has been known to have been caught fromusing the church communion cup. The public drinking-cup has been aprolific source of syphilitic dissemination to innocents. Legislatorsare just waking up to the danger that lurks in this institution and itwill no doubt be done away with, not only in public places, but on allrailroad and steamboat lines. 

An infected mother can transmit syphilis to her child. If the father isaffected, but not the wife, the child may escape. 

Syphilis attacks every organ in the human body. The actual degree ofinfection has no relation to the size or character of the externalmanifestations. The external evidence may be minute and insignificant, while the internal extent and ravages of the disease may be tremendousand of large proportions. Many men when asked regarding incidents of thelong ago, may state, "Oh, yes, I had a chancre twenty-five years ago, but it was a very small affair and soon healed up and was cured. " Yetthat same little chancre, that made only a mild impression on the man'smind, may, and most probably will, be the direct cause of that man'sdeath. 

It is not possible to tell with absolute certainty that an individual issuffering with syphilis by any known test. The most recent one--theWassermann test--is not absolute by any means. 

The first symptoms, or what is known as the initial lesion of syphilis, is the chancre. 

THE CHANCRE is a small, hard tumor, or it may be a small ulcer with ahard base, or it may simply appear as a thin small patch on any mucousmembrane. It is not painful, it can be moved if taken between thefingers, showing it is not attached to the deep structures, and when itis so moved it is not tender or sore. Any little lump which ulcerateslocated on the genitals must be regarded with suspicion. Boys and menshould not be satisfied with any offhand statement that, "it isnothing. " It may be a chancre, and it may be exceedingly serious if notproperly diagnosed. 

Systemic, or constitutional symptoms, begin to show themselves any timefrom the sixth to the tenth week after the appearance of the chancre. 

ERUPTIONS OF THE SKIN characterize every case of syphilis. They occur inall degrees from the mild rash to the foul ulcer. The ulcerative processis very often extensive and loathsome. 

MUCOUS PATCHES AND ULCERS affect the mucous membranes. The mouth andthroat are favorite locations for these lesions. They occur in the anusand rectum, and may be mistaken in that region for other seriousconditions. Men who drink and smoke suffer as a rule severely frommucous patches in the mouth and throat. 

Syphilis attacks the blood vessels and the lymphatic glands. These casesmay have been unrecognized, and may have existed for many years. A manmay die from a rupture of a blood vessel in the brain during middle lifeas a consequence of a forgotten, supposedly cured case of syphilis manyyears before. 

THE INTERIOR ORGANS may be attacked by syphilis. As a result we getdisease of the liver, heart, stomach, kidneys, lungs, and other parts. It has been suggested that many diseases affecting these organs, forwhich treatment proves unsatisfactory, may have had their origin in aformer syphilis. 

THE BRAIN AND SPINAL CORD are quite often the seat of syphiliticaffections. A tumor, known by the name of "gumma, " is the result. Theblood vessels of the entire nervous system may be affected and, as aconsequence, we often see cases of paralysis, apoplexy, epilepsy, locomotor ataxia and death. 

THE NOSE, EYE, EAR, THROAT, are frequently very seriously compromised asa result of the syphilitic poison. Deformity, caused by rotting of thebones of these parts is not infrequent. Loss of voice, or smell, orhearing, or sight, may result. 

THE HAIR AND NAILS may fall out. The bones may ulcerate and rot. Theorgans of procreation usually participate in the degenerative process. Virility is destroyed, and impotence is quite common after a severeattack. 

WHAT THE BOY WITH VENEREAL DISEASE MAY CAUSE IN OTHERS

GONORRHEA. --When the average boy acquires gonorrhea he frequently doesnot know, for many weeks, that he is the victim of a dangerous, infectious disease. He appreciates probably, that it relates to thesexual indiscretion he was guilty of, and feels that it is something tobe ashamed of. He therefore hides his condition, confides in no one, andblindly hopes it will get better somehow or at some time. Meantime thedisease, which may have been mild at the beginning, is gradually gainingground and strength, and his neglect may eventuate in lifelong misery. No means are taken to guard against spreading the infection, thedischarge may lodge on his fingers and he may infect his eyes and maylose his sight because he did not know that the discharge is one of themost dangerous fluids known. It may get on water-closet seats and infectothers. Eventually he is compelled to seek aid, and he may, after a longperiod, be freed from the immediate consequences of his folly. At alater date he marries, and as previously explained, he infects his wife. This is the beginning of much of the domestic infelicity that is soprevalent to-day, and, inasmuch as it is a subject that should bethoroughly understood by every woman and mother, I shall carefully andclearly explain its significance and its consequences. 

Let us first, however, briefly consider what may occur to others if theboy is unfortunate enough to acquire syphilis. Again the boy fails tocomprehend the nature of his affliction. There is imminent danger of themembers of his household becoming infected. He uses the same dishes, spoons, towels, and utensils, any one of which may convey the disease tohis father, mother, sister, or brother. He may use the common drinkingglass in school, college, or office, and spread the disease in this way. He may kiss any member of his family, or a baby, and infect them. He mayhave his hair cut, or be shaved, and the virus may be spread around inthis way if the barber does not sterilize the article used, --which henever does. He may drink at a soda fountain, or at a saloon, and thenext individual to use the same glass may acquire the disease. He is amenace to the individual, to the community, and to the race. Wives oftenacquire syphilis from their husbands. 

THE INFECTED WIFE. --It has been previously stated that eight out ofevery ten males between the ages of sixteen and thirty, have had orhave, gonorrhea or syphilis. Seventy-five per cent. Of these cases havenot been cured. About thirty-five per cent. Of these are destined toinfect wife, or wife and children, and in all probability many others. 

If a young wife acquires infection from her husband, she is exactly inthe same condition as the diseased boy, --she does not know what ailsher, so she wastes precious time in unprofitable worry. Why should sheknow what the trouble is? She came to the marriage bed pure, and clean, and healthy. Her previous education did not include instruction whichwould even help her to guess what the trouble might be. She is simplyconscious of new distressing conditions which she does not understand. She may try to believe that these conditions are incidental to thechange in her life. Shortly, however, the discharge, which she has hadfor a number of weeks, and which she thought was only a leucorrhea, or"the whites, " becomes so profuse and nasty that she begins douching. This procedure simply blinds her to the true nature of the affection, and in the end she is driven, ashamed and reluctant, to consult aphysician. She may be informed that her condition is bad, and that itwill be necessary that she submit to a course of treatment. After a timethe physician may succeed in tiding her over the immediate consequencesof the gonorrheal infection she innocently acquired. She may soon afterbecome pregnant, and she may miscarry as a result of the old trouble, orshe may carry the child the full period. When the child is born it maybe blind and this defect is a consequence of the old infection to themother from the father. If the mother is syphilitic the child mostlikely will inherit all the horrible possibilities of transmittedblood-poison. 

Pregnancy frequently "lights up" any old, gonorrheal infection in thefemale, so this young wife fails to completely recover after theconfinement. She is able to be about, but her strength refuses to berestored. It may be months later when she begins to suffer pain and torealize that she is quite sick. She develops a fever and may have achill. The physician discovers that she has pus in her tubes and thereis danger of peritonitis or general blood poisoning. The old germs havebeen roused and are active. Unfortunately they are located where it isimpossible to dislodge them without resorting to a serious operation. Itis now a problem of saving her life. She is taken to the hospital andher womb, tubes, and ovaries, are removed--she is unsexed. 

Young wives are being operated on every day, in every city in thecivilized world for just such causes. It is a notorious fact, that, inevery city in the world, the number of operations that are daily beingperformed on women, is increasing appallingly. Every surgeon knows thateighty per cent. Of these operations are caused, directly or indirectly, by these diseases, and in almost every case in married women, they areobtained innocently from their own husbands. It is rare to find amarried woman who is not suffering from some ovarian or uterine trouble, or some obscure nervous condition, which is not amenable to the ordinaryremedies, and a very large percentage of these cases are primarilycaused by infection obtained in the same way. 

When a girl marries she does not know what fate has in store for her, nor is there any possible way of knowing, under the present marriagesystem. If she begets a sickly, puny child, --assuming she herself hasprovidentially escaped immediate disease, --she devotes all her motherlove and devotion to her child, but she is fighting a hopeless fight asI previously explained when I stated that one-half of the total effortof one-third of the race, is expended in combating conditions againstwhich no successful effort is possible. Even her prayers are futile, because the wrong is implanted in the constitution of the child and theremedy is beyond her power to find. These are the tragedies of life, which no words may adequately describe, and compared to which theincidental troubles of the world at large are as nothing. 

If the conditions are not as bad as those depicted above, the originalinfection may have rendered her sterile. If the germs reached the womband tubes, the inflammatory process may close these tubes, with theresult that conception is impossible. In these cases the woman has tobear the stigma and disgrace of a childless union, though she is notthe guilty party. Many husbands are sterile, however, as a result ofvenereal disease. It is claimed that eighty per cent. Of childlessmarriages are caused by sterility of the male partner. Curiously andunfortunately these men never suspect themselves. The wife is thedelinquent member, in their estimation. She is the victim of jest andsuspicion, and later of jibes and insults. Many women have had theirlives rendered miserable and unhappy because of this suspicion. They arecompelled by their husbands to submit to examination and unpleasant andpainful treatment and operations with the intention of rectifying adefective condition that does not exist. Many conscientious physiciansrefuse to treat women patients against whom the charge of sterility ismade, before subjecting the husbands to thorough examination, and, sinceeighty per cent. Of childless marriages are due to sterility in themale, this is a just and reasonable course to pursue. 

During the course of all this domestic trouble and tragedy, the youngwife's health has suffered--she scarcely enjoys one day of good health. Her mental condition is even worse. She submits to innuendo and insultunder the impression that she is the unwitting cause of all the domesticwretchedness and often wishes she had never entered the marriage state. We must remember that these conditions wreck ideals and homes, and thatthey frequently render inefficient both husband and wife. The economicbusiness of marriage becomes a failure, ambition is crushed and hopedies in the heart. 

If the mother has been inoculated with the virus of syphilis herexistence is equally wretched; her health is ruined; her efficiency isforever mortgaged. If she becomes pregnant she will most likely abortand she will go on aborting for years, in the effort to bring childreninto the home, accusing herself meantime and submitting to thereflections which are heaped upon her, while the real culprit is thehusband. He assumes an injured and innocent attitude and behaves as ifhe had been imposed upon by marriage with a woman who cannot carry outher marital contract. 

If she gives birth to a child or children, they are syphilitic. Theymay be deformed, or they may be feeble-minded or idiots. They may liveat home for years, always ailing, always sick. They may developepilepsy, St. Vitus' dance, skin disease, or mental vagaries, and theymay have to be put into institutions for the feeble-minded, or they maydie by inches at home. 

IS THE HUSBAND TO BLAME?--If a boy had gonorrhea a number of yearsbefore entering the marriage state, was treated for it by a physician, until all symptoms had disappeared and had enjoyed apparent good healthin the interim, and had never been told any of the facts regardingprobable consequences, is it just to blame him if he infects his wife?It is certain no man would willingly subject his bride to the risk ofinfection, with all its horrible consequences. These conditions exist asa result of the prudish attitude of society in the past toward allquestions affecting sex hygiene. We have not told all the truth to theboy. Whatever knowledge he may have had was gained from companions, orfrom individuals who knew the garbled facts only. There is of course noexcuse for the man who acquires disease after marriage and conveys it tohis wife or children. This is a very different situation and one whichshould merit the severest condemnation and punishment. We are, however, only interested in the boy at present and will not take up the reader'stime with a discussion of the "social evil" from this standpoint. 

BUILDING A MAN. --When the boy is about fifteen years of age certainchanges begin to manifest themselves. He grows more rapidly, a growth inwhich his whole system participates. His bones grow bigger and stronger, his muscles increase in size, even his heart, and lungs, and liver, andhis digestive system accommodate themselves to this transformation; thevoice changes and hair begins to grow on his face. The mental processalso keeps pace with the new order of things. He thinks differently andhe sees from a new viewpoint. Nature is making a man out of a boy. 

These changes were not understood in the past, but we are beginning toappreciate the reason for this evolutionary process. We have discoveredthat the cause depends upon certain active changes which take place inthe sex organs. About this time the testicles begin to be active. Foryears these glands have been preparing themselves for this work, so theyfirst grow rapidly, increasing in size until they are about eight timesbigger than they were before this time, then they begin to pour into thecirculation a secretion which stimulates changes in all other parts ofthe body and is directly responsible for the wonderful change that isevident in the stature of the boy's body. 

This substance or "internal secretion" must not be confused with thesemen. The internal secretion is simply the substance which natureemploys in the developing process and is responsible for the degree ofgrowth and quality of manhood which the boy manifests. The semen, on theother hand, is the procreative or fertilizing fluid which enables a manto beget offspring. When a boy understands this process it aids him inappreciating the importance of his sex organs and a little thoughtenables him to understand that if he abuses these organs he willseriously interfere with his own development. This process goes on for anumber of years, until the boy reaches maturity. Any act or habit whichweakens the quality of this secretion will deplete his powers and renderhim physically and mentally inefficient. To make a man, nature must bepermitted to work in her own way. You cannot improve on her methods norcan you break her laws with impunity. 

CHAPTER XIII

THE PARENTS AND THE BOY

 Abuse of the Procreative Function--The Continent Life--Provide the Environment Necessary to the Clean Life--The Period of Procreative Power--Self-abuse--Masturbation--Treatment of Masturbation--Night Losses or Wet Dreams--Causes of Night Emissions--Sexual Excesses--Treatment of Sexual Excesses--What Parents Should Know About the So-called "Social Evil, " Before Speaking with Authority to the Boy--The Need of Enlightenment in Sexual Matters--"No One Told Me, I Did Not Know"--Fake Medical Treatment of Venereal Diseases--Sowing Wild Oats--Should Circumcision be Advised?

ABUSE OF THE PROCREATIVE FUNCTION. --Breeders of animals have discoveredthat to breed from very young stock is not good. The quality and staminaof the progeny is lowered and the vitality of the parent stock isreduced. It is not a good economic proposition. 

Boys should therefore be taught that any form of sexual indulgence isharmful before the period of full growth. 

Nature did not intend that the procreative function should be exercisedby individuals who were not fully developed. The perpetuation of thespecies must not depend upon the license of immaturity. The instinct ofsex-attraction must not be debased to serve a puerile, rather than aholy purpose. 

Sexual indulgence in any form, and in any degree, at any age prior tofull maturity is a perversion of the primal instinct of raceperpetuation. The practice has a more intimate and a more personalassociation with growing boys, however, than a merely altruisticreference. Any indulgence of this character at this time is physicallyand mentally injurious. No boy can hope ever to acquire the full measureof his possible development as an efficient working or thinking machineif he wastes his vital forces in unnatural liberties. He should betaught this truth in an emphatic manner by those responsible for hiseducation. 

There is a false idea prevalent that a continent life is harmful. So faras continence relates to immaturity, it may be strongly and justlyasserted that it is probably the most important factor in theconservation of health and strength. The retention of the procreativefluids, at a time when nature is opposed to their loss, enables thegrowing economy to utilize them in the conservation of nervous energyand virility. If a boy dissipates these energizing fluids, he depriveshis body of the richest products which he is capable of manufacturing ata time when he needs every aid in the building up of a physically andmentally sound and vigorous constitution. There cannot exist a normaldevelopment if the body is deprived of the essential ingredientsnecessary to growth and mental vigor. 

There was a time when young men were actually taught that sexualintercourse was necessary to develop full manhood. This was followed bya period of silence, which has practically extended to recent times. Both of these systems are pernicious. We know that sexual intercourse isnot necessary to the development of mature normal manhood or womanhood. On the contrary, we know that continence, not incontinence, is anabsolute essential to the growth of full sexual, virile maturity, aswell as to the growth of efficient and healthy manhood and womanhood. 

We must appeal to a boy's reason and show him the personal side of cleanliving. When he understands that to attain success in every departmentof human effort, --on the baseball and football fields, in the ring, ingymnastic contents, in examinations, in social intercourse, in tradesand professions, --a continent life is the only means possible thatpromises success, he will give the appeal consideration. 

We must employ all the safety devices possible to guard against theinclination of youth to wander. Regular exercise is one of the very bestinstitutions in this respect. If we can instill into our boys a love ofmanly sports and encourage every effort in this direction, we will bedoing much to minimize the growth of any tendency toward incontinence. We must provide the environment necessary to right living. The homeshould be attractive and we should permit the boy to have privilegeseven at the expense of the housekeeping decorum. His companions shouldbe made welcome if they are the right kind of intimates, and the parentsshould enter into the life of the boy and try to look at "things" fromhis standpoint. 

THE PERIOD OF PROCREATIVE POWER. --The procreative ability begins atpuberty. There is no fixed period at which it may be said to end. Frompuberty until the period of physical maturity, it grows in vigor and itremains stationary until middle life, when it gradually declines. Thestandard of virility is unquestionably an individual problem. It dependsupon the various factors that contribute to good health and longevity. It may be stated that the boy who abused his procreative function, during the period of immaturity, will not enjoy, during the matureperiod of his sexual life, a normal standard of vigor, nor will he carrythe ability into old age, to the same relative degree, as he would, andas he had the innate promise to do--if he had led a normal continentexistence. It may also be stated here that there is no effectiveremedial measures known, that will "bring back" the procreative abilityif it is lost as a result of disobeying natural laws. Drugs andtreatments by quacks to cure impotence are impositions and fakes. Moneyand time spent in the pursuit of this dream is money and time wasted. 

SELF-ABUSE OR MASTURBATION. --By self-abuse is meant the production ofthe venereal orgasm, with or without emission, by any means other thanthe natural union of the sexes. 

It is a fact that the large majority of boys acquire the habit ofself-abuse at some time. This is a very serious reflection upon parent, teacher, and physician, because it is through ignorance of theelementary principles of sex hygiene that this condition continues toexist. If they were warned against the possibility of self-abusearising in innocent ways, as well as in more reprehensible ways, theywould exert their influence against its acquirement. If however a boydiscovers accidentally a condition of which he was innocent, and ofwhich he does not know the significance, it is human nature that heshould investigate the phenomenon and in the end suffer as aconsequence. In the effort to relieve some local irritation he mayhandle himself and be led into a dangerous practice. He does not knowthat the practice may have serious results--in fact he does not know heis doing anything wrong. Many boys have practically ruined theirphysical health and become morally irresponsible because no one--neitherparent, teacher, physician, nor friend--told them of their danger. Thisis unjust, but great strides are being made in this direction and we mayreasonably hope, that in the not far distant future, every boy will beplainly told the true facts about himself. 

Most boys acquire this habit from other boys, but as we have intimatedit is possible to acquire it in what are termed innocent ways. Sometimesthe sensation which leads to it is discovered by sliding down banisters;or it may be that climbing trees or poles first awakens the feeling. Very young children are sometimes taught the vice by depraved nurses. Local irritation, as has been stated, may necessitate itching andhandling the parts and in this way the vice is begun. The results arethe same, no matter how the habit may have originated. 

If the habit is persisted in, the muscular system suffers, --the musclesbecome weak and flabby; the patient develops weariness and languor andloses his mental and physical vigor. He is no longer forceful orenergetic, his efficiency is impaired and as a consequence his nervoussystem begins to show signs of depleted strength. He cannot concentratehis thoughts, he falls behind in his studies, his mental effort issluggish, he becomes diffident and shy, shuns society, loses confidencein himself, is morbid and emotional and may even think of suicide. 

It is astonishing how indulgence in this habit may affect the moralnature of a boy. First of all, he is no longer frank and open. Hebecomes shifty and suspicious and will not look you squarely in theface. A boy cannot become a slave to this habit without it affecting hismind. He invites debasing thoughts, --the old pure and clean method ofthought and living no longer satisfy. His imagination even becomescorrupt and his moral nature and moral sense is perverted until he nolonger seems to be able to tell the difference between right and wrong. He has little regard for the truth and if occasion demands it he willlie without appreciating the dishonorable part he is playing. In the endhis will power is lost--even the effort to save himself is too feeble tosucceed--he is a slave to the habit, his health and strength ruined. 

If every boy could realize the possible end of this evil habit he wouldmake an effort to rid himself of it before he becomes its victim and itsslave. It may be easy to abandon the practice in the beginning. Thelonger he continues it, however, the less chance he has of finallymastering it, until, if he persists beyond a certain point, it is amatter of serious question whether he will ever be able to free himselffrom its grip. If the boy has lost the will power to carry out hisresolves, no number of good desires or resolutions will avail. And it isjust this will power that the wasting of the semen saps little by littleaway. 

TREATMENT. --What can we do for these boys? Most of them can do much forthemselves by simply stopping the practice. There are, of course, otherswho need careful management before the habit may be controlled andhealth restored. It is well to always remember to be tactful and patientand kind to these boys. Many of them are standing on the brink ofdespair, weak in body and weak in mind. They do not know where to turnto look for a friend--the right kind of a friend. It is a terriblethought that your own boy may be abjectly miserable in his own homebecause he is harboring a secret that is wrecking his health, and, though he may long for sympathy and a helping hand, neither his fathernor mother have invited his confidence or spoken to him about thesethings. A watchful mother can usually tell when her boy becomes addictedto this habit. He will show it in his manner, he will not be free andopen, he will want to be by himself. Later he will show the effects ofthe abusive treatment he is subjecting himself to in his appearance. Hewill be sunken-eyed, pimply-faced, pasty-skinned, shiftless, sneaking, silent, unmanly. No mother can fail to note these signs and she shouldsuspect the cause and take steps to tactfully reach him before he hasruined his health absolutely. 

We would advise regular exercise of a vigorous kind. Tire out the bodyso that sleep may be sound. Cold baths, followed by brisk rub-downs; nointoxicants, light meals, plenty of drinking water morning and night. The bowels should be regular every day. He should sleep alone on a hardbed in a well-aired room with light covering. He should keep busy everyminute of the day and he should not think of himself at all. 

The boy must realize that his salvation rests with himself. After heknows the real danger which the habit carries with it, he must be on hisguard every moment to abstain. If he does not he may rest assured thatthe practice will ruin his health, render him, a business failure anddeprive him of all happiness during the rest of his life. 

NIGHT LOSSES OR "WET-DREAMS. "--A so-called wet-dream is an unconsciousemission of semen during sleep. The discharge may or may not beaccompanied with an erotic dream. 

After a certain age--which may be from the twelfth or fourteenth year--aboy may discover that he has discharged some substance during his sleep. He finds the discharge on his night clothes and it naturally puzzles himgreatly. He may be entirely unconscious of the whole proceeding, havingslept soundly during the night, or he may wake up to find the fluidactually discharging. 

If a boy has not been told of this phenomenon he may regard it as a formof self-abuse of which he may have heard and as a consequence he mayworry himself sick, as the night emissions continue to occur from timeto time. Many pure-minded boys have been rendered miserable, and theirefficiency and health have suffered as a result of just such anexperience. It is, therefore, proper that they should fully understandthe true significance of these occurrences. 

CAUSES OF NIGHT EMISSIONS. --I have explained how nature makes a man outof a boy. During this maturing process the testicles are very activeorgans--their function is to manufacture or secrete the fertilizingfluid or semen. This maturing process begins actively, as I stated, about the age of fifteen, though in some boys it frequently occursearlier, sometimes as early as the twelfth year. When the testiclebegins to grow at this time they manufacture more semen than the littlepockets can hold, so nature adopts the method of permitting the surplusto escape during sleep. These night emissions, therefore, are perfectlynatural losses, and need cause absolutely no distress of mind whatever. The frequency with which they may occur depends altogether upon thetemperament of the boy. If the boy is a strong, active, athletic boy, they may not be so frequent in him as they may be in a quiet, studiousboy. The system of the athletic boy seems to utilize more of thissurplus than the quieter existence of the studious boy calls for. If thedischarge does not occur oftener than once every two weeks, it may beregarded as normal and natural. Should they become more frequent thanthis, the boy should inform his mother or father and the familyphysician should be consulted. It may be that he is in need of a tonic, or special instructions regarding his method of living and his mode ofexercising. Whatever the cause may be, it can be corrected, and the bestplan is to give it attention as soon as it is noted that the losses aretoo frequent. 

SEXUAL EXCESSES. --It is well known to the medical profession that themarital relation is frequently practiced to excess. The same indictmentmay be passed on what may be termed extra-marital relations. No one hasever formulated a general sexual standard which could be safely regardedas normal. Too many individual conditions of temperament and healthenter into the proposition to permit of a standard being formulated. Itmust, therefore, be regarded as an individual question to be adjusted, if necessary, by the family physician. What may safely be regarded asnormal and harmless in one, constitutes, for many reasons, excess inanother. When a man performs hard physical or mental labor, his sexualaptitude or capacity is limited, and this limitation cannot be exceededwithout risk. Such a limitation may not constitute an excess in a manwhose occupation does not call for a great expenditure of physical ormental energy. Any indulgence which produces exhaustion is excessive. 

The age of the individual has undoubtedly much to do with his sexualendurance. A young, virile adult will tolerate a sexual expenditurewhich would seriously affect the health and vigor of an older man. 

Environment and inclination are factors in determining the standard ofsome people. If the marital relations are participated in simply topreserve peace and harmony in the home, they are productive of harm evenif indulged in moderately. 

The symptoms of sexual excess are much the same as those of self-abuse. To a certain extent, however, they are favorably influenced, because theconditions under which the relationship is practiced are natural, because the participants are matured physically, and because there is noelement of worry over the probable effects. 

Sexual excess defeats its own purpose, because it engenders a lack ofdesire and consequently it is to a certain extent a self-limitingprocess. We must also remember that excess entails consequences just asthe breaking of any natural law is followed by retribution of some kind. In these cases we find that discomfort follows excess. The parts becomeirritated and congested and disease of the prostate gland alwaysfollows. 

TREATMENT. --Stop the excess by self-control and self-restraint. Employall the aids dictated by an intelligent perusal of the laws of sexhygiene. Preserve the general health. It may be necessary to resort tolocal treatment, because, if the parts have been abused by excessiveindulgence, there is always more or less irritation and congestionpresent. This condition affects the nerves, suggestive reflex sensationsare produced by a congested prostate and the patient becomes morbid. Itis essential for such patients to consult a physician whose localtreatment will stop the sensitiveness in the parts and relieve him sothat he may carry out his programme of restoration unhampered byconditions which are only amenable to local treatment. 

WHAT PARENTS SHOULD KNOW ABOUT THE SO-CALLED "SOCIAL EVIL" BEFORESPEAKING WITH AUTHORITY TO "THE BOY. "--To be qualified to speak withauthority, or convincingly, to a boy upon sex hygiene, the parents mustbe familiar with, and well versed in the subject. The facts related inthe preceding pages must be thoroughly understood. No parent can studythese facts intelligently without being impressed with the importance ofthe subject; without realizing that it is absolutely essential that thefundamental principles of sex hygiene should be taught to the risinggeneration; without acknowledging the tremendous part for evil whichprudery and ignorance play in the education of youth; and without beingconvinced that most of the evil is the product of ignorance on the partof the boy, and that parents are in a large sense to blame if they failto impart the necessary knowledge in time. 

The need for enlightenment in sexual matters is a product of existingconditions. Civilization and the social environment are developing alonga plane which subjects the youth to temptations that practically did notexist in the past. There is a broader and looser code of ethics. Business monopolizes the entire time of the father, and social andpolitical unrest and misdirected ambition distracts the mother. The sonor daughter has a wider latitude and a freer reign than they once had. The opportunities for promiscuous intimacies are easier, and the publicconveniences and utilities lend themselves to the designs ofevil-intentioned and loose-moraled women. The ease of travel, the laxityof laws, the theater, with its unchaste and indecent plays, the movingpicture snows, the vaudeville resorts, whose highest priced "talent" issome voluptuous female, who has cultivated the art of draping nuditywith suggestiveness and singing immoral songs, all tend to give youth afalse impression of the reality of life and to make the path of thedegenerate easy and profitable. The rich are growing richer, and theirchildren are pampered and overfed and underrestrained. Time hangsheavily on their hands and their only mental effort is to devise newmethods and new ways of satisfying the lust of liberty andoverstimulated desire. The poor are growing poorer, and to "keep in thering, " to live and dress beyond their means as many do, it is necessaryto have an unexacting standard of morals. In this way the promiscuouslibertine is evolved, --the most insidious and dangerous product ofpresent day civilization, and the most pernicious factor in the spreadof immoral impulses and indecent diseases. 

Parents must accept these institutions and agencies as necessaryinstruments of evil and adopt measures to nullify their attractiveness. Eternal vigilance is the price of success, but the quality of thevigilance must be dictated by love, not by suspicion and distrust. 

When the parent can convince the boy that the knowledge is imparted, notwith the intention of depriving him of what he may construe as hisnatural liberties and rights, but with the single intention of adding tothe sum total of his pleasure and success, he will look more kindly uponany proposition that suggests a course of conduct that leads to cleanliving. Sex hygiene will eventually find a natural place in the schemeof education. It will be taught to male and female alike. In themeantime, however, we must begin by educating the educators--theparents. In the beginning, their task will not be easy. There will bemuch to overcome, much ignorance, prudery, false modesty, hypocrisy;there will be much vicious teaching and evil example to live down. Butwe cannot hope to achieve results in the noblest cause, save by patient, intelligent, and persistent effort and by self-sacrifice and a constantenthusiasm. The aim is to tell all, --all the truth, --so that we maynever be assailed by the cry, "No one told me, I did not know, " from theloved lips of son or daughter gone astray. 

THE FATHER AND THE BOY. --The right kind of father can always find thetime and the way to awaken in the heart of the boy the spirit ofcompanionship. No boy living will resent the fellowship of the rightkind of father. It depends upon the father! If the spirit of chumminessdoes not exist between you and your boy, you are at fault, you have madea mistake, you have missed your opportunity, you "did not go about it inthe right way and in the right spirit. " Try again--it may not be toolate. 

The father who adopts the habit of taking his boys (and his girls too)out for long walks, at least every Sunday, and who spends an hour withthem every evening--is the right kind of father. One who has nevertested the merit of walks with children cannot possibly appreciate theenjoyment and benefit that can accrue from them. It is not only thephysical good that results, nor the inspiration which one may draw fromnature, but the concrete advantages that come from the fellowship withthe children are a new and a real experience--this is what counts. Youwill have opportunities of sewing seeds in their minds that will growinto a harvest that will astonish you. Children in the right mood--andthey are in the right mood when they are happy, and they are happy outin the open with an interesting companion--are alert, and responsive, and eager to be told "things, " and this mood can be put to marvelous useby the "right kind of father. " The father who wanders forth with thefixed purpose of thinking out some business problem during the walk andpermits the children to find their own amusement is the wrong kind offather. He must choose to be a child again, he must desire to pleasethem, he must make an effort to be in harmony with them, he must draw onhis experience to interest them, he must talk to them entertainingly ofevery interesting problem which the walk itself suggests or he mustformulate a plan and select a subject with a definite educational schemein view. We can, in a most effective way, begin to build theircharacters, and, by the right kind of talk and enthusiasm, he candetermine their resolves to be honest, truthful, just, clean, sympathetic. He can instill into them, in a thousand different ways, thedetermination and inspiration to succeed. It is a wonderful and aprecious chance, and it will make the "right kind of father" more just, more sympathetic, more optimistic, and it will make him young again andmore successful. Try it. 

Implant in the hearts of your children a love of home, make the eveningmeal and hour by the fireside a period of congenial fellowship, when allthe little irritable ruffles of the day may be ironed out and sweptaway. The secret is to be intimate. Tell them the secret of success fromyour standpoint, how happiness is gained only by being efficient andsuccessful, and that, to be efficient, one must be energetic andhealthy. Drum into their ears the truth that life is a battle, and onlythe brave "win out, " and health is the one essential necessity. It isastonishing how such talks will impress young minds. They will remindyou of things you said, that made a lasting impression on them, longafter you have forgotten the incident. 

A father can, in this way, by talking of the future to his boy, conveyto him the high hopes he entertains of the great success the boy isgoing to achieve--you establish a standard in the boy's mind, and heunconsciously hopes to attain that standard. If you have impressed himwith the necessity of preserving his health and strength, as anessential to success, he will be slow to yield to any temptation thatmay interfere with his plans. This reasoning may sound quixotic to somepeople, but it is the truth. Many a boy has been inspired to success bythe knowledge that his mother or father believed in him, and wasconfident he would be a leader. He strove to justify the pride andconfidence of those who held him dear, and he won out. 

To retain his health, therefore, is the first impulse to be conveyed tothe boy. When he recognizes this truth, it is an easy task to instill alove of exercise, gymnastics, swimming, fresh air, cleanliness andtemperance in him. If these are attained, you will have tided him overthe tendency to self-abuse, and you will have rendered him less likelyto yield to evil suggestion or temptation. His confidence in you will bewhole-hearted and implicit. You can do anything with him at thepsychological moment. It is now time to talk of more intimate matters. Carefully and tactfully, the father approaches the fundamental truths ofsex hygiene. 

The selection of a subject for a text as a means from which to advancetoward the real facts is sometimes of importance. It must not appear asthough the subject was designedly chosen. If it follows in a natural wayit will more thoroughly interest the boy and he will have swallowed alarge dose of truth before he is impressed with the personal viewpoint. A passing trotting horse has served me a number of times for intimatetalks with boys on heredity and kindred subjects. I invite the boy towatch how the horse uses his legs, and how rhythmically and beautifullyhe places his feet, and how his whole attitude serves the end for whichhe is exerting himself--to gain speed. Tell the boy the story of howprofessional breeders have achieved such marvelous results; how forgenerations the "strain" has been kept clean and pure, how anydescendant of a great sire, who showed any habit detrimental to thedevelopment of the highest racing qualities--no matter how trivial thedisability might be--was cast aside, experience having taught that itdoes not pay to waste effort and time on any horse whose physical ormental characteristics are not up to the highest standard. Such a horsewill not win, and it is only "wins" that count. 

Change the subject to human beings. Tell him how the race maintains itsstandard; but show him the difference between the methods employed. Howthe horse has his mate selected because of the female's good qualities, so that the offspring may possess like qualities, if not better, andthat the selection is made by men who know their business, and have hadlong experience in the work. How, on the other hand, a young man with noexperience is permitted to choose any woman he may fancy irrespective ofher qualifications. As a consequence, we have all kinds of children, good and bad, feeble and strong, honest and dishonest, some degeneratesfrom birth, some criminal, and many diseased and inefficient, few ofthem "winners. " It is an easy matter to preach a little sermon from thistext. Show him how essential it is to select the mother of one'schildren wisely, to know if there is disease in the future wife's blood, if her family history is good, if her temperament is suited to his, ifher domestic qualities are satisfactory, if her principles are moraland normal, and if she understands and appreciates the true object andfunction of marriage. Show him also the element of justice involved inthe marriage contract; that he must give what he exacts, that if heexpects a healthy and normal wife, he must be healthy and normalhimself; if he expects purity and cleanliness he must give purity andcleanliness; if he expects to mate with a fit female he must be anefficient and fit male. Remember that every act, deed, thought, andaspiration is regulated by laws which one cannot fool with, or disobey, without reaping a harvest which will conquer, crush and ruin you, nomatter how clever or smart you may think yourself. 

Show him the wisdom of the breeders' habit of never permitting sexualliberties in a too young stallion. For the same reason the boy mustconserve his strength and virility for the marriage state and for thefunction of procreation. 

In a further talk, the father may extend this subject and gradually leadup to the "consequences" of the unclean life. The boy will be ready forthis talk and will evince an interest in it that will be encouraging andpromising. 

The talk about the science of mating the horses he will understandreadily and thoroughly, and he will not fail to see the point when youswitch to man and apply the same principles. Then when you show howmismating is responsible for poor children quality and how diseaseaccounts for feeble-minded and degenerate offspring, he will be fairlywell posted, and he will be ready to imbibe more details, and you willhave done much of your duty. His curiosity will be quickened and hisinterest is awakened. It depends upon the father. If your boy is honestand clean, open and decent, he will not fall without a fight, and whilehe is fighting he is maturing. If your picture of the consequences ofthe venereal diseases has been effective and vivid, he will grow up witha healthy horror of them. If your conduct as a father has been wise andexemplary, and if your home has the right kind of environment, and theright kind of mother in it, you have done all a father can do to helpthe boy over the rough spots. The proper kind of encouragement and theright kind of vigilance, and books which will satisfy the boy's cravingfor more knowledge along this line is all that is needed to help the boyto "win out. "

FAKE MEDICAL TREATMENT FOR VENEREAL DISEASES. --Parents should in everypossible way discourage the use of patent medicines and fake medicalmethods of curing these diseases. Untold harm has been done to boys andto women by these nostrums. 

In every instance the motive underlying the methods of people sellingthese things is to frighten the patients into the belief that theircondition is more serious than it is in order to justify a long andexpensive course of treatment. 

Their work is carelessly performed, and frequently they are directlyresponsible for the development of complication and dangerous sequelæ. The promises of speedy cures are false, and, not infrequently, methodsof black-mailing have been known to follow an expensive and unsuccessfulcourse of treatment. 

There is no class of disease in which the help and honesty of thelegitimate medical profession is needed more than in the treatment ofthe venereal diseases. Parents should see to it that the familyphysician is prescribing any strange medicine that may appear in theboy's room, and not some unknown individual who may be an impostor and ablackmailer. 

SOWING WILD OATS. --Writers of fiction and others of a more serious trendof thought have recognized the sowing of wild oats as an institutionwhich, if it does not merit the full approval of society's moral code, is, at least, tolerated. No serious consequences befall the offender. Onthe contrary, the libertine is the type of hero who receives thecommendatory quips of erotic dames and the questionable interest ofhysterical maidens. 

Women of easy morals are always willing to espouse the cause of the"black sheep, " and to further the matrimonial success of the penitent_roué_. Many mothers are willing to marry their daughters to thepolished villain of society, who is known as a rake and debauchee, ifhis family connections are desirable. It has been even held that ayouth who did not "sow his wild oats" was of doubtful stamina. 

That many able men have sown wild oats is indisputable, and that manymen who are respectful husbands, have also gone "through the mill" isalso true, but this need not blind us to the fact that thousands uponthousands, who could have been successful men of affairs and creditablehusbands and fathers, have been utterly ruined, as a result of havingsown wild oats. No man is a better man because of a past record oflicentious habits. The man who sows and escapes the harvest is lucky. The man who reaps, reaps in abundance. Most men regret the lapses ofyouth. Most of these lapses would never have occurred if the impulsecould have been governed by the reasoning of maturity. These acts arethe promptings of an impetuosity which may be entirely foreign to theindividual's innate character, but brought out by promiscuouscircumstances and the ignorance and license of youth. If we can protectyouth, by an adequate knowledge of the consequences, we will furnish themeans to tide over the impressionable period. Until a healthy maturityof judgment will assume the task unaided. 

The effects of the wild oats' theory are too tragically evident to needany argumentative refutation. The statistics of the prevalency ofvenereal diseases alone is sufficient; the results of these diseases aremore than enough. 

Study the records of the jails and prisons, courts and asylums, hospitals and health resorts, think of the hundreds of thousands ofdiseased and deformed and mentally inferior children, of the multitudeof paretics, melancholies, ataxics, maniacs, syphilitics, --all theproducts of "wild oats, "--and ask if the wild oats' theory isjustifiable. 

Think of the ruined homes, the wretched lives of fallen women, thehopeless prayers of abandoned wives, the loneliness and misery ofparents neglected and forgotten, the "bastards" and fatherless children, the drunkards and criminals and tramps--all weeds of the wild oats'harvest. 

Then reflect upon the tragedies, the suicides of the betrayed and of thediseased, the bank thief, the broken hearts of deserted and hungrychildren, the army of inefficients--around whose necks hang wild oats'medals, the men of big business, who constantly fight the effects ofearly incontinence and abuse, and the thousands who go to early graves, and then ask, in all justice, if the sowing of wild oats needsjustification. 

Who supports the thousands of prostitutes? Who made them? Wherever youfind pauperism, crime, drunkenness, insanity, idleness, immorality, viceand disease, you will find that the sower of wild oats has traveled thepath and left his stain and his footprints there. 

SHOULD CIRCUMCISION BE ADVISED?--The answer to the above question is"Yes, " in every instance. If circumcision is done early, --during thefirst two weeks of life, --the operation is without danger andpractically without pain. In quite a considerable percentage of allmales, circumcision is an absolute necessity. For excellent medicalreasons, about which your family physician can inform you, every boyshould be circumcised. 

CHAPTER XIV

A MOTHER'S DUTY TO HER DAUGHTER

 What a Mother Should Tell Her Little Girl--Where Do Babies Come From--How Baby Birds and Fish Come from Eggs--How Other Animals Have Little Nests of Their Own--The Duty of Mothers to Instruct and Direct--What a Mother Should Tell Her Daughter--Every Mother Should Regard This Duty as Sacred--Every Female Child is a Possible Future Mother--Motherhood the Highest Function of the Sex--Health the One Necessary Essential--Symptoms of the First, or Beginning Menstruation--The Period of Puberty in the Female--Changes in the Reproductive Organs at Puberty--The Female Generative Organs--The Function of the Reproductive Organs--The Age of Puberty in the Female--The Function of the Ovary--The Function of the Womb--Why Menstruation Occurs Every Twenty-eight Days--The Male or Papa Egg--The Function of the Spermatozoa--"Tell the Whole Story"--"How do These Spermatozoa Get There"--The Union of the Species--"How Can a Baby Live in There for Such a Long Time"--How the Baby Gets its Nourishment in the Womb--Girls Must Not Become Mothers. 

WHAT A MOTHER SHOULD TELL HER LITTLE GIRL. --Every little girl should betold the Story of Life by her mother. It should be told in simplelanguage, so that the little girl will understand. Very early in lifethe little girl will be prompted to inquire of her mother "Where dobabies come from?" It is wrong to give an evasive reply to this naturalinquiry or to postpone telling the story, because they will be told itby playmates and will receive very wrong and very crude impressions ofthis wonderful subject. 

Every mother knows enough of life to tell her little girl its story in away that will impress her with the sacredness of God's beautifulreproductive plan. She should begin by telling her a story about how thebirds live. How at a certain season of the year they choose a mate andgo housekeeping. They build a nest, and when it is all nicely finished, the mother bird lays her eggs. Then the papa and mamma bird take turnsand sit on the eggs to keep them warm, and after a time the egg breaksand a little bird is born into the world. They feed the little babybirds until their feathers grow, and when they are old enough they flyaway from their home and begin life by themselves. 

Many questions will be asked as the mother tells the story in her ownwords, and the correct answers to these questions will fill in all thedifficult-to-understand points. The story of how the fish lay eggs inshallow water so that the sun may keep them warm and hatch them out willinterest also. Be careful to impress upon them that there is always amamma and a papa, a male and a female bird and fish, --that this isnecessary because God made it so, and we must obey His wish. When thelittle girl fully understands the story of the egg bird, and egg fish, the mother can tell how the Creator thought out a different plan forother animals like the dog, horse, lion, elephant, and cow. He knew thatit would neither be safe nor possible for these animals to stay at homelong enough to sit on eggs and hatch their babies, so he made a nest forthem inside of their bodies. There they would be warm and would alwaysbe with their mammas no matter what they were doing. So we come to theanswer to their question: "Where do babies come from?"

These interesting stories, according to the intelligence and sincerityof the mother, can be taken advantage of, to impress the little girlwith the importance of many of the lessons of life. For example, herattention can be drawn to the fact that man and woman are the highesttypes of living things that God made. No other living thing, animal, orfish, or bird, or tree, or flower, can talk, and think, and reason asman and woman can. Because of this faculty--to think and reason--thehuman family are always trying to find out what can be done with all theother things God made. We try to find out what the different rocks aregood for; what the different trees are good for, and the different kindsof earth, and animals, and birds, and fishes, and everything in theworld. We study these, and we learn much, and we are made happier andmore comfortable by what we learn. For example, by studying horses, andfeeding and breeding them carefully, and training them, and caring forthem, we can make stronger horses and better and faster horses; bystudying trees, and planting them in soil best suited to them, andgiving them plenty of water to drink, we can compel these trees to growbetter apples and pears and peaches. In the same way we can producebetter strawberries, and oranges, and grapes, and we can grow flowerswith sweeter smells and prettier colors. We do all this by trainingthese animals and trees to grow a certain way, to eat certain food, todrink pure water, and we protect them from the cold and sometimes fromthe sun if it is too hot. Our faculty to think and reason has taught usjust what is good for them, and we compel them to obey our laws. As aresult they become strong and more healthy. Now show the little girl howimportant she is; how much more precious she is than a tree, or animal, or flower, and how much more necessary it is that we, mammas and papas, should use our ability to think and reason in her interest. Show her howwe have found out all about babies and little girls and how we know justwhat to do to make strong and healthy, and pure, and good, and clean menand women of all the little boys and girls in the world. Tell her thatthis is what mother is doing now, training her and compelling her to dothe things that will make her a strong and a good mother when she growsolder. Let her distinctly understand that it is the duty of mothers toinstruct and to correct their little daughters when they do any wrong. Mothers know, because they have had experience in these matters, andthey know just how a little girl must live, and dress, and eat, andbehave, in order to be strong and pure, and good. So when motherreproves and corrects, it is because she knows that what you are doingto merit a correction is not for your ultimate good. Show them that allyoung things, and young animals, and young babies, and young girls, mustbe compelled to obey certain rules and laws, otherwise they would notgrow up to be strong and healthy. Sometimes a rose bush grows up amongstones and weeds, but it never thrives, it is always more or less sick. It does not grow strong, its flowers are poor little sickly thingscompared to the roses on a bush that is planted in proper soil, andcarefully tended and pruned, and watered. So would the little girl turnout if she grew up in bad company and did not have a mother to guard andguide her, --to prune her when she was growing careless. Everything inthis world has a meaning, and when mother tells you that you must not doa certain thing you very much want to do, she has a very good reason fortelling you not to do it. You may not know the reason, but you shouldhave confidence in your mother, you should believe that she knows whatis best, and that she would not inflict pain or cause you sufferingunless she knew it was for your good. The young horse does notunderstand why a halter is put around its neck and is made to run aroundin a circle until it is tired. It would much rather enjoy itself in itsown care-free, and happy way. And when finally a full set of harness isput on, and it is put into the shafts of a wagon and tied there, andmade to pull it and its driver many weary miles the horse does not likeit, and he rebels strenuously. He is, however, compelled to obey in theend, and he finally consents to become a useful horse. 

It is exactly the same way with every little boy and girl. We are putinto this world for a certain purpose, and we must all work. Now parentsknow this, and they know just how to prepare little girls and boys forthis work. They therefore ask them to do many things that are notpleasant or agreeable but which must be done in order to prepare themfor the work ahead. 

WHAT A MOTHER SHOULD TELL HER DAUGHTER

Your daughter is now about fourteen years of age. She is about to passfrom girlhood to womanhood and she should know more of life's story. Themother will now tell her the complete story in the form of little talks, based upon the following facts as texts. Each mother will doubtless addto the story as conditions justify and as the education of the motherand daughter may dictate. A multitude of little side talks can be wiselyindulged in to make clear any uncertain or doubtful explanation, andevery one of these incidental excursions can be made exceedinglyinteresting if wisely and opportunely chosen. Always remember, however, to emphasize the sacredness of the story. Do not permit your daughter toget the impression that you are telling her something that simply has tobe told, just as you told her the correct way to boil an egg. Let herrealize and get the impression that this is the most serious and mostwonderfully interesting story in existence, the most important story shewill ever hear. Let her understand that motherhood, for which she is nowpreparing, is the duty God assigned her in this world: that that dutymust be carried out, and that she must do nothing, nor leave anythingundone, to interfere with its accomplishment. Do not only impress herwith the story itself, but let your own explanation be so emphaticallyserious, that she will deeply appreciate its momentous significance--anoccasion to be remembered all her life. 

If she gets the proper impression from you at this time she will nevertreat the subject lightly, or permit it to be promiscuously discussedwithin her hearing. 

Begin by telling her that she is about to enter the most importantperiod of her life. Explain why this is so in the following way, in yourown words. If we admit every female child to be a future mother, andmotherhood the highest function possible to the sex, then the awakeningof the sex organs and the mother instinct, must be the most importantdevelopmental episode in the life story of every woman. If this is so, then it follows that every girl should enter this period in the verybest physical health possible, in order to reap the best resultsincident to this evolutionary period. We impress and warn her, therefore, that, as her system is about to undergo important changes, she must be particularly careful of her health. A little mistake at thistime may be followed by more serious consequences than if made at anyother time in her life. If a girl is to become a mother, certain changesmust occur in her body before the nest, of which we previously wrote, can be made ready. God did not overlook anything when He peopled theearth; He therefore wisely planned that these changes in the femaleshould occur at a time when the girl is strong and healthy. 

THE PERIOD OF PUBERTY IN THE FEMALE. SYMPTOMS OF BEGINNINGMENSTRUATION. --At about the age of fourteen these changes begin to giveevidence of existence. They affect the girl's whole system and themother must be especially patient and sympathetic. Her disposition maychange, she may want to be alone, and she may be more or lessmelancholy. She will be dissatisfied with the things that previouslyinterested her. She will tire easily, and she may have many spasmodicpains from time to time. The wise mother will tactfully see that shetakes plenty of nourishing food and systematic exercise, and that shegets enough sleep in a well-aired room. There are other physical changeswhich are observable at this age. The girl grows taller, the figurebroadens out, the hips widen, the bust enlarges, and the waist lineincreases in size. These are all part of the great change from girlhoodto womanhood. 

CHANGES IN THE REPRODUCTIVE ORGANS. --The principal change takes place inthe reproductive organs themselves, and it is very essential that sheshould have a clear mental picture of just what is meant by"reproductive" organs and their location in her body. We mean by thisterm the group of organs which are concerned in creating and nourishinga child until it is old enough to be born into the world. 

THE FEMALE GENERATIVE ORGANS. --These organs are the womb or uterus, twoovaries, two fallopian tubes and the vagina. The womb or uterus is the"nest. " It is about the size of and is shaped like a pear. It is hollow, however, though its walls are quite thick. The ovaries are about thesize of a peach stone and lie at the side of the womb, --one on eitherside. The fallopian tubes connect the ovaries with the womb. The vaginaconnects the womb with the outside world, --it is sometimes known as thebirth canal. In the very lowest part of the abdomen, or belly, in front, is the bladder, which collects the urine until it is necessary to passit out. In the back part of this region is the rectum; it collects allthe undigested food, etc. , from the intestinal canal. Between thesetwo, --the bladder and rectum, --we find the reproductive organs, thewomb, ovaries and vagina, described above. 

THE FUNCTION OF THE REPRODUCTIVE ORGANS. --It will be difficult, even formothers, to acquire a clear understanding of the function of thereproductive or generative organs. It is an exceedingly interestingprocess, however, and it is well worth a patient, attentive study toclearly understand the brief description we give of it. If you acquire adistinct mental picture of the problem you will be able to tell yourdaughter a story that will be of intense interest to her, and a talethat is interesting is impressive and is productive of thought andreflection. That is the condition of mind we want daughters to be inwhen they hear this story. 

The human ovaries begin to prepare themselves for their life work whenthe girl is about eight years of age. When they are ripe, or ready toperform this duty, the girl menstruates for the first time. This isknown as the age of "puberty, " which implies that she has developed, passed from girlhood into womanhood. After having reached the age ofpuberty it is possible to become a mother. 

THE AGE OF PUBERTY. --There is no fixed age at which the firstmenstruation takes place. Some girls develop quicker than others, --acondition that depends upon the health and type of girl. A strong, robust, full-blooded girl will menstruate at an earlier age, than will asickly anemic girl. The average age is fourteen years, though there isno reason to worry if a girl does not menstruate for a number of yearslater. In warm climates the age of puberty is from two to four yearsearlier than in more temperate climates. 

THE FUNCTION OF THE OVARY. --Just what takes place in each ovary when itis ripe is best explained by likening an ovary to an orange, --though ofcourse the ovary is very much smaller than an orange, as was previouslynoted. If you make a cut in an orange and squeeze it, you express someof its juice and most likely you will also express one or more seeds. The seeds of the ovaries are called "ovules, " and the process by whichit expresses them is called "ovulation. " Of course there is no actualsqueezing of the ovary, --the ovules grow in the ovary, and as they ripenthey come to the surface, and when actually ripe, the part of thesurface of the ovary to which they come, opens up (like a flowerunfolding when in bloom), and they fall out. The ovule we may regard asthe human female egg, and one ripens and falls out every twenty-eightdays. 

When the egg falls out of the ovary it falls into the tube which carriesit into the womb. This tube you will remember is called the fallopiantube. The ovule or egg is now in the cavity of the womb where we willleave it for the present. 

THE FUNCTION OF THE WOMB. --While these changes are going on in theovary, the womb is also preparing itself for its share of the work. Thelining or internal surface of the womb is composed of mucous membrane, much the same as the interior lining of the mouth and throat. Thislining becomes congested with blood, and is so intensely swollen at thetime when the ovule or egg reaches the womb, that it is ready to ruptureand bleed all over its surface. Just whether it will rupture and bleed, depends upon whether the egg is going to grow into a child or not. If itis not going to grow into a child, it immediately bleeds freely, andcontinues to bleed, until the whole lining of the womb and egg is passedout into the outer world. This takes four or five days and constitutes"menstruation. " After menstruation is over, the womb begins again toprepare itself for the coming of the next ovule or egg, and as thisoccurs every twenty-eight days, menstruation is commonly termed the"monthly periods. "

WHY MENSTRUATION OCCURS EVERY TWENTY-EIGHT DAYS. --The reason why thewomb does this every twenty-eight days is because it is impossible totell just when the womb will be called upon to nourish and support achild. If it did not get rid of the old blood, it would not be in ahealthy condition to nourish and take care of a baby, nor would itsinterior be ready to supply new fresh blood for the growth of theinfant. Hence nature constructs and builds a new "nest" in the interiorof the womb each month. It very much resembles the new home into whichthe bride and groom, go to begin housekeeping. 

When you told your little girl the story of life, you particularly drewher attention to the important fact that every living thing is createdby the union of a male and female principle, and, therefore, has a mammaand papa. This applies to trees, flowers, vegetables, fish, animals, birds, insects, --every living thing, including human beings. We haveseen that the ovule from the ovary is the female egg, or principle. Itis the part the female contributes toward the future child. Before achild is possible, however, the ovule must meet the egg from the male. 

THE MALE OR PAPA EGG. --The male or papa egg is called a "spermatozoa. "It reaches the interior of the womb through the lower opening, which youwill remember opens into the vagina. Emphasize to your daughter that thefemale ovule or egg, and the male egg, or spermatozoa, are minuteobjects, so microscopically small that a hundred million of them couldcomfortably lie upon a ten-cent piece. 

THE FUNCTION OF THE SPERMATOZOA. --God gave the male spermatozoa thepower to move. To watch them under the microscope you would imagine youwere looking into a bowl of water, in which there were hundreds oflittle fish all squirming around. But the most wonderful thing aboutthem is, they can only move in an upward direction, --they seeminglycannot move downward, or sideways. If you think for a moment you willunderstand why God gave them this marvelous property. When the malesemen is deposited in the female vagina, there are thousands of theseminute, living, moving spermatozoa in it. The womb is above the vagina, and the female egg is in the womb, consequently, to reach this egg, thespermatozoa must travel upward. To travel in any other direction wouldbe fruitless energy. There is only one female egg, but there arethousands of male eggs, or spermatozoa; it is easy, therefore, tocomprehend how one of these spermatozoa should exactly be in line withthe female egg in its upward path, since there are so many of them. Itis only necessary that one should meet the female egg in order toimpregnate it. 

The shape of the male principle, or spermatozoa, is exactly like alittle tadpole, and you no doubt recall that a tadpole has a minutetail, the movement of which enables it to swim around. So has thespermatozoa, and by the incessant movement of this microscopic tail theyall move upward as soon as discharged by the male. I told you that Godgave the male-germ life. It is necessary now to explain the character ofthis life. It is very brief; it is estimated that they are active fortwo hours, and then become inactive, or die. The best way to explain thebrief activity to your daughter, is to liken the spermatozoa, to amechanical toy, which is wound up to go for a certain time. After itruns out it becomes inactive; this is exactly what happens to the littlehuman tadpole. If during this brief life none of them has happened toreach the female egg, pregnancy does not take place and menstruationoccurs. On the other hand, if this were not so, --if these spermatozoawere active for a longer period, pregnancy would almost be certain totake place every time the womb was not already occupied with apregnancy. 

TELL THE WHOLE STORY. --When a mother reaches this stage of the wondroustale she will be asked by an innocent girl, --"How do these spermatozoaget there?" or, "You have not told me where these tadpoles came from"or, "I don't understand how these spermatozoa got into the vagina" or, "I don't know why you call these the male egg when they are in mamma. "It does not matter how it is expressed, the intent is plain enough. Ihave said, that an innocent girl will ask this question, the implicationbeing that one who is not innocent will refrain from asking thisquestion. A girl who knows the answer will not ask, because, if she isfamiliar with this subject before her mother thinks it wise and properto tell her, she obtained her information from a source which, mostlikely, insinuated a suggestive, or evil, meaning into the explanation, consequently she would be afraid, or ashamed, to ask the question. Aninnocent girl, on the other hand, would rightly ask for informationwhich is obviously kept back, and which she has a right to know, sincea complete, and intelligent understanding of the story depends upon theelucidation asked. If it is proper to tell part of the story, it isessential to tell all of it. Tell it in your own words in this way:

When God conceived the human race He ensured its perpetuation bydesigning a method whereby this would be rendered possible: He did more;He wisely decided that the function, involving the very existence of thehuman race, should be attended with a sentient gratification. He furtherinstilled into the fundamental economy of mankind, sex attraction, whichis involuntary, undeniable, and unquenchable. If God conceived the meansand the method, no human mind in possession of its faculties should seeevil where it does not exist. It was by Him designed that the male organof reproduction should deposit its germinating fluid in the vagina ofthe female, and this is accomplished by a union of species. 

The one set of reproductive organs is a complement of the other, andessential to the other. It is by this act that the male spermatozoa isenabled to complete the function of fecundation. 

If now we assume the male and female element to have met and united, menstruation does not take place. The egg or embryo (the future child)begins to grow, and it remains in the womb for two hundred and eightydays from the day when the male and female egg met. It is quite naturalfor an intelligent girl to ask her mother to explain, "How a baby canlive in there for such a long time, " or "What makes it grow if it doesnot get anything to eat or drink. "

HOW THE BABY GETS ITS NOURISHMENT IN THE WOMB. --These questions can beanswered in this way. While the baby is in its little comfortable homeit gets everything it needs. You are in your home now. If you wanted adrink, what would you do? Wouldn't you go to the water faucet and draw aglass of water? The water comes to you through a pipe, right into yourhome, you don't have to go out of the house to get it. And if you wantedlight when it is dark you would turn on the gas and light it. It, too, comes into your home through a pipe. Now baby gets its air; and food, and all it needs to drink in just that way. There are two little pipeswhich go into its nest or home, and then into the baby's body at thenavel, and through these pipes fresh blood runs in and out. When motherbreathes, her blood sucks up oxygen from the air in her lungs, and theblood carries oxygen to every part of her body. In this way, all partsare supplied with the proper quantity of air. Now the baby is simply anew part of mamma as long as it is in its nest in her body, so it toogets air in this way. When mother eats, the food is taken into herstomach and it is there changed into liquid and so prepared, that whenit passes into the intestines, the part of the food that is good forher, is sucked up into the blood, and the blood carries it to every partof her body. It distributes whatever is needed to all parts, and as thebaby is a part, it gets its share. The other pipe carries the blood backagain, out of the baby for new supplies, and as this is going on all thetime, there is no danger of the baby starving in any way, or at anytime. 

When your daughter understands this, show her how important it is thatmothers should be in good health, otherwise the baby will not get goodfood, it will not be properly nourished and will be born a poor, littlesickly child. Little girls, consequently, should try to eat properly, exercise regularly, and do everything their mothers tell them, so thatwhen they become mothers, they will be able to nourish their babies andnot bring into the world poor little starved infants. 

GIRLS MUST NOT BECOME MOTHERS. --We have previously stated that girls canbecome mothers when they have reached the age of puberty. God did notintend, however, that girls at the age of twelve or fourteen shouldbecome mothers, because their bodies are not strong enough, nor are theyfully grown, nor have they the experience, to undertake the physicaltask and responsibility of bringing a baby into the world. We know thisfrom experience, because we have seen the sickly babies such girls have, and we have seen how much these girl mothers suffer, and how they ruintheir health, by trying to do what God did not intend they should do. Even the trees teach us this lesson. An orange tree will bring out buds, which would develop into oranges, when it is two years old. Theexperienced farmer, however, will pluck these buds off, and will do soevery year, till the tree is five years old. If he allowed the tree tobear fruit during its young years, the oranges would not be good, orsweet, or large; so he waits until the tree has grown and is strong andhealthy, when its fruit will be large and sweet. An orange tree of thistype will have better fruit, and will continue to produce this goodvariety for many years. A tree allowed to bear fruit when two years oldwill never have first class oranges, nor will it continue to have, evenpoor oranges, as long as the other. 

CHAPTER XV

PREPARING FOR MOTHERHOOD

 Menstruation--Irregular Menstruation--Changes in the Quantity of the Flow--How the Womb is Held in Place--Symptoms of Menstruation--Menstruation Should Not be Accompanied with Pain--Don't Give Your Daughters Patent Medicines or "Female Regulators"--Take Your Daughter to the Doctor--Leucorrhea in Girls--Bathing when Menstruating--Constipation and Displaced Wombs--Dress and Menstruation--Absence of Menstruation, or Amenorrhea--Treatment of Amenorrhea--Painful Menstruation, or Dysmenorrhea--Causes of Dysmenorrhea--Treatment of Dysmenorrhea--Sterility in the Female--Conditions Which Affect the Fertility of Women--Climate--Station in Life--Season of the Year--Age--The Tendency to Miscarry--Causes of Sterility in the Female--Displacement of Womb--Diseases of Womb, Ovaries, or Tubes--Malformations--Lacerations--Tumors--Leucorrhea--Physical Debility--Obesity--Special Poisons--"Knack of Miscarrying"--Miscarriage--Cause of Miscarriage--The Course and Symptoms of Miscarriage--What to do when a Miscarriage is Threatened--Treatment of Threatened Miscarriage--Treatment of Inevitable Miscarriage--After Treatment of Miscarriage--The Tendency to Miscarriage. 

MENSTRUATION

We have explained in the previous chapter what menstruation is, itsfrequency, its significance and its origin. There are a number of itscommon characteristics with which the mother and daughter should beacquainted. 

IRREGULAR MENSTRUATION. --Menstruation may occur once (the first time)and fail to recur the following month or for a number of months. Thisneed cause no alarm as long as the general health remains good. It willcome again in its own time. Nervousness may cause a suspension ofmenstruation. This is quite common in school girls who are driven toohard at school, whose sleep is interfered with, whose appetite is poorand who are allowed too many social indiscretions, as parties, dances, etc. , where late hours are observed, all of which should be put asideuntil school life is over. Sometimes menstruation will temporarily stopif the girl goes away from home on a visit. 

Sometimes the quantity will be greater than at other times, and a veryscant flow, after it has been free and regular may cause apprehension. Various causes may be responsible for a decrease, catching cold, sittingon cold steps or cold ground, wearing damp clothes, nervousness, mentalworry, physical exhaustion, insufficient food and exercise, and anemia, may cause it. For these reasons a girl should be exceedingly careful ofher health, she should guard against catching cold. Do not change theunderwear until certain that the weather is far enough advanced inseason to justify such a change. She should not become exhausted orworry. In all cases of suppression, or of increased flow, a physicianshould be consulted at once, and girls should be instructed to telltheir mothers of any change in the character of the "periods, " as soonas it occurs. Mothers should instruct their daughters to rest the firstday of their monthly flow, and all during the menstruation they shouldrefrain from any unusual activity. Even play should be moderated andabstained from entirely if there is any pain. In order that the girlfully appreciates why these rules are laid down, it is advisable toexplain just how the womb is held in place in her body. 

This appears to the writer as being a particular important point. A girlmust not be expected to give these matters the serious considerationthey merit unless she thoroughly understands the reasons why. Anexplanation, in the form of even an intelligent talk, will soon beforgotten. If, however, a definite, concrete picture, is impressed uponher; if she actually sees in her mind the process that is going on, shewill understand why it is necessary to do as she is told. If the motherwill therefore assure herself that the daughter actually knows what isbeing accomplished in her womb at the menstrual period, she will carryout the instructions more faithfully. 

HOW THE WOMB IS HELD IN PLACE. --The human uterus, or womb, is held inits proper place in much the same way as a clothes pin sits on a clothesline. The heavier part is the upper part, and that part is held in placepartly by resting on the rectum behind, and the bladder in front. Whenmenstruation occurs, the body of the womb becomes much heavier becauseof the increased amount of blood in its interior. This added weightincreases its liability to tip over, and if any extra strain or effortis made at this time it will become tipped, or as the physician callsit, displaced. If a womb becomes displaced, every menstruation afterwardwill be painful and prolonged, --sometimes excessively so. A displacedwomb becomes congested and unhealthy. It causes leucorrhea or a chronicdischarge, makes a nervous wreck of the woman, results in sterility andfrequently in a dangerous operation. There are, therefore, ample reasonsfor watchfulness and care on the part of the growing girl. 

SYMPTOMS OF MENSTRUATION. --After menstruation is established thereshould be no actual pain at each period. There are, however, certainundefined feelings, --premonitory symptoms, --which may be explained inthe following terms:--A day or two before the date on which themenstruation is expected, the girl will appreciate that "her sickness"is coming. She will not, or should not, complain of pain, but will statethat she has a bearing down feeling, is a little more nervous thanusual, has no desire to go into company, and wants to be more or lessher own entertainer. The "sick" period usually lasts four or five days. The second day is the most important. 

MENSTRUATION SHOULD NOT BE ACCOMPANIED WITH PAIN. --If any actual painaccompanies menstruation, either before or after it is established, themother should at once take the daughter to the family physician. Menstruation is a natural, physiological act and should not beaccompanied with actual distress or pain. It is astonishing how manymothers will allow their daughters to suffer needlessly, for months andyears, because of the mistaken idea that "since the pain is there, itmust be, " or because she--the mother--suffered, so also must thedaughter suffer. There is no more unfortunate mistake, and many a girl'shealth and happiness has been blasted because of this misbelief. Thecause of the pain is, in a vast majority of the cases, a very simpleone, and can be removed in a very brief time. 

Should the menstrual period last too long, be too frequent, or be in anyway not what it should be, consult your physician. If you are not sureof "what it should be, " or if you have any doubt, ask your doctor. Don'tlet any false pride or feeling of modesty on your part, or on the partof your daughter, dictate your policy under such circumstances. Don'ttake the advice of your friends or neighbors in a matter so vital. It istoo important, and they are not qualified to "guess" any more than youare. Don't, if you have any respect for yourself, or love for yourchild, begin dosing her with the advertised patent medicines and "FemaleRegulators" for which so much is claimed, and which seem to "just suit"your daughter's case at this particular time. Take her to the doctor, whose advice you value (or you should not have him as a familyphysician), who has no interest at stake except to help you and yourchild, and whose fee is no more than the price of one of these bottlesof advertised poison. He is the only one qualified to speak withauthority on such a momentous subject, and you will never spend a dollarto better advantage. Warn your daughter not to speak about "hersickness" to other girls. 

Especial attention should be paid to cleanliness during this period. Themistaken idea that bathing of any kind at this time may have disastrousconsequences is responsible for much of this neglect. If proper care istaken warm sponge baths, in a warm room, will not cause any trouble. Unpleasant odors can be avoided by sponging the parts with a warmsolution, into which a mild antiseptic is put, upon changing the cloths. 

LEUCORRHEA IN GIRLS. --It has been stated above that a displaced womb maycause leucorrhea or a discharge. It must be remembered that leucorrhea, or "whites, " may occur in girls as well as in married women. It can alsoresult from catching cold during the menstrual period. Another mistakenidea is that girls should not take douches for fear of injuring thehymen. This is erroneous, and while they are entirely unnecessary in avast majority of cases it is sometimes absolutely essential to douche inorder to cure leucorrhea. When they are given, it is advisable to usethe small nozzle that comes with every douche bag set. 

CONSTIPATION AND DISPLACED WOMBS. --When the picture is fresh in the mindof the girl, of how the womb is held upright in her body, the mothershould speak to her about the serious results that may occur fromconstipation. If the rectum is full of hardened feces the womb will bepushed out of place, and if under these circumstances straining isnecessary to empty the bowel, and if this condition is habitual, constipation may be the actual cause of displacement of the womb. 

DRESS AND MENSTRUATION. --It is also an opportune time to demonstrate towhat extent serious results may follow mistakes in dressing. The habitof permitting growing girls to constrict the waist, to bind and pull theabdomen by too tight garters, or too tight corset, is wrong, and nomother should permit it. In another part of the book, this matter istaken up more fully, but if it is explained to the girl while she isconsidering the subject of menstruation, she may more quickly and morefully appreciate its significance. 

ABSENCE OF MENSTRUATION--AMENORRHEA. --The absence of menstruation afterit has been established, does not, as a rule, indicate any disease ofthe womb or female sexual organs. It is to be regarded merely as asymptom and can be, as previously stated, safely ignored if the generalhealth is good. If the general condition is poor, and the quantity andquality of the blood deficient, it is a provision of nature to suppressmenstruation in the interest of the general health. For this reason itis safe to disregard the amenorrhea and build up the bodily strength. This explains why some girls pass the usual age of puberty and show nosigns of menstruating. They are poorly developed sexually, throughdeficiency of blood. If, on the other hand, a girl should have all thesymptoms of menstruation every month, but no flow, she should beexamined by a physician to determine if there is any obstruction to theescape of blood. Total absence of any symptoms of menstruation extendinginto adult life, may indicate an absence of the sexual organs. Duringthe first year after puberty it is quite natural for menstruation to beirregular; after the function is thoroughly established there are manycauses that may be responsible for its temporary absence. 

CAUSES OF AMENORRHEA. --Any condition or circumstance which reduces thegeneral health or impoverishes the quality or quantity of the blood andweakens the nervous system, will result in a stoppage of the monthlyperiods. Among these are insufficient food and exercise, overwork, overstudy, exposure to cold, sitting on cold steps or gold ground, wearing damp clothes, bathing in cold water at the beginning ofmenstruation, powerful emotions, as great fright, anger, anxiety; acutediseases, such as typhoid fever, cholera, the infectious skin diseases;chronic diseases such as Bright's disease, heart disease, consumption;anemia and chlorosis are very common causes. Obesity or an overfatcondition will cause an early suppression of the menses which may resultin a fruitless marriage. Displacement of the womb and other localdisorders frequently result in scanty or delayed menstruation. Anxietylest pregnancy may occur in the newly married may cause a delay in theperiods. A radical change of climate or sometimes a visit to thecountry, or changed circumstances may stop the flow for the time being. 

TREATMENT. --The treatment of amenorrhea, or absence of menstruation, will depend on the underlying cause. A careful investigation should bemade into the mode of life and the hygienic surroundings of the patient. Her general health and her mental condition should be inquired into. Ifthe patient is not in good health, or is not obtaining exercise in theopen air, or if she is a victim of mental worry or of domesticunhappiness, or if any sufficient cause exists for the amenorrhea itmust be removed before any treatment may be expected to relieve thecondition. If the patient is a married woman the possibility ofpregnancy should always be borne in mind, and no radical treatmentinstituted until this has been excluded. If the absence of menstruationis dependent upon defective development of the sexual organs we cannotexpect much from any treatment. The amenorrhea from exhaustive diseaseswill usually correct itself with, or soon after, the establishment ofconvalescence. In diseases which tend to death, as in consumption, heartdisease, etc. , the function is never reestablished. A very common habitof most people is to regard the absence of the monthly periods as thecause of their ill health. It is not, it is the result of the illhealth. Get rid of the bad health and the menses will take care ofthemselves. That form of amenorrhea which is the result of change ofclimate or surroundings will regulate itself as soon as the victimbecomes acclimated or reconciled to the change, or returns home if thevisit is of brief duration. 

As a general routine treatment, good wholesome food, regular hours, fresh air, sunlight, and judicious exercise, with such other measures asmay be suggested by the condition of the blood and nervous system, arethe indications in the way of treatment. Anemia and chlorosis (poorblood) should be treated by the administration of iron in some form. Obesity should be reduced by diet, exercise, and such other treatment asmay be found efficient and not detrimental to health. Overwork, mentaland physical, should be stopped, and sedentary habits changed to a moreactive out-door life. The acute suppression from exposure to cold, wearing of damp clothes, sitting on cold stones or cold or damp ground, sea bathing in very cold water, is very often associated with an acuteinflammation of the womb itself and calls for rest in bed, laxatives toopen the bowel, hot application to the lower part of the abdomen and ateaspoonful of Hayden's Viburnum in a glass of hot water every fourhours until relieved. The use of the sitz bath is frequently successfulif taken at night followed by a laxative and a hot drink. 

PAINFUL MENSTRUATION--DYSMENORRHEA. --Most, if not all, victims ofpainful menstruation are of a nervous temperament. Dysmenorrhea issimply one symptom of the general nervous condition. The nervousness maybe acquired or it may be the result of heredity. In girls it has beenfound to be an accompaniment of the overwork and worry of school andstudent life. Girls who suffer greatly from it while in school areentirely free during vacation from school. 

There is a type of painful menstruation known as neuralgic dysmenorrhea. This is simply a local expression of a general neuralgic tendency. Itcomes under conditions which favor neuralgias in other parts of thebody. Girls and women affected with this type of dysmenorrhea are oftenanemic, hysterical, and not infrequently the victims of malaria, rheumatism, or other diseases which tend to impoverish the blood andreduce nerve vitality. The pain resembles neuralgia elsewhere. It comesand goes, it may last a brief time or a long time, it may be very mildor very severe. The pain bears no fixed relation to the flow, it mayproceed, accompany or follow it. 

Mechanical dysmenorrhea is that form in which a mechanical impedimentexists to the escape of the menstrual fluid. The internal canal may betoo small, displacement, growths, either inside or out of the womb, faulty development, or frequently simple congestion will act as anobstruction and cause pain from tension. The pain accompanyingmechanical dysmenorrhea is very different from the neuralgic type. Itcomes on gradually, increases slowly until it is very severe and stopssuddenly. A gush of blood from the womb announces the fact that theobstruction has been overcome and the womb has emptied itself; as soonas this occurs the pain ceases. 

In the mechanical variety there are frequently clots in the menstrualflow. Inasmuch as this type may be caused by imperfect development ofthe womb, it is common to find that pain has characterized the monthlyperiods from the time of the first menstruation. It may, however, asstated above, be caused by growths which had their beginning at a laterperiod. 

TREATMENT. --For the neuralgic variety the treatment should be general. The whole object is to build up the general health. Fresh air, sunlight, out-door exercise, plain, substantial food, regular hours, pleasantsurroundings, and such medication as may be indicated, should be thecourse to follow. The bowels should be kept regular and digestion aidedin every way possible, if necessary by rest from school, or work, or bya change of air and scene. If the patient is inclined to malaria shemust take quinine and live in a locality free from that tendency. Ifrheumatic she should take the remedies advised in that disease and avoidcolds, wet clothes, or sitting in cold, badly ventilated rooms, churchesor theatres. If there are no distinct evidences of special tendencies, general tonics may be given to advantage. These should consist chieflyof iron, arsenic, phosphous, nux vomica, cod liver oil, etc. 

The treatment of mechanical dysmenorrhea of course implies removal ofthe cause. As this necessitates operative procedure, or at least anexamination by a physician, it is best left in his hands. 

STERILITY

Sterility means the inability to become a parent. A woman who is sterilecannot become a mother. She is for some reason unable to have a baby. 

A childless union is frequently the cause of much unhappiness. There issomething lacking in the expression "a childless home. " It seems aparadox, as home is inherently associated with children and happiness. It has been stated that one out of every eight marriages is barren. Theaverage time which elapses after marriage and the birth of the firstchild is seventeen months. Physicians agree that if a woman goes overthree years after marriage without having a baby her chances of havingone are small. If children are desired, and they usually are bychildless parents, every effort should be made within the first threeyears to ascertain the cause of the sterility, and if it can berectified. The barrenness may be dependent upon some physical defectwhich will quickly respond to the proper medical treatment. It is wellto remember, however, that the defect is not always the woman's. Inevery six childless marriages about one is due to sterility in thehusband. The age of the greatest fertility in women is between twentyand twenty-four years. It is rare to find a barren woman between theseyears. Nature evidently intended that the duties of maternity should beassumed between the twenty and twenty-fourth year. If married before theage of twenty the statistics prove that barrenness exists in one womanin every twelve. If married after the twenty-fourth year the chances ofhaving children decreases with the age of the woman. 

If a mother goes for three consecutive years without becoming pregnantthe chances are that she will have no more children. Consequently ifother children are desired it is unsafe to rest upon the assumption thata woman will again be a mother simply because she has been one in thepast. Many conditions could, and may, have occurred since the lastpregnancy (and may be as a result of that pregnancy) to change hernatural fertility into a condition of temporary sterility. Anexamination should therefore be made before too long an interval elapsesand the facts learned. It will usually be found in such cases that adisplacement or laceration, or at most, some cause easily remedied isimmediately responsible for the apparent barrenness. 

CONDITIONS WHICH AFFECT THE FERTILITY OF WOMEN

CLIMATE. --It is a well-known fact that more children are born insouthern regions than in northern countries. It may be asserted, therefore, that climate affects the fertility of the race. 

STATION IN LIFE. --Children are more numerous among the poor than amongthose who are wealthy and enjoy the luxury of riches. This conditioncannot, however, be construed as a true expression of fertileefficiency. It is more a comparison of ethics, and when we express itthus we are giving it its most charitable name. 

SEASON OF THE YEAR. --The spring of the year, being more favorable tofecundity, exerts an influence over the increase of population. Nursingmothers are as a rule sterile until after weaning time. This is notalways so however, and the possibility of pregnancy taking place whilenursing a baby, and before menstruation is reestablished must bereckoned with as it occurs quite frequently. 

AGE. --Age may be said to affect the fertility of women inasmuch assterility is the natural and proper condition before menstruation isestablished and after menstruation ceases. 

THE TENDENCY TO MISCARRY. --Because a woman has never given birth to aliving child is no proof that she is sterile. Many women have theability to conceive but for some reason they have acquired themisfortune, or the "knack, " of miscarrying. This is a condition of thegravest significance and will be considered at length in its properplace. 

The influence of a temporary separation has had excellent results in agreat many historical cases. Where the married couple seem to be lackingin some one or other of the emotional or temperamental qualifications, it is advisable to suggest a temporary separation. When this period hasexpired and they resume marital relationship the element of novelty, acting as a stimulus, quite frequently reestablishes a fertility thatwas seemingly suspended, or awakens it if conception has neverpreviously taken place. 

There are a great many cases on record where, conditions having remainedthe same, women have become fertile after years of seeming barrenness. It is impossible to explain, or to satisfactorily understand thesecases. It is quite common to note cases in which women have never becomepregnant until a number of years after marriage, even when the desire tohave children existed. There is one case on record of a woman married ateighteen, but although both herself and her husband enjoyed habitualgood health, conception did not take place until she was forty-eightyears of age when she bore a healthy child. Women should not, therefore, become easily discouraged in the hope of having a baby, especially whenthey have a clean history, and a healthy body. The conditions may changeand may become favorable when hope is about to die. 

CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent physician in allcases of sterility, it is not necessary to go into detail regarding eachpossible cause, other than to explain how each may produce barrenness. It will be observed that a competent physician is specified and advisedin these cases. This is very important because many advertising, or"quack" doctors, particularly solicit these kind of cases. They are notcompetent to be trusted with such cases and will likely effect more harmthan good. A woman should not hesitate to consult the best availablemedical authority if she is a victim of sterility. There is nothing tobe ashamed of. It is a perfectly proper medical situation and shouldreceive the best medical advice and investigation. The following are themore frequent causes of absolute sterility. 

(A) Displacement of womb. 

(B) Diseases of womb, ovaries or fallopian tubes. 

(C) Malformations. 

(D) Lacerations or tears of mouth of womb. 

(E) Tumor. 

(F) Leucorrhea. 

(G) Physical debility. 

(H) Special blood poisons. 

(I) Great obesity. 

(J) Anemia. 

(K) Self-abuse. 

(L) Habitual alcoholism. 

(M) Lack of moderation in the marital relations. 

(N) Certain diseases may be associated with barrenness: cancer, diabetes, consumption, Bright's disease, etc. 

(O) Certain temperamental conditions may be associated with barrenness:lack of affinity, frigidity. 

THE KNACK OF MISCARRYING

DISPLACEMENT OF WOMB. --In many instances the primary cause of thedisplaced womb was some energetic, muscular effort, made while thevictim was yet a girl, --probably before menstruation began. Whatever actfirst caused a slight tilting of the womb, must necessarily have beenan unusual physical effort, and as girls are getting more and morestrenuous we may look for more trouble in this direction in the future. Inasmuch as a slight tilting of the womb gradually gets worse it is areasonable expectation to believe that sterility is a natural sequenceto displacement. The girl may have been the victim of painfulmenstruation which was neglected, because not quite painful enough tocompel medical relief, which is sought for only as a last resourceunfortunately under the circumstances. Intercourse may also have beenmore or less painful, --a condition which again is mistakenly andimprudently borne in silence and left to take care of itself. But whenpersistent sterility faces her, the woman seeks medical assistance andher trouble is discovered. As the displacement is found to be the causeof her sterility, its correction, which is a comparatively easy medicalproblem, not only cures the barrenness but happily relieves her of themenstrual distress and all other pain. 

The treatment for displacement consist of placing medicated pieces ofwool or cotton, called tampons, in the vagina in such a position as tohold the womb, _as_ nearly in its proper place as is possible. After atime nature will so strengthen the ligaments that they will hold thewomb and a cure is, therefore, affected. The length of time necessary tocure depends upon the length of time the displacement has existed. Itmay take, from two to four months. When the displacement is of longstanding and is accompanied with more or less inflammation, adhesionssometimes grow between the womb and the adjacent organs. It is necessaryto resort to surgery in such cases, but the result is always good andthe danger practically nothing. 

DISEASE OF THE WOMB, OVARIES OR FALLOPIAN TUBES. --Disease of the womb, ovaries, and fallopian tubes, which renders the victim sterile, is as arule the direct result of infection. Such infection is conveyed by thehusband to the wife. This is quite a common condition. The simple factthat such conditions exist leads us to hope that the time is not fardistant when it will be compulsory for all participants in the marriageceremony to submit to a thorough physical examination. By this means, and by this means only, will the innocent be protected. No one canconceive, unless he has been identified, as a physician, with one of thelarge metropolitan hospital clinics, of the extent of this class ofdisease, and of the frightful suffering caused, and innocent livesruined, by infection conveyed in this way. It is a tragic corollary tothe marriage vow "for better or for worse. "

If a woman is fortunate enough to fall into the hands of an honorablephysician, who will tactfully explain to her the serious significance ofher condition and obtain her consent to treat her until she is cured, which in all probability will include a surgical operation, and will doso with diligence, without regard to the size of the bill, she willindeed be a lucky woman. It is from women who are suffering with suchdiseases, --most of them without the slightest idea of what ailsthem, --that the venders of advertised nostrums reap their fortunes, andit is from the same victims that most of the advertised medical "quacks"look for their blood-money. The great difficulty, however, lies in thefailure of the woman to appreciate the seriousness of her condition, andas a consequence she fails to understands why it should take so long tocure her. She loses confidence in her physician, she buys certain"cures" recommended to her by Mrs. Busybody and later tries otherphysicians and ends by losing faith in herself. Meantime she grows worseand worse. There are thousands such. It may be here stated without fearof contradiction that if the public in general would repose moreconfidence in the medical profession, there would be much lesssuffering, much less sorrow, fewer regrets, fewer irresponsible "isms, "and cults, because there would be fewer disappointed individuals tosupport them. If the medical profession would condescend to employ thetactics and devices of those questionable, fashionable agencies thatclaim the power to cure human suffering, it could quickly reap theprofit and the laudation that it now escapes because it keeps the faith. 

The way to be cured of any disease, if it is curable, is to engage areputable physician and follow his instructions implicitly. Let himunderstand you expect him to see you through your trouble and let himknow you have confidence in him. There isn't one physician in a thousandwho will cheat you under these circumstances. 

MALFORMATION. --Under this heading are all those cases of sterilityresulting from imperfect generative organs. These are products of afailure on the part of nature to furnish or develop the structuresparticipating in the propagation of the species. The entire generativeorgans are sometimes wanting. The womb may have failed for some reasonto grow with the rest of the body, it remains (as it is known) as an"infantile womb. " Occasionally the womb grows together, that is, it issolid instead of being a hollow organ. The mouth of the womb may be toosmall, representing what is called "a pin head opening. " The naturalopening is large enough to admit a lead pencil, a "pin head opening"would not be larger than the lead in the pencil. The latter condition isquite a common cause of sterility and is readily amenable to treatment. Most of the malformations which produce sterility are impossible tocure. 

LACERATIONS OR TEARS IN MOUTH OF WOMB. --This subject is fully discussedon another page of this volume. 

TUMOR. --A tumor may be so situated as to prevent conception, or it mayinvolve the body of the womb constituting a reason in itself forsterility. 

LEUCORRHEA. --Leucorrhea or "the whites" may be of such an acid characteras to kill the spermatozoa in the vagina, or it may be of such volume asto render impregnation impossible. The treatment of this condition isdiscussed elsewhere. 

PHYSICAL DEBILITY. --When the general health is bad, no matter from whatcause, sterility usually exists. This lack of vitality may be due tochronic disease, or it may have been caused by a very severe acuteillness, such as typhoid fever. One's mode of living, if unhygienic, maybe responsible for continued bad health and a consequent sterility. 

OBESITY. --Very fat women are usually barren. If a woman rapidlyaccumulates fat after marriage she as a rule does not have more than oneor two children. Women often become stout immediately after the childbearing age ceases. 

SPECIAL POISONS. --Certain special poisons in the blood cause sterilityby producing miscarriage. 

MISCARRIAGE

By the term "miscarriage" we mean that for some reason the progress ofpregnancy has been interrupted and the fetus is expelled from the womb. A miscarriage or abortion (both terms meaning the same--the differencebetween the two terms is a technical one and need not concern us here)can occur any time after conception up to approximately the seventhmonth, when, if labor takes place, the child may be born alive. Thecondition would then be termed a premature labor. A miscarriage orabortion is an immature labor and implies an immature or dead child. 

The condition is a serious one no matter whether it is attended withgrave symptoms or apparently no symptoms. If it occurs shortly afterconception, during the first few months of married life it is serious, if not in its physical consequences, it is in its significance, becauseit establishes the tendency to miscarry, --a tendency that may result ingreat mental distress because of the worry and fear it engenders, and ofsorrow and heartache because it may blast the hope of parentage. Such amiscarriage may take place at once after conception. If so, thefollowing menstruation may be delayed for a week or so and is then alittle more profuse than is customary. This will be the only indicationthat a life has been sacrificed that the young wife may have, andfrequently the significance of such an occurrence is never understood, yet the tendency to miscarry is nevertheless established, and a seemingsterility is apparently the fate of the woman. It is, therefore, of thegreatest importance that extreme care should be taken to bring the firstpregnancy to a successful consummation. A young wife should realize thatshe is apt to become pregnant at any time. Her conduct therefore shouldbe such at least as not to harm the life principle with which she hasbeen entrusted. To this end any excessive sexual activity should bestrictly avoided. 

CAUSES OF MISCARRIAGE. --Any strenuous physical effort must be guardedagainst. Included in such efforts may be the following: dancing, running, jumping, surf-bathing, sewing on a machine, sweeping, washing, house-cleaning, moving furniture, etc. Sometimes the primary cause of amiscarriage is to be found in some hygienic act, such as a hot bath, tooprolonged or too many hot douches near the menstrual periods. A blow ora fall, even a fright or shock may cause a miscarriage. Anything thatviolently shakes or agitates the womb, which may at this time beirritable because of its condition, will be sufficient to excite it tocontract and miscarry. Hence violent coughing or vomiting should beavoided if possible; horseback riding, jolting in a carriage, convulsions, hysterical crying, may also be the causative factors. Displacement of the womb by limiting its tendency to grow when pregnant, may cause it to miscarry. Very severe general diseases such assmall-pox, pneumonia, etc. , will cause the womb to empty itself. Diseaseof the fetus or the presence of syphilis in either of the parents willalso have the same result. 

THE COURSE AND SYMPTOMS OF MISCARRIAGE. --The cause of a miscarriage orabortion is much the same as an ordinary labor at term. Whateverinterrupts the pregnancy causes the death of the fetus. The dead fetusacts as a foreign body and excites the womb to contract as it doesduring an ordinary confinement. The contractions open up the mouth ofthe womb and the fetus is expelled together with its membranes andafter-birth. The significant and the most important symptom of amiscarriage or abortion is hemorrhage or bleeding from the privates. Theflow of blood may not amount to much or it may be excessive andalarming; it may not be constant, it may come from time to time in theform of clots. 

The next significant and important symptom of miscarriage or abortion ispain. The pain, like the flow of blood, may be only slight or it may bevery severe, sometimes it is absent in very early miscarriage. As a rulethe pain is severe when the miscarriage occurs after pregnancy haslasted for a number of months. 

A miscarriage or abortion is said to be "complete" when the fetus withits membranes and after-birth is expelled clean and whole, or in otherwords when the womb empties itself completely. A miscarriage or abortionis said to be "incomplete" when some part of the embryo is left in thewomb. 

WHAT TO DO WHEN A MISCARRIAGE IS THREATENED. --When a woman, who ispregnant, begins to flow she should at once go to bed and keep perfectlyquiet and send for a physician. A miscarriage is a treacherous conditionand is so regarded by all medical men. It may not amount to much or itmay, on the other hand, develop into a serious situation. The immediatedanger is from hemorrhage; the ultimate or remote danger is sepsis orblood poisoning. The condition is one that can only be taken in chargeby a qualified physician in whose hands we can safely leave the conductof the case. 

As a general rule it is quite safe to assert that a woman will not bleedenough at the beginning of a miscarriage to do any permanent harm. Consequently there is no occasion for unnecessary alarm. She must, however, as stated above, heed the warning and go to bed, keep perfectlyquiet and send for a physician. If she fails to follow this advice it isquite possible that she may have a hemorrhage during the course of themiscarriage of a sufficiently serious character to endanger her life orfrom the effects of which she may suffer for the remainder of her life. 

There is practically no danger during the course of or after a"complete" miscarriage. The danger which may ensue from an "incomplete"miscarriage is hemorrhage and a form of poisoning caused by theabsorption into the system of putrifying products of the part of thedead embryo left in the womb. 

There are a large number of cases of criminal abortion in which septicpoisoning occurs caused by the utensils or instruments used in inducingthe abortion. All of these cases are operative cases which must beattended to promptly to save life. 

TREATMENT OF THREATENED MISCARRIAGE. --Not all of the cases of beginningmiscarriage end in miscarriage. If the physician is sent for in time hecan very frequently give directions that will, if carried outfaithfully, avert the disaster. Success is more likely to attend thosecases in which the trouble has been caused by some accidental injury, asa fall, or blow, or extra exertion. This is more especially the case ifthe woman has previously borne children, is healthy and in goodcondition and whose womb is known not to be diseased. In these casesthere is a partial separation of the fetus from the wall of the womb, which causes the bleeding. The physician will direct that the woman beput to bed, in a quiet, darkened room. He will instruct the nurse tosterilize the external genital region: a sterile gauze dressing is thenleft in place. Some form of prescription will be given to diminish thepatient's nervous fear and to allay any tendency on the part of the wombto contract. It is always essential and very important to saveeverything that passes from the womb during the course of a threatenedmiscarriage in order that the physician may know exactly just what thecondition is. Each cloth, each clot of blood will have to be examinedbefore the proper treatment can be pursued in safety. 

When the miscarriage cannot be prevented it is called an "Inevitablemiscarriage. "

TREATMENT OF AN INEVITABLE MISCARRIAGE. --In these cases every precautionis taken, just as in a normal confinement, to avert blood poisoning. Thehands, instruments, dressings, etc. , are carefully rendered sterile andthe whole field must be surgically clean. The physician will conduct thecase as conditions justify and as the situation develops. 

AFTER TREATMENT OF A MISCARRIAGE. --It is one of the many thankless tasksof a physician's life to insist on each patient staying in bed at leastten days after a miscarriage. The average woman and frequently theintelligent woman fails to appreciate the absolute necessity for thisprocedure. It is necessary and it is the physician's duty to insist onit being done in the interest of the woman. Many of the multitude ofdiseases of women are caused by disregarding advice on such occasions. 

THE TENDENCY TO MISCARRY. --If a woman, for any reason, has had amiscarriage, her womb will tend to miscarry at the same period during asubsequent pregnancy. If the miscarriage should occur during her firstpregnancy the tendency to miscarry will be greater than if acquiredafter she has had a baby. 

This is one of the reasons why young wives often fail to have children. They "get rid" of the first one or two, because they are not ready tohave children, or because they want some enjoyment themselves beforethey are tied down with a family. Having established the habit theirwomb has been educated to abort, and it will keep this habit up, much totheir astonishment and chagrin. 

Young wives should therefore faithfully follow out all the rules of theHygiene of Pregnancy laid down by their physician, and which are givenin detail in this book. 

[Illustration: _Courtesy of New York World_

AT WORK WITH THE CALIPERS

Watching carefully the physical development of the child month by monthis one of those many little things which may result in disaster ifneglected. 

Abnormal development, or lack of development, should be promptlyreported to the physician, as it may be a warning of serious trouble. 

For the table of standards, mental and physical, adopted by the AmericanMedical Society see page 271. ]

THE BABY

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

 What to Prepare for the Coming Baby--Care of the Newly-born Baby--The First Bath--Dressing the Cord--Treatment After the Cord Falls off--A Pouting Navel--Bathing Baby--Clothing the Baby--Baby's Night Clothes--Care of the Eyes--Care of the Mouth and First Teeth--Care of the Skin--Care of the Genital Organs--Amusing Baby--Temperature in Children--The Teeth--The Permanent Teeth--Care of the Teeth--Dentition--Treatment of Teething--How to Weigh the Baby--Average Weight of a Male Baby--Average Weight of a Female Baby--Average Height of a Male Child--The Rate of Growth of a Child--Pulse Rate in Children--Infant Records, Why They Should be Kept--"Growing Pains. "

WHAT TO PREPARE FOR THE COMING BABY. --The physician should instruct theyoung wife just what to provide for the coming baby. The following listwill be found useful as a general guide. 

 An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably the handiest and best one on the market. 

 Pin cushion;

 Puff-box and puff;

 Soap box containing pure castile soap;

 Hair brush and fine comb;

 Two wash cloths;

 Four ounces of crystal boracic acid, a saturated solution of which is used for cleansing baby's eyes and mouth;

 One pound of good absorbent cotton;

 A flexible tube of white vaseline;

 A bath thermometer;

 A package of sterile gauze;

 A half dozen baby towels, good quality;

 A soft, white, good blanket, --one and one-half yards square;

 One pair small blunt pointed scissors;

 A package of the best safety pins;

 Three or four dozen bird's-eye cotton diapers. First size, eighteen inches square. Second size, twenty-five inches square;

 One yard of soft white flannel for belly bands; each band should be five inches wide, by twenty-four inches long. 

 Two silk and wool shirts;

 Three flannel shirts (all shirts should be high necked, long sleeved, and open down the front);

 Three Eiderdown wrappers;

 Three Cashmere sacques;

 Three pads for crib;

 Six dresses;

 Six petticoats (they should be thirty-three inches long from neck to hem; they should be turned up at the bottom for about four inches and should button there to keep the feet warm; if it is desired to use pinning blankets for the first two months in place of the petticoats, they should be made of soft white flannel with cotton bands);

 Six night slips;

 Six pair socks;

 Two cloaks;

 Two hoods;

 One dozen bibs. 

Simplicity, warmth, and freedom are the essentials in latter-day babyclothes. It is cheaper to make the clothes than to buy them. Excellentand accurate paper patterns can be obtained, giving the quantity ofmaterial necessary and suggesting the kind and quality best suited forthe purpose. These patterns may be obtained from the ButterickPublishing Company in New York City. 

CARE OF THE NEWLY-BORN BABY. --After the nurse has completed her dutieswith the mother after the confinement, she will prepare to give baby itsfirst bath. 

The bath should be given in a warm room. This is a matter that shouldreceive more consideration than has been given it. Nurses do not as arule attach much importance to this duty, while in reality it is a mostimportant one. I have seen trained nurses make ready to give baby itsfirst bath in rooms, during the night, that were not heated adequately. I am convinced that many babies have been victims of this careless habitto the extent of grafting on them the tendency to catarrhal colds andbronchitis because of undue exposure at this critical period. If onewill remember that a baby has just been removed from an environmentwhere the temperature was suitable and constant, to one in which itneeds a large degree of artificial heat until such time as it may becomeaccustomed to the change, one may appreciate the risk taken in exposingthe child for even a short time. The mother should therefore warn thenurse not to undertake the baby's first bath until the temperature andother conditions are favorable. Many nurses and other individuals havethe impression, without knowing why, that the baby should be cleansedand bathed immediately after birth. This is not at all necessary. If theconditions are not favorable, it would be far better to wrap the babysnugly in a warm blanket--first having put a diaper on--and place it inits crib with a hot water bottle near it and defer the bathing until thefollowing forenoon. By that time the baby will be adapted to its newsurroundings; its lungs will have become accustomed to the air which itis breathing for the first time; the mother will have been renderedcomfortable; in other words, the conditions and the environment will befavorable for the baby and for a better performance of the duty. 

The next important feature of the first bath is that it should be donein the quickest time consistent with efficient service. Only thenecessary exposure should be indulged in. It is not necessary that thebaby should be exposed to the admiring inspection of every member of thehousehold--there will be plenty of time for that without risking thehealth of the child. A pan of water at a temperature of 100° F. Shouldbe placed on a stool in front of the nurse. The nurse should have on arubber apron, and on top of this, an ordinary apron and a warm bathtowel laid over her knees. The child should be gently rubbed with warmsweet oil to remove the _vernix caseosa_ (the greasy substance which ison all babies when born to a lesser or greater extent). Particularattention is to be given to all folds of the skin, as under the arms, inthe fold of the neck, in the groin, behind the ears, etc. , because inthese parts the substance is thickest and if not carefully removed itwill cake, and cause painful eruptions and sores, which may bleed andrender the infant extremely uncomfortable. It is not necessary toexpose the whole body at one time while applying the oil. The lower halfmay be covered with a warm soft towel while the nurse is oiling theupper part, and vice versa. After the body has been thoroughly oiled itshould be cleansed with water at the proper temperature, in which purecastile soap has been dissolved. Absorbent cotton only should be used towash the baby. All the washing is done with the baby on the nurse'sknee; it is not put into the water. 

The baby should be mopped dry with sterile gauze, or with a soft steriletowel, the cord dressed and the flannel band adjusted. It should then becompletely dressed and put to the nipple and later to sleep. 

DRESSING THE CORD. --The cord should be covered with powder and sterilegauze. The powder to use should be plain subnitrate of bismuth. If thereis any reason to use another powder the physician will write aprescription for it according to indications. The subnitrate of bismuthwill be found much better than any ordinary talcum or toilet powder, many of which do not make good dressing powders. 

Very few nurses know how to dress the cord. It seems to be impossible toimpress them with the need of frequent attention to the cord. Freshpowder should be put on every time the diaper is removed, every time theinfant urinates, and at other times during the day. The cord should bekept absolutely dry. Putting on powder twice daily will not keep thecord dry and many nurses are too lazy to bother to do it oftener. Youcannot make a mistake in putting on too much powder, you can make aserious mistake by not putting on enough. Every time the cord ispowdered it should be lifted up, away from the skin of the abdomen, andthe powder put below it. The cord should be slightly drawn out and thepowder applied round its base where it meets the skin. Many nurses areafraid to touch or handle the cord--they find it easier to neglect it. The mother should see that the nurse dresses the cord at least fivetimes every day. 

APPLYING THE STERILE GAUZE TO THE CORD. --A piece of gauze, six inchessquare is taken, a hole is cut the size of a ten-cent piece out of thecenter, the cord is drawn through the hole, the gauze folded lengthwiseover the cord and then sidewise, and this is held in place by thebinder. This piece of gauze will adhere to the cord and will most likelybe removed with the cord on the fifth day. If it should fall off, another piece may be put on in the same way. 

If the cord does not fall off until very late it is because it has notbeen attended to rightly or because it was a very thick cord. 

TREATMENT AFTER THE CORD FALLS OFF. --The stump of the cord should bepowdered with the same powder used on the cord; a pad two inches squareof sterile gauze and quite thick should be held over the stump for anumber of days by the abdominal binder. This is used to prevent apossible rupture. After a week the size of the pad may be reduced, but asmall pad should be used over the stump of the cord for a month or more. 

A POUTING NAVEL. --If the stump of the cord should protrude, a piece ofstrong pasteboard, the size of a fifty-cent piece, should be wrapped insoft gauze and placed over the navel, over this a gauze pad, and ifnecessary this should be held in place by a strip of adhesive plaster, though the binder is usually sufficient if it is put on carefully. Ifthis pad is held properly and worn for a month the tendency toprotrusion or rupture will have passed away. These pads may of course, be removed when the baby is being bathed and put back again before thebinder is applied. 

BATHING BABY. --A baby should not be put into water for a bath untilafter the cord has been off for forty-eight hours. 

During the first few months the temperature of the water should be 98°F. The temperature of the water should be taken with a bath thermometer;it should not be guessed at. A bath thermometer is an inexpensivecommodity and it will be in daily use in many ways in a home where thereis a baby--it should therefore be procured wherever possible. The roomshould be warm; there should be no draughts. The mother or nurse shouldcultivate the habit of bathing baby quickly and with system. Everythingshould be ready and at hand. A little salt in the water will tend tostrengthen the skin; it will also relieve any superficial rashes orexcoriations which may be on the skin. Four tablespoonfuls to a gallonof water will be sufficient. The sea salt sold in the stores may be usedin lesser quantities. 

By the end of the fifth month the temperature of the water may bereduced to 95° F. , and by the end of the first year to 90° F. After thefirst year the mother should accustom the child to a quick sponge withcool water on the chest and spine immediately after the bath. Thissimple means, if kept up, will often prevent the development of coldsand bronchial troubles so common to children in temperate latitudes. 

The best time to give the warm bath is at night. In the morning a coldsponge bath is desirable. This should be given as described in thechapter on cold sponge or shower baths. 

In certain children bathing seems to depress their entire system. Theydo not react well even to a warm bath. They remain blue or pale aroundthe mouth and eyes; bathing should therefore be carefully undertakenwith these children until such time as they acquire strength. 

CLOTHING OF BABY. --The baby should wear a woolen shirt, with a high neckand long sleeves. The abdominal binder may be worn for the first threemonths. It is not necessary after that time. If worn longer the habit isacquired and chronic indigestion may ensue when it is ultimately takenoff. If the baby is very thin it may be wise to leave it on, simply forits warming effect, for a few months longer. If the child is normal andhealthy the binder should be left off permanently after three months. The band for the first four weeks should be made of plain flannel; afterthis period a knitted band with shoulder straps is the better article. All petticoats and skirts should be supported from the shoulders. Stockinet is a good material for diapers; it is soft, warm, and pliable. 

Baby's feet should be warm always. Cold feet are frequently responsiblefor colic and gastro-intestinal troubles. A hot water bottle should beplaced in the carriage if the weather is cold, but care should be takento see that it does not touch the feet, otherwise it may burn them. Thesame measure may be adopted in the baby's crib if the feet are cold. 

During the summer the outer clothing should be made of the thinnestquality of material possible, and the underclothing of the finestflannel or gauze. Body heat may be maintained during changes oftemperature by extra outer wraps--not by dressing the baby in clothesthat keep it too hot and uncomfortable all the time. 

The main object to be attained in clothing the baby is to ensure asufficient protection, but the clothing must be light, warm, loose, andnon-irritating. Don't bundle up the arms and legs so that they cannot bemoved; don't pin them so tight that the child cannot breathe properlyand don't put the band on so that the child is in torture all the timefrom inability to move the abdomen. 

BABY'S NIGHT CLOTHES. --The night clothing should be the same as thatworn during the day, but it should be loose and of the lightest flannelmaterial. For older children a thin woolen shirt (not the one wornduring the day) and a suit of union clothing with feet is best. 

The mistake must not be made to cover children too warmly at night. Theycan do with relatively less than adults. Too much covering will renderthe sleep restless, will encourage nightmare, and in older children willengender bad habits. Delicate children especially must not beover-covered at night. 

For the first few months children should sleep in a darkened room. 

CARE OF THE EYES. --The eyes should be cleansed for the first few dayswith a saturated solution of boracic acid. They should be protected fromthe direct light for two or three weeks after birth. 

CARE OF THE MOUTH AND FIRST TEETH. --Boiled cooled water should be usedto cleanse the mouth every morning after the bath. A soft piece ofsterile gauze should used for this purpose. The mother must guardagainst using too much force in cleaning the mouth of an infant. 

The milk teeth should receive attention. If they are allowed to becomedirty they will become carious and cause bad breath and neuralgia. Teeth of this character are a menace to health because they harbor germsand in this way infect the mouth and cause stomach troubles. Teeth thatare carious should be filled or removed. 

CARE OF THE SKIN. --The skin of a baby, because of its delicatecharacter, is susceptible to the slightest changes in the weather or tothe condition of the digestive organs. Babies are frequently subject torashes, intertrigo, excoriations, eczema, and other skin affections. Itis much easier to prevent these conditions than to cure them. Cleanliness, not only in giving a daily efficient bath, but in everyother respect, is essential. Castile soap only should be used, and norubbing indulged in, simply mopping the parts with gauze well saturatedwith soapy water. All napkins should be removed as soon as soiled. Ifthe skin is easily chafed the child should be bathed in salt water orwater in which bran is mixed as explained in the chapter on bran baths. 

The baby should be well powdered with a good quality of toilet powder. Ordinary starch, or talcum, or the stearate of zinc is suitable. Fatinfants should be powdered in all the skin folds; otherwise they aresure to chafe. 

CARE OF THE GENITAL ORGANS. --The mother should make it a habit to removeany dirt from the genitals of the baby during the morning bath. Fecalmatter sometimes gets into the folds of the female baby; this should beremoved promptly. In older female children, dirt and dust get into thegenitals which often has to be removed carefully with a soft piece ofcloth. An exceedingly chronic form of inflammation is often seen in poorchildren because of neglect of these parts. 

In male babies the mother must daily push back the foreskin and cleanunder it. If this is not done the natural secretion will gather thereand cause much trouble. If the foreskin is long, the child should becircumcised; if it is not long it must be pushed back daily for a numberof weeks; otherwise it will contract and it may be necessary to operateon it at a later date. If this is not faithfully attended to the prepucewill become adherent, the child becomes nervous and irritable, and itmay become addicted to self-abuse at a very early date--simply becausethe mother is derelict in the performance of her duty. If you are afraidto do your duty, don't neglect it, ask the doctor to show you just whathas to be done and just how it should be done. You will find it to be asimple matter when you know how, as most things are. 

AMUSING BABY. --Mothers should understand that it is not necessary toamuse a baby under one year of age. Their nervous systems are not readyfor any such sport. To excite a baby to laughter is to subject it to ashock which may injure it. The healthy development of the brain of achild demands quiet and restful surroundings. It should sleep, eat, andbe allowed to amuse itself in a natural way. 

TEMPERATURE IN CHILDREN. --The normal temperature in a child varies morethan it does in an adult. The rectal range may be between 98° and 99. 5°F. And may be normal to that particular child. A rectal temperature of97. 5° F. Or of 100. 5° F. Is of no importance unless it continues. 

The best place to take the temperature in a child is the rectum and thenext best place is in the groin. The temperature will always be from ahalf to a full degree higher in the rectum than in the groin. Thethermometer should be left in the rectum for two minutes, and in thegroin for five minutes. 

The temperature in a child is a very fair guide as to the severity ofthe disease. It must be remembered, however, that a child will develop atemperature of two or three degrees from a very slight cause. It is notthe height of the fever that is significant, but rather the duration ofthe fever that is important. A fever of 102° F. In a child may only meana slight indigestion which will wholly disappear after a laxative isgiven, while the same degree of temperature in an adult usually meanssomething much more serious. The degree of the temperature thereforeshould not occasion unnecessary worry; if, however, it continues and ifthe child shows other signs of illness, it may be regarded as indicatingan abnormal condition which should be immediately found out. Atemperature of 100° F. To 102° F. Usually means a mild illness, and oneof 104° F. Or over, a serious sickness. 

It is not advisable that the ordinary mother should possess a clinicalthermometer. There are many occasions when a child will have a feverwhich should not cause any worry; if the mother gets the thermometerhabit, she will many times occasion unnecessary calls of the physicianonly to learn that they are false fears. 

THE TEETH. --There is no definite time at which the first teeth appear. They usually come between the sixth and eighth months. They may not, however, come until much later; or they may come earlier than the sixthmonth; and yet the child may be perfectly healthy. They come as a rulein the following order:

 1. The two lower middle teeth, 6 to 8 months. 2. The four upper middle teeth, 8 to 10 months. 3. One on each side of two lower middle teeth, 8 to 12 months. 

 4. One on each side, above and below, back of above teeth (four in all), 12 to 15 months. 

 5. The next one on each side, above and below, back of those already in (four in all), 18 to 24 months. 

 6. The four back teeth on each side, above and below, 24 to 30 months. 

 At 1 year a child should have 6 teeth

 At 1-1-2 years a child should have 12 teeth

 At 2 years a child should have 16 teeth

 At 2-1-2 years a child should have 20 teeth

They may not come in the above regular order even in well children. Theupper front teeth may come first. If the child is sickly there may bemarked irregularity in the order in which they appear. Twenty teethcomprise the first set. 

THE PERMANENT TEETH. --This set consists of thirty-two teeth. They beginabout the sixth year and they are usually not complete until thetwentieth year. They appear in the following order:

 First molars 6 years Incisors 7 to 8 years Bicuspids 9 to 10 years Canines 12 to 14 years Second molars 12 to 15 years Third molars 17 to 25 years

CARE OF THE TEETH. --The teeth should be given attention as soon as theyappear. It is an excellent custom to wash the teeth and gums twice dailywith a piece of clean absorbent cotton rolled round the finger of themother and dipped in a saturated solution of boracic acid. This shouldbe done up to the second year. After the second year a soft brush shouldbe used and the teeth thoroughly cleaned morning and night with purecastile soap or a powder. The teeth of every child should be examined bya dentist every six months. All cavities should be filled with a softfilling. The milk teeth should not decay, but should fall out, or beforced out by the second set. A child should be taught to gargle earlyand a mouth wash should be used morning and night. 

DENTITION. --As a general rule the process of teething is accompanied bysome symptoms. There may be fever, restlessness, and loss of appetite;though in many cases there are absolutely no symptoms. Some childrenseem to teethe hard, others easily. The same child may have some teethwithout pain, and with others it may suffer severely. The condition ofthe child at the time, its age, and the season of the year undoubtedlyhave an influence. Children who are sickly and puny may have muchdifficulty while teething. 

The degree of sickness varies quite considerably. There may only be, asstated above, slight fever, restlessness, with loss of appetite; orthere may be, in addition to these symptoms, a pronounced fermentativediarrhea, which may lead to serious intestinal diseases; frequentlythere is a cough. This is more apt to be the case if the child isteething during the hot season. 

TREATMENT. --When dentition affects the child's disposition it is a goodplan to reduce the feeding in quantity and quality for the time being. If the child is bottle-fed, two ounces can be taken out of each bottleand one ounce of boiled water added. If the child is breast-fed, heshould be given two ounces of warm, boiled water before each feeding, and the actual feeding time at the breast shortened. 

Rubbing the gum over the erupting tooth with a clean cloth may aid inhelping it through. If the child is very restless and has lost sleep, the cloth may be moistened with brandy and water. Lancing the gum, though it is seldom done now-a-days, is justified in a few cases. Teething is not the cause of actual disease as was once thought, but itmust be remembered that a child whose vitality is reduced by fever, restlessness, loss of appetite, loss of sleep, and irregular bowels, ismore susceptible to disease than when enjoying robust health. 

Sometimes a child will have a fever for one or two weeks during a harddentition. There is apt to be more or less intestinal indigestion andfermentation at this time and as a consequence actual intestinal diseasemay develop. To avoid such a possibility it is an excellent plan to givean occasional dose of castor oil to clean thoroughly the wholeintestinal canal. This should be done irrespective of the condition ofthe bowel, because frequently a diarrhea is caused by retainedfermenting products. 

Mothers must not acquire the habit of attributing all symptoms to theteething process simply because the child is teething. It must beremembered that a child may get a disease, or an ailment, whileteething, that has nothing to do with teething. If this is neglected, serious consequences may result. Many children have lost their lives bya mother's carelessness in this way. Be on the safe side, consult yourdoctor; let him assume the responsibility. 

HOW TO WEIGH THE BABY. --The test of weight is one of the mostsatisfactory we possess as an indication of physical progress andhealth. It is not an absolute test, but it may safely be relied upon. The fattest baby is not necessarily the healthiest. A gradual and auniform increase is a satisfactory growth. At birth a baby weighs, on anaverage, from seven to eight pounds, though some babies weighing lessare equally healthy. The normal and customary gain is from four to sixounces every week after birth. 

The baby should be weighed about the same time of the day each week, andbefore a meal. 

The average weight of a male child at different ages is as follows:

 Birth 7-1/2 lbs. 3 weeks 8 lbs. 1 month 8-1/2 lbs. 3 months 12 lbs. 4 months 13-1/2 lbs. 5 months 15 lbs. 6 months 15-1/2 lbs. 7 months 17 lbs. 9 months 19 lbs. 1 year 21 lbs. 1-1/2 years 23 lbs. 2 years 26-1/2 lbs. 3 years 31-1/2 lbs. 4 years 35-1/2 lbs. 5 years 40 lbs. 6 years 45 lbs. 7 years 49 lbs. 8 years 54 lbs. 9 years 59 lbs. 10 years 65-1/2 lbs. 

A female child weighs about one-fifteenth less than a male child, as arule. 

Table showing the average height of a male child, at different ages:

 At birth 20-1/2 in. 6 months 26 in. 1 year 29 in. 2 years 32-1/2 in. 3 years 35 in. 4 years 38 in. 5 years 41-1/2 in. 6 years 44 in. 7 years 46 in. 8 years 48 in. 9 years 50 in. 10 years 52 in. 

THE RATE OF GROWTH OF A CHILD. --A child grows most rapidly during itsfirst year--six to seven inches; from fourth to sixteenth, about twoinches annually; thence to twentieth, one inch. Commonly, a child at twoand a half years has attained half of its ultimate adult stature. Thediseases of youth always accelerate growth. 

PULSE RATE IN CHILDREN AND ADULTS. --Normal Pulse, --of new born, 130 to140, per minute; first year, 105 to 115; second year, 106 to 115; thirdyear, 95 to 105; fifth to twelfth year, 80 to 90; thirteenth totwenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; inold age, 75 to 85. 

INFANT RECORDS. --A record should be kept by the mother of every childwhich would embrace exact data as to weight, diet, size, development ofmental power, teeth, ailments, sickness, pains, etc. , with dates and anyinformation which would aid in recalling exact conditions. Such recordsare of the utmost value in a number of ways. They help in givingsuggestions as to diet, general health, and mental qualities of thechild in question, and they aid in furnishing what physicians call "pasthistory, " which past history has a very valuable significance inestimating the character and importance of sickness during later years. 

Such a record is also of importance in comparing a child's developmentwith what is regarded as standard development, and also with the growthand development of other children in or out of the family. 

If a child should thus be found to fall seriously below the standard andyet not appear actually sick, a very thorough and routine investigationshould be instituted to discover if possible the cause. Some error mightthus be detected which might seriously affect the child's future growthand well-being. 

The date of the closing of the soft spot on the baby's head should benoted, and if it is still open, when it should be closed, it might meanthat the child has a serious brain condition. The soft spot should closebetween the eighteenth and twenty-fourth months. The family physicianshould be notified if the soft spot is open later than the second year, as he may want to investigate the cause. 

Should the child be unusually backward in walking, and when it does soshould limp and feel pain in the knees, it should be examined for anysymptom of hip joint disease, of which these are the earliest signs. 

If the child complains of so-called "growing pains, " keep in mind thatthese are rheumatic and may need attention. There are no such pains asactual "growing pains, " that is, pains caused by the child growing. 

CHAPTER XVII

BABY'S FEEDING HABITS

 Overfeeding Baby--Intervals of Feeding--How Long Should a Baby Stay at the Breast--Vomiting Between Feedings--Regularity of Feeding--Why is Regularity of Feeding Important--"A Baby Never Vomits"--What is the Significance of So-called Vomiting After Feedings--Mothers Milk That is Unfit for Baby--Fresh Air for Baby--Air Baths for Baby. 

OVERFEEDING BABY. --Every nursing mother should have printed and hung up, so she may read it every time she nurses her child, the following motto:"DON'T OVERFEED BABY. " Few, if any, babies die of willful starvation:many die as a result of overfeeding. Mistaken kindness and lack ofjudgment are responsible for one-half of all the troubles of infancy. Babies require much less than is constantly given them. The stomach of ababy at birth will not hold more than one ounce, which is twotablespoonfuls; and at two months it will not hold more than threetablespoonfuls; and at six months, six or seven tablespoonfuls. Readthese quantities once again carefully and try to realize thesignificance of the smallness of them. A baby is just like a little pig;it will go on feeding as long as it is allowed. The baby does notreason; it has no judgment; it depends upon its mother's judgment. Ifthe mother is false to the trust the baby overloads its stomach. Aswollen, distended, overloaded stomach causes indigestion. A baby withindigestion is a colicky, fretty, sick baby. Overfeeding, therefore, isthe beginning of lots of trouble to the mother, and needless pain andsuffering and sickness to the baby. A simple matter, but it is one ofthe most difficult lessons nursing mothers have to learn. 

Overfeeding is most apt to occur at night. Many mothers put the child tothe nipple for its regular feeding and fall asleep; the child keeps onnursing at intervals until twice the proper quantity is taken; or shegives it the nipple or the bottle if it cries, without regard to whetherit is the proper feeding time or not. The habit of overfeeding is verycommon in infants who are suffering from indigestion. They cryfrequently, and are irritable most of the time; nothing seems to satisfythem but the nipple. Taking the warm milk into the stomach seems toallay the distress for the time being, so mothers get into the habit ofquieting them in this way. The cry of the drinking man, whom we try tosober up, is: "Just one more drink and I'll quit. " You give the drinkand in a little while the demand is repeated. If the mother understoodthe seriousness of this practice of giving the child the nipple orbottle at irregular times, she would not do it. 

Overfeeding an infant may lay the foundation for a lifelong ailment. Theexcess of food remains in the stomach or bowels undigested. If youremember that this mass of undigested matter is confined in a smallspace which is both warm and damp, it will be easily understood thatputrefaction is the inevitable outcome. As a result of this putrefactionthere are produced certain ptomaines and leucomaines. These poisons arecarried through the body, causing "auto-intoxication" which upsets andirritates the child's nervous system and may cause very seriousconsequences, as it frequently produces sudden death from apoplexy and"heart failure" in the adult. These children are always restless, fretful, continually uncomfortable, sleepless and colicky. They loseweight, the stomach becomes distended and a gastritis or inflammation ofthe stomach results. 

Frequently a mother with such a fretful baby, seeing her child gettingthinner and thinner, will think that it is not getting enough to eat, and will proceed to add to the trouble by giving the child more to eat. 

Mothers must therefore learn not to overfeed their infants; not toimagine that a failure to gain weight means the need of more food (ifthe quality of the food being given is wrong, will increasing thequantity of bad food do any good?); not to feed irregularly, no matterhow insistent the child may be. 

INTERVALS OF FEEDING. --The physician will give instructions regardingthe feeding of the newly born baby for the first few days. After thefirst few days and up to the beginning of the third month, it should befed every two hours from 7 A. M. Until 9 P. M. , and twice during thenight between 9 P. M. And 7 A. M. , when the regular two-hours' intervalagain begins for the following day. The two night feedings should beabout 1 and 4:30 A. M. 

After the third month, and up to the sixth month, feed every three hoursand once during the night. From the sixth month until weaned, everythree and one-half or four hours, and not at all during the night. 

While it has been pointed out that regularity of feeding is absolutelyessential, the above schedule is not to be regarded as an absoluteguide. It is a general guide, --approximately it will be found correct ina large majority of cases. Each baby is a rule unto itself. The quantityof the mother's milk will dictate the interval after the first month andfor each month as the baby grows. If a mother with no milk to spare, isnursing a big, strong, husky baby, the three-hour interval during theday may have to be shortened to two and one-half hours. As a rule, however, these exceptions are better regulated by attention to the timethe baby is given at each nursing to fill its stomach. 

HOW LONG SHOULD A BABY STAY AT THE BREAST?--Babies differ as to theirmethod of feeding; some of them seem to like to nurse a moment or twoand then look around; others seem to regard nursing as a seriousbusiness, and resent any effort to take the nipple away until they havefinished. A baby should be taught to nurse methodically; it should notbe allowed to play the nipple. Let it fill its stomach and put it downas quickly as possible. A mother will very soon know just how long ittakes the baby to fill its little stomach, and when she finds this outshe should time it by the clock. When the supply of milk is sufficient, and the child is strong, and nurses freely, eight to twelve minutes aresufficient. After it is taken away from the breast it must be left quiettill the next feeding. 

Other babies, according to the ability they evince to nurse, even whenthe milk runs freely, require a longer time, --from twelve to fifteenminutes. The rule, however, is never to allow them to nurse so long thatwhen they are taken away the milk runs out of the mouth. If this occurs, cut down the length of time they are at the breast, and always time thelength of feeding by the clock, --don't guess at it. 

CHILDREN WHO "VOMIT" BETWEEN FEEDINGS. --When a child habitually bringsup food between feedings it is usually a symptom of gastric indigestion. In these cases it is advisable to add lime-water to each feeding, and toremove some of the fat in each feeding. If improvement does not followremove more of the fat by removing some of the cream from the top of thebottle before shaking it. 

Remove from the bottle four ounces of cream and shake before preparingthe food from what is left. If the child improves after a few daysremove only three ounces, then in a few days remove two ounces and laterone ounce. After a time, sufficiently long to permit the stomach tobecome accustomed to the graded amounts of fat, the former diet of wholemilk can be again resumed. 

Never decrease the interval of feeding of a baby who is bringing upparts of its meal between feedings; it is frequently advisable toincrease the interval. If a child is colicky and is bringing up lots ofgas in addition to some food, one-half grain of benzoate of soda may beadded to each ounce of food given and continued for a number of weeks ifnecessary. When the gas is located in the intestines and is not broughtup, it must be made to pass downward. Attention to the bowels is ofgreat importance in these cases and it may be necessary to peptonize themilk for some time. A reduction of the sugar and starch in the feedingfrequently cures this condition. (See "Colic. ")

There are children who continue to have symptoms of indigestion and whodo not thrive despite various changes in the quantity and quality of thefeedings. It may be necessary to obtain a wet nurse for them, as it iswith "the delicate child. " If a wet nurse cannot be obtained, or if theage will permit, a substitute may be tried. Borden's Eagle brand ofcondensed milk, canned, is probably the best substitute under thesecircumstances. Condensed milk should never be used as a continuous food;as a substitute, however, for a few weeks it is often invaluable. Withan infant of three or four months it should be used at the beginning inthe proportion of one ounce of the milk to sixteen ounces of plainboiled water or barley water. The proper quantity, whatever the child istaking (four or six ounces according to the age) at the time, can betaken from the sixteen ounces and fed to the child. As the symptomsimprove the milk should be diluted less and less, 1 to 14, 1 to 10, andso on until the proper strength is reached. After the child has been onthe condensed milk for a month it should be changed back to cow's milk, using of course a diluted formula until the child becomes accustomed tothe change. Condensed milk, if used as a permanent food, will fattenbabies, but their vitality is very deficient, the muscles flabby, andthe resistance to disease exceedingly poor. They are apt to developrickets and sometimes scurvy. 

REGULARITY OF FEEDING. --One of the very first, and one of the mostimportant factors in contributing to the good health and the comfort ofa baby is absolute regularity in feeding. A regular interval of feedingis particularly essential during the first month of a baby's life. 

Despite the explicit way in which young mothers are instructed in thisrespect, it is one of the disappointing incidents of the practice ofmedicine to observe how many of these mothers fail to heed the advice. We have personally tried to find an explanation for this astonishingcarelessness, and have come to the conclusion that it is not due tointentional forgetfulness, but rather to an inexplicable failure toappreciate that the physician means exactly what he says. 

If, for example, specific instructions are given to feed, or nurse, thechild every two hours (and by "specific instructions" it is meant, thatthe physician takes time to explain in detail the instructions hegives--that the instructions are not incidental to the call, but partof the call;--that the advice is given not as a choice of what isdesirable, but as an absolute rule to follow; and carefully explains whyit is imperative to do as he says; and is satisfied the motherunderstands what he means) it would seem that there could be no possiblereason why the directions should not be faithfully carried out. Yet suchis not the case in many instances, and the excuses given by mothers forfailure are so trivial and annoying that they show a failure toappreciate that they are dealing with a serious problem--a problemaffecting human life. They fail to understand that fatal consequencesmay follow their negligence. They treat the baby problem exactly as theywould a household incident, and as they do not consider it importantwhether the breakfast dishes are washed at 9 A. M. Or at twelve noon, neither do they consider it important whether the baby is fed at 9 A. M. Or an hour later. When mothers learn that the attention they must givetheir babies is essentially different from the attention they giveordinary household duties, the problem of raising children with successand comfort will be greatly simplified. 

If the instructions are to feed the baby at certain intervals, do so atall hazards. To offer the foolish excuse that the baby was asleep whenfeeding time came, is no excuse at all; as a matter of fact the babyshould be asleep at each feeding time, if it is healthy. Wake it andfeed it, for, as will be shown later, it is the constant regularity thatcounts. It will be more difficult to institute regular feeding intervalsduring the first month, because a healthy baby is very difficult to wakeup, even to be fed, during the first few weeks of life. It is absolutelyessential, however, that it should be wakened: otherwise the tendency tooverfill the stomach at the next feeding will lead to indigestion andcolic. 

WHY IS REGULARITY OF FEEDING IMPORTANT?--Because a baby's stomach holdsa very small quantity, and experience has taught us that a baby willthrive better on small quantities given frequently, rather than largequantities at longer intervals. The smaller the baby, the smaller thequantity to begin with. Some babies weigh from five to seven pounds atbirth, while others weigh from nine to twelve pounds. It would beunreasonable to expect a very small baby to be able to hold and digestas much as a very large baby. Considerable common sense and the exerciseof some judgment is therefore necessary on the part of the uninstructedmother, as to just the right quantity to give. Fortunately, a littleexperience will enable the observant mother quickly to solve thisimportant problem. Nature promptly furnishes the symptoms which willcorrectly guide her. Before considering the significance of thesesymptoms let us appreciate certain facts common to all babies, and wewill more easily interpret the meaning of the special symptoms the babywill furnish. 

First of all the baby never vomits. The ejection of food, therefore, isdependent upon a condition, not a disease. If milk runs out of its mouthimmediately, or within a few moments, after a feeding, the explanationis that it was fed too much; it does not vomit, the stomach simplyoverflows. It is exactly like trying to put more milk into a cup afterit is full, --it will not hold more, it overflows. 

The significance of this symptom, therefore, is that the quantity of thefeeding is wrong (it is not the baby's stomach that is at fault, --it isthe mother's judgment). Reduce the quantity of each feeding and you willquickly cure it. If the milk does not overflow soon after a feeding, thebaby will appear satisfied and will go to sleep, and will sleep until itis time for the next feeding. It may not do this, however. In half anhour, or a little longer, after the feeding, it wakes, it begins to fretand cry, and very soon it suddenly belches gas and ejects a mouthful ofmilk, after which it will rest quietly for a few moments, when it willbegin fretting all over again. It may keep up this performance for anhour, or until the next feeding, and if so it is exhausted and unfit tocarry on the digestive process. It is in these cases where most mothersmake serious mistakes. This is the beginning of real trouble, and thefamily physician is the only one qualified to give advice under suchcircumstances. Remember the warning given regarding heeding the adviceof every busybody just at this time. Your baby's health is at stake;maybe its life depends upon what you choose to do. 

WHAT IS THE SIGNIFICANCE OF "VOMITING" AFTER FEEDINGS IN BABIES?--Let usexamine the difference between the milk which overflowed immediatelyafter the feeding and the milk which the baby ejects one-half hour or solater, and which is now being considered. 

The first milk looks like ordinary milk (breast milk), or if the baby isbeing fed from the bottle, it looks just like the mixture in the bottle. It not only looks like what it took, but it smells just like it. Nowexamine the other; we find it looks like curdled milk, it is lumpy, andwe immediately can tell that it is sour, because it smells sour andlooks sour. 

The explanation of the first overflow (immediately after the feeding)was the too great quantity; the explanation of the second overflow(one-half hour or so after the feeding), is the wrong quality of milk. The quantity was right because none overflowed right after the feeding, but the quality was wrong. Again, it is not the baby's stomach that isat fault, --it is the quality of the milk. 

How do we know this? Because of what takes place in the baby's stomachduring the one-half hour between the feeding and the time of theoverflow of the sour milk. The quantity being right, why should the babyhave any trouble if the quality is correct? It should not. Therefore bychanging the quality (not the quantity as in the former case) we curethe trouble, thus proving the quality of the milk to be at fault. 

What took place in the baby's stomach in the intervening half hour? Thequality being wrong, the little stomach could not digest the mixturequick enough. Fermentation set in, gas was evolved, and as the stomachwas full before the gas was manufactured (and as more and more gas ismanufactured when food ferments), the stomach overflowed and out of thebaby's mouth comes gas, and sour, fermenting, curdled milk. This processgoes on until fermentation stops, or until the little stomach has justenough left to fill it and no more. But think what this is, --a sour massof rotting, indigestible, curdled milk, --and that is what this baby isexpected to live and thrive on. 

Some babies seem to have trouble from the very first day of life. Eitherthey will not retain the food, or the food fails to agree with them. Ifthe baby is put upon artificial food at once, these troubles are, ofcourse, not unexpected (because the right artificial food may not befirst chosen for the particular baby), but it is not always theartificially fed baby that gives us trouble, and it is sometimesdifficult to find the cause for such trouble in a baby who has hadnothing but its mother's milk since it was born. 

The cause of stomach trouble in a baby a few days old, fed exclusivelyon mother's milk, is invariably to be found in the quality of the milk. 

The quality of the mother's milk may be affected in a number of wayswhich will render it unfit for the baby. For example, if the mother forany reason becomes sick, and has a high fever shortly after confinement, it will affect her milk and render it unfit temporarily. 

If the mother worries or becomes highly nervous during the first fewdays of her baby's life, she will so affect her milk as to render itunfit for baby. If a baby is fed for a number of days after its birth byits mother, and it should prove afterward that she has not enough milkto continue feeding it, and has finally to put it on artificial food, the baby will most likely have acquired slight stomach ailments that maybe troublesome for some time, because in this case both the quality andthe quantity were no doubt wrong. Constipation in the mother will alsocause trouble. The child will develop colic and extreme irritabilityuntil the mother's condition is relieved. 

Each of these conditions affecting the milk of the nursing motherusually demands a change of food for the baby, and the substitution ofthe proper artificial food will invariably immediately correct thetrouble. In some cases, however, the quality of the mother's milk is notdependent upon a temporary temperamental condition, but is caused byerrors in diet, or conduct, or both. The milk of a physically tired, worn-out mother, is not good, no matter whether the exhaustion is causedby actual physical labor or by the exactions of a strenuous socialprogramme. The milk of a mother who persists in eating irregularly, orwho willfully caters to an appetite which craves the rich, highlyseasoned articles of diet, or who attempts to satisfy a legitimatehunger by drinking large quantities of stale tea or coffee and eatingbread, is unfit for her baby. 

These cases are amenable to the proper treatment, which of course means, that the mother must change her conduct if at fault, and live strictlyupon the diet prescribed elsewhere for nursing mothers. 

If these troubles occur in babies who have been fed exclusively uponartificial food, an entire change of food is frequently necessary. 

FRESH AIR FOR BABY

Baby's first journey out of doors depends upon so many contingenciesthat no specific age can be given when it would be perfectly safe totake it. 

First, the weather and season of the year should be considered. The babyshould not be taken out at all when it is wet, or foggy, or very humid;nor when it is extremely cold. 

Second, the vigor or vitality of the individual child must beconsidered. Some children can safely be taken out if the weather ispropitious when two weeks old, others cannot be taken out without riskuntil they are two months old, regardless of the weather conditions. Ifa child is robust at birth, and nurses well, and increases in weightfrom the beginning, he can be taken out when he is two weeks old whilethe sun shines during the middle of the day. If a child is small andpuny when born, and begins to have nursing troubles from the beginning, does not increase in weight, is fretting, and crying, and sleepsspasmodically, it would be unsafe to take it out before the sixth weekunless it is at a season of the year which would justify exposure to thesunshine. 

The question of suitable clothing will be important, and will decide theadvisability as to when the baby should go out. Every baby should bedressed in wool weather is not too distinctly bad. Remember always to[Transcriber's note: words missing in text] from neck to ankles. Itshead should be warmly clad. Dressed thus and well wrapped in blankets, ahealthy child is ready for an out-door trip at any time, if the[Transcriber's note: words missing in text] have plenty of blanketsbelow the child as well as above it, if it is in a baby carriage. Invery cold weather the child should be buried in blankets, and a hotwater bottle can be wrapped in near his feet. Great care must be takenthat the water in the bottle is not too hot, and that it does notactually touch the skin. No matter how many or how few blankets areused, the face should be exposed directly to the fresh air. When the airis very gusty, or high, a light veil can be laid over the face, butnever at any other time. 

AIR BATHS FOR BABIES. --Babies necessarily require plenty of exercise andplenty of fresh air, as has been pointed out. It is a splendid custom toallow the baby to lie naked after his bath for half an hour. If the roomis comfortably warm, select a spot that is free from draughts, and laythe baby on a pillow or two and let him kick and coo. In the sun by thewindow, his head and especially the eyes shaded from the direct rays ofthe sun, is an excellent place in the summer time. The influence of thedirect sun rays on the little naked body is conducive to good sturdyhealth, good nerves, and sound sleep. 

CHAPTER XVIII

BABY'S GOOD AND BAD HABITS. FOOD FORMULAS

 Baby's Bed--The Proper Way to Lay Baby in Bed--Baby Should Sleep by Itself--How Long Should a Baby Sleep--Why a Baby Cries--The Habitual Crier--The Habit of Feeding Baby Every Time it Cries--The Habit of Walking the Floor with Baby Every Time it Cries--Jouncing, or Hobbling Baby--Baby Needs Water to Drink--The Evil Habit of Kissing Baby--Establishing Toilet Habits--Baby's Comforter--What can be Done to Lessen the Evil Effects of the Comforter Habit--Beef Juice--Beef Juice by the Cold Process--Mutton Broth--Mutton Broth with Cornstarch or Arrowroot--Chicken, Veal, and Beef Broths--Scraped Beef or Meat Pulp--Junket or Curds and Whey--Whey--Barley Water--Barley Water Gruel or Barley Jelly--Rice, Wheat or Oat Water--Imperial Granum--Albumen Water--Dried Bread--Coddled Egg. 

BABY'S BED

THE PROPER WAY TO LAY BABY IN ITS BED. --The baby should be accustomed tosleep by itself from the day of its birth. Mothers have been known tosmother their babies during sleep. The mother may pull the bed-clothingover the baby's head during the night and thus deprive it fresh air. Amother is much more apt to nurse her baby regularly and to do it moreefficiently, if she is compelled to get up to do it. If she occupies thesame bed with baby, she may fall asleep while nursing him; the babyconsequently nurses too long, fills his stomach too full, and soondevelops indigestion and colic in addition to acquiring a very badhabit. 

For the first few weeks an ordinary basket arrangement is all that isnecessary. As soon as the baby begins to move around it should have aregular baby crib, so that possible accidents may be avoided. 

When the baby is placed in bed after a feeding, it should be laid uponits back, being tilted slightly toward its right side. By placing asoft, small pillow, under its left side, the baby will rest more on itsright side, which is the proper position. The reason of this is becausethe liver of a child grows quicker and larger than any other organ, andit is on the right side. By placing the child on this side, it preventsthe heavy liver from sagging over on the little full stomach. If thechild were laid on its left side, the liver would crowd the full stomachand embarrass the heart, and cause pain and restlessness. Frequently achange of position fully to the right side, when a child has beenrestless or crying, and especially if it has been lying on its back, will at once relieve it and allow it to go to sleep again. It is theknowledge of these little things that count in babyhood. 

HOW LONG SHOULD A BABY SLEEP?--A perfectly healthy baby should sleep, while very young, eighteen or twenty hours out of the twenty-four. As itgrows older it will sleep less. It should have, and nothing shouldinterfere with its having, two sound naps every day, --one in theforenoon after its bath, and the other in the afternoon. When four orfive months old, it should also sleep from 7 P. M. Until 10 P. M. , thenit should be fed and allowed to sleep until morning. It has been aptlysaid, that, "a child might easily overeat, but he practically neveroversleeps. " During the second year a child should sleep twelve hours atnight, and about two hours during the day. The twelve-hour night restshould be continued until the child is six years of age. The practice oftaking a nap at noon is a very good one, and it should be encouraged aslong as possible. It can usually be kept up until the child beginsschool life. The strenuous activity of childhood, makes some such resthighly desirable, and the result will necessarily be a stronger body, abetter disposition, and firmer nerves than otherwise. The practice ofretiring early should be strictly enforced during childhood. Children oftwo years of age, should retire at 6:30 P. M. , or at latest at 7 P. M. , those from three to five years, may remain up an additional hour. Atthirteen or fourteen the regular bedtime should be at 8:30 P. M. Thereis no justification for the late hours which growing children areallowed to keep, especially in large cities. 

Regular sleep is largely a matter of habit, and if the infant is startedright, with suitable feedings, given at definite times, followed by theproper periods of sleep, but little trouble will be experienced withsleeplessness. When sleep is disturbed and broken, it means bad habits, unsuitable food, minor forms of indigestion, or positive illness of somekind. Sleep is absolutely essential in infancy and all through childhoodfor purposes of growth. It is wrong to permit a child to sleep too muchduring the day; it will become a habit, and it will not sleep wellduring the night as a consequence. In order to prevent or break thishabit, the child should be kept in a well-lighted room and should beamused and entertained so as to keep it awake. The nap during the middleof the day is an exceedingly important factor in keeping the averagechild in good physical condition. It is a valuable adjunct inpreventing, and in treating, nervousness in children. Children who areanemic should be encouraged to sleep long and freely in well-airedrooms. 

WHY A BABY CRIES. --As has been stated, every healthy baby should cry forhalf an hour each day. Nature suggests, demands this as an essentialexercise. Muscular movements involving a greater part of the whole bodyaccompany the act of crying and furnish this necessary exercise. It isof great importance to an adequate and uniform development of the lungs;deep breathing is necessary to lusty crying, hence the lungs areexpanded and the blood renewed and oxygenated. Crying is also ofmaterial aid in moving the baby's bowels. Babies in perfect health will, however, cry under any of the following circumstances, and doubtlessunder circumstances of lesser importance and frequency when frightenedor uncomfortable from hunger or position, soiled napkins, inflamedbuttocks, earache, pain, from heat or cold, unsuitable clothing, andduring difficult bowel movement, when displeased or angry. Childrenslightly but painfully ill may cry incessantly for an hour or two. Thus, with intestinal colic, when the cry is loud and continuous until thechild is relieved or until he falls asleep from exhaustion. 

The healthy, well trained child seldom causes trouble; it is the rulefor it to be happy and good natured in its own way. 

THE HABITUAL CRIER. --If a child becomes a habitual crier, it is becauseit is uncomfortable and unhappy. There are restless, often vigorous, crying, whining infants, and the trouble, as a rule, is in theintestinal tract. Badly managed, "spoiled babies" cry from inattention, and when left alone. If they are taken up and talked to, the cryingceases, thus proving that it was not pain or discomfort that was causingthe crying. In the case of the habitual crier we try to find out thecause of the bowel trouble and cure it; the spoiled infant we disciplinerigidly, or leave it alone if its parents prefer that kind of baby. 

THE HABIT OF FEEDING BABY EVERY TIME IT CRIES. --The habit of regularfeeding will, if persisted in and successfully established, renderadvice on this subject unnecessary. So also will the explanation of theevil of overfeeding have its effect on mothers. Apart from thesereasons, however, the habit of feeding baby every time it cries is apernicious one, and no doubt the mother, who will be striving tofaithfully follow instructions, will have to overcome the advice ofmeddling friends who will regard it as a cruelty to allow the baby tocry. Do not give in to these busy-bodies; insist on attending to yourown affairs, but be absolutely sure baby is not crying for a just cause. A child can only cry; that is its only language, but it cries for manythings other than the nipple or the bottle. Examine it carefully, --a wetdiaper a pin, an uncomfortable position, a drink of water, any of thesemay be the cause. 

It is just as essential that a child should cry as that it should sleep. Every healthy child should cry for twenty or thirty minutes everytwenty-four hours. Nature calls for this as an exercise in order todevelop the lungs; therefore, if there is no just cause for the cryingyou must regard it as a necessary evil, even if you look upon it as adomestic affliction. 

THE HABIT OF WALKING THE FLOOR WITH BABY EVERY TIME IT CRIES. --This isanother habit that is indulged in to the sorrow and ridicule of therace. If you are a victim of this habit, you have yourself to blame. Itis a matter of education, or habit, pure and simple, and, like all badhabits, it is difficult to break away from. In the preceding paragraph, you have been told that when baby wants something, or is uncomfortable, it employs the language nature gave it, --it cries. No child ever criedto be walked up and down the floor in the dead of the night. Begin atthe beginning, when it first cries, find out why it is crying. Offer ita little water if it is not feeding time. Examine its diaper and ifsoiled change it. It may be overdressed and consequently hot, perspiring, and uncomfortable; change its position. Find out if any pinis open and hurting it; loosen the binder so it can breathe easily. Ifit is a colicky child follow the instructions given in the treatment ofcolic. Be patient the first few nights, and be thorough, because you maydiscover why it cries and each discovery will help you next time. If youdiscover something wrong, some reasonable excuse for the crying, does itnot prove the folly of walking the floor? If it wants a drink of water, or if its diaper is wet, how is walking the floor going to cure it, orhow can you expect the baby to stop crying when you so unjustly construeits reasonable and its only way of asking a favor? If walking the floorstops its crying, it stops it by exhausting the child, not by relievingit of its little ailment. 

JOUNCING OR HOBBLING BABY. --This is another habit that should be frownedupon. So many persons are addicted to this form of baby torture, that itis astonishing more immediate harm does not result from it. Beparticularly careful not to indulge in it, or permit anyone else to doit immediately after feeding. If you form the habit of putting baby downat once after each feeding, as you have been instructed to do, theopportunity to jounce it will not exist. A little reasoning will clearlyconvince you that to subject a baby to violent exercise when its stomachis full would interrupt digestion and so shake the full stomach hat itwould distend it and cause indigestion. You would not think ofexercising yourself after a meal; why exercise a baby?

BABY NEEDS WATER TO DRINK. --Boil a quantity of water each morning, putin a clean bottle, and keep in a cool place. Give the baby some, threeor four times daily between feedings. One teaspoonful is enough to beginwith, and as it grows older it will take more. It may not always takethe water but it will take what it wants, and it needs some every day;it is therefore your duty, inasmuch as baby cannot ask for it, to offerit regularly each day as part of your daily routine. 

KISSING

A child should never be kissed on the mouth by anyone, not even its ownparents. 

Kissing should not be allowed among children. If any kissing is done itshould be on the brow, never on the mouth, hands, or fingers. 

Many diseases are carried by this pernicious habit, and you cannotafford to have baby's health jeopardized by this promiscuous andunnecessary liberty. 

ESTABLISHING TOILET HABITS

When baby reaches the age of three months, a regular systemized effortshould be made to educate it to "habits of cleanliness. " Nothing can bedone in this direction previous to this age, as a child at that periodof its life is scarcely conscious of the natural functions of its body. Each time a baby, after the third month, is making an effort to move itsbowels, the nurse or mother should go to it as it lies in its crib, andtalk to it by making a certain sound or say a certain word--whicheverword or words you want to educate your child to say, when it wants tomove its bowels. By constant attention and effort in this direction, achild with quick perception and initiative will soon associate the soundand the function, and it will begin to make the sound when the functionis about to be performed. As soon as it begins to make this sound, ifprior to the act of moving the bowels, the child should be immediatelytaken up and held on a chamber, into which some hot water has been put, and encouraged to relieve itself, the nurse or mother still repeatingthe sound, or word, or words. 

Having successfully accomplished this programme a number of times, thechild should be encouraged and petted every time it gives a satisfactorywarning, and discouraged and reproved every time it wets or soils itsnapkin. A little later, say about six months, the child should be heldon the chamber at a certain time each morning and evening, thusencouraging it to move its bowels regularly twice daily. The carefulcarrying out of a scheme such as the above will establish regular, cleanly habits, and will to a very large extent guard againstconstipation in the future. 

BABY'S COMFORTER. --The discovery and introduction of the comforter orrubber teat was an unfortunate episode in someone's life. By thecareless, conscienceless nurse, or thoughtless mother, it is regarded asa real comfort and blessing. Any temporary comfort, however, which thenurse or mother may enjoy as a result of its use, is at the expense ofthe health of the child. Its use is a serious reflection upon the goodintention and intelligence of the mother who permits her child to useone. It is a bad habit from every viewpoint possible. In order thatmothers, open to conviction and capable of reasoning, may appreciate thecharacter of the harm done by the use of the comforter, we will brieflyrecord these conditions:

1st. The constant sucking pulls upon the delicate structures of themouth and throat, and so impairs the health tone of these structuresthat they become flaccid and feebly nourished. This to a certain degreecauses adenoids, enlarged tonsils, loose palate and weak throat, withthe constant tendency to winter colds and coughs, and to catarrh. 

2nd. It causes an excessive flow of saliva. Saliva should only bestimulated previous to stomach digestion. By causing an excessive flowof saliva into an empty stomach, the digestive powers are interferedwith, and seriously weakened. Stomach trouble, and consequentlyintestinal disease, may therefore be caused by the seemingly innocentcomforter. 

3rd. A constantly used comforter always causes disease of the mouth. Mucous erosions, canker sores, little ulcers, etc. , are produced in thisway. 

4th. The use of the comforter makes it impossible to put the child tosleep, or even to leave it alone, without first placing it in its mouth. 

5th. To stifle a baby's cry, by pushing the comforter into its mouth, isas bad as giving it chloroform to mask a serious and dangerous pain. Ifmay have a just reason for crying, as is explained elsewhere, and ifthat reason is not searched for and found, it may mean serious troublelater. 

6th. Actual deformities of the mouth are produced by constant use of thecomforter. The continuous sucking affects the gums, pushes them out ofshape and position, and the teeth as a consequence come at wrong angles, thus causing unsightly deformities, which last throughout the life ofthe child. 

7th. The worst fault of the comforter is to be found in itsuncleanliness. We are quite satisfied that the use of the comforter willbe legislated against one of these days. If preventive medicine meansanything, it must certainly reckon with the comforter in the very nearfuture. Have you ever watched your baby suck on its comforter? If youhave, you must have noted the tireless energy with which it works itstiny jaws and tongue. Suddenly the comforter slips from the little mouthand baby begins to cry, attracting the attention of the mother, ornurse, or little sister, who promptly, recognizing the trouble, pounceson the offending comforter, which has fallen to the floor, and with aperfunctory wipe replaces it in baby's mouth. It is done just as we havewritten it, many thousand times, and yet the problem of infant mortalityis represented as a vexatious mystery. The newspapers solicit charitableaid, and write eloquent appeals regarding the necessity of sending a fewbabies to the seashore in the summer time or to supply a few with iceduring the hot spells. A hundred other energetic enthusiasts send forththeir laudable effort to raise the standard of child hygiene, yet themanufacturers of the comforter, and the ignorant mother and nurse whouse it, do more harm in one day than all the honest effort of thesecombined forces can neutralize in a year. 

The rubber comforter is one of the most fertile causes of infection andillness in babies because of the peculiar adaptability to collectinggerms which it possesses. 

When the comforter is finally discarded the habit of sucking is sofirmly established that the child will suck its thumb for many yearsafter. This results in further disease and deformity to the growingmouth and throat, and also to the thumb. 

After a child has used a pacifier or comforter for some time itinvariably becomes a mouth breather. A mouth-breathing child is very aptto catch cold and as a consequence of the habit may become catarrhal ortubercular. 

WHAT CAN BE DONE TO LESSEN THE EVIL EFFECTS OF THE "COMFORTER"HABIT?--It is a most difficult habit to cure when once established. Thevery least that can be done is to keep the comforter scrupulously clean, washing it several times daily. To have not one, but two or three, keptin a saturated solution of boracic acid, ready to put into the baby'smouth should one be required to replace another that has fallen out. Weshould furnish a large shield to prevent it being swallowed. We can trythe method of weaning the baby from the comforter by tying a ribbon toit and to the child's bodice. The system is gradually to shorten theribbon until it becomes too short for the baby to suck in comfort. Itwill then gradually grow away from the habit. 

FOOD FORMULAS

BEEF JUICE. --Take one pound of round steak and broil it slightly. Pressthe juice out with a lemon squeezer, or, with a meat-press. Season withsalt and serve hot or cold as desired. If it is heated after it has oncebeen cold, it should not be overheated as this will coagulate thealbumen which will appear as flakes floating on the surface of thejuice. 

BEEF JUICE BY THE COLD PROCESS. --Take one pound of finely chopped roundsteak, six ounces of cold water, a pinch of salt; place in a covered jarand stand on ice, or in a cool place, six hours. This mixture should beshaken from time to time. Strain and squeeze all the juice out byplacing the meat in a coarse cloth and twisting it very hard. Season andfeed as above. 

Beef juice made in this way is more nutritious than that made from thesteak when broiled; it is not, however, quite so palatable. 

Beef juice made in either of the above ways is much more nutritious thanthe beef extracts sold ready to use. 

MUTTON BROTH. --Take one pound of finely chopped lean mutton, includingsome of the bone, one pint of cold water and a pinch of salt, cook forthree hours over a slow fire down to half a pint, adding water to makeup this quantity if necessary; strain through muslin. When it is coldremove the fat and add more salt if required. It may be fed warm or coldin the form of a jelly. 

MUTTON BROTH WITH CORNSTARCH OR ARROWROOT. --Add to the above sufficientcornstarch or arrowroot to thicken, cook for ten minutes and then addthree ounces of milk, or one ounce of thick cream, to a half pint ofbroth. This makes a nutritious and extremely palatable broth. 

CHICKEN, VEAL, AND BEEF BROTHS. --These may be made and used in the sameway as mutton broth. 

SCRAPED BEEF OR MEAT PULP. --Take a rare piece of round or sirloin steak, cut the outer part away, scrape or shred with a blunt knife. Cutting themeat into small pieces is not satisfactory. One teaspoonful to onetablespoonful may be given well salted, to a child a year and a halfold. It is best to begin with a small dose and work up to the larger toaccustom the digestive apparatus to its use. 

JUNKET, OR CURDS AND WHEY. --Take one pint of warm fresh cow's milk, apinch of salt, a teaspoonful of granulated sugar, to which add twoteaspoonfuls of Fairchild's essence of pepsin and allow the mixture tostand until firmly coagulated--this may take about twenty minutes--placein the ice box until thoroughly cold. Nutmeg may be added for olderchildren and adults. 

WHEY. --The coagulated milk prepared as above is broken up with a forkand the whey is strained off through cheesecloth. If a stimulant isdesired, brandy, in the proportion of one teaspoonful to sixtablespoonfuls of the whey may be added. 

BARLEY WATER. --One level tablespoonful of Robinson's barley is rubbed upwith a little cold water, to this is added one pint of boiled watercontaining a pinch of salt. The mixture should be stirred while thewater is being added. Cook for thirty minutes in a double boiler andstrain. Enough boiling water should be added to the mixture to make upthe full pint if any has boiled away. 

BARLEY GRUEL OR BARLEY JELLY. --Repeat the above process, but instead ofusing one tablespoonful of the barley powder, use from two to fouraccording to the consistency of the gruel or jelly desired. 

Barley water may be made from the grains. A formula for this processwill be found in the chapter on artificial feeding. 

RICE, WHEAT, OR OAT WATER. --These are made from the rice, wheat, or oatflour in the same way as barley water described above. They may be madefrom the grains also, using the same proportions as in the making ofbarley water. 

IMPERIAL GRANUM. --This is prepared in the same way as the barley flourabove described. 

ALBUMEN WATER. --Take half a pint of cold water, the white of one freshegg, a pinch of salt, and a teaspoonful of brandy, shake and feed from aspoon or from a bottle. This is frequently used in cases of vomiting, orin irritable stomachs. It is often retained when all other food isrejected. 

DRIED BREAD. --Cut either stale or fresh bread into thin slices and placein the open oven. When it is dried and crisp but not browned it may begiven to children in preference to crackers. 

CODDLED EGG. --A fresh egg with the shell intact is placed in boilingwater which is immediately removed from the fire. The egg is allowed toremain in the water for eight minutes when it is ready for use. Thewhite only should be used if the digestion is poor. 

ARTIFICIAL FEEDING

CHAPTER XIX

ARTIFICIAL FEEDING

 Elementary Principles of Milk Modification--The Secret of the Efficiency of Mother's Milk--Two Important Factors in Successful Artificial Feeding--Every Child is a Problem in Itself--Proprietary Foods of Little Value as Infant Foods--Their Value is in the Milk Added to Them--The Credit Belongs to the Cow--Difference Between Human and Cow's Milk--What "Top-milk Feeding" Means--Utensils Necessary for Home Modification of Milk--Artificial Feeding from Birth to the Twelfth Month--How to Measure Top-milk--Easy Bottle-feeding Method--Condensed Milk Feeding--Objections to Condensed Milk Feeding. 

ELEMENTARY PRINCIPLES OF MILK MODIFICATION. --Mothers who have to raisetheir children on artificial food should understand the elementaryprinciples of milk modification. They should know, for example, that theone object of milk modification is to render it as nearly an exactsubstitute for mother's milk, according to the age of the child, as ispossible. If we could do this with scientific exactness, artificialfeeding would be a simple process. We cannot, however; nor has thereever been devised a method by which we may hope successfully toduplicate mother's milk. It is a comparatively simple matter for theefficient chemist to analyze the breast milk of any nursing mother; andit is quite possible to duplicate the milk according to the analysis, with chemical exactness, but the two fluids will not be the same. Thereis present in the mother's milk something which synthetic chemistrycannot discover. This something is nature's secret, --it is akin to thelife-giving principle which is contained in the germinal fluid, and inthe hen's egg. We cannot therefore hope to build up an artificial foodthat contains this mysterious life-giving principle which is the secretof the efficiency of maternal milk, --we can only hope to approximateit. It is possible that we might be successful so far as its nursingefficiency is concerned, if all children were alike, if all childrenwere of a uniform standard of health. As a matter of fact, no two babiesare exactly alike. And while the mother of each child undoubtedlysecretes a milk suitable to the degree of healthfulness of her ownchild, the same milk might not be equally suitable to another child. Themilk, therefore, that is manufactured to agree with an average mother'smilk is dependent for its success upon the vitality of the child towhich it is fed. If that child is not a well child, according to anaccepted standard, the milk will not agree with it, even though it isthe best possible substitute for an average breast milk. 

We have consequently two factors to consider in successful or efficientartificial feeding:

 1. Our inability to duplicate exactly mother's milk. 2. The lack of a uniform health standard in children. 

It is the lack of a uniform health standard in children that gives toartificial feeding all its difficulties. It renders the successfulartificial feeding of children a personal or individual problem. Somechildren, --those who approximate a standard of health for their age; inother words, "well" children, --thrive on a milk modification thatexperience has taught us is suitable for well children of their age. Others, and they are in the majority, have to be fed on a modificationwhich actual test proves to agree with their digestive capabilities. Every artificially fed child therefore must be studied from its ownindividual standpoint. A certain modification of milk may not agree witha child fed every two and one-half hours, which will be found to agreeif fed in the same quantity, to the same child, every three hours. Theslightest change, a change which would seem to be so insignificant initself as not to justify serious consideration, may mean the differencebetween normal healthfulness and constant ill health. A food that is toostrong for a child's digestive ability, and which causes vomiting, colic, and diarrhea, may be rendered exactly right by the slightestmodification one of its constituents. To effect such a change quicklyand successfully, one must be trained to interpret the symptomscorrectly and to know how to make the change in the modification of themilk. Mothers cannot be expected to possess this degree of skill: theyshould therefore refrain from experimenting, because an experiment on ababy is not only dangerous, but ethically it is criminal. Call thefamily physician; put the burden on his shoulder. 

It is this element of uncertainty in our ability to effect a standardmodification of milk that has afforded manufacturers the richopportunity of putting on the market various baby foods for which muchis claimed. These foods are really substitutes for the inefficiency ofthe average mother. There is no real justification for their use. If allmothers were clean, faithful, and efficient, there is no reason why eachone could not be taught to modify cow's milk to suit her child, just assatisfactorily, or more so, than a manufacturer who never saw her child. The manufacturers, however, do the work, and the naturally ignorant orlazy and inefficient mother, is willing to pay for the extra cost oflabor, to save herself the trouble on the one hand, and to subject herchild to a series of experiments in order to discover the manufacturedfood that is particularly adapted to her particular baby on the otherhand. We believe that most mothers have never considered the questionfrom this standpoint; that most mothers adopt this method of artificialfeeding at the direct suggestion of their family physician, and are not, therefore, responsible. These foods do not contain the nutritionalelements necessary to healthy growth; or as they exist in normal breastmilk; or as they can be approximated in ordinary milk modification athome. Proprietary foods are of decidedly poor value in infant nutrition, and should not be used. They have a value, however, in certain diseasedconditions, but within a very small range. As a food for a healthygrowing infant, they should not be used, and when the average physicianappreciates this fact, and so instructs the mothers of the country, itwill be to the distinct advantage of the race in every respect. Proprietary foods to which fresh cow's milk is added, are not foods atall, --they depend upon the milk so far as any nutritional value isconcerned; and it would be far safer to modify at home a good milk thanto buy a proprietary food, the analysis of which cannot be dependedupon. The credit for the fat, healthy babies we see advertised does notbelong to the manufacturers, but to the cow whose milk you add to themanufacturer's sugar. 

The proprietary beef foods are also valueless as infant foods. Incertain illnesses, when we want a mild stimulant, a teaspoonful or twoin hot water may have a certain value, but that is all. The beef juiceof home manufacture is much more valuable. 

DIFFERENCE BETWEEN HUMAN AND COW'S MILK. --The composition of cow's milkis as follows:

 Fat (represented by cream) 4% Sugar 4% Proteids (represented by curd) 4%

The composition of an average human breast milk is as follows:

 Fat 4% Sugar 7% Proteids 1-1/2%

It will be observed from a comparison of the above tables that cow'smilk is much richer in proteids (the substances which form with waterthe curd of sour milk) than is human milk. If one remembers that cow'smilk is manufactured by nature primarily for the feeding of calves, notfor babies, and that the stomach of a calf is intended to existexclusively on vegetable products, and that nature is preparing it forthis purpose, and feeds it a food when young that will enable it to growso as to be adapted for that purpose, one can understand that theproblem of the modification of cow's milk to suit the stomach of a babyis not by any means a simple matter. Since the proteids are so much inexcess in cow's milk, we must dilute cow's milk with twice its bulk ormore of water to render it fit food for a new born baby. If we dilutecow's milk to this extent to get the proteid percentage right, weimmediately disarrange the percentage of the cream or fat. We overcomethis difficulty by taking the cream from the top of the bottle anddiluting it because it is richer in fat and does not need so muchdilution. This is the explanation of the so-called "top-milk feeding. "The percentage of sugar represents another problem. The percentage ofsugar in cow's milk compared with the sugar in human milk is deficient, so we add milk-sugar to the cow's milk to make up the deficientpercentage. 

There is yet another feature which we must rectify; cow's milk is acid, while human milk is alkaline. To overcome this difference we addlime-water. We must also take into consideration that cow's milk isordinarily full of germs, while human milk is free from them; toovercome this danger we resort to heating the milk to a degree whichexperience has taught us will kill all germs. Cooked milk is not aswholesome as uncooked milk, and it has a tendency to cause constipation. We have to a certain extent overcome the need for cooking all milk forbabies, as will be noted later, but in summer time, unless the milk isknown to be pure and free from germs, it is advisable to sterilize it. 

UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK

 One dozen round, eight-ounce nursing bottles. One dozen black rubber nipples. One eight-ounce measuring glass or graduate. One brush for cleaning bottles. One two-quart glass preserve jar for mixing the various ingredients. One one-ounce Chapin dipper, for removing the top-milk. One glass funnel. 

A detailed description of the proper kinds of bottles and nipples willbe found elsewhere. The measuring glass or graduate should bewide-mouthed. It is not safe to spoon the top-milk off, nor is it safeto pour it out. Absorbent cotton should be provided to close the nursingbottles when filled and left standing in the ice box. 

ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH

The following formulas for the different ages may be found useful forwell babies:

From the third to the tenth day:

 Milk (top 16 oz. ) 3 ounces. Lime-water 1/2 ounce. Milk-sugar 1 ounce. Boiled water to make 16 ounces. 

Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding. 

From the tenth to the twenty-first day:

 Milk (top 16 oz. ) 6 ounces. Lime-water 1-1/2 ounces. Milk-sugar 1-1/2 ounces. Water to make 24 ounces. 

Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at eachfeeding. 

From third to the sixth week:

 Milk (top 16 oz. ) 10 ounces. Lime-water 2-1/2 ounces. Milk-sugar 2 ounces. Water to make 32 ounces. 

Eight to nine feedings in twenty-four hours; 2 or 3 ounces at eachfeeding. 

From sixth week to the third month:

 Milk (top 16 oz. ) 12 ounces. Milk-sugar 2 ounces. Lime-water 3 ounces. Water to make 32 ounces. 

Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at eachfeeding. 

From third to fifth month:

After this age two bottles of milk are required, 16 ounces being takenfrom the top of each bottle and mixed. 

 Milk (top 16 oz. ) 18 ounces. Milk-sugar 2 ounces. Lime-water 4 ounces. Water to make 40 ounces. 

Six feedings in twenty-four hours; 4 to 5 ounces at each feeding. 

From the fifth to the seventh month:

 Milk (top 16 oz. ) 21 ounces. Milk-sugar 2 ounces. Lime-water 5 ounces. Water to make 42 ounces. 

Six feedings in twenty-four hours; 5 to 7 ounces at each feeding. 

From the seventh to the ninth month:

 Milk (top 16 oz. ) 27 ounces. Milk-sugar 2-1/2 ounces. Lime-water 6 ounces. Water to make 48 ounces. 

Five to seven feedings in twenty-four hours; 6 to 8 ounces at eachfeeding. 

From the ninth to the twelfth month:

 Milk (top 16 oz. ) 35 ounces. Milk-sugar 2-1/2 ounces. Lime-water 6 ounces. Water to make 56 ounces. 

Five to six feedings in twenty-four hours; 7 to 9 ounces at eachfeeding. 

It will be observed that 16 ounces of top-milk is used to make thevarious formulas from. This means that the mother will dip off, with aChapin dipper, 16 ounces from the top of a bottle of milk which hasstood for four or five hours to allow the cream to rise; she will thenmix this and take from the mixture the number of ounces called for inthe formula she is using according to the age of the child. The ordinarymilk that is delivered in New York City may be assumed to have stood thefour or five hours necessary. This may not be so, however, in thecountry, as it is frequently delivered there as soon as it is milked. Insuch cases the mother will permit it to stand in the ice box until thecream has risen. 

When the mother is about to make the mixture called for in feeding fromthe third to the fifth month she will observe that 18 ounces of milk iscalled for. Now since she only uses 16 ounces of the top-milk from onebottle this will not be enough. She must therefore use 16 ounces fromtwo bottles of milk; this she will mix together and from this mixtureshe will take the 18 ounces wanted. Whatever milk is left over may beused for ordinary table purposes. 

EASY BOTTLE-FEEDING METHOD

The following formulas and instructions for bottle-feeding are takenfrom the Rules for the Care of Infants and Young Children which are usedby Dr. Kerley at the out-patient department of the Babies' Hospital andgive the simplest and easiest means of bottle-feeding:

 BOTTLE-FEEDING. --The bottle should be thoroughly cleansed with borax and hot water (one teaspoonful of borax to a pint of water) and boil before using. The nipple should be turned inside out, scrubbed with a brush, using hot borax water. The brush should be used for no other purpose. The bottle and nipple should rest in plain boiled water until wanted. Never use grocery milk. Use only bottled milk which is delivered every morning. From May 1st to October 1st the milk should be boiled five minutes immediately after receiving. Children of the same age vary greatly as to the strength and amount of food required. A mixture, when prepared, should be put in a covered glass fruit-jar and kept on the ice. For the average baby the following mixture will be found useful:

 "For a child under six weeks of age: Nine ounces of milk, twenty-seven ounces of barley-water, four teaspoonfuls of granulated sugar. Feed from two to three ounces at two and one-quarter hour intervals, nine feedings in twenty-four hours. 

 "Sixth to the twelfth week: Twelve ounces milk, twenty-four ounces barley-water, five teaspoonfuls sugar. Feed from three to four ounces at each feeding. 

 "Third to the sixth month: Eighteen ounces of milk, thirty ounces of barley-water, six teaspoonfuls of sugar. Feed four to six ounces at three-hour intervals, seven feedings in twenty-four hours. 

 "Sixth to the ninth month: Twenty-four ounces milk, twenty-four ounces barley-water, six teaspoonfuls granulated sugar. Feed six to eight ounces at three-hour intervals, six feedings in twenty-four hours. 

 "Ninth to twelfth month: Thirty-eight ounces milk, twelve ounces barley-water, six teaspoonfuls of granulated sugar. Feed seven to nine ounces at three and one-half hour intervals, five feedings in twenty-four hours. "

BARLEY-WATER. --The barley-water used in the above formulas may be madein the following way: To two teaspoonfuls of pearl barley, add one quartof water, and boil continuously for six hours, keeping the quantity upto a quart by the addition of water; strain through coarse muslin. Thebarley will be better if it is soaked for a number of hours, or overnight, before cooking. The water in which it is soaked is not used. 

An equally good barley-water may be made in an easier way by usingRobinson's prepared barley. This may be procured in the drug stores. Itis only necessary to take one even tablespoonful of this barley totwelve ounces of water and cook for twenty minutes. 

CONDENSED MILK. --When the mother cannot afford to buy bottled milk fromthe wagon, when she has no ice-chest and cannot afford to buy ice, sheshould not attempt cow's-milk feeding, but may use canned condensed milkas a substitute during the hot months only. The can, when opened, shouldbe kept in the coolest place in the apartment, carefully wrapped inclean white paper or in a clean towel. The feeding hours are the same asfor fresh cow's milk:

"Under three months of age: Condensed milk one-half to one teaspoonful;barley-water, two to four ounces. 

"Third to sixth month: Condensed milk, one to two teaspoonfuls;barley-water, four to six ounces. 

"Sixth to ninth month: Condensed milk, two to three teaspoonfuls;barley-water, six to eight ounces. 

"Ninth to twelfth month: Condensed milk, three teaspoonfuls;barley-water, eight to nine ounces. "

OBJECTIONS TO CONDENSED MILK FEEDING. --Condensed milk is not to berecommended as a permanent food where good cow's milk can be obtained. In most cases it should be used as the sole food for a few weeks only. It may be used when the digestion is impaired for some reason. If thesymptoms are intestinal it will be more apt to agree than if they arecaused by stomach ailments. The symptoms of intestinal disturbancesare, --colic, flatulence (gas), curds or specks in the stools, constipation or diarrhea. It will not be found suitable if the child issimply vomiting. 

The objections to condensed milk are: It is very rich in sugar and verydeficient in proteids and fat. Children fed on condensed milk often gainvery rapidly in weight but have little strength or resistance. They donot fight disease well for this reason; they are apt to develop ricketsand scurvy. 

CHAPTER XX

ARTIFICIAL FEEDING--CONTINUED

 How to Prepare Milk Mixtures--Sterilizing the Food for the Day's Feeding--How to Test the Temperature of the Food for Baby--When to Increase the Quality or Quantity of Food--Food Allowable During the First Year in Addition to Milk--Beef Juice--White of Egg--Orange Juice--Peptonized Milk--The Hot or Immediate Process--The Cold Process--Partially Peptonized Milk--Completely Peptonized Milk--Uses of Peptonized Milk--Objections to Peptonized Milk--What a Mother Should Know About Baby's Feeding Bottle and Nipple--Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks is not Quite Enough to Satisfy it--Certain Conditions Justify the Adoption of Artificial Feeding from the Beginning--Mothers' Mistakes in the Preparation of Artificial Food--Feeding During the Second Year--Sample Meals for a Child Three Years of Age--The Diet of Older Children--Meats, Vegetables, Cereals, Bread, Desserts--Fruits. 

HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret of success in raisinga baby efficiently on artificial food is to be cleanly and to be exact. The bottles and the nipples must be scrupulously clean; the hands of themother must be clean; the water used must be boiled and each ingredientmust be measured exactly. 

First dissolve the sugar in the boiled water, which must be the exactquantity; then remove the top-milk and measure the exact amount wantedin the graduate, pour into the jar, add the water and sugar mixture, andfinally the lime water. 

It is always desirable to make the entire quantity for the day at onetime. After the total quantity has been mixed in the jar, fill eachbottle with the amount for each feeding, put in a cotton stopper, andplace the bottles in the ice box. 

In measuring the sugar, it should be remembered that two scantdipperfuls equal one ounce by weight of the sugar. 

When each individual bottle is to be filled, do it with the aid of theglass funnel which has been previously sterilized. 

STERILIZING THE FOOD FOR THE DAY'S FEEDING. --The simplest method is toplace the two-quart jar containing the milk mixture for the nexttwenty-four hours' feeding upon a saucer in the bottom of an open pan, and then to pour enough tepid water into the pan (outside of the jar)until it will come up as high as the milk level. The water in the pan isthen brought slowly to the boiling point. The pan is then moved to theback of the stove and left for half an hour. The jar is then removed andrapidly cooled by allowing cool water to flow over the outside; theindividual bottles filled and put in the ice box. 

It is always wise to taste the milk before making up the day's feedingto be sure it is not sour. The milk from a herd of good cows is alwaysbetter than the milk from one cow no matter how good that one cow maybe. 

When about to feed the baby, the bottle is taken out of the ice box andheated to the desired temperature in a water bath. The temperature ofthe milk can be tested by allowing a few drops to fall on the wrist; itshould feel warm, not hot; it should not be tasted by putting the bottleto the mouth of the nurse, or mother, as it may become infected by doingso. A flannel cover, or bag, should be made to fit the bottle and itshould be put on while the baby is nursing so that the milk may retainits heat. The baby must not be disturbed while nursing, nor should he bejounced or carried around after nursing. These habits cause vomiting andindigestion. He should be put in his crib. 

WHEN TO INCREASE THE QUALITY OR QUANTITY OF FOOD. --Children of the sameage may have different digestive abilities. A strong, robust child maybe permitted to take a richer quality of milk than a weak, puny infantof the same age. If the quality or quantity of each feeding is too weakor small for the baby he will be dissatisfied and he will cry after thefeeding. In such cases, if the bowel discharges are natural and yellowwithout curds or white specks, and if he is not gaining sufficiently inweight, the next stronger formula may be tried. If it is decided to puthim on the stronger mixture, it is wise to cut the quantity down for aday or two in order to test out his digestive ability. If the stoolsremain good after three days, the quantity may be slowly increased untilthe amount in the recipe is allowed. It is a much more serious risk tooverfeed the baby than to underfeed him. If too large a quantity isgiven, he may vomit it at once, or he may develop colic with intestinalindigestion. Such babies lose weight, become fretful and irritable, eventhough the appetite may remain good. If too strong a quality is given hemay vomit sour, buttery-smelling milk, or have colic, and pass curds inthe stool. If this happens it may be necessary to go back to a weakformula and work up from that standard. This is always a tedious andanxious experience and may lay the foundation for digestive disturbancesfor a long time. Don't be too anxious to increase the quality, orquantity, of your baby's food. It is much better to go slow and have awell baby, than to try to force matters and get into all kinds oftrouble. No science calls for more elementary common sense, than thescience of infant therapy. 

Digestive disturbances incident to this period are fully explained inthe chapter on Diseases of Children. 

FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

About the twelfth month the baby should receive plain milk mixturesinstead of the top-milk heretofore used in making up the food. At firstthe milk may be plain milk from an ordinary bottle shaken up. Of this hemay take five ounces, to which may be added three ounces of barleywater. The barley water may be gradually withdrawn, an ounce at a time, replacing this amount with milk, until the child is taking eight ouncesof milk and two ounces of barley water. Later plain mixed milk will besuitable for a child about the fourteenth month. 

Barley water may be added to the milk at any time after the third monthin place of the plain boiled water in the preceding formulas. It isadvisable to do this if there is any trouble with digestion, or if thereare curds in the stools. Some children take more kindly to barley waterthan plain water at a very early age. 

BEEF JUICE. --The juice squeezed from broiled steak may be given a childat about the eighth or ninth month, or, in cases of anemia, earlier thanthis. It is given before the milk feeding, diluted with an equal amountof water. At first a teaspoonful of the extracted juice should be givenwith the same quantity of water; increase every four days until at theend of two or three weeks two tablespoonfuls are given. 

WHITE OF EGG. --Place an egg in boiling water and allow the water to coolwith an egg in it. In ten minutes the white of the egg will becoagulated and ready for use. It may be used in place of the beef juiceif the latter does not agree and may be begun at the sixth month andgiven once daily. One-half of the white of the egg should be tried, thenat the end of a week, if it agrees with the child, the whole white ofone egg may be given. 

ORANGE JUICE. --This juice has a good effect on the bowels and may begiven even to very young children who are disposed to be constipated. Itis also of benefit in counteracting the effect of boiled milk. The juiceshould be extracted from fresh oranges and strained. One teaspoonful maybe given at first one hour before a feeding. The amount may be increaseduntil four teaspoonfuls, or one tablespoonful, are given daily. 

PEPTONIZED MILK. --The object of peptonization of milk is partly orwholly to digest the casein, or curd, of the milk before feeding. 

Fairchild's Peptonizing Powder is used for this purpose. The powder isput up in tubes, and instructions are furnished in each box as to itsuse. 

There are two methods of using the powders:

THE HOT OR IMMEDIATE PROCESS. --Fifteen minutes before feeding add fromone-eighth to one-quarter of the contents of a tube to the milk mixturein the nursing bottle ready for use. The bottle is then put in water ata temperature of from 110° to 120° F. , and allowed to remain in thewater for fifteen minutes. The amount of the powder used and thetemperature of the water depend upon the amount of milk in the nursingbottle. 

THE COLD PROCESS. --Four ounces of cold water are put into a clean quartbottle and the powder from one of the tubes. Shake the mixturethoroughly until the powder is dissolved. Add a pint of cold fresh milk, shake the bottle again and place directly on ice. When any of this milkis used the bottle should be again shaken and put immediately back onice. 

If necessary this process may be modified so that partially orcompletely peptonized milk may be made. 

PARTIALLY PEPTONIZED MILK. --Put four ounces of water and a whole tube ofpowder into a clean pan and stir well; add a pint of cold milk and heatto the boiling point, stirring the mixture all the time. There should beenough heat to bring the milk to the boiling point in ten minutes. Allowthe mixture to cool somewhat and strain into a clean jar, cork tightlyand keep in a cool place. Shake the jar before and after using any ofthe contents. 

If partially peptonized milk is properly prepared it should not becomebitter. 

COMPLETELY PEPTONIZED MILK. --Put four ounces of cold water and thepowder contained in one of the tubes into a clean quart bottle and shakethoroughly. Add a pint of cold fresh milk and shake again; then placethe bottle in a pan of warm water about 115° F. , or not too hot to placethe hand in comfortably. Keep the bottle in the water bath for thirtyminutes; then place the bottle directly on ice. 

USES OF PEPTONIZED MILK. --Partially peptonized milk is useful in younginfants who have difficulty in digesting the curd of milk. Completelypeptonized milk is frequently used during attacks of indigestion. It isused also to tide a delicate infant over a period when for some reasonthe digestive apparatus refuses to digest and assimilate even dilutemixtures. It is of value also in acute or chronic illness when the childhas to be fed through a tube. When it is necessary to feed per rectumpeptonized foods are often selected in preference to others. 

OBJECTIONS TO PEPTONIZED MILK. --Complete peptonization of milk rendersthe milk bitter. For this reason many children will not take it. Veryyoung children whose sense of taste is not developed may be induced totake it after a few days. It is not wise to continue its use longbecause the function of the stomach will become accustomed to the use ofpredigested food and refuse to work when called upon. If it is used fora number of weeks it is wise to stop it gradually in order to permit thestomach to resume its function in a normal way. 

WHAT A MOTHER SHOULD KNOW ABOUT BABY'S FEEDING BOTTLE AND NIPPLE. --Inthe first place, always buy round bottles, --round everywhere, inside andout, --there should be no corners anywhere. The reason for this is, thatbottles that are round everywhere, are easily cleaned, and can bethoroughly cleaned, and having no corners they do not lend themselves tocollecting dirt and bacteria. When these bottles are first bought theyshould be boiled. After each feeding they should be thoroughly washedwith soap or washing powder. A long-handled bottle brush should be usedto help clean the bottle. After the bottle has been thoroughly rinsed anumber of times with hot water, it should be set aside filled with warmwater into which one teaspoonful of bicarbonate of soda has been put. Before filling them with the freshly prepared food each morning thebottles should be boiled. Every mother with a bottle-fed baby should buya dozen bottles, all of the same kind and size to begin with. This is agreat advantage for a number of important reasons, two or three of whichI will mention:

1st. Having enough bottles means that each bottle will be used once onlyduring the twenty-four hours; there is less chance therefore of a bottlebeing cleaned carelessly. 

2nd. Having a fresh bottle for each feeding permits all of the food fortwenty-four hours being made at one time. This ensures uniformity ofquality of each feeding. 

3rd. By cleaning all the bottles at one time (previous to filling) it ismore apt to be done thoroughly; and by making all the food for a day atone time it is more apt to be correct than if each feeding was madeseparately. 

The baby's nipple should be made of plain black rubber. It should not betoo thick because it is necessary to turn it inside out in order toclean it thoroughly. The hole in the nipple should not be too large--ifthe child can empty the bottle in less time than fifteen minutes thehole is too large. If the milk drops out but does not run it is aboutright. Don't buy nipples too long or too large. A long nipple tends togag the child and cause vomiting. A large nipple prevents the child fromsucking properly and usually allows the food to be taken too quickly andwith air, which causes colic and indigestion. It is well to have alwayshalf a dozen nipples of the right kind on hand. When new, nipples shouldbe boiled before using. After each feeding the nipple should be washedin borax and water on both sides, then it should be put in a dishcontaining fresh, cold, borax water and left there until again required. A large portion of the success of raising healthy, bottle-fed babies isin being everlastingly clean in the details of caring for the bottlesand nipples which are in daily use. 

SHOULD A MOTHER PUT HER BABY ON ARTIFICIAL FOOD IF HER SUPPLY OF MILK, DURING THE FIRST TWO WEEKS, IS NOT QUITE ENOUGH TO SATISFY IT?--This isa question that cannot be answered by a simple yes or no. A great dealdepends upon circumstances, and these circumstances must be weighed andcounterweighed before an answer is given. It is a serious matter, in ourjudgment it is a criminal proceeding for a physician to advise the useof an artificial food without exhausting every aid and means to preserveand increase the mother's milk. This is a subject in need of earnestmissionaries in all walks of life, and it should be the duty of everywoman's club and gathering to voice the conviction of the highestwomanhood by advocating the use of mother's milk with every child born. A woman who can and will not nurse her own child is scarcely deservingof the name of mother. 

It does not seem quite human to deprive a baby of the milk whichrightfully belongs to it; yet in certain walks of life this is not anuncommon procedure. On the other hand the percentage of women able tonurse their children is decreasing. This is especially true as appliedto cities, though it is also true, in a less degree, in the ruraldistricts. One eminent authority states that less than twenty-five percent. Of the well-to-do mothers, who have earnestly and intelligentlyattempted to nurse their babies, succeed in doing so for a period longerthan three months. This authority also says: "An intellectual citymother who is able to nurse her child successfully for the entire firstyear is almost a phenomenon. " Women nowadays have so many diversifiedinterests, that the primal duty of maternal nursing is not at all afashionable function. If, however, the mother is willing, and hasconscientiously tried to nurse her baby, and after seven or eight daysit is found that she has not enough milk to satisfy it, and if thequality seems to be good, some expedient should be immediately adoptedto tide the condition over until the mother resumes her customaryhousehold routine. The safest expedient under these circumstances is toalternate the feedings; one feeding from both breasts of the mother, andthe next an artificial food. Some arrangement of this kind is the justand the safest way, because a very large percentage of mothers sufferfrom inactivity while lying in bed after a confinement. This inactivityexpresses itself in a failure of some of the organs to perform theirduty properly. This may affect the quantity, and sometimes the quality, of the milk, but it is, as a rule, quickly rectified as soon as themother is up and active. 

If, however, the milk is still found to be inadequate after she is upand has resumed her usual habits, and if her health is good, and she iseating well, it is distinctly best to put the child exclusively on anartificial diet. 

CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING FROM THEBEGINNING

1st. Woman suffering with any wasting disease such a cancer ortuberculosis. (One of these days, and very soon we hope, it will belegally impossible for a tubercular or cancerous patient to become amother. )

2nd. When a mother is the victim of any of the serious childbedcomplications such as convulsions, kidney disease, extensive loss ofblood or blood poisoning, or runs a high temperature because of somedisease occurring at the same time as the confinement, as, for example, appendicitis, scarlet fever, typhoid fever, etc. 

3rd. Epilepsy, chorea, insanity, are also conditions which renderartificial feeding necessary. 

It is much wiser immediately to put the child on artificial feeding ifthere is a justifiable reason for it than to experiment, because anyexperiment at this time is almost certain not to be in favor of thechild. Artificial feeding is a comparatively easy and successfulproblem, provided it is begun with healthy digestive organs. If you keepthe child at the breast of a mother whose milk is inadequate in quantityor quality, or both, for two or three days, and then begin artificialfeeding, the child's stomach is already unable to perform its duty, andyou have to treat it with the greatest degree of care and attention, andprobably begin with a weak food, until you regain the lost ground. 

MOTHERS' MISTAKES IN THE PREPARATION OF ARTIFICIAL FOOD. --Anotherinteresting condition which is quite common, is the tendency on the partof the mother to fail to follow instructions correctly, --even thoughwritten or printed, --regarding the preparation of the baby's food. Whenthe baby is not thriving and gaining steadily in weight, or is frettyand cries a good deal, and does not rest and sleep peacefully, something, of course, is wrong. If, after a careful physical examinationof the child, nothing is found to justify these symptoms, a physicianinvariably finds, if he questions the mother closely, that she hasmistaken the instructions and is preparing the food wrongly. 

Infinite care in every little detail is the price of success in raisingbabies as well as in every other field of human endeavor. Revisecarefully your method of preparing baby's food if there is any troublesuch as is described above. Despite your absolute assurance that you aremaking no mistake, do not be surprised to find that you are notfollowing directions to the letter, and because of this unintentionalmistake, your negligence is responsible for your baby's condition. Goover the instructions with your husband, and let him follow your methodof preparation, as you repeat it. He may detect the mistake if anyexists, --two heads are always better than one. So important is thismatter that the following two actual cases will demonstrate how easy itis to make a mistake, despite the absolute confidence of the mother, ineach case, that she was following the printed directions correctly:

I was called to see a baby whose mother informed me that it was having agreat deal of trouble. It was apparently not thriving; its bowels werebad; it constantly cried, and seemed to be suffering from colic andindigestion. The mother stated that it lay with its legs constantlydrawn up and passed enormous quantities of gas. The baby certainlylooked sick. It had been a small baby at birth; and at three months itweighed only six pounds. After a careful examination, I could findnothing in the physical condition of the child itself, whichsatisfactorily explained the condition, and had made up my mind that thefood upon which it was being exclusively fed, and upon which it had beenfed since birth, was not agreeing with it. Before recommending a changeof food, I asked the mother to state in detail just how she prepared it. 

The directions printed on the can in which the food was bought calledfor so many ounces of a certain quality of "top milk. " She thought thismeant simply so many ounces off the top of a bottle of milk, which, ofcourse, meant that she was feeding her baby exclusively a very richcream and absolutely no milk. The result was that the baby--small andweak to begin with--could not digest this rich mixture, so it graduallylost vitality, as the mother kept increasing the strength of the food, according to the age, as directed by the instructions, until it wascompletely knocked out. I pointed out her mistake and suggested a changein her methods; she was instructed to use the formula for a child of twomonths, instead of the one for three months, as she was doing. The childimmediately began to pick up and in the course of six weeks was entirelycured, and had gained considerably in weight. This mother was acareful, clean, painstaking, attentive nurse, and it was a long timebefore she forgave herself for the mistake. The mistake here was alittle matter, but the results were big and convincing. 

The second case was that of a child of about the same age, but in thisinstance it had been a robust, healthy child when born, and of normalweight and size. The mother nursed it for about one month, when her milkfailed, and it was put upon a well-known, patent barley preparation. Thefood seemed to agree with it for a time, but, as the mother explained, the child soon seemed to be dissatisfied at each feeding, --it gave herthe impression that it was not getting enough to eat, so she increasedthe quantity. Despite this increase of food, it was apparent that thebaby was getting weaker, and more and more irritable, and sleepless, until there was no rest night or day for the mother or baby. About thistime the child began to "swell up" as if dropsical; it lost its healthycolor and looked as if made of wax. It was very evident that the childwas being starved, yet this scarcely seemed probable when the actualquantity of food consumed was considered. The directions on the can ofthis food, called for a certain amount of the barley powder to be mixedwith boiled water; and in an additional paragraph it was directed to mixthis with a certain amount of milk. When I requested the mother to statehow she prepared the food, I was astonished to learn that she hadevidently never read the second paragraph of the directions. She wasfeeding her baby on barley powder and boiled water, --an excellentstarvation diet. When her attention was called to the grave carelessnessshe had been guilty of, she was the most contrite mother I ever knew. Assoon as the milk was added to the food the baby immediately began tothrive was very soon a robust, healthy infant. 

Of course these were errors of bad judgment and gross negligence ofwhich few mothers would be guilty, but these types of mistakes come tothe attention of physicians frequently, and emphasize the need ofconstant vigilance in every detail in the management of babies if wewish to achieve success. 

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at thefollowing hours, 6 and 10 A. M. , 2, 6, and 10 P. M. 

Early in the second year the child should be taught to drink from a cup. 

A proper diet for a child of twelve months, of average development, would be as follows:

6 A. M. Milk and barley water, or milk and oat gruel, in the proportionof seven ounces of milk to three ounces of the diluent. 

9 A. M. The juice of an orange (strained). 

10 A. M. The same as at 6 A. M. 

2 P. M. Chicken broth with rice or stale bread crumbs, six ounces; or alight boiled egg mixed with stale bread crumbs; or beef juice, threeounces. Milk and gruel same as at 6 A. M. , but four ounces only. 

6 P. M. Two tablespoonfuls of cereal jelly in eight ounces of milk; apiece of stale bread and butter. (The jelly is made by cooking thecereal for three hours the day before it is wanted; it should then bestrained through a colander; oatmeal, barley, or wheat may be used. )

10 P. M. Same as at 6 A. M. 

About the fifteenth month the cereals may be given much thicker and fedwith a spoon. The child can at this time take a number of various fruitjuices. Orange juice is the best. Carefully strained juice of ripepeaches, strawberries, raspberries, may be given in reasonable amounts, one or two tablespoonfuls, once daily. Custard, cornstarch, plain ricepudding, junket, wheatena, cornmeal, hominy, oatmeal, zwieback, branbiscuit, each with butter, may be added in reasonable quantities betweenthe eighteenth and twenty-fourth months. When cereals are given theyshould be thoroughly cooked, usually for three hours, and strained. Whenapple sauce is given to a child about the second year it should containvery little sugar and baked apples should be fed without cream. Watermust be given to the child between meals especially during the summer. It should be boiled and cooled kept in a cool place. The followingschedule for a child about the third year constitutes a good averagediet for a healthy child:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber's Note: The ages were difficult to read and may not all becorrect. ]

Age in Months Weight Height Circumference of head Circumference of chest Circumference of abdomen Lat. Diameter of chest Chest front to back Length of arm Length of leg------------------------------------------------------------------------------- lbs. In. In. In. In. In. In. In. In. 6 17 27 17-1/2 17-1/2 17-1/2 5 4-1/2 10 10 9 19 28 18 18 18 5 4-1/2 11 1112 20 29 18-1/2 18-1/2 18-1/2 5 4-3/4 12 12-1/216 23 30 18-1/2 18-1/2 18-1/2 5-1/2 5 12-1/2 13-1/221 24 31 18-1/2 19-1/2 19-1/4 6 5 14 1524 25 32 19 20 19-1/2 6 5 14-1/2 15-1/228 27 33-1/2 19 20 19-1/2 6 5 14-3/4 15-3/432 29 35 19-1/2 20-1/2 19-1/2 6-1/4 5-1/2 14-3/4 15-3/436 32 36-1/2 20 21 20 6-1/4 5-1/2 15 16-1/2===============================================================================

MENTAL DEVELOPMENT

 Attention, facial expression, irritability and disposition should be considered. 

 Six Months

 Child sits unsupported for a few minutes. .. . Balances head. .. . Eye follows a bright object. .. . Looks in direction of an unexpected sound. .. . Child seizes an object and holds it. .. . 

 Twelve Months

 Stands and walks with support. .. . Makes a few sounds, such as mam-mam, da-da, co-oo. .. . Plays with toys. .. . Attempts to use paper and pencil. .. . Shows interest in pictures. .. . Clings to mother. .. . 

 Eighteen Months

 Child walks and runs alone. .. . Says a few words, such as Mama, Papa, Baby. .. . Points to common objects in pictures. .. . Imitates a few simple movements, such as placing hands on head or clapping hands. .. . 

 Two Years

 Runs. .. . Repeats two or three words. .. . Knows features. .. . Obeys simple commands, such as "Throw me the ball". .. . Imitates movements. .. . 

 Two and One-Half Years

 Talks in short sentences. .. . Knows names of members of the family. .. . Roughly copies a circle. .. . Recognizes self in mirror. .. . Imitates more complex movements. .. . 

 Three Years

 Talks distinctly. .. . Repeats sentences of six simple words. .. . Repeats up to two numerals--meaning repeats first one numeral and then two numerals. .. . Enumerates objects in a complex picture and attempts to describe it. .. . 

 Four Years

 Knows its sex. .. . Names familiar objects, such as key, knife, etc. .. .. Repeats three numerals. .. . Compares two sticks (can select the longer). .. . Distinguishes the longer of two lines. .. . 

 Five Years

 Compares weights and lengths. .. . Copies a square. .. . Counts four pennies. .. . Describes a picture. .. . 

Breakfast:--(7 to 8 o'clock) Oatmeal, hominy or cracked wheat (cookedthree hours), served with milk, a little salt but very little sugar. Asoft egg, boiled, poached, or coddled. Stale bread and butter. One glassof warm milk. At 10 o'clock, the juice of one orange. 

Dinner:--(12 o'clock) Strained soup, four ounces. Chop, roast beef, steak, chicken, small quantity of any one. Baked potato and cooked rice, or spaghetti. A selection of green vegetables may be made from asparagustips, string beans, peas, spinach, cauliflower, carrots; they should becooked until very soft, and mashed or put through a sieve. For dessert, plain rice pudding or bread pudding, stewed prunes, baked or stewedapple, junket, custard or cornstarch. A glass of milk or water. 

Supper:--(6 o'clock) Cereal; farina, arrowroot, cream of wheat, wheatena(each cooked two hours), with salt but no sugar. Give two or threetablespoonfuls. Drink of milk with stale bread and butter. Twice a week, a little plain ice cream, or junket, custard or cornstarch. 

Three meals a day at this time are better than more frequent feedings. The child has a better appetite and much better digestion. It may befound necessary to give delicate children a luncheon at 3 o'clock. Aglass of milk and a Graham wafer, or a cup of broth and a zwieback, willanswer the purpose. Children recovering from serious illness will needmore frequent nourishment. Up to the sixth year the diet may conform tothe above schedule, increasing the individual quantities ascircumstances may warrant. 

THE DIET OF OLDER CHILDREN (FROM SIX TO TEN YEARS)

After the sixth year the diet will conform to the adult diet, withcertain exceptions. The important exceptions are as follows: All meatsare to be excluded except roast beef, steak, lamb chops, roast lamb, mutton chop; all meats should be cooked rare and either scraped orfinely divided. They should be broiled or roasted, never fried, andnever given oftener than once daily, and then only in small quantity. Pies, rich puddings, pastries of all kinds, gravies, sauces, all highlyseasoned dishes; wine, beer, coffee, tea, should never be given tochildren. Ham, bacon, sausage, pork, liver, kidney, game, and all driedand salted meats, codfish, mackerel and halibut, are particularly bad. 

The following articles are permissible: Broiled chicken, shad, bass. The"platter gravy" from a roast is very nourishing if given in smallamounts. Milk should continue to form an important part of the dietaryup to the tenth year. It should be clean and fresh but not too rich. Sometimes it is found advisable to dilute the milk with water that hasbeen boiled and cooled. Some children will take it if a pinch of salt orbicarbonate of soda is put into it, and they will digest it easier andbetter. They should never be allowed to take more than one quart dailyand frequently less will do more good. Cream is not good for children ofthis age. Eggs are valuable; they should never be given fried or in theform of omelets, they are best given boiled, poached or coddled and onlyslightly cooked. It is never necessary to give more than one egg at ameal. There are children with whom eggs do not agree; these children aredisposed to "biliousness. "

VEGETABLES. --Certain vegetables are objectionable at this age: Rawcelery, radishes, raw onions, cucumbers, tomatoes, lettuce, corn, limabeans, cabbage, egg plant. The following are good: White potatoes (neverfried), spinach, peas, asparagus tips, string beans, celery, youngbeets, carrots, squash, turnips, boiled onions and cauliflower. It isimportant to remember that all vegetables should be thoroughly cooked;they cannot be cooked too much. After boiling for some time the watershould be drained off and fresh water used to complete cooking. Vegetables should be fed in small quantities. From the third to thetenth year they form an important and essential part of the diet of allchildren. After the tenth year they can be eaten as served to adults, and other vegetables may then be added. As a rule salads of all kindsshould be omitted until after the twelfth year. 

CEREALS. --Children should not be allowed to eat too much cereal at onemeal, --never more than one small saucerful. Cereals should be properlycooked. It is not safe to adhere strictly to the directions on thepackage of any cereal. As a rule they require much longer cooking. Theyare best cooked in a double boiler. They may be served with milk, salt, and not more than one teaspoonful of sugar. 

BREAD. --Fresh bread is never allowable. Graham wafers, oatmeal crackers, Huntley and Palmer breakfast biscuits, bran muffins, rye bread, cornbread, stale rolls, are all suitable to growing children. 

Hot bread, fresh rolls, buckwheat or griddle cakes, all sweet cakes, areobjectionable. 

DESSERTS. --The only permissible desserts for this age are junket, custards, plain rice, or sago; or bread pudding. The only safe rule tofollow so far as "sweet things" are concerned, is not to give them atall. This applies to candy, ice cream, pies, pastries, jam, syrups, preserved fruits, nuts and dried fruits. The parent who indulges a childto "a taste, " is guilty of a bad habit, and it can only lead to trouble. 

FRUITS. --These should always be fresh and selected with care. Fruit isthe most important article of diet to a child of this age. Up to fiveyears it is safest to use only cooked fruits and fresh fruit juices: ofthese the juice from sweet oranges, grape fruit, peaches, strawberries, and raspberries may be given. Stewed or baked apples, apple sauce, figs, prunes, peaches, apricots, pears are excellent because of their effecton the bowels. When the bowels are loose, and especially in hot weather, great care must be taken when fruit of any kind is used. The pulp of anyfruit should never be used; cherries, bananas, pineapples, and berriesare not to be given to children. Milk should never be allowed at thesame meal when sour fruit is served. 

WHAT MOTHERS SHOULD KNOW

CHAPTER XXI

 "Life has taught me that it is the women of a country in whose hands its destiny reposes. No cause that is not great enough to command their devotion and pure enough to deserve their sympathy can ever wholly triumph. "

 JOSEPH H. CHOATE. 

THE EDUCATION OF THE MOTHER

 What Mothers Should Know About the Care of Children During Illness--A Sick Child Should be in Bed--The Diet of the Sick Child--A Child is the Most Helpless Living Thing--The Delicate Child--How to Feed the Delicate Child--How to Bathe the Delicate Child--Airing the Delicate Child--Habits of the Delicate Child--Indiscriminate Feeding--Poor Appetite--Loss of Appetite--Treatment of Loss of Appetite--Overeating in Infancy--What Correct Eating Means--Bran as a Food--Breakfast for a Child at School--Lunch for a Child at School--Bran Muffins for School Children--Bran Muffins in Constipation--Hysterical Children--What a Mother Should Know About Cathartics and How to Give a Dose of Castor Oil--Castor Oil--Calomel--Citrate of Magnesium--When to Use Castor Oil--When to Use Calomel--Vaccination--Time for Vaccination--Methods of Vaccination. --Symptoms of Successful Vaccination. 

WHAT MOTHERS SHOULD KNOW ABOUT THE CARE OF CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance. Whenillness comes it should be our duty to maintain the vitality andresistance to the highest degree. We should, therefore, irrespective ofthe nature of the illness, surround the child with all the conditionsthat will minister to the preservation of whatever strength and vitalitythe child has. Experience has taught us that there are certainrequirements that should be carried out in the general management ofsick children. 

A SICK CHILD SHOULD BE IN BED. --In the first place a sick child shouldbe in bed. There is no exception to this rule. It is impossible to dojustice to a child if you allow him to dissipate his strength andexhaust himself moving from place to place while he is sick. A mothershould not forget that it is she who must exercise wisdom and decidewhat is best for her child. The judgment of a sick person is not to berelied upon, and it would be wrong to submit to the whims and fancies ofan ailing child, if these are known to be medically disadvantageous toits best interests. 

Quiet surroundings are essential in all acute illnesses. The nurseshould be congenial to the child. If the patient demands the presence ofthe mother she should remain, but she should not try to entertain him orinterfere with the nurse. 

The clothing of the patient should be the ordinary night-dress which isworn in health. In no disease is any special kind, or quantity ofclothing required. 

The temperature of the room should be 68° F. Thermometers are cheap andan exact knowledge of the degree of heat in a sickroom is an essentialrequisite. Nothing drains the vitality during sickness quicker thanvarying degrees of heat and cold. It uses up nerve force and energy andrenders the patient irritable and difficult to manage. 

The strictest attention should be paid to the ventilation of thesickroom. We are learning more and more that fresh air is essential tothe speedy cure of all diseases and to the general well-being of thepatient. A direct, continuous communication between the sickroom andout-of-doors is imperative. It is a splendid measure to use two roomsfor the patient and to change him twice daily, and to air thoroughly theunused room. 

The sickroom itself should be large and in a quiet part of the house. Insummer time the windows may be wide open, in winter months the degree ofventilation can be regulated by the thermometer. 

Many mothers fail to appreciate that drinking water is an importantrequisite in all ailments of childhood, should be given freely, but itshould be known to be absolutely pure. The same rule applies to spongingthe patient. It must be done every day; sometimes it is necessary to doit more often, but if so it will be so directed by the attendingphysician. 

THE DIET OF THE SICK CHILD. --Prescribing the diet of the sick child isan important undertaking. It should be remembered that during sicknessthe digestive capacity is reduced; consequently the food must belessened in quantity and in strength. If the patient is an infant atbreast the best way to accomplish our purpose is to give before eachfeeding two ounces of boiled water, cooled to the temperature of thebody. This dilutes the mother's milk and renders it more easy ofdigestion. If bottle-fed, it is accomplished by replacing one-half ofthe milk with water. In certain diseases milk is totally withdrawn, butthese cases will be noted when discussing the treatment of the variousdiseases. With older children, we give milk diluted with water, orgruels, soups, or cereals, as conditions warrant. 

Needless interference with the patient must not be indulged in. Sleepand quiet are essential features of nature's reparative process. It isseldom necessary to disturb a sick child for the giving of food ormedicine oftener than every second or third hour. Medicine may always begiven with food. Meddlesome interference, talkative attendants, orexcessive noise may exhaust a child and may prolong and render dangerousor fatal a condition that would otherwise go on to recovery. 

One satisfactory movement of the bowel daily is essential to the comfortand progress of a sick person. If this does not take place naturally, itshould be obtained by an enema. 

At the beginning of any illness in childhood it is a safe procedure togive a dose of a suitable cathartic as soon as it is discovered that thechild is sick. 

A CHILD IS THE MOST HELPLESS LIVING THING. --Nature endows the young ofevery species--except those of the human family--with certain instincts, which, when developed, govern and control their lives absolutely. Thetechnical definition of an instinct is an exceedingly complicated wordpicture. It is only essential to an intelligent understanding of oursubject that the reader should have a definite idea of the differencebetween an act that is the result of a process of reasoning and an actthat is the result of an instinct. If a man finds his way out of hisburning home he will stay out as long as there is any danger. Thecrudest kind of reasoning will teach this lesson. A horse, on the otherhand--and incidentally it may be noted that a horse is regarded as anintelligent animal--if led out of a burning stable and let loose, willimmediately reënter and be burned to death. The horse is the victim ofinstinct; he obeys the unconquerable instinct to return to his stall--hecannot reason as the man can that a home that is burning is not a properplace to seek safety in. When an ostrich fears danger he buries his headin the sand, under the impression that if his head is out of sight he issafe from danger. This is his instinctive plan of procedure in thepresence of danger, and it is the plan of every ostrich, everywhere, always. A little reasoning would show them how foolish the idea is--butthey cannot reason. That is the province of man alone. If the firstmember of a flock of sheep jumps over a fence to get into the nextfield, every member of the flock will follow, each one jumping thefence, though there may be an open gate between the two fields a fewyards away. Instinct dictates the plan to the sheep as they havereceived instructions from their ancestors always to "follow the lead. "This is their hereditary legacy and they cannot disobey it. 

Animals are born with instincts which need only circumstances to bringthem out. Now a baby is not born with instincts of this character, --ithas not even the instinct to help itself; it cannot find the breaststhat were made for it; it is more helpless than the baby cat or dog orworm. Therefore a baby in whose brain the potential faculty of reason isslumbering must of necessity begin its career wholly dependent upon thesupervision and love of its mother, until such time as it may be capableof reasoning for itself. Motherhood is therefore the supreme privilegeof womanhood. It cannot be superseded, hence the fundamental factor inany system of race culture, or in any system of infant mortality, musttend to raise the quality and the intelligence of motherhood as a basicnecessity. Motherhood at the present time, though the most important andsacred profession in the world, is almost exclusively carried on byunskilled labor. The maternal instinct is deeply rooted and universal;its absence must be regarded as an abnormality, or as a product ofmisdirected education. The requisites for the mothers of the futureshould be absolute physical health and love of children. 

If nature endowed a baby with instincts there would be no need forreason or education. Education cannot teach a cat how to nurse or wash akitten any better than it does, --its instinct is good enough. The motherof a human baby, however, is not born with the instinct which enablesher to care for her baby equally as well as the cat cares for herkitten. She must be educated or taught to care for it. She can then carefor it better than the cat cares for the kitten, and she can be taughtto bake, to sew, to read; to play on the piano, which a cat cannot betaught. So while a baby may be the most helpless living thing at onestage of its career it has in it--in the faculty of reasoning--theability to become the Lord of all the Earth and of all the animalstherein. To limit the environment of a child by imposing instincts uponit, would be to limit its inherent freedom. To be obliged to obey aprescribed instinctive law would rob mankind of his creative orreasoning faculty, and that would be to lower him to the level of thebrute creation. Reason is of no use if our acts are already determinedfor us. There are therefore good reasons why the human baby should be, at the moment of its birth, the most helpless living thing; and as aconsequence it is imperative, if the eugenic ideal is worthy ofattainment, that every baby should have the benefit of trained andefficient care and education. 

THE DELICATE CHILD

There is a certain standard by which we measure the physical and mentaldevelopment of children. This standard we regard as the evidence ofnormal development. Some children exceed these requirements; they arebigger and stronger at a given age than the average child at the sameage. There are other children who cannot be called sick, but who arephysically and mentally inferior to the average standard, whom wedesignate as "delicate. " These children are not as big, or as strong, oras heavy, as other children of the same age. They are born with areduced vitality, or through mismanagement in early infancy they haveacquired a subnormal standard of development. Children born of parentswho are not of standard vitality are predisposed to be delicate. If theparents are of average development, and the delicacy of the child isacquired by mismanagement, the proper dietetic and hygienic managementwill, as a rule, promptly result in a satisfactory restoration to normalhealth. 

TREATMENT. --When a mother awakes to the knowledge that her child isdelicate; when she understands that her child's vitality is not what itshould be, and when she resolves to "do something" in the interest ofher child, she is on the right road, and we hope to encourage her in thegood intention. We would however tell her that her effort must bethorough, and that she must be patient and persevering. If she does notfalter in well doing she will succeed beyond her expectation, and thesatisfaction she will experience in noting the evidences of returninghealth and strength in the appearance and conduct of her child, shouldbe ample recompense for the effort made and the time bestowed. 

She must begin with a definite knowledge of just what she intends doing;she must know, however, what must be done and she must begin at thebeginning and build from a sure foundation. It is therefore absolutelyessential to ascertain if there is any actual disease underlying thereduced vitality which is responsible for the delicacy of the child;this necessitates a thorough examination by a competent physician. Ifyou are assured there is no disease present, no tuberculosis, nosyphilis, no malaria, and that debilitating conditions, such asadenoids, sexual abnormalities, the results of self-abuse, skin disease, do not exist, then certain fixed rules can be laid down, and definiteprinciples followed in the daily management. 

WEIGHT, AS A STANDARD OF DEVELOPMENT. --It has been stated elsewhere inthis book that one of the safest guides to follow, as to whether a childis thriving, is its weight. This can be relied upon as a general rule. Achild should therefore be weighed regularly every week. If it is notgaining an average of four ounces weekly it is not thriving up tostandard. When the average is below four ounces there is something wrongwith the quality or quantity of the food. 

HOW TO FEED THE DELICATE CHILD. --If the child is breast-fed and theweight standard, as evidenced by the weekly averages, is persistentlybelow normal, we must find a substitute for the mother's milk. If thechild is bottle-fed and it is demonstrated that it is impossible tomaintain normal development on cow's milk, a wet-nurse should beobtained. After the child is weaned, or put upon a more liberal diet, milk should continue to be the chief article of diet. From the first tothe third year a child should take one quart of milk daily in additionto the other food. There are some children, however, who seeminglycannot take milk without getting indigestion; they should be put onskimmed milk, to which may be added a small quantity of sugar to make upfor the loss of fat. Mothers must be certain that too much milk is notgiven, or the desire for other necessary food will diminish. 

After the first year it is a very good plan to give one teaspoonful ofscraped beef daily. If this is well borne, two may be given and laterthree. It can be given immediately before the regular feeding of cerealand milk. From the twelfth to the sixteenth month eggs may be given: atfirst one-half, and later a whole egg mixed with bread crumbs. Variousvegetables should also be given cooked in the form of a purée. If at anytime the child should refuse the food, or act as if it had no appetite, leave the milk out of the diet; this may then restore the appetite andit will take the other food freely; the milk can be resumed later. 

As the child grows older, the distaste for milk may grow, or he may beone of those children with whom milk really does not agree; in eitherevent, do not hesitate to leave it out of the child's dietary. Thesechildren should be encouraged to eat plenty of good butter on theirbread and crackers. Butter will not only agree with them, but it willsupply any fat deficiency in the general diet. The diet may now consistof milk (unless it disagrees), cereals cooked three hours, raw or raremeat, poultry, eggs, vegetables, purées, cooked and raw fruit, bread, crackers. 

HOW TO BATHE THE DELICATE CHILD. --Regular daily baths are particularlyof benefit to the delicate child, despite the prevailing fear that theymay catch cold. The salt bath is advised and the time to take it is justbefore retiring. The room should be warm and the temperature of thewater should be 90° F. : it should not last longer than five minutes, andthe water should be cooled down to 70° F. , before the child is removedfrom the bath. While the cold water is running in, the surface of thebody should be briskly rubbed with the mother's hands and after removalthe child should be dried with a fairly coarse bath towel to ensure agood reaction. Very delicate children need not have the temperature ofthe water reduced; others may stand water of 80° F. , but no lower. Inthe poorly nourished it is frequently advantageous to rub the body, after drying, with olive oil or goose oil. This aids nutrition andbecause of the massage it aids circulation. In some older children adaily cold spinal douche seems to act particularly well. If the childdoes not promptly react from the effect of the cold water it is best todiscontinue it. 

AIRING THE DELICATE CHILD. --Delicate children should, above all things, be assured of the maximum amount of fresh air and sunlight. Many mothersentertain the idea that these children are disposed to take cold easily, if in the open air, --which is not the case. All children need anabundance of fresh air and the delicate need it particularly. The seasonof the year and the character of the weather will, of course, dictatejust how much open-air exercise they may take. 

If the weather is very cold and the air damp, or if there is a very coldhigh wind, it is best to remain indoors; otherwise the child shouldremain out for four or five hours. Indoor airing is obtained bydressing the child to go out-doors, putting him in his carriage, andleaving him before an open window in a room of good size with all thedoors closed so as not to create a draught. 

HABITS OF THE DELICATE CHILD. --The amount of sleep necessary for adelicate child is the same as for a normal child of the same age. Theroom should always be well aired, night and day, and should be devotedto the exclusive use of the child. 

These children should never be allowed to sit on the floor. It is alwaysa difficult matter to avoid this, but it must be religiously guardedagainst; otherwise a cold is the inevitable result. 

A change of air is sometimes advisable and essential, especially duringthe hot, humid weather of July and August. Much better results will beobtained by sending these children to the mountains than to theseashore. 

Delicate children should always be clothed warmly, but not too warmly. The feet and legs must always be kept comfortable. Moderate exercise, short of fatigue, is necessary. A midday nap after the noon meal shouldbe taken every day. The child should be undressed and put to bed for twohours and left there, whether it sleeps or not. This applies to delicatechildren of all ages. 

The education of delicate children should be postponed until the healthis restored. They should, however, be made to obey and they should betaught good habits. When school work begins it should be made light andeasy. They should not go to school before the eighth year, and then notunless physically fit. They should not play at rough games or with roughcompanions, though it is not wise to shield them too much. Their habitsand peculiarities should be studied and every possible effort made todirect them kindly and wisely so that they may contribute to their ownupbuilding. 

A systematic observance of these suggestions will save many lives andwill aid very considerably in producing stronger men and women. Infinitepatience, tact and self-sacrifice is necessary, but the results in everycase justify the measures adopted. 

INDISCRIMINATE FEEDING: POOR APPETITE. --In considering many of thediseases of childhood the term "indiscriminate feeding" is used. Anexplanation of just what is meant by this will be of decided advantage. There are two fundamental essentials in the successful feeding ofinfants and children: regularity and suitable food. 

A child whose feeding intervals are not regular and whose food isunsuitable is a victim of indiscriminate feeding. 

The lack of observance of the regularity rule always leads to loss ofappetite and indigestion. 

Loss of appetite is a serious condition in a growing child and may giveinfinite trouble. Indigestion in a growing child is unnecessary, unfortunate, and frequently is the one factor that spoils an entirelife. It is unnecessary, because it means and is caused by neglect onthe part of the mother; it is unfortunate, because it always paves theway for any serious ailment that is epidemic or "in the air"; and it isimportant, because it very frequently weakens the stomach and renders itunfit for normal digestion for a long period, if not for life. 

If for some reason a child's appetite becomes poor and it is notproperly managed until the appetite is restored to normal, indiscriminate feeding is always the result. 

The reason for the poor appetite may be because the child is keptindoors too long, or because it is being fed on unsuitable food, or isliving in unsanitary surroundings, or many other reasons, sometimestrifling reasons, may cause it. When a child will not eat at meal time, the mother feels that it should eat sometime, so she encourages it toeat between meals, and because of a mistaken kindness she breaks the lawof regularity, --a law that can never be broken without serious resultsfollowing. A child in this condition becomes a disturber of the peace;the parents can do nothing with him; he insists on eating just what helikes and when he likes; and he chooses, as a rule, candy, cake, pastries, ice cream, tea, coffee. Indigestion follows, the child losesweight, is languid and listless and constipated. 

When finally the physician is called in he finds it necessary to go backto first principles. He lays down the law in a definite, stern way, andthe mother and the child must obey. Most parents know and admit they aredoing wrong to give in to a whimsical child, and if they would only makeup their minds to conquer when conquering is easy they would savethemselves many heartaches, many regrets, and the child much sufferingand much possible permanent injury as a consequence. Usually one parentis willing to be master but the other lacks the mental equipment to meetthe issue, and argues, as he or she imagines, in favor of the child. Theparent whose instinct is correct, whose judgment is true, whoseinterpretation of the situation is just, should not be dissuaded, orargued away from his or her duty. If it is the first real problem inyour domestic experience in which a decided stand must be made, make itwithout fear and without hesitation, and carry it through to the bitterend. Results will justify and vindicate you. 

The general treatment of these children will be found outlined in thefollowing paragraph on Loss of Appetite. 

LOSS OF APPETITE. --If a child complains of not being hungry, and willnot take enough food, and if this condition continues for some time, wemust regard the matter as being abnormal and find the cause. This isnecessary because a child must eat in order to maintain a certainstandard of growth and vitality. These children are not sick; they areactive and continue to play as usual and they sleep soundly, but theyhave no appetite. One of the most frequent causes of this condition istoo frequent feedings. Some children are naturally small eaters. Theythrive and maintain a satisfactory weight; their system seems not todemand large quantities or even ordinary quantities of food. Parentsobserve this habit of little eating and begin to coax and bribe thechild to eat more at meal time, and to eat between meals. In this waythe child really overeats, the appetite becomes capricious, and thestomach rebels. In a very short time the condition of "loss of appetite"is established as a consequence. Another cause is the drinking of toomuch milk, and yet another and very common cause is indiscriminateeating of candy, cakes crackers, and fruit between meals. Children whoare fed at the table with adults eat things they should not eat, andspoil their digestive organs and loss of appetite is the result. TheScotch custom of compelling children to eat at a separate table is anexcellent one. They are not tempted to ask for things they cannot have. Lack of fresh air and exercise frequently results in impaired appetite. 

TREATMENT. --The very first thing to do with these children is to stopany habit that may be responsible for the loss of appetite. If the childhas been eating between meals, stop it absolutely. If too much milk hasbeen taken, stop milk entirely. If the child has not been getting enoughfresh air, or if it has been sleeping in a badly ventilated room, or ifbaths have been too infrequent, rectify the fault. If eating at thefamily table and fed indiscriminately, change the programme; feed himbefore the family sits down to meals. Now regulate the time of feedingto suit the age of the child and adhere to strict regularity. It is apernicious and absolutely wrong custom to force children to eat, or tocoax them to eat when they do not want to eat. Loss of appetite willnever be cured by forced feeding, or by reducing the interval betweenfeedings, or by giving the child stronger or more concentrated foodunder the mistaken idea that in this way the loss of appetite can be"made up. " The interval of feeding should rather be lengthened thanotherwise in order to give the digestive organs an opportunity to regainthe normal desire for food. Pay strict attention to the bowels. Becertain the child has a daily satisfactory movement and that he drinksfrequently between meals. 

If the child does not promptly respond to the proper hygienic anddietary treatment as outlined above there are two things that can bedone:

1st: Send the child away. A change of scene and climate will sometimeswork like a charm in these cases, and will, after a reasonable length oftime, establish a permanently good appetite. 

2nd: If this is not possible, as sometimes it may not be with poorpatients, then we can give the child suitable tonics. 

OVEREATING. --The large majority of individuals eat too much. Most of uswould enjoy better health, better spirits, and greater efficiency if weconsumed from one-third to one-half less food than we habitually do. 

Every living organism requires a certain amount of nourishment accordingto the work performed and to replenish wear and tear; when food issupplied in excess, the system cannot utilize it, but it is compelled torid itself of the excess in some way. The work involved in thiseliminating process is exceedingly detrimental to the various organs andto the individual. To overeat is to overwork, and to overwork a machineor an animal is not only poor economy but bad judgment. If the digestiveapparatus is required to work overtime, it is a self-evident assumptionthat the various organs will not digest efficiently the food necessaryfor ordinary existence. If the necessary nourishment is not adequatelydigested, the general health will suffer as a consequence. If thegeneral health is below standard the individual will not be competent tocarry on the requirements of a normal, healthy life. 

We must, however, give some thought to the effect which the excess offood exerts upon the human machine. 

Nature provides and maintains a standard relationship between thecapacity of the individual and his needs. A child has a digestivecapacity to digest and assimilate a quantity of food sufficient for hisgrowth and proper nourishment; an adult maintains the same standardaccording to his requirements. All the other organs are adjusted toharmonize with this scheme. If we overeat, the immediate result is todisorganize this relationship between the various organs; hence we havea multitude of effects which manifest themselves in various ways as adirect result of overeating. The combined general effect expressesitself in the form of what is regarded as poor health and a low standardof efficiency. When a larger quantity of food is taken into the stomachthan it can properly digest within a reasonable time, two conditionsimmediately follow. The stomach itself is dilated and the food is notthoroughly digested. If the habit is persisted in, indigestion, andlater chronic gastritis ensues. The direct symptoms of these conditionsare given in detail in another part of this book. Very few individuals, however, appreciate the indirect consequences of overeating and ofindiscriminate eating on the general health. It is impossible totabulate in so many words the effect which this habit has on efficiencyand temperament. We read and hear a great deal to-day about efficiency. Now, an individual's efficiency is an expression of that individual'shealth standard or capacity. To be 100 per cent. Efficient one mustenjoy good health. It would be absurd to expect a high standard ofefficiency from an individual with a low standard of health. Poor healthmeans poor vitality. Vitality is the mark of the master. Withoutvitality one can never dominate. All the great achievements of the racehave been consummated by those who conserved their vitality. No singlefactor contributes a larger percentage of inefficients and failures thanovereating. The man or woman who, from habit or experience, has learnedthe lesson of right eating and living need not be lacking in efficiency, nor need they despair of the attainment of success. 

SYMPTOMS OF OVEREATING. --Efficiency depends not only upon one's capacityto perform, but upon the character of the performance. The spirit mustbe willing to perform. The overeater is heavy, phlegmatic, indifferent, lacking in energy, tact and initiative. She is constantly subjecting hersystem to needless overwork; she is depressed, nervous, imaginative andshe is not ambitious. She is a victim of self-poisoning, ofconstipation, indigestion, headaches, flatulency, neuralgia, vertigo, and melancholia. An overeater never enjoys good health, never isefficient, and cannot possibly be successful. 

To enjoy good health one should know how to select food and how tocombine and proportion it. It has been said that the American people area race of dyspeptics, and it must be admitted that the assertion ismore or less true. There are millions of people who suffer fromindigestion in some degree, and it may justly be said that indigestionhas its beginning in overeating, in some form. It may not be overeatingin actual bulk, but it is overeating some article or articles that donot agree with the individual, and the fact that certain articles do notagree is unquestionably dependent upon the nervous temperament of theAmerican people--and the temperament of a people is a product of thekind of existence the people subject themselves to. We are, therefore, unwittingly, victims of our environment. 

Correct eating means simple eating--only a few things at a time. Foodshould be selected according to one's age and occupation, and accordingto the season of the year. To eat habitually large quantities and at thesame time a large variety is suicide pure and simple. If one dared tomake the experiment of cutting down one's diet one-half, it isabsolutely certain the effect would be immediate benefit. The benefitwould not only be manifest in the physical betterment, but theefficiency and general well-being would be greatly enhanced. It is notthe kind of food that makes a dyspeptic, but the quantity. A well personneed not consider whether a certain kind of food will or will not agree, providing she does not eat too freely of that food, or combine it withother food. The combination of which may in itself form too much of onekind at a time. 

Some people imagine, for example, that oatmeal porridge does not agreewith them. When the matter is inquired into, however, it is found thatthey habitually eat bread, eggs, and other articles, with coffee at thethe same meal with the porridge. From this combination they experiencedistress and blame the porridge. If these would take a plate of oatmealporridge with cream and salt, and some stewed fruit for breakfast theywould not experience any trouble, and this would be an ample meal forthe ordinary individual. It is not the porridge, but the unsuitablecombination, that is at fault. The same may be said of milk. Many peoplestate that they cannot take milk and they deprive themselves of one ofthe very best articles of diet because of this idea. There are very fewpeople in the world who cannot take milk in some way. It is not the milkthat is at fault; it is the combination of it with other less nutritiousarticles that is the cause of the distress. Even candy is responsiblefor thousands of cases of indigestion. Anyone may safely take areasonable quantity of good candy, but if it is taken at a wrong time, or combined with other articles, it may readily produce indigestion. 

Indiscriminate eating and overeating are prolific causes of rheumatism, kidney disease, heart disease, liver troubles, obesity, arteriosclerosis, and apoplexy. These diseases are notoriously on theincrease and must be construed as a direct consequence of the tendencyof the American people to overeat and to eat indiscriminately. 

BRAN AS A FOOD. --In the chapter on constipation there may be found aformula for making bran muffins. These muffins are invaluable tochildren in health, and to the victim of indigestion or constipation, whether child or adult. One muffin with each meal will solve the problemof constipation in growing children without the use of drugs or otheraid. They will regulate the bowels of adults in many instances withoutresorting to drugs. 

Raw fruit in season, or stewed fruit, or a baked apple, with a lightboiled egg and one bran muffin, is an ample and a nourishing breakfastfor a child at school. 

For lunch the same child should have a plate of thoroughly donevegetable soup, a bran muffin, and more fruit. After school, a glass ofmilk with two or three Graham wafers may be given. 

For dinner the child at school may have a mixed meal. This meal shouldnot be later than six-thirty o'clock and the child should retire ateight-thirty at the latest. A bran muffin should be taken with this mealunless the child's bowels are too loose. 

Mothers should insist on their children eating these muffins. If a childeats only what it likes it will not eat what is good for it. If themother insists in the right way she will win; if she does not the childwill win. If the child wins, the mother is the wrong kind of mother. Ido not know of any other single article of diet that is of such valueto growing children as these bran muffins. Children who eat themregularly will have less sickness than other children; they will bestrong, healthy and full of energy. The bran in itself is notresponsible for this list of excellent acquirements, but the regulareating of the bran is. Most ailments of children are ofgastro-intestinal origin; bran keeps the entire length of thegastro-intestinal tract sweet and clean; if the child eats a bran muffinwith each meal it will not have much desire or much room for any otherform of bread or pastry. If white bread or pastry is abstained from thechild will not have indigestion, or constipation, and hence it will notbe constantly poisoning itself as most children do whose diet is notrestricted and whose bowels are more or less constipated. 

These muffins should be made of the ordinary unsifted bran. If this isnot procurable the sifted bran (Johnstone's) may be employed. This branmay be bought in any good grocery. 

Modern milling methods, modern cookery, and modern methods of forcedfarming, have each contributed their share of rendering food inert andfrequently deleterious. The miller has extracted the coarse cellulosefrom the various flours in the effort to manufacture a product suitableto the super-civilized public demand. This cellulose is absolutelyessential to gastric and intestinal digestion, and if children aredeprived of it constipation and indigestion are the natural result. Forced farming accomplishes the same effect--the fiber of the vegetableis deficient. Bran is rich in mineral salts, iron, protein, andphosphates, and gives to growing children the ingredients which ordinaryfood is deficient in. Bran prevents intestinal fermentation and childrenwho eat it are free from intestinal gas and putrefaction. It harmonizeschemically with all other foods. Children should be made to take itevery day as a matter of self-preservation and of duty. 

HYSTERICAL CHILDREN. --Hysteria is not a disease of infancy or of youngchildren. It is seen as a rule after the eight year. Male as well asfemale children may be the victims to an equal degree. It is much morefrequently seen in the offspring of parents who are themselves nervous, or alcoholic, or who suffer from insanity, or have insanity in thefamily history. If these children in addition to the hereditaryinfluence suffer from stomach or intestinal disease, or general poorhealth and are overworked at school, they are very apt to becomehysterical. 

They are capricious, indifferent, and excitable. Their disposition isirritable; they frequently exhibit fits of great excitability of temperand passion. They cry or weep without cause. They often havehallucinations and while asleep have attacks resembling night terrors. They complain of pains in the joints, and are frequently treated fordisease that does not exist. Such condition as hysterical cough, spasmof the muscles of the face, mouth, eyes, and of the neck exist and aredifficult to diagnose from real disease. These children complain ofpainful sensations and sensitive areas and exaggerate all symptomsunnecessarily. 

The possibility of curing these patients is good, providing thetreatment is faithfully carried out. It is less favorable when markedhereditary influences are strong. 

TREATMENT. --In all children of distinctly nervous type and especiallythose of nervous parents, the first essential duty is to develop theirmuscular system. Try in every way to make healthy animals of them. Attention and treatment should not be directed toward the nervoussystem. If the child is made strong by out-door life, good plain, digestible food, early hours, regular sleep in thoroughly aired rooms, regular bathing, and if the school work is conducted with moderation andjudgment, the nerves and the nervous temperament will participate in thehealthy growth which will follow as a result. Tea and coffee should beforbidden. Exciting books and questionable entertainment as given inpicture shows and theaters must not be allowed. If older members of thefamily, or parents, are excitable and nervous the children should besent away to the country from them. 

They should be put in charge of a person who will exercise firm controlover them. It may be necessary to take these patients away from otherchildren, and isolate them under proper control until they are able tocontrol themselves. They should be interested in exercise that compelsthem to work; they should live and if convenient sleep out of doors; andthey should take iron or cod liver oil, or any other indicated tonic. Ifthey complain of pain they should receive cold-water douches, or thecold pack, or the shower bath; and they should be put to bed and treatedfirmly but kindly. Attention to the bowels is always essential, becausethese children are as a rule the victims of chronic constipation. 

WHAT A MOTHER SHOULD KNOW ABOUT CATHARTICS AND HOW TO GIVE A CHILD ADOSE OF CASTOR OIL. --Broadly speaking there are three kinds ofcathartics. I will, in a simple way, explain their action so that amother may know which one to select under certain circumstances. Frequently a mother is told by her physician to "keep the bowels of herchild open. " Few mothers know how to keep the bowels open, and as thisis an important matter, every mother should know the reason why "any"laxative or cathartic is not always suitable. 

CASTOR OIL. --This is one of the oldest and one of the best cathartics wepossess for children. It is a mechanical cathartic; it acts in exactlythe same way as a street-cleaning machine. It cleans the street bysweeping or pushing everything before it. 

CALOMEL--This is a chemical cathartic. It acts through the blood. Whenit is absorbed by the blood its chemical ingredients act on certainnerves as irritants. These nerves excite the liver and bowel to actionand an evacuation is the result. 

CITRATE OF MAGNESIA. --This is a saline laxative. It acts by drawing outof the bowel wall enough liquid from the blood to sweep the contentsout. It may be likened to the street cleaner who flushes and cleans thestreet by means of a hose pipe attached to the water hydrant. 

Under what condition should a mother use these remedies? Castor oil isordinarily the best cathartic in childhood; it is not, however, alwaysthe best. Most ailments of children are of gastro-intestinalorigin--they have either overeaten or they have eaten the wrong kind offood. The stomach and bowel are overloaded: they must be cleaned out. Wewant a mechanical cathartic, one that will push everything ahead of it, so we use castor oil. When a child needs a cleaning out, use castor oil. By a "cleaning out" we mean, when we know he has eaten too much of aquestionable variety of food, as pastries, cakes, fruit, ice cream, etc. , as children do at parties; or when he has eaten unripe fruit, asgreen apples, etc. ; or when for some reason he is constipated andcomplains of not feeling well, use castor oil. 

If you decide to use castor oil, use enough. A large dose will actpromptly and with less pain and with more certain results than a smalldose. 

It is always safe and it is always best to decide upon castor oil as theproper remedy, if the child has no fever. If he has a fever he will mostlikely vomit castor oil when another kind of cathartic would stay on thestomach. 

Castor oil works more effectively, more thoroughly, and is less likelyto be vomited if given on an empty stomach, so we give it two hoursafter eating and we give no food for two hours after it is taken. 

Castor oil is distinctly of advantage in many chronic diseases of theintestines because of its healing properties. In chronic colitis, forexample, when the child is suffering with malnutrition, irregular bowelaction with an odor, and mucous or bloody stools, a combination ofcastor oil and salol, in emulsion, in small doses, --to which a smallquantity of opium may be added or withheld according to the frequency ofthe movements, --with an occasional colon irrigation, is sometimesinvaluable. 

Mothers must remember that castor oil is not good in the treatment ofconstipation, because its after effect is to constipate, consequently wewould not use it "to keep the bowels open, "--it is only of use to cleanthe bowel out thoroughly when that is indicated. 

HOW TO GIVE A DOSE OF CASTOR OIL--The best way to give a child castoroil is as follows: Place the bottle containing the oil on its side on apiece of ice in the ice box; chill it thoroughly. Take a tablespoon andsmear it with butter; pour the ice cold oil into the spoon; it willstick together like a piece of chewing gum and it will slide out of thebuttered spoon in one lump. In this way it will not spread over themouth and teeth and throat, leaving a bad taste, but will go straightand surely into the stomach. The child cannot swallow some and retainenough in the mouth to sputter it all over itself and only get half adose; it will not nauseate it, because it practically is tasteless ifgiven cold, and the stomach will tolerate the cold oil much better thanwhen given in the ordinary way. 

A baby can be given oil in the same way, but in smaller doses. When theteaspoon is put into the mouth of a baby it should be immediately turnedon its side so that it will keep the mouth open. If the nose is heldclosed and the mouth wide open for a few seconds the baby cannot spitthe oil out--it must swallow, and if the oil sticks together as cold oilwill, it gets the whole dose. It usually takes two persons to give ababy a dose of oil--one to open the mouth and give the medicine, theother to hold the nose and arms. 

CALOMEL. --The general indication for calomel is fever. When a childdevelops a disease it immediately gets a temperature, and veryfrequently the fever is quite high because the slightest ailment gives achild fever. When fever begins, digestion practically stops, it istherefore imperative to clean the whole gastro-intestinal canal;otherwise the undigested material will putrefy and poison the entiresystem and render the disease more serious than it need be. 

Now we select in such conditions calomel for two reasons:

First, because the presence of fever indicates that infection of theblood is taking place; this may come either from the intestinal canalitself, or from the germs of the disease with which the child issuffering. Since calomel acts chemically through the blood it is thecathartic indicated. 

Second, because a cathartic like castor oil does not act through theblood and it would most likely be vomited by a fevered stomach. 

Certain conditions indicate calomel; biliousness and jaundice, forexample, because it has a specific action on the liver and if the liveris at fault calomel is the proper remedy. 

Calomel is best given in small divided doses, 1-10 of a grain every halfhour, for ten doses. It is best given combined with soda; every drugstore carries tablets of calomel and soda for this reason. 

Calomel should never be given in the treatment of constipation, norshould it be used indiscriminately by mothers, as much harm may result. It has its specific use as indicated above, but it should never be usedunder any other circumstances. 

CITRATE OF MAGNESIA. --This is a mild laxative. After the bowels havebeen thoroughly opened with castor oil or calomel, small doses ofcitrate of magnesia may be given for a few days, "to keep the bowelsopen. " There is no danger or harm in its use if used for this purpose. It must not be used, however, in the treatment of constipation ofchildren for the simple reason that you cannot cure constipation by theuse of drugs of any kind. Laxatives of this type have become a nationalcurse. Adults, especially women, use them constantly. All theseadvertised saline laxative waters work by weakening the blood--when adose is taken the chemicals in it draw through the bowel wall bloodserum, and produce, because of the excess of this watery fluid, large, and frequently many, liquid movements. 

If this practice is continued, as it often is every day, the quality ofthe blood will suffer seriously, and many individuals are the victims ofneuralgic pains, headaches, nervousness, insomnia, anemia, and generalbroken health as a direct consequence of this pernicious habit. 

Mothers will try to remember, therefore, that drugs and saline watershave no place in the treatment of constipation in children orthemselves. Constipation must be treated by diet, exercise regularliving and by the observance of hygienic and sanitary common-senserules. 

VACCINATION

TIME FOR VACCINATION. --The best time to vaccinate a child is during thefirst three months if he is healthy. The reason for selecting so early aperiod is because the constitutional disturbances are much less at thistime than in later childhood. It should not be done during activedentition. If the child is delicate if his nutrition is bad it should bedeferred until a later time. Children suffering from eczema or from anyskin disease or those syphilitic should not be vaccinated until it iscompulsory, or until exposed to small-pox. 

METHODS OF VACCINATING. --It is customary in America to vaccinate at onepoint rather than to make a number of inoculations as is the custom insome other countries. The leg or the arm is the usual location selected. In infants the sore can be protected better on the leg; in children ofthe run-about age, the arm is the better location because it can be keptat rest easier. 

Before vaccinating the skin should be rendered surgically clean; thiscan be done by washing with soap and water, drying and then rubbing withalcohol. The wound should be left uncovered for about twenty minutes todry, it may then be covered with a bandage, or with a vaccine shield. The part should not be washed for twenty-four hours. 

THE SYMPTOMS OF SUCCESSFUL VACCINATION. --Nothing is noticed until thethird or fourth day, when a red papule appears. In the course of thefollowing day a vesicle appears; this vesicle enlarges until it reachesits full development on the ninth day. The size of the vesicle is aboutone-half inch in diameter; it is surrounded with a reddish inflammatoryarea for about two inches. The vesicle begins to dry and is shortly adark crust which remains from one to three weeks and then falls off. Itleaves a bluish scar which soon turns white and the part is roughenedand honeycombed. During the period when the vaccination is at its heightthe child suffers from fever and irritability and loss of appetite. 

If vaccination does not "take" in an infant it should be done two orthree times and if then unsuccessful it should be repeated every yearuntil it takes. The fact that vaccination does not take does not implythat the child would not take small-pox but rather that the vaccine usedis not suitable. There are some children, however, who seem to be immuneto vaccination. 

Sometimes the symptoms are more severe than those enumerated; this seemsto depend upon the susceptibility of the child. The vesicle may be muchlarger and the area of inflammation much more dense and angry. The fevermay be higher and may last longer; there may be a general rash and thedegree of depression more profound. Vesicles may be produced on otherparts of the body as a result of scratching. Mothers must alwaysremember that vaccination is a surgical wound to begin with and that itis capable of infection in the same way as are other wounds, and thatany result coming from such an infection is not due to the vaccine or tothe process of vaccination, but to the infection. Many people get unjustideas about vaccination from just such cases. If the mother is notcleanly or neglects the vaccinated area and permits it to becomeinfected she must not and others should not decry vaccination as aconsequence. Anyone who doubts the virtue of vaccination is condemninghimself; he is simply ignorant of the accumulation of evidence in favorof it and assumes a position without any possible justification. Themortality of vaccination is stated by Voigt from statistics to be 35 in2, 275, 000 cases. In fact, all the deaths are from causes which arepreventable and no doubt the result of direct carelessness on the partof the operator or the mother. 

TREATMENT. --The mother must understand in what way she may contribute tothe successful termination of a case of vaccination. She should see thatthe part upon which the child is to be vaccinated is absolutely clean sofar as she can make it with soap and water. She should see that the partis allowed to dry thoroughly after vaccination. She should not wash thepart for at least twenty-four hours. If a vaccine shield is put on sheshould not disturb it. If the mother is prepared to do her partfaithfully a vaccine shield is not necessary from a medical standpointand in some cases it is objectionable. A simple, clean bandage is allthat is necessary. It is very important that the child be kept fromscratching the part; most of the troubles of vaccination come from thishabit. It is desirable that the limb should be kept at rest during thestage when the process is at its height. If the vesicle discharges it isnecessary that the area should be kept clean and dusted with boracicacid. If the wound becomes infected it must be treated by a physician. The mother must not resort to home remedies in such cases unless she isprepared to take the consequences, which may be serious. 

CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

 "It is a greater disgrace to be sick than to be in the penitentiary. When you are arrested it is because you have broken a man-made statute, but when you are ill, it is because you have disobeyed one of God's laws. "

 Constipation--Regularity of Bowel Function--The Function of the Stomach--Fermentation--Incomplete Constipation--Importance of a Clean Bowel--A Daily Movement of the Bowel Necessary--Constipation in Breast-Fed Infants--Treatment of Constipation in Breast-Fed Infants--Constipation in Bottle-Fed Infants--Treatment of Constipation in Bottle-Fed Infants--Constipation in Children Over Two Years of Age--Diet List for Constipation in Children--Bran Muffins in Constipation--Treatment of Obstinate Constipation--Oil Injections in Constipation. 

CONSTIPATION. REGULARITY OF BOWEL FUNCTION

The most frequent cause of ill health and inefficiency in the human raceis inattention to regulation of the bowel function. Good health dependsupon many causes of which good blood is an absolutely necessaryrequisite. Good blood depends upon what feeds and sustains it. There areother contributing factors, such as the proper kind of exercise, theproper amount and quality of fresh air, the method of living, etc. , butthese are all food in a sense. The food we take in is acted upon by thevarious digestive juices until everything is extracted from it thatcontributes to the building up of the body. Whatever is left, whateverthe body does not want, is immediately, or within a reasonable time, passed out in the form of a movement of the bowels. 

If any part of the digestive function is deficient, impaired health, ormental and physical inefficiency expressed in the form of indigestion, is the result. If the bowel is at fault, constipation is the usualconsequence. A perfectly healthy living machine must maintain a perfectdigestion and regular bowel movements. 

THE FUNCTION OF THE STOMACH is to mix and churn the food, and to addcertain ingredients to the mixture so that before it is carried into theintestines it is (as far as it is the stomach's duty to render it) readyto be absorbed into the system. Before it reaches that part of theintestine which absorbs, it is acted upon again and certain otheringredients are added to it by certain other digestive organs. In timeit is in shape to be used and it is sent along on its way. As it passesonward the little sucking glands in the wall of the bowel suck up allthe liquid element in the mass of food. The liquid element in the massis the food itself, rendered liquid by the stomach and other digestiveorgans and juices. The remaining solid mass is that part of the foodwhich the body cannot use and does not want. By the time the liquidelement is absorbed, the solid mass (always kept moving by the bowelwall) has reached the rectum, ready to be passed out at once, or verysoon, provided--and upon this provision depends the success of theentire process, --it has all been done within a certain time. If thestomach takes too long to do its work we have indigestion. If the boweltakes too long to do its work we have constipation. 

FERMENTATION. --Now let us consider the matter from another standpoint. If food stays too long in the stomach it begins to ferment. Whenanything ferments it makes and evolves gas. You, no doubt, have noticedmany times how the cork pops out of a bottle if its contents are"working, " or fermenting. If you watch that bottle you will notice thatit is quietly or actively evolving air bubbles. That is gas, --gasmanufactured by the process of fermentation. This is exactly the processthat goes on in the stomach or bowel of a dyspeptic, and it is thiscollection of foul, poisonous gas that causes the distress and bloatedfeeling which every dyspeptic suffers from after eating, --if it is this"flatulent" type of indigestion which is present. 

THE SIGNIFICANCE OF CONSTIPATION. --If the food takes too long to passthrough the bowel it causes, as we have stated, constipation. What isthe real significance of constipation? It means that in passing throughthe bowel the food has given up all its liquid element (which is all itsnourishing element), but the bowel has been too slow in passing italong. Consequently it is not ready to be expelled while it is yet aharmless semi-solid mass. It stays in the bowel too long--it begins toputrefy, bacteria attack it, and it is soon a semi-liquid, foul, rottingmass. The sucking glands in the intestinal wall continue to suck--thatis their duty. They cannot discriminate between what is good and what isbad--they simply go on absorbing whatever is there to absorb. So thereare absorbed into the system liquid and gaseous products which arepoison. 

This process has been called by a number of names; "self-poisoning"explains the condition thoroughly. The other names are, auto-infection, auto-intoxication, enteric-infection, enteric-toxemia, intestinalindigestion. 

The condition is a serious one, because it is absolutely impossible tofeel well, or to enjoy good health, while it lasts. The feeling of beingconstantly sick, yet not sick enough to stop working or to demand aradical cure, affects a woman's efficiency, interferes with her capacityto work, her ability to render the home an abode of contentment, to bean agreeable companion, or to adequately take care of her children. 

The constant absorption of intestinal poisons affects the systemitself, --the symptoms are headache, neuralgia, loss of appetite, nervousness, insomnia, vertigo, inability to concentrate, lassitude, indigestion. The condition which we name constipation is therefore oneof supreme importance. From a medical standpoint, it is the biggestproblem in the whole realm of disease. It is the most significanthygienic function of life, and it is becoming more and more important, and more and more a problem. Every modern factor upon which physicalefficiency seems to depend is an enemy to the systematic regulation ofthis function. Our method of hurried and indiscriminate eating, oursystem of strenuous living, our unsanitary environment, our businessactivity, our method of pursuing pleasure, take no account of, andresent the time devoted to cultivating, as a hygienic necessity, thistoilet requirement. This imperative call of nature is pushed aside bythe child at play, by the housewife for a duty which could wait, by themerchant for an engagement. It is particularly an American disease, andit is uniquely an American woman's affliction. It is a curiouscommentary on the intelligence of the American people, who areordinarily alert and analytical, to realize how few of them really knowhow serious a matter constipation is. They don't know because they havegiven the matter absolutely no thought. They have accepted it as a merematter of fact, almost of fate. 

INCOMPLETE CONSTIPATION. --There is a type of constipation that is notknown to the average person and not well understood by those few whoknow of its existence. In this form of constipation there is a dailybowel movement but the movement is not complete. The bowel does notthoroughly empty itself; it has established this habit because ofconditions under which it has had to do its work. If a womanneglects herself, becomes muscularly inactive, does not takeproper out-door exercise, grows fat and lazy, eats irregularly andindiscriminately, --the bowel suffers with the rest of the system. Thewoman may have a healthy appetite, may eat the wrong things at the wrongtime, yet the bowel is supposed to go on acting rightly, but it doesnot. It, too, becomes lazy and acquires bad habits, and this form ofincomplete constipation is the result. These patients look healthy andget little sympathy for any pains they may have. They may even gain inweight; they get headaches once in a while, and if they go shopping orvisiting they don't feel quite well afterward. They are suffering fromthe effects of chronic constipation, though their bowels are apparentlyregular. They are marching onward toward apoplexy or Bright's disease ofthe kidney. 

IMPORTANCE OF A CLEAN BOWEL. --Every mother, sooner or later, observesthat a physician always thoroughly cleans out the bowel of a sick childat once, no matter what the character of the sickness is. He does thisfor two reasons, --first, because he knows that the great majority ofchildren's ailments are of gastro-intestinal origin; second, if theorigin of the disease is not in the stomach or bowels, experience hastaught him that if the bowels are clean at the beginning of a disease, that disease will run a milder and shorter course than if complicatedwith a condition of self-poisoning. If a child develops fever thedigestive function stops; whatever food is in the stomach or bowel willpromptly ferment and putrefy because of the abnormal heat caused by thefever and the arrested digestion. If this is not cleaned out at once theself-poisoning process begins. 

The above is a suggestive admission for a physician to make. It simplymeans that the vast majority of the calls made by a physician on ailingchildren are caused by errors in diet and can be completely cured by adose of castor oil or calomel, or, better still, need never occur. 

A mother who neglects, who is guilty of inattention to the conditions ofher child's bowel, fails in one of the most important duties ofmotherhood. I know as a father and a physician that if a child's bowelacts regularly and thoroughly, that child is fortified to the highestefficient degree against the multitude of little ailments common to allchildren. A clean bowel means good blood, good digestion, ability toexercise properly, to sleep soundly and to think clearly. Such a childwill resist infection and throw off the minor troubles that pave the wayfor serious sickness. It is a secret worth knowing. 

A DAILY MOVEMENT OF THE BOWEL NECESSARY. --In order to preserve goodhealth one thorough movement of the bowel is necessary daily. A baby mayhave two or three and enjoy robust health. A larger daily numbersuggests an abnormal condition of the bowel and an investigation shouldbe made. If a nursing baby's bowels do not move before bedtime it shouldbe given an injection of equal parts of glycerine and hot water, one-half cupful; or an enema of soap and water, or a glycerinesuppository. When a child is six months old, in some sooner, it shouldbe put on the stool at a certain time every morning. This will aid inthe establishment of the habit, as a child soon understands why it ismade to assume this position and acts accordingly. 

The condition referred to above and which we termed incompleteconstipation may affect the nursing infant. A child's bowels may movedaily and yet the child will suffer from constipation. If the movementsare watched it will be observed that certain children strain when atstool, and after a time succeed in passing hard, dry lumps or balls offecal matter. Such a movement is a certain indication that the bowel isnot emptying itself satisfactorily and that a constant toxemia orpoisoning is going on. Very faithful efforts should be made to remedythis condition by the use of articles of diet that are known to belaxative, otherwise the condition is one that will "grow" with the childand establish an obstinate chronic constipation with all its miseriesand dangers. 

CONSTIPATION IN BREAST-FED INFANTS. --Many nursing infants thrive andgain in weight, yet they are constipated. Before you drug your baby besure the fault is not your own. Many mothers are responsible for theconstipation with which baby suffers. If the mother is constipated, sowill the child be. Cure the constipation of the mother and the baby'sbowels will regulate themselves. Nursing mothers who are largetea-drinkers have irregular bowels as a rule. A baby whose mother islazy or indolent, who does not take a reasonable amount of exercise, whose diet is faulty and whose hours are bad, is a sufferer fromconstipation. The mother's life must be regulated, her diet and habitscorrected, and the instructions carried out as already recommended. Thebreast milk should be examined and if any cause for constipation existsin it, it should be rectified as suggested elsewhere. 

If it is thought advisable to resort to drugs for the immediate reliefof the constipation of infants, the best ones are the aromatic fluidextract of cascara sagrada; milk of magnesia with equal parts of thearomatic syrup of rhubarb given in doses of one to three teaspoonfulsdaily. 

Irrigations, enemas, and suppositories should not be used continuously. The habit is a bad one. The parts become accustomed to their use andfail to act. If the child is passing dry and hard stools it is ofadvantage to inject two ounces of warm sweet oil at night, allowing itto remain in the bowel until the following morning. See page 312. 

CONSTIPATION IN BOTTLE-FED INFANTS. --It is much easier to treat theconstipation of bottle-fed babies than of those breast-fed, because thefood can be changed to ensure regular bowel movements. The first changeto be made in a bottle-fed baby who is habitually constipated is to addmore cream to the food. The way to do this is to take out of the bottleof each feeding one tablespoonful of the food and put in its place onetablespoonful pure cream. If this change partly rectifies the bowelailment, add more cream until the bowels are of the proper consistency. Milk given constipated babies should be raw, never boiled, as boiledmilk will always aggravate the trouble. 

The use of oatmeal water instead of plain water in making the baby'sfood may cure the bowel trouble. Taking the sugar of milk out of thebaby's food and putting in its place the same quantity of Mellin's foodwill sometimes cure the constipation. 

One or two teaspoonfuls of milk of magnesia put into one feeding daily, or fifteen drops to one tablespoonful of the aromatic fluid extract ofcascara sagrada will move the bowels. Orange juice, strained, twoteaspoonfuls twice daily, is an excellent remedy and should be tried inevery case. Sweet oil and pure cod liver oil, in doses of thirty dropsto two teaspoonfuls three times daily after feedings, if the littlepatient is poorly nourished. If the stools remain hard and dry, aninjection of two ounces of warm sweet oil at bedtime is an excellentmethod of aiding the bowel. The oil should remain in the bowel allnight. This lubricates the parts, softens the fecal mass and stimulatesthe gut to perform its own work. See page 312. 

CONSTIPATION IN CHILDREN OVER TWO YEARS OF AGE. --Most children when putupon a varied diet after the nursing days are over are relieved of anyconstipation which may have existed up to that time. There are a few, however, whose condition does not seem to improve. These children needattention. We should first insist on regular habits. A child should betold that its bowels must move every morning after breakfast. If thisis absolutely insisted upon the child will soon recognize theuselessness of fighting the proposition and submit. If at any time aconscientious effort is made to move the bowel without result afterfifteen minutes it is wise to use a glycerine suppository so that thebowel will empty itself. 

It has been stated in another part of this book that there are childrenwith whom milk does not agree. Experience has taught us that milk, especially milk that has been boiled, causes more cases of constipationin growing children than all other causes combined. Find out if it ismilk that is the cause in any individual case. While these childrencannot take whole milk just as it comes from the dairy without sufferingin a great many ways, they can take milk and water, or milk and oatmealwater, prepared in the following way, without becoming constipated. Abottle of fresh milk is allowed to stand in a cool place for five hours, when the top ten ounces are skimmed off with a Chapin dipper and mixedwith twelve ounces of oatmeal gruel or plain water. This can be used asa drink. 

Parents can select from the following list of articles such combinationsas may be suitable to constitute the regular meals of a constipatedchild:

 Lamb chops. Rare steak. Rare roast beef. Hashed chicken. Soft boiled eggs. Cracked wheat. Hominy. Cornmeal. Oatmeal, Scotch. Bran biscuits. Oatmeal crackers. Graham wafers. Stewed or baked apple. Apple sauce. Plain vanilla ice cream. Animal broths, purées of peas. Beans, and lentils. Peas. String beans. Spinach. Cauliflower. Asparagus. Stewed tomatoes, strained. Whole wheat bread. Zwieback. Custard. Stewed prunes. Junket. Cornstarch. 

Malted milk is agreeable and advisable as a drink. 

Orange juice or a scraped raw apple is allowable at this time. Constipated children should eat plenty of good butter. Olive oil, twoor three teaspoonfuls after each meal, is excellent. It can be kept upfor months to advantage. Older children may eat raw and cooked fruits, figs, dates, baked potatoes, poultry, and fish. One or two raw apples ora peach or orange may be given daily. A strict observance of the aboverules and diet will result in normal movements of the bowel if persistedin for a reasonable time. It may be necessary occasionally to use asuppository or an enema now and again until the habit is established. 

In children from five to fifteen years of age the use of bran muffins, with fruit, etc. , as described above, will effect a cure of constipationwithout having to resort to drugs. I have cured many cases ofconstipation in growing children with these muffins without making anyother change in their diet or habits. 

RECIPE FOR BRAN MUFFINS

 Take one pint of best flour, one quart unsifted bran, one teaspoonful bicarbonate of soda (baking soda), a pinch of salt. Mix these thoroughly together, then add: six to eight tablespoonfuls good, New Orleans molasses, one pint of milk. Mix together very thoroughly. Put in muffin rings and bake in oven. About one ounce should be put in each ring as they raise easily. Eat with plenty of good butter. They should be given to children before each meal, when they are hungry, not after their stomachs are full. Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly together, then add one pint of milk (two cupfuls) and six to eight tablespoonfuls of New Orleans molasses. The quantity of molasses depends upon the individual taste. They are good for any child or adult whether constipation exists or not. 

Drugs may be of temporary service in some cases. A pill of cascarasagrada is the best for this purpose. It should not be continued formore than two weeks. Castor oil, calomel, and other frequently-usedcathartics should never be used in simple constipation. 

TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described above. Dietand drugs do not succeed in establishing the habit of daily bowelmovements. In these cases radical treatment is imperative. The dietshould be the same as that described above, but it will be foundadvisable to cut out milk altogether. Cereals can be taken with sugarand butter instead of milk. The oil injection plan of Professor Kerleyhas given me excellent results. I quote his comments upon and method ofgiving it:--

"OIL INJECTIONS. "--"For this purpose a soft-bulb syringe of four ounces'capacity is ordered. Over the hard rubber tip is place a small sizedadult rectal tube or a No. 18 American catheter. The catheter or tube iscut so that but nine inches remain for use. The cut end is forced overthe small, hard rubber tip of the syringe. A fountain syringe isimpracticable for this purpose, as it is soon destroyed by the oil andrendered unfit for use. Besides, sufficient pressure is not produced toforce the oil into the gut even with a high elevation of the bag. Thechild is placed on his back or on his left side. The syringe is filledwith oil, the tube is lubricated, and passed through the rectum as faras it can go. When it has been passed to the full nine inches, as mayreadily be done with a little practice, the syringe is emptied and thetube withdrawn. The injection should be given after the child has beenplaced in bed for the night. It is our object to have the oil retainedduring the night. If a passage of the bowels is produced at the time, orif the oil leaks out during the night, a small quantity should be used. In some of my patients I have been able to use but one ounce. In veryfew, indeed, does it cause an evacuation at the time. If there is atendency to leakage a napkin should be worn to avoid soiling thebed-linen. The following morning after breakfast, the child is placed onthe vessel and kept there until a bowel movement results or untilfifteen minutes have elapsed. In a great many cases if the constipationhas been obstinate for months, the bowel will be at once evacuated. Whenthis does not occur in fifteen minutes, a glycerine suppository isinserted, which invariably produces an evacuation. This use of thesuppository, according to my observation, can usually be dispensed within a very few days; the use of the oil, however, may have to becontinued for several weeks. When the child has had the oil nightly andan evacuation the next morning without assistance for two weeks, Idirect that the oil be omitted for a night and the effect noted. If theusual passage occurs after breakfast, the oil is given for five nightsand then omitted. If the case progresses satisfactorily the use of theoil is gradually omitted, being given at first every second night, thenevery third, fourth, or fifth night, etc. A considerable number of caseshave been completely relieved in two months. In the event of no passagefollowing the omission of the oil, its use is continued for two weekslonger, when it is again omitted for a night. " To illustrate this pointthe following case is cited. 

"ILLUSTRATIVE CASE. --A boy three years of age had never had a bowelevacuation without drugs, soap enemas, or suppositories since birth, andfinally these were no longer effective. The mother, thoroughlyfrightened, brought the child to me. Eight months of diet and the use ofthe oil were required before he was entirely well. It is now threemonths since the local treatment was discontinued and the bowel functionremains normal. 

"The diet with the absence of milk must be continued for months afterthe patient is apparently well, and he must not be allowed to pass asingle morning without an evacuation at the usual time. In assuming themanagement of one of these cases I explain to the mother or nurse thatthe treatment is not pleasant for the child or the attendant, and thatit may have to be persisted in for weeks, and unless she is willing tocarry it out to the end, it would better not be undertaken. I assureher, however, that with her coöperation, which is usually readily given, the child will make a complete recovery. Cases that are slow inresponding to treatment, I usually give the additional advantage ofabdominal massage from twenty minutes to one-half hour, before the childis placed at stool. The massage should practiced by one skilled in thework. 

"The above local measures apply particularly to children after theeighteenth month. They may be used earlier, however, following out thediet along the lines laid down for bottle-fed children who suffer fromconstipation. In very young children a smaller amount of oil should beused, never more than two ounces, usually one ounce is all that isrequired. When the oil treatment is under way, whatever the age of thepatient, laxative drugs should not be given. "

CHAPTER XXIII

CONSTIPATION IN WOMEN

 Chief Cause of Constipation in Women--Constipation a Cause of Domestic Unhappiness--The Requirements of Good Health--The Cost of Constipation--Constipation and Social Exigencies--One of the Important Duties of Mothers--Constipation and Diseases of Women--Constipation is Always Harmful--Constipation and Pregnancy--Explanation of Incomplete Constipation--Causes of Constipation--Negligence--Lack of Exercise--Lack of Water--Lack of Bulk in the Food Taken--Abuse of Cathartic Drugs and Aperient Waters--Overeating--Treatment of Constipation in Women. 

It has been stated that constipation is almost universal among the womenof America. It is a fact that very few American women enjoy, to areasonable degree, a permanently satisfactory bowel condition. Constipation is an acquired habit and unquestionably negligence is theprimary and the chief cause of it. The negligence, no doubt, begins at avery early age; it is at least an established habit before anyintelligent, consecutive effort is made to remedy it. Inasmuch as womenare the mothers of the race, and as their part in the scheme of life_is_ the supreme one; and as constipation has been shown to be aserious, far-reaching, significant disease, a very sincere andpersistent crusade should be made to educate women as to its importance. For a less altruistic purpose, tremendous popular movements have beencarried to success. For a less service rendered to the race names haveachieved renown. In addition to the symptoms stated in the precedingpaper, the condition which we now desire to emphasize is the effect ofthe constant self-poisoning on the general health and its effect upon awoman's reproductive efficiency. 

The poison being constantly absorbed, means general bad health, badhealth to a degree depending upon the degree of constipation which isthe cause of the poisoning. It may be simply that the woman does notwholly enjoy good health, or that she is completely incapacitatedbecause of chronic bad health, or any degree of indifferent healthbetween these two extremes. 

If the degree of poison is sufficient to cause habitual poor health, itseffect upon the blood must be bad, and the effect of the bad blood uponthe nervous system and the other vital organs cannot be good. Now ifthis process has been going on for many years, the condition of thewoman, who is its victim, as an efficient machine, compared with thewoman in whom this condition never did exist, must be very differentindeed. This condition of affairs--inasmuch as constipation is so commonin women--must have a tremendous significance when estimating thevitality and efficiency of the coming generation. 

We might go much further and yet be sure of our position, and maintainthat it is this national autotoxemia, this scourge of womanhood, that isto a great extent responsible for the characteristic American "vice ofneurasthenia, " and of the domestic infelicity and unhappiness which areso common in the large cities of this country. If we add to theintestinal autotoxemia of constipation, the tendency to, or vice of, indiscriminate eating and drinking--of which the American people areparticularly guilty--we would be on firmer ground. In fact we would feelthat we had pointed out the one underlying cause of most of the domesticirritability prevalent to-day, which is of serious importance, and whichis, fortunately, capable of correction. It is a matter of everlastingand continuous education. 

THE REQUIREMENTS OF GOOD HEALTH. --There are certain fundamental basicrequirements which are essential to good health: fresh air, good water, a reasonable amount of physical and mental exercise, nutritious food, freedom from unnecessary and unreasonable worry, frequent bathing, and adaily movement of the bowels. The reason why constipation is of suchserious importance is because it is the only basic requirement of goodhealth that afflicts a large majority of the race at the same time. Thehealth of so many is being undermined by this one affliction, that itdominates all other factors that have any bearing upon posterity. Awoman may enjoy all the essential conditions necessary to good health, yet she may be constipated, and the presence of this condition willundermine, in her constitution, all the benefits she derives from heradvantageous environments. It will do more; it will be responsible forthe disposition, --the temperament, --of that woman. The naturaldisposition of that woman may be an amicable one; if it were allowed toexpress itself naturally it would be kind, gentle, considerate, affectionate. No woman, however, the victim of chronic constipation, canpreserve an equable temperament or an amicable disposition. It isimpossible--with her nerves being constantly poisoned--that she can holdthe symptoms of that condition in abeyance. She must be irritable andnervous and sick of herself and everything and everybody. The home as adirect result suffers; its atmosphere is not one of contentment andpeace and affection. Constipation, therefore, blights the home and theinfluence of one blighted home may have a far-reaching effect on thestory of the human race. It is responsible also for that woman's mentalattitude outside the home. Instead of exerting an optimistic influence, her whole existence is a message of pessimism and discouragement. Multiply these influences and messages to correspond with the prevalenceof the disease and we have a condition that is tremendously significant, a condition that is really a pressing economic issue. A constipatedwoman is an anti-eugenist--a eugenic atrocity. 

We have no desire to create a false impression or to build up a foolishfear. Are we justified in regarding this as one of the most important, if not the most important, disease condition; the most menacing physicalvice, which the human race has to combat? Let us offer the followingbrief facts in witness of our stand:

THE COST OF CONSTIPATION. --It has been estimated that consumption (thegreat white plague) kills one-tenth of all the human race. Cancer killshalf as many, or one in every twenty. Constipation, and the diseaseswhich are caused directly by it, kills one in every three of all thepeople on the civilized globe. 

Constipation has been responsible for the expenditure of millions ofdollars in advertising in the newspapers alone, --more, probably, thanhas been spent in advertising remedies for all other diseases combined. Do you suppose this money was a donation? Do you suppose these keen, alert interpreters of the spirit of the times, the up-to-date businessmen, were not and are not aware that constipation is the "universaldisease"?

Every drug store, in every civilized spot on earth, has its shelvesloaded down with constipation remedies; dinner pills, liver pills, cathartic pills, tablets in all possible coatings and combinations, mineral waters from a multitude of springs, aperient drinks by thedozen, laxative teas and cordials, cathartic oils and emulsions. If thedemand for these articles should cease most of the drug stores wouldclose up. 

Many millions of dollars have been made and are being made by variousmen and concerns, who have devised ingenious mechanical agencies whichare supposed to cure, and in curing renew the lost health caused byconstipation. We have in mind in this connection, a man who conceivedthe ingenious plan of putting the opening of an ordinary fountainsyringe in the middle instead of at the end and made a fortune out ofit. In this opening he places an upright nozzle, and instead of hangingthe bag up and allowing the water to run into the bowel, he has thepatient sit on the bag and thereby the water is forced into the bowel. He has written a two-hundred page book on the advantages of this idea, and his "literature" contains the names of famous men and women in allwalks of life who use his device. The name of one of the famous judgesof the Supreme Court of the United States was there; another was thename of a popular operatic beauty who writes for the daily press littleessays on "How to be beautiful!" and "How to keep well!" He deserves hissuccess. He is an emancipator and has doubtless done a great deal ofgood. His success demonstrates, beyond contradiction, the prevalence ofthe malady under discussion, and it must be remembered that he is onlyone of hundreds who garner from the same ample harvest. 

If we could estimate in value the economic loss sustained by the racebecause of the inefficiency of the victims of intestinal intoxication, due to constipation, the sum would be colossal. Even then it would onlyrepresent the direct economic deficiency--it would not express, norcould any figure adequately represent, the indirect loss sustained bythe race because of the temperamental characteristics, which are theproducts of intestinal poisoning, and which produce domestic tragediesand economic failures. 

Has this array of evidence any meaning, or does it just happen to be so?We leave it to the reader; if it stimulates thought, or pricks aconscience it will have done its duty. 

CONSTIPATION AND SOCIAL EXIGENCIES. --The cause of constipation in women, whose social station commands every sanitary, hygienic, and dietaryluxury, is their method of living, the food they eat, and the negligencewhich is almost obligatory because of social exactions. If constipationdid not so frequently accompany "good" living (which is the modern namefor overeating and drinking) we would have thousands and thousands ofhealthy, robust, contented women, fit and willing to assume the onerousduties concomitant with motherhood. All their enthusiasm, however, isexpended in the effort to keep "in the ring, " to overcome the effects ofthe poison of constipation, to preserve their youth and freshness, toundo what neglect has accomplished. It is because of the failure of thissimple function that my lady seeks the masseur, the facial artist, thesociety doctor, the beauty expert, and the thousand and one agencies, which an extravagant and profligate age has made necessary to foster theefficiency of its votaries. 

I am optimistic, however, regarding the future. I believe the human raceis improving, despite the disadvantageous surroundings and conditionswhich hamper honest effort and stultify truth. A higher efficiency isthe goal, and the intention is to obtain this desideratum by fair and byjust means. There is an awakening, an unrest, a groping for knowledge inalmost every field of human endeavor, and there is none in which theyearning for fact, for truth, for instruction, is stronger and keener, than in the world-wide movement in the interest of a better motherhood, and in a more serious study of child life. It is an encouraging sign, ahopeful promise, of what the future has in store. 

ONE OF THE IMPORTANT DUTIES OF MOTHERS. --The immediate lesson to belearnt from the facts just recounted is to instruct mothers in theirduty toward their daughters. If each mother would retain the confidenceof her daughter sufficient to instruct her in the duties which areimportant, how much needless suffering would be saved. To know as amatter of fact whether the daughter's bowels are in good condition willappeal to all who read this as being of very great importance. It is notonly necessary to know if they have a movement every day, it isnecessary to know the character of the daily movement; whether it ishard and dry and necessitates straining, --the evil consequences ofwhich, in young girls, is very serious indeed, --or if it is habituallyloose and suggestive of what has been described as incompleteconstipation. 

If the mothers of America would consecrate themselves to this simpletask, who could tell in mere words the effect it would have on the raceyet unborn? There are problems of scientific intent, and of fancy names, that engage the attention of philanthropically inclined ladies, andwhich are emblazoned on the society columns of the daily press, of muchless importance to the human family than the homely duty we ask mothersto devote themselves to. 

CONSTIPATION AND DISEASES OF WOMEN. --Constipation is present in a verylarge majority of the cases of diseases of women. It may be caused bydisease of the womb, or it may cause disease of the womb. There is noquestion about the bad effect constipation has upon all diseases of thistype. In many cases it is absolutely impossible to effect a cure withoutfirst curing the accompanying constipation. 

We seldom appreciate how severe a degree of constipation a growing girlwill submit to without seeking relief. Some of the worst cases ofconstipation that have been known, have been in girls between the agesof sixteen and twenty. The mechanical effects of such a condition canwell be imagined. The constant, severe straining, necessary to evacuatethe bowel, has, in very many instances, produced congestion anddisplacement of the womb and ovaries. It is not observed at this time, or if observed it is not understood, and thus is laid the foundation foryears of neurasthenia, helplessness, and disease. 

The more we investigate the ramifications of constipation the more welearn of its seriousness and of its significance. 

CONSTIPATION IS ALWAYS HARMFUL. --There is no period in life whenconstipation can be borne with impunity. Youth, with its virility andvitality, will endure its consequences with an apparent negation, so faras positive or specific results are concerned, but it is only anapparent impunity. There is always a certain amount of strength builtup, held in reserve as a heritage of youth, which will withstand acertain amount of physical license, but if this reserve is assailed byan unnecessary imposition, and is successfully undermined, there will beinfinitely less reserve to call upon in the legitimate battle of life. Life is too real, too concentrated, too strenuous, and health is tooprecious to be wilfully wasted in any form of self-abuse. 

CONSTIPATION AND PREGNANCY. --Mothers will appreciate from the foregoingexplanation why constipation is eugenically a crime during pregnancy. The evils which result from constipation mechanically, frequently haveserious consequences by interfering with the circulation of the blood tothe womb, by forcing the womb to assume wrong positions, by straining atstool, and by preventing the kidneys from functionating properly; thesemay render the life of the pregnant woman miserable, and may be thedirect cause of a painful, prolonged, difficult labor. The evils whichresult from constipation because of the absorption of poisons by thebowel are of the gravest importance during pregnancy. These poisonsaffect the general health; the victim is tired, listless, and apathetic, and is thereby disinclined to exercise adequately; the appetite ispoor; there are headaches, neuralgias, insomnia, nervousness, melancholia, and general mental and physical inertness. What hope may apregnant woman entertain of having "an easy confinement, " or of bringinga healthy child into the world under these circumstances? Who is toblame? Sometimes it is necessary to tell the unadorned truth, --the womanis to blame. No woman has a right to assume the responsibilities ofmaternity who has not had enough respect for herself to discontinuehabits which caused this failing, or who has not had strength of willenough to begin its successful cure. Get busy, --do something, --it isnever "too late, " but do it now. 

Before we take up the treatment of constipation in women, it isnecessary to explain more fully the type of constipation which wereferred to as "incomplete" constipation. There is a condition of thebowel, in which we find its wall coated with hard fecal matter. The sizeof the bowel may be dilated as a consequence. This condition may occupypart, or most, of the entire length of the large intestine. In themiddle of this hard mass there is a small channel through whichsemi-liquid matter passes. When the bowel moves, it is this semi-liquidmatter that passes out, and this constitutes the daily movement. We haveconsequently a condition in which we have a daily movement but not acomplete emptying of the bowel. The character of the stools from such abowel must necessarily be more or less of a semi-liquid consistency, because the intestine, being coated with a hard dried out layer of oldfecal substance, is prevented from absorbing the liquid part of thefresh fecal mass passing through it. This condition may exist for aconsiderable time, but it will slowly undermine the health and vitalityof any person in whom it exists. The symptoms which a patient in thiscondition complains of are, --a feeling of being tired and languid, noenergy or vim, headache, loss of appetite, loss of flesh, neuralgicpains, nausea, vertigo (dizziness), insomnia, frequent colds, cold handsand feet, biliousness, sallow skin and muddy complexion, liver spots, coated tongue and a "bad breath, " nervousness, melancholia, variousabnormal conditions and diseases of the skin, pimples, blackheads, eruptions, eczema, piles, appendicitis, diseases of the intestinal wallas a result of the constipation, Bright's disease of the kidney, andmany other morbid conditions. Any physician could name many symptoms, which were never properly understood but which are now known to becaused by the absorption of poisons resulting from inactivity of thebowels. Patients may not necessarily have all of the above symptoms;they may have a number of them, or they may have all of them, and theymay have others not mentioned at all. 

TREATMENT OF CONSTIPATION IN WOMEN. --To effect a movement of the bowelsin a patient who is a victim of constipation is not a cure. We canindefinitely cause bowel action by drugs, etc. , but the condition willremain the same or worse. When habitual constipation exists there is anunderlying condition affecting the entire system which indicates thatsomething is radically wrong. It may be necessary to change the wholeroutine of the patient's life. It will certainly be necessary at thevery beginning to inquire into the daily diet, exercise, andsurroundings. 

During the past ten years there has been born every few days a newmedical "ism, " a new religious cult. Why? Because human nature is anunstable equation. We are never satisfied with the old order of thingsand there will always be a following wherever there is a leader. These"isms" and cults do not survive. Some seem to thrive, others die anatural death. There is a law, as old as the hills, that you cannot getsomething for nothing in this world. We learn its bitter truth as theyears pass, and when we get over the day dreams and the sentiment ofyouth we settle down to real work. If we desire to retain good health, or regain lost health, we must do something. No one can hand it to us ona silver plate, nor can anyone work a miracle in our behalf. We cannotbuy health, we must deserve it. 

This is the secret of the success of all schemes to cure disease. Thehuman family will not knuckle down and swallow the truth. The man orwoman in poor health is looking for Aladdin's lamp everywhere andalways. A new bait, dressed up in lubricated, oily words, promisingimpossible results, will be accepted as the simple unadorned truth, andwill be bought and paid for, in the end forgotten. The royal road, theeasy road, which they are looking for is impossible. There is no way bywhich any one of us may continue to break the laws of nature and retainor regain our lost health. Miracles are impossible. Prayers withoutdeeds are empty mouthings and a waste of time. Let us see how this worksout in the treatment of constipation. We must find the cause of theconstipation. I will name the causes in their order of frequency. 

NEGLIGENCE. --This is unquestionably the primary cause of almost allcases of bowel inactivity. As has been already noted, the exigencies ofmodern life are of such a strenuous nature that we do not find the timeto devote to this function the degree of systematic attention which itdemands in order to preserve a healthy condition of intestinalregularity. The bowel is simply a complex muscle controlled by anelaborate system of nerves of an involuntary type. In order to preservethe highest degree of efficiency of this complicated mechanism, it mustbe permitted to obey the laws nature endowed it with and which it mustobey. When the fecal mass reaches the rectum the nerve centers, actingthrough the spinal cord, send a message to the rectum something likethis: "Empty yourself of your contents, we have made all preparationsand everything is ready. " The rectum obeys to the extent of notifyingyou that it wants to be relieved; you feel the desire to evacuate thebowels. If you obey, all is well, nature is appeased, you encourage thesystematic regularity necessary to good health. If you do not obey, youupset the delicate mechanism, and frequent negligence of this characterwill result in the complete disarrangement of this complex machinery sothat it will fail to warn you that a bowel movement is necessary andconstipation is established. We must therefore retrace our steps andre-educate the bowel systematically to empty itself at a certain timeevery day. This can be done in nearly every case without artificialassistance. It may take time but it is worth a little methodicalpersistence. The point is, you must do it; no "ism" or esoteric agencycan do it for you. 

Mothers will recognize from this explanation the necessity ofestablishing the habit in children at the earliest possible moment. 

LACK OF EXERCISE. --What does the word exercise imply? It impliesmovement, better circulation of the blood, better health and tone toevery part of the body, more oxygen, and a richer, better quality ofblood, and because of a better quality of blood, which is the fuel ofthe body machine, we have a better, smoother working machine. Everyhuman being requires a certain amount of exercise; otherwise the machinewill not run smoothly. If this exercise is not obtained, things begin togo wrong. One of the very first signs to indicate that the machine isnot running as it ought to run, is a sluggish condition of the wholedigestive apparatus and a certain degree of bowel inactivity(constipation) follows. There is no substitute for this need. Drugs willnot help you, mechanical devices will not do the work for you, thoughthey may aid you. You must do the work yourself. If you fail or hesitateto recognize the truth, if you temporize or procrastinate, you are onlydeferring the issue. The argument that you have not the time, that yourwork will not permit you, is no argument at all. You must do it or reapthe consequences; you certainly cannot escape them. The wise womanaccepts the situation, the fool goes to an early grave. 

LACK OF WATER. --Constipation may be due to a deficiency of water in thesystem. Women who suffer from this type do not drink enough water. Thebowel may be willing and able to do its duty, but is handicapped becausea certain amount of liquid is essential to proper digestion and naturalbowel activity. At least six glasses of water should be taken by everyhealthy adult human being in each twenty-four hours. The best time totake this water is as follows: one glass on arising, two betweenbreakfast and lunch, two between lunch and dinner, and one on retiring. Between meals means one hour after a meal and at least one-half hourbefore the following meal. No liquid should be taken during a meal, orimmediately after, or before a meal. All water taken may be hot or cold, according to the fancy of the taker. It is of advantage to squeeze thejuice of half a lemon into the water taken on arising if there is anytendency to constipation or if the liver is lazy or torpid. It is alsogood for the complexion. 

LACK OF BULK IN THE FOOD TAKEN. --Sometimes the character of the foodtaken is such that there is no body to it. The process of digestion socompletely liquefies it that the bowel has no solid matter tomanipulate. To excite the peculiar movements of the intestinal wallthere must be substance in the contents. The variety of the daily foodmust be so arranged as to provide this. A list of these foods isprovided elsewhere in this book. Certain other foods stimulateintestinal activity, not because of their bulk, but because of thechemical elements they contain. All forms of sugar, the sugars offruits, the acids of fruits and vegetables, are excellent naturallaxatives. Sour milk and buttermilk, oils and fats, are also of distinctvalue in this respect. 

On the other hand, soups, gruels, porridges, and purées are constipatingbecause the digestive process reduces them to liquids and leaves no bulkfor the bowel to act upon. New bread, hot biscuits, "noodles, " anddoughy foods are also objectionable, especially to children. Hot baths, hot drinks, hot enemas, and sweating are also constipating because theyextract so much liquid from the bowel leaving the contents excessivelydry. 

ABUSE OF CATHARTIC DRUGS AND APERIENT WATERS. --This is a widespreadevil; it may justly be regarded as a national curse. The victims of thiscustom do not realize that they are addicted to a habit which must berightly regarded as equally as bad as the drink habit, so far as itsultimate effect on the general health and the prospect of longevity isconcerned. Its popularity is a product of our national vice ofindiscriminate eating and drinking. It is more common among the classwho live in restaurants, hotels, and boarding houses, who keep latehours, eat late suppers and who do not exercise enough. Theseindividuals eat too much and live too high. After a time the liverbecomes sluggish, the stomach fails to digest properly, the bowels losetheir tone, and flatulent indigestion or some other more or less seriouscondition follows; to maintain the pace, to feel and keep fit, theydiscover that a glass of some advertised aperient or laxative waterbefore breakfast works wonders, tides them over for the time being andkeeps them "in the ring. " They compliment themselves and push thespecter of age aside. 

The thought that they were not "as young as they once were, " or thatthey must go slow, was not a very pleasing suggestion, so having found a"cure" by adding another bad habit on top of an existence which iscomposed of nothing but bad habits, they start all over again. Thesuggestion that their trouble is a warning that "things are going wrong"and that the whole plan of living must be radically and promptly changeddoes not meet with their approval, and so the Department of Healthstatistics heap up the records of deaths due to heart disease, hardeningof the arteries, Bright's disease of the kidneys and apoplexy. It is nota happy tale, but the truth is often tragic. 

When a woman finds that her physical efficiency depends upon thehabitual use of cathartic drugs or laxative waters, she must regard theknowledge with respect, she must give it serious consideration, and shemust adopt means to so change her method of living, that nature will begiven a chance to work in her interest--not against her. Better to findout exactly where the trouble _is_ now, and go after it than to traveltoo far along the wrong road. Many die from the "disease" ofprocrastination. 

OVEREATING. --Overeating may be included in this classification becauseit so overworks the digestive apparatus that it is impossible for itsatisfactorily to complete its function. Any reader desirous ofunderstanding the full significance of overeating in this connectionshould carefully read the article on this subject on pages 289 and 290. 

There are, of course, a great many other causes for constipation butthese are the important ones. When we find the cause of any particularcase it will suggest the remedy and we must employ it faithfully if wehope to effect a cure. If it is negligence, we must correct that faultand compel our daily routine to accommodate itself to a regularobservance of this function. If it is lack of exercise, we must get moreexercise, or if it is lack of bulk in our food, we must change ourmethod of living and select with more care the foods we eat. If it islack of water, we can correct the constipation by adding the properamount of water at the proper time. 

A patient who has been a victim of chronic constipation for some timemust live a life somewhat after the following general plan:

She should increase the vegetables, fruits, and fats in her diet and sheshould drink enough water. It is a good plan to sip slowly one-half pintof hot or cold water morning and evening. Daily exercise in the open airis advisable; exercise of some kind, even if taken indoors, isimperative. Walking, riding, bicycling, tennis, golf, swimming, are thebest forms of exercise for women. Indoor gymnastics can be made asatisfactory substitute. After the exercise a hot shower bath and a coldsponge bath or cold plunge or a swim should follow. 

Women in very moderate circumstances may walk briskly a distance ofthree or four miles, and on returning can take a warm bath followed by abrisk rub-off with a coarse towel wrung out of cold water, or they canuse a hose with a spray nozzle and allow the cold water to run over themfor a few seconds after the warm dip in the bath tub. After the adoptionof these measures the bowels may tend to regulate themselves. If so, this is the proper time to cultivate the habit of regularity, byselecting a certain time each morning or before retiring for thisfunction. The patient should go to the toilet at the regular time evenif the desire is not present. By straining slightly, and by encouragingthe voluntary desire, the bowel may receive the necessary stimulationand an evacuation may result. If there should seem to be no dispositionon the part of the bowel to become accustomed to this procedure, we mustaid it for the time being. A glycerine or soap suppository, a glass ofaperient water, Pluto, Hunyadi, Apenta, or the imported Carlsbad salt inwarm water, or the effervescent Citrate of Magnesium, will result in aprompt emptying of the bowel. There are a great many other catharticdrugs and many well-known laxative pills, etc. , but these are notnecessary if a systematic effort is being made to cure the constipation, because success will come within a reasonable time if the patient willnot become unduly discouraged. Many victims are deficient in fat; thebowel needs lubrication; we therefore recommend a good quality of oliveoil, one tablespoonful after each meal. Frequently it is of advantage toinject, high up in the bowel, two or three ounces of sweet oil at night, as is done in children, and which is fully described in the previouschapter. 

If the constipation is due to deranged nerves, in which the reflexes ofthe intestinal wall seem to share, we advise massage of the abdomen, andan occasional hot or cold rectal injection. The proper quantity to usefor this purpose is from two to three quarts. The solution to use is thenormal salt solution. See page 627. 

In that form of incomplete constipation in which we stated that therewas a layer of hard, impacted feces covering the bowel wall, a specialmethod of treatment is necessary. In these cases nothing will succeed assatisfactorily as very hot, high rectal injections. The object of courseis to rid the bowel of the old, hard, dry mass, which has collectedthere, before we can hope to get the bowel into condition to perform itsown work. It is almost incredible that the human bowel can hold so muchold dried-out, nasty stuff as is stored up in these constipated bowels. Hot salt water, as hot as can be tolerated, two or three quarts at atime, is the correct way to dislodge this mass. It will not be done atonce; it frequently takes two or three weeks before the bowel is fairlyclean. The irrigations should be given every second night until thebowel is clean. The method of giving these washings is fully describedon page 312. While these irrigations are being given the patient shouldtake olive oil by the mouth, one tablespoonful after each meal. Theproper food, open-air exercise, sanitary living, plenty of water, andregular attention to the bowel movements will in the end cure theaffliction.